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Blanc P, Boussuges A, Von Elm BE, Rampanjato MR, Petit B, Amiel F. [Right heart insufficiency due to thiamine deficiency]. Presse Med 2000; 29:1231. [PMID: 10916536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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153
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Lagrange A, Lagrange P, Boveda S, Espaliat E, Penot JP, Defaye P, Arentz T, Tabaraud F, Virot P, Blanc P. [Ventricular tachycardia by branch to branch re-entry. Familial case with Steinert's disease]. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX 2000; 93:743-9. [PMID: 10916658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Ventricular tachycardia by branch to branch reentry is a rare arrhythmia. It occurs in cardiomyopathies associated with conduction defects. During tachycardia a His potential precedes each QRS complex which usually has a left bundle branch block appearance. The authors report two familial cases of ventricular branch to branch tachycardia (son and mother) without cardiomyopathy. The diagnosis of Steinert's disease was made post-mortem in these two patients. In cases of branch to branch ventricular tachycardia, the diagnosis of myotonic dystrophy should be excluded. Conversely, endocavitary electrophysiological investigation with ventricular stimulation should be proposed for symptomatic patients (dizzy spells, syncope) to diagnose branch to branch ventricular tachycardia, even in cases with conduction defects which could also explain the symptoms.
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154
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Blanc P, Boussuges A. [Cardiac beriberi]. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX 2000; 93:371-9. [PMID: 10816808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Interest has recently risen regarding thiamine deficiency (beriberi). In industrial countries, not only alcoholics, but also deprived people with malnutrition, elderly patients and patients with AIDS are at risk of thiamine deficiency. Moreover, long-term furosemide use may be associated with thiamine deficiency through urinary loss, contributing to cardiac insufficiency in patients with congestive heart failure. Cardiovascular (wet beriberi) manifestations of thiamine deficiency are characterized by peripheral vasodilatation with increased cardiac output, myocardial lesion, sodium and water retention and biventricular myocardial failure. Treatment consists of thiamine administration with rapid clinical improvement after supplementation.
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Adham M, Blanc P, Douek P, Henri L, Ducerf C, Baulieux J. Laparoscopic resection of a proximal splenic artery aneurysm. Surg Endosc 2000; 14:372. [PMID: 10854524 DOI: 10.1007/s004640010051] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/1999] [Accepted: 09/15/1999] [Indexed: 10/25/2022]
Abstract
The usual treatment for splenic artery aneurysm is resection under laparotomy. In recent years, the laparoscopic approach has consisted of ligation without resection. More recently,laparoscopic resection was reported by the Cleveland Clinic. In this paper, we describe the technique used in the laparoscopic resection of our first case of laparoscopic resection of splenic artery aneurysm (SAA). The patient was a young woman with a 12-mm SAA discovered on systematic abdominal ultrasound. The laparoscopic procedure was done successfully, and the aneurysm was resected using an ultrasonic dissector. The postoperative course was uneventful, and the patient was discharged on the 3rd postoperative day. Pathological examination revealed the atherosclerotic origin of the aneurysm. The patient is doing well 12 months after surgery, with normal splanchnic Doppler ultrasound. This procedure offers a one-step definitive cure via a minimally invasive surgical procedure.
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156
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Blanc P, Porcheron J, Pages A, Breton C, Mosnier JF, Balique JG. [Laparoscopic excision of a duodenal neuroendocrine tumor]. ANNALES DE CHIRURGIE 2000; 125:176-8. [PMID: 10998805 DOI: 10.1016/s0001-4001(00)00110-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 75-year-old woman with melena was found to have a carcinoid tumor in the posterior wall of the duodenal bulb. The biology was normal. The tumor measured 10 mm in size, and endoscopic ultrasonography showed only submucosal involvement. There was no liver metastasis and no regional lymph nodes. Tumoral resection was performed laparoscopically with success. Postoperative course was uneventful. Laparoscopic resection could be an appropriate minimally invasive treatment for selected small size duodenal tumors.
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157
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Blanc P, Adham M, Berthoux N, Baulieux J. [Extended venous ischemia of the small intestine caused by portal thrombosis. Value of diagnostic celioscopy and intestinal bi-exclusion (Thiry-Vella technique)]. ANNALES DE CHIRURGIE 2000; 53:920-4. [PMID: 10633945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Mesenteric venous thrombosis is a rare disease with no specific signs. It's major risk is intestinal ischaemia and necrosis. We report the case of a young women who presented with unexplained abdominal pain and subnormal abdominal ultrasound. The diagnosis was made on laparoscopic exploration which allowed anticoagulant therapy followed by proximal and distal divertingostomies of the ischemic bowel. Small bowel continuity was re-established after 3 month of total parenteral nutrition. The patients is doing well 1 year after surgery. She is still under anticoagulant therapy. The etiology found was a hypermegacaryocytosis as seen in myeloproliferative disease.
