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Layec S, Seynhaeve E, Barbottin E, Trivin F, Carsin-Mahé M, Dussaulx L, Picot D. Hydration by enteroclysis in the distal intestine in patients with a high output stoma: an alternative to parenteral hydration. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Koelfat KV, Picot D, Chang X, Desille‐Dugast M, van Eijk HM, van Kuijk SM, Lenicek M, Layec S, Carsin M, Dussaulx L, Seynhaeve E, Trivin F, Lacaze L, Thibault R, Schaap FG, Olde Damink SW. Chyme Reinfusion Restores the Regulatory Bile Salt-FGF19 Axis in Patients With Intestinal Failure. Hepatology 2021; 74:2670-2683. [PMID: 34133768 PMCID: PMC8596508 DOI: 10.1002/hep.32017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/20/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Automated chyme reinfusion (CR) in patients with intestinal failure (IF) and a temporary double enterostomy (TDE) restores intestinal function and protects against liver injury, but the mechanisms are incompletely understood. The aim was to investigate whether the beneficial effects of CR relate to functional recovery of enterohepatic signaling through the bile salt-FGF19 axis. APPROACH AND RESULTS Blood samples were collected from 12 patients, 3 days before, at start, and 1, 3, 5, and 7 weeks after CR initiation. Plasma FGF19, total bile salts (TBS), 7-α-hydroxy-4-cholesten-3-one (C4; a marker of bile salt synthesis), citrulline (CIT), bile salt composition, liver tests, and nutritional risk indices were determined. Paired small bowel biopsies prior to CR and after 21 days were taken, and genes related to bile salt homeostasis and enterocyte function were assessed. CR induced an increase in plasma FGF19 and decreased C4 levels, indicating restored regulation of bile salt synthesis through endocrine FGF19 action. TBS remained unaltered during CR. Intestinal farnesoid X receptor was up-regulated after 21 days of CR. Secondary and deconjugated bile salt fractions were increased after CR, reflecting restored microbial metabolism of host bile salts. Furthermore, CIT and albumin levels gradually rose after CR, while abnormal serum liver tests normalized after CR, indicating restored intestinal function, improved nutritional status, and amelioration of liver injury. CR increased gene transcripts related to enterocyte number, carbohydrate handling, and bile salt homeostasis. Finally, the reciprocal FGF19/C4 response after 7 days predicted the plasma CIT time course. CONCLUSIONS CR in patients with IF-TDE restored bile salt-FGF19 signaling and improved gut-liver function. Beneficial effects of CR are partly mediated by recovery of the bile salt-FGF19 axis and subsequent homeostatic regulation of bile salt synthesis.
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Affiliation(s)
- Kiran V.K. Koelfat
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Denis Picot
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Xinwei Chang
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Mireille Desille‐Dugast
- INSERM, INRAEUniversity of RennesNutrition Metabolisms and CancerNuMeCanNutrition UnitCRB SantéCHU RennesRennesFrance
| | - Hans M. van Eijk
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Martin Lenicek
- Institute of Medical Biochemistry and Laboratory Diagnostics1st Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Sabrina Layec
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Marie Carsin
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Laurence Dussaulx
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Eloi Seynhaeve
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Florence Trivin
- Department of Nutritional and Digestive RehabilitationClinique Saint YvesRennesFrance
| | - Laurence Lacaze
- INSERM, INRAEUniversity of RennesNutrition Metabolisms and CancerNuMeCanNutrition UnitCRB SantéCHU RennesRennesFrance
| | - Ronan Thibault
- INSERM, INRAEUniversity of RennesNutrition Metabolisms and CancerNuMeCanNutrition UnitCRB SantéCHU RennesRennesFrance
| | - Frank G. Schaap
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands,Department of General, Visceral and Transplantation SurgeryRWTH University Hospital AachenAachenGermany
| | - Steven W.M. Olde Damink
- Department of SurgeryMaastricht University Medical CenterMaastrichtthe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands,Department of General, Visceral and Transplantation SurgeryRWTH University Hospital AachenAachenGermany
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Layec S, Seynhaeve E, Dussaulx L, Carsin-Mahé M, Barbottin E, Trivin F, Picot D. Hydration by colonic enteroclysis: An alternative to parenteral hydration in patients with high-output double enterostomy. Nutr Clin Pract 2021; 37:625-633. [PMID: 34520595 DOI: 10.1002/ncp.10769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND High-output double enterostomies (DESs) result in sodium and fluid loss responsible for frequent episodes of dehydration and hospitalizations. Hydration by enteroclysis (HE) is an alternative to parenteral hydration when the small bowel, or the downstream colon, is accessible and functional. METHODS A retrospective analysis was conducted on all consecutive patients admitted in our institution with high-output (≥1200 ml per 24 h) DES