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158
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Israel CW, Böckenförde JB, Nowak B, Hartung W, Gascon D, Campanale G, Lellouche D, Pascotto P, Manolis AS, Martinez JG, Timmermans AJ, Blanc P. [Not Available]. Herzschrittmacherther Elektrophysiol 2000; 11 Suppl 1:73-74. [PMID: 19495651 DOI: 10.1007/bf03042535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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159
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Kappenstein AC, Moisy P, Cote G, Blanc P. Contribution of the concept of simple solutions to calculation of the stoichiometric activity coefficients and density of ternary mixtures of hydroxylammonium or hydrazinium nitrate with nitric acid and water. Phys Chem Chem Phys 2000. [DOI: 10.1039/b001351j] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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160
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Pochon P, Moisy P, Donnet L, de Brauer C, Blanc P. Investigation of neptunium(VI) complexation by SiW11O398- by visible/near infrared spectrophotometry and factor analysis. Phys Chem Chem Phys 2000. [DOI: 10.1039/b002875o] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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161
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Blanc P, Ruszniewski P. [The journal enters the new millennium. A readership survey: why?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2000; 24:15. [PMID: 10679581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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162
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Remy AJ, Daurès JP, Tanguy G, Khemissa F, Chevrier M, Lezotre PL, Blanc P, Larrey D. [Measurement of the quality of life in chronic hepatitis C: validation of a general index and specific index. First French results]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1999; 23:1296-309. [PMID: 10642618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To report the validation of 2 questionnaires of quality of life in chronic hepatitis C and the first results in 100 patients. METHODS The questionnaire included 118 items and took 30 to 45 minutes to answer. It included a general index, the Nottingham Health Profile, with 38 items in 6 themes (physical mobility, social isolation, emotional reactions, pain, sleep and energy) and a specific index, the Montpellier Specific Index, with 80 items in 7 themes: symptoms, food, alcohol and tobacco, work, relations with other people, perception of disease. RESULTS The questionnaires were self-administered to the 100 first patients with chronic hepatitis C without cirrhosis before treatment; 55 men, 45 women, average age 40 year-old, median Knodell's score 8 and median METAVIR score A2 F1. Reduction in the quality of life was frequent and was not highly correlated with biological, virological and histological parameters; it was associated with psychological disorders, reduced sexuality and apprehension of the future. CONCLUSION This study showed the feasibility, validation, sensitivity and agreement of a quality of life questionnaire, which included a general index and a specific index of chronic hepatitis C in France. These initial results must be confirmed in studies during antiviral treatment of patients.
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163
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Lavabre-Bertrand T, Blanc P. [Three hundred years ago, Racine died of liver disease]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1999; 23:1283-4. [PMID: 10642615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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164
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Blanc P, Von Elm BE, Geissler A, Granier I, Boussuges A, Durand Gasselin J. Economic impact of a rational use of antibiotics in intensive care. Intensive Care Med 1999; 25:1407-12. [PMID: 10660849 DOI: 10.1007/s001340051089] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the economic impact of a rational policy in antibiotic treatment. DESIGN Comparative study with a retrospective and a prospective part. SETTING An 11-bed intensive care unit (ICU) in a general hospital. PATIENTS All patients admitted to the unit in 1994, 1995 and 1996. INTERVENTIONS In 1995, a program of cost control was started and a contract of agreed objectives signed with the director of the hospital. This contract included a commitment to refund the eventual savings in order to improve the quality of care. Prescribing protocols were established by consensus as guidelines for a rational policy in antibiotic therapy. MEASUREMENTS AND RESULTS The cost of antibiotic therapy, the patients' characteristics and the incidence of nosocomial infection were compared prior to and during the program. The expenses for antibiotic drugs decreased by 19% in 1995 and by 22% in 1996. Most of the savings were refunded to the ICU and contributed to the employment of an additional nurse and the purchase of new material. In number of patients, type of disease, mean age, Simplified Acute Physiology Score, occupancy rate, length of stay, omega score, artificial ventilation, readmission within 7 days, mortality and incidence of nosocomial infection, no significant difference was found. CONCLUSIONS We proved a positive economic impact of a rational policy in antibiotic therapy realized with a contract of agreed objectives. The savings made while applying our program of cost control were used to improve the quality of care.
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165
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remy AJ, Desprez D, Ducos J, Blanc P, Larrey D. [Risk of transmission of hepatitis C virus by biopsy clamps during gastrointestinal biopsy]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1999; 23:1260-1. [PMID: 10651538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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166
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Védrinne C, Laroux MC, Blanc P, Durand PG, George M, Lehot JJ. [Anesthesia consultation in cardiovascular and thoracic surgery. A survey of patient and physician satisfaction]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:834-42. [PMID: 10575498 DOI: 10.1016/s0750-7658(00)88190-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess the quality of the preadmission anaesthetic consultation prior to cardiovascular and thoracic surgery with a satisfaction inquiry. STUDY DESIGN Prospective study with a questionnaire, extended over a period of two months. PERSONS Patients and anaesthetists of the cardiothoracic surgical service. METHODS The inquiry, which took place after completion of the consultation was achieved by a person non member of the staff. Anaesthetists were questioned on the medical content, its exhaustive character and its value for the patient's perioperative care. RESULTS Out of the 273 patients included in the study, 121 agreed to answer the questionnaire. Participation in the study was more significant in older patients (58 +/- 20 vs 51 +/- 24 years) and following shorter waiting time (WT) [15 +/- 13 (0-60) vs 25 +/- 18 (0-66) min]. The duration of the consultation (DC) was not different between the two groups [29 +/- 12 (8-70) vs 31 +/- 14 (6-75) min]. However patients' participation increased when the DC exceeded by 0.6 the sum of DC and WT [DC > 0.6 (DC + WT)]. The analogic score (AS) assessing reduction in preoperative anxiety was 8.4 +/- 1.5 (2-10). Finally, 108 patients out of 121 considered to have been well informed about the anaesthetic [AS = 8.7 +/- 1.2 (4-10)], 113 considered the preadmission consultation as a useful procedure [AS = 8.6 +/- 1.5 (2-10)]) and for 41 a personalized follow-up by the same anaesthetist was valuable. Only three operations had to be postponed the day before surgery. One third of the anaesthetists considered that the consultation improved the clinical and therapeutic management of the patients. CONCLUSION This inquiry showed that the preadmission anaesthesia consultation was considered as benefitful by patients and anaesthetists. However the participation of patients in this study was poor. Subsequently to the inquiry information forms have been produced and handed to the patient prior to the consultation.
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Aouifi A, Piriou V, Blanc P, Bouvier H, Bastien O, Chiari P, Rousson R, Evans R, Lehot JJ. Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations. Br J Anaesth 1999; 83:602-7. [PMID: 10673877 DOI: 10.1093/bja/83.4.602] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We have measured serum procalcitonin (PCT) concentrations after cardiac surgery in 36 patients allocated to one of three groups: group 1, coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (n = 12); group 2, CABG without CPB (n = 12); and group 3, valvular surgery with CPB (n = 12). Serum PCT and C-reactive protein (CRP) concentrations were measured before operation, at the end of surgery and daily until postoperative day 8. Serum PCT concentrations increased, irrespective of the type of cardiac surgery, with maximum concentrations on day 1: mean 1.3 (SD 1.8), 1.1 (1.2) and 1.4 (1.2) ng ml-1 in groups 1, 2 and 3, respectively (ns). Serum PCT concentrations remained less than 5 ng ml-1 in all patients. Concentrations returned to normal by day 5 in all groups. To determine the effect of the systemic inflammatory response (SIRS) on serum PCT concentrations, patients were divided post hoc, without considering the type of cardiac surgery, into patients with SIRS (n = 19) and those without SIRS (n = 17). The increase in serum PCT was significantly greater in SIRS (peak PCT 1.79 (1.64) ng ml-1 vs 0.34 (0.32) ng ml-1 in patients without SIRS) (P = 0.005). Samples for PCT and CRP measurements were obtained from 10 other patients with postoperative complications (circulatory failure n = 7; active endocarditis n = 2; septic shock n = 1). In these patients, serum PCT concentrations ranged from 6.2 to 230 ng ml-1. Serum CRP concentrations increased in all patients, with no differences between groups. The postoperative increase in CRP lasted longer than that of PCT. We conclude that SIRS induced by cardiac surgery, with and without CPB, influenced serum PCT concentrations with a moderate and transient postoperative peak on the first day after operation. A postoperative serum PCT concentration of more than 5 ng ml-1 is highly suggestive of a postoperative complication.