and access to downstream intestine (including colon), who were treated by enteroclysis between 2015 and 2019. A sodium chloride and bicarbonate solution was instilled through a tube inserted in the colon. The objectives were diuresis >1 L, natriuresis >40 mmol/24 h, and urinary sodium-to-potassium ratio >1. RESULTS HE was conducted in 52 patients (24 female, 28 male). Initially, 30 patients received intravenous support. Fifteen patients (50%) were weaned from all parenteral support, of whom 11 of 12 (92%) received fluid and electrolyte support and 4 of 18 (22%) received parenteral nutrition (PN). When intravenous fluids were still required, daily volumes decreased from 2714 ± 1424 to 1578 ± 1000 ml per 24 h (P = .001), as did the energetic intake (NS), from 1439 ± 556 to 1230 ± 362 kcal per 24 h (P = .096). CONCLUSION HE through the efferent intestine limits the requirement for parenteral hydration in patients with high-output DES. For patients with intestinal failure dependent on PN, it reduces daily infused volumes.
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Affiliation(s)
- Sabrina Layec
- Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, Rennes, France
| | - Eloi Seynhaeve
- Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, Rennes, France
| | - Laurence Dussaulx
- Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, Rennes, France
| | - Marie Carsin-Mahé
- Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, Rennes, France
| | - Elise Barbottin
- Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, Rennes, France
| | - Florence Trivin
- Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, Rennes, France
| | - Denis Picot
- Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, Rennes, France
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Layec S, Seynhaeve E, Trivin F, Carsin-Mahé M, Dussaulx L, Picot D. Management of entero-atmospheric fistulas by chyme reinfusion: A retrospective study. Clin Nutr 2020; 39:3695-3702. [DOI: 10.1016/j.clnu.2020.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/01/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
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Picot D, Layec S, Seynhaeve E, Dussaulx L, Trivin F, Carsin-Mahe M. Chyme Reinfusion in Intestinal Failure Related to Temporary Double Enterostomies and Enteroatmospheric Fistulas. Nutrients 2020; 12:nu12051376. [PMID: 32403450 PMCID: PMC7285017 DOI: 10.3390/nu12051376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Some temporary double enterostomies (DES) or entero-atmospheric fistulas (EAF) have high output and are responsible for Type 2 intestinal failure. Intravenous supplementations (IVS) for parenteral nutrition and hydration compensate for intestinal losses. Chyme reinfusion (CR) artificially restores continuity pending surgical closure. CR treats intestinal failure and is recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) when possible. The objective of this study was to show changes in nutritional status, intestinal function, liver tests, IVS needs during CR, and the feasibility of continuing it at home. A retrospective study of 306 admitted patients treated with CR from 2000 to 2018 was conducted. CR was permanent such that a peristaltic pump sucked the upstream chyme and reinfused it immediately in a tube inserted into the downstream intestine. Weight, plasma albumin, daily volumes of intestinal and fecal losses, intestinal nitrogen, and lipid absorption coefficients, plasma citrulline, liver tests, and calculated indices were compared before and during CR in patients who had both measurements. The patients included 185 males and 121 females and were 63 ± 15 years old. There were 37 (12%), 269 (88%) patients with EAF and DES, respectively. The proximal small bowel length from the duodeno-jejunal angle was 108 ± 67 cm (n = 232), and the length of distal small intestine was 117 ± 72 cm (n = 253). The median CR start was 5 d (quartile 25-75%, 2-10) after admission and continued for 64 d (45-95), including 81 patients at home for 47 d (28-74). Oral feeding was exclusive 171(56%), with enteral supplement 122 (42%), or with IVS 23 (7%). Before CR, 211 (69%) patients had IVS for nutrition (77%) or for hydration (23%). IVS were stopped in 188 (89%) 2 d (0-7) after the beginning of CR and continued in 23 (11%) with lower volumes. Nutritional status improved with respect to weight gain (+3.5 ± 8.4%) and albumin (+5.4 ± 5.8 g/L). Intestinal failure was cured in the majority of cases as evidenced by the decrease in intestinal losses by 2096 ± 959 mL/d, the increase in absorption of nitrogen 32 ± 20%, of lipids 43 ± 30%, and the improvement of citrulline 13.1 ± 8.1 µmol/L. The citrulline increase was correlated with the length of the distal intestine. The number of patients with at least one liver test >2N decreased from 84-40%. In cases of Type 2 intestinal failure related to DES or FAE with an accessible and functional distal small bowel segment, CR restored intestinal functions, reduced the need of IVS by 89% and helped improve nutritional status and liver tests. There were no vital complications or infectious diarrhea described to date. CR can become the first-line treatment for intestinal failure related to double enterostomy and high output fistulas.