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168
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Pageaux GP, Michel J, Coste V, Perney P, Possoz P, Perrigault PF, Navarro F, Fabre JM, Domergue J, Blanc P, Larrey D. Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism. Gut 1999; 45:421-6. [PMID: 10446113 PMCID: PMC1727657 DOI: 10.1136/gut.45.3.421] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND/AIMS Alcoholic cirrhosis remains a controversial indication for liver transplantation, mainly because of ethical considerations related to the shortage of donor livers. The aim of this study was to review experience to date, focusing on survival rates and complications, and the effect of alcohol relapse on outcome and alterations in marital and socioprofessional status. METHODS The results for 53 patients transplanted for alcoholic cirrhosis between 1989 and 1994 were compared with those for 48 patients transplanted for non-alcoholic liver disease. The following variables were analysed: survival, rejection, infection, cancer, retransplantation, employment and marital status, alcoholic recurrence. The same variables were compared between alcohol relapsers and non-relapsers. RESULTS Recovery of employment was the only significantly different variable between alcoholic (30%) and non-alcoholic patients (60%). Two factors influenced survival in the absence of alcohol recidivism: age and abstinence before transplantation. For all other variables, there were no differences between alcoholic and non-alcoholic patients, and, within the alcoholic group, between relapsers and non-relapsers. The recidivism rate was 32%. CONCLUSION The data indicate that liver transplantation is justified for alcoholic cirrhosis, even in cases of recidivism, which did no affect survival and compliance with the immunosuppressive regimen. These good results should help in educating the general population about alcoholic disease.
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169
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Blanc P, Porcheron J, Breton C, Bonnot P, Baccot S, Tiffet O, Cuilleret J, Balique JG. [Results of laparoscopic hernioplasty. A study of 401 cases in 318 patients]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1999; 124:412-8. [PMID: 10546395 DOI: 10.1016/s0001-4001(00)80014-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
STUDY AIM The aim of this retrospective study was to report a series of laparoscopic hernioplasty performed in two surgical centers, and to evaluate the results with a mean follow-up of 31 months. PATIENTS AND METHODS From January 1992 to January 1997, 318 patients with 401 inguinal hernias were operated on through laparoscopy by six senior surgeons and six junior surgeons. There were 302 men and 16 women (mean age: 53 years). The operation was performed through an extra-peritoneal approach (TEP) in 298 hernias, a trans-abdomino-preperitoneal approach (TAPP) in 62 hernias, and an intra-abdominal approach (IPOM) in 41 hernias. RESULTS Conversion into open surgery was necessary in 7% of the patients. There was no postoperative death. The postoperative morbidity rate was 10%. The average hospital stay was three days. With a 1 to 5 year follow-up, 4% of the 94% of the patients who answered the questionnaire showed a recurrence (3% in the extra-peritoneal group; 4% in the trans abdomino-preperitoneal group; 10% in the intra-abdominal group). CONCLUSION Laparoscopic hernioplasty seems as efficient as traditional hernoplasty with the advantages of mini-invasive surgery. The extra-peritoneal approach was preferred and performed in most cases of this series. The intra-peritoneal approach was abandoned.
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170
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Charrin N, Moisy P, Garcia-Argote S, Blanc P. Thermodynamic Study of the Ternary System Th(NO3)4/HNO3/H2O. ACTA ACUST UNITED AC 1999. [DOI: 10.1524/ract.1999.86.34.143] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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171
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Blanc P, Aouifi A, Chiari P, Bouvier H, Jegaden O, Lehot JJ. [Minimally invasive cardiac surgery: surgical techniques and anesthetic problems]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:748-71. [PMID: 10486628 DOI: 10.1016/s0750-7658(00)88454-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review current data on minimally invasive cardiac surgery. DATA SOURCES Search through the Medline data base of French or English articles. DATA EXTRACTION The articles were analysed to make a synthesis of the various techniques with their main indications and contra-indications. DATA SYNTHESIS Minimally invasive cardiac surgery includes various surgical procedures. The usual techniques are described, their major benefits and drawbacks are discussed. The main goals of anaesthetic management are preservation of ventricular function and systemic perfusion, detection and treatment of myocardial ischaemia, prevention of hypothermia in case of coronary artery bypass grafting on the beating heart via sternotomy, intermittent selective ventilation of the collapsed lung using CPAP in case of limited thoracotomy. Expertise in transoesophageal echocardiography is essential for insertion and checking the accurate positioning of the various catheters of the endovascular CPB Heartport system (pulmonary vent, endosinus catheter, venous cannula, endoaortic clamp) allowing coronary artery bypass grafting and mitral valve surgery through limited thoracotomy and finally, detection of retained intracardiac air and assessment of complete clearing of cardiac cavities after mitral valve surgery through limited thoracotomy and aortic valve surgery via ministernotomy. Short-acting anaesthetic agents allow rapid recovery from anaesthesia, early extubation and discharge to the surgical ward within 24 h, whereas overall time spent in the operating room is often longer than with conventional cardiac surgery.
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172
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Karsenti D, Metman EH, Viguier J, Blanc P, Doumerc S, Dubois F, Goudeau A. [Transmission by colonoscopy of hepatitis C virus: apropos of a group of 97 patients at "presumed risk"]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1999; 23:985-6. [PMID: 10533150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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173
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Laurent F, Philippe JC, Vergier B, Granger-Veron B, Darpeix B, Vergeret J, Blanc P, Velly JF. Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings. Eur Radiol 1999; 9:1190-6. [PMID: 10415259 DOI: 10.1007/s003300050815] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to describe high-resolution CT (HRCT) and MR findings of exogenous lipoid pneumonia and to correlate them with pathologic findings. A retrospective review of the medical records of our institution revealed seven patients with a diagnosis of lipoid pneumonia based on clinical data, chest films, bronchoalveolar lavage, and follow-up. Both HRCT and MR imaging were reviewed by two readers. Pathologic examination of the resected specimen or surgical biopsies were also reviewed in the four available cases. The HRCT findings were pulmonary consolidations (n = 6) with fatty (n = 3) or unspecific but low attenuation values (n = 3), areas of ground-glass opacities (n = 5), septal lines, and centrilobular interstitial thickening (n = 5). In five of the seven cases, a crazy-paving pattern of various spread was also present, either isolated (n = 1) or surrounding a pulmonary consolidation. In two cases traction bronchiectasis and cystic changes consistent with fibrosis were seen. At MR imaging (n = 2) a pulmonary consolidation of high signal intensity on T1-weighted image consistent with lipid content was present in one case. Pathologic examination (n = 4) showed the coexistence of lobules with lesions of various ages, sometimes in contiguous lobules, within the same patient. Recent lesions were those with alveolar fill-in by spumous macrophages and almost normal alveolar walls and septae. In more advanced lesions, lobules were filled in with larger vacuoles often surrounded by inflammatory infiltrates of alveolar walls, bronchiolar walls, and septa. The oldest lesions were characterized by fibrosis and parenchymal distortion around large lipid-containing vacuoles. The HRCT findings reflect pathologic findings in exogenous lipoid pneumonia. Although non-specific, consolidation areas of low attenuation values and crazy-paving pattern are frequently associated in exogenous lipoid pneumonia and are indicative of the diagnosis.
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Palmeri J, Blanc P, Larbot A, David P. Theory of pressure-driven transport of neutral solutes and ions in porous ceramic nanofiltration membranes. J Memb Sci 1999. [DOI: 10.1016/s0376-7388(99)00081-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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175
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Calés P, Oberti F, Payen JL, Naveau S, Guyader D, Blanc P, Abergel A, Bichard P, Raymond JM, Canva-Delcambre V, Vetter D, Valla D, Beauchant M, Hadengue A, Champigneulle B, Pascal JP, Poynard T, Lebrec D. Lack of effect of propranolol in the prevention of large oesophageal varices in patients with cirrhosis: a randomized trial. French-Speaking Club for the Study of Portal Hypertension. Eur J Gastroenterol Hepatol 1999; 11:741-5. [PMID: 10445794 DOI: 10.1097/00042737-199907000-00011] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Beta-blockers have been shown to reduce portal pressure in patients with cirrhosis and limit the development of portosystemic shunts in portal hypertensive animals. Thus, a randomized double-blind trial was conducted to evaluate propranolol in the prevention of the development of large oesophageal varices in patients with cirrhosis without varices or with small varices. METHODS One hundred and two patients received long-acting propranolol (160 mg/day) and 104 patients received a placebo. At inclusion, there was no significant difference between the two groups in terms of clinical characteristics or biochemical tests. At 2 years, the size of varices was estimated on video recordings. RESULTS One-third of the patients were lost to follow-up, and 95%/97% of the remaining patients were compliant in the propranolol and placebo groups, respectively. At 2 years, the proportion of patients with large varices was 31% in the propranolol group and 14% in the placebo group (P< 0.05). Three and four patients bled in the propranolol and placebo groups, respectively, and nine and ten died, respectively. CONCLUSION This trial suggests that propranolol administration cannot be recommended for the prevention of the development of large oesophageal varices in patients with cirrhosis; thus other studies are needed in selected subgroups of patients.
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