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Picot D, Koelfat K, Layec S, Carsin M, Dussaulx L, Seynhaeve E, Trivin F, Lacaze L, Schaap F, Chang X, Olde Damink S, Thibault R. La réinstillation du chyme restaure la signalisation de la sécrétion des sels biliaires (étude RESCUE). NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Picot D, Layec S, Dussaulx L, Trivin F, Carsin M, Seynhaeve E. Réinstillation du chyme à domicile de patients insuffisants intestinaux avec double entérostomie temporaire à haut débit : suivi prospectif de 73 patients consécutifs. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Guiltat ML, Dussaulx L, Trivin F, Carsin M, Layec S, Seynhaeve E, Picot D. Prise en charge nutritionnelle de 90 patients atteints de sclérose latérale amyotrophique ayant bénéficiés d’une gastrostomie radiologique. Étude monocentre pendant 10 ans. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dussaulx-Garin L, Picot D, Trivin F, Layec S, Bachmann P, Caldari D, Guex E, Zeanandin G, Quilliot D, Coti P, Thibault R. Référentiel de pratiques professionnelles : revue de mortalité-morbidité en nutrition artificielle : exemple de la pose de gastrostomie percutanée radiologique. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Picot D, Layec S, Dussaulx L, Trivin F, Thibault R. OR022: Chyme Reinfusion Restores Intestinal Function During Temporary Small Bowel Interruption with Intestinal Failure. 15-Year Experience of a Referral Centre. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30122-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dussaulx-Garin L, Layec S, Picot D, Trivin F. P076: Gastrostomie percutanée radiologique pour cancer ORL ou oesophagien : incidence des greffes tumorales sur l’orifice de stomie. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Layec S, Dussaulx-Garin L, Trivin F, Picot D. PP054-MON PREDICTIVE FACTORS OF SUCCESSFUL MEDICAL TREATMENT OF ENTERO-CUTANEOUS FISTULAS: A RETROSPECTIVE STUDY. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garin L, Trivin F, Layec S, Trevilly A, Picot D. P184 1 000 gastrostomies posées et suivies en consultation de nutrition. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Picot D, Layec S, Trivin F, Garin L. P119 Fistules entéro-cutanées du grêle : réadaptation digestive et nutritionnelle par réinstillation du chyme. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Picot D, Garin L, Layec S, Trivin F. Insuffisance intestinale des entérostomies temporaires : traitement par réinstillation du chyme. 138 patients (434). ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1878-786x(10)70061-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marteau P, Gerhardt MF, Myara A, Bouvier E, Trivin F, Rambaud JC. Metabolism of Bile Salts by Alimentary Bacteria During Transit in the Human Small Intestine. Microbial Ecology in Health and Disease 2009. [DOI: 10.3109/08910609509140093] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- P. Marteau
- Service de Gastroentérologie and INSERM U 290, Hôpital Saint-Lazare, 107 bis rue du Faubourg, Saint-Denis, 75010, Paris
| | - M. F. Gerhardt
- Service de biochimie, Hôpital Saint-Joseph, 7 rue Pierre Larousse, 75014, Paris, France
| | - A. Myara
- Service de biochimie, Hôpital Saint-Joseph, 7 rue Pierre Larousse, 75014, Paris, France
| | - E. Bouvier
- Service de biochimie, Hôpital Saint-Joseph, 7 rue Pierre Larousse, 75014, Paris, France
| | - F. Trivin
- Service de biochimie, Hôpital Saint-Joseph, 7 rue Pierre Larousse, 75014, Paris, France
| | - J. C. Rambaud
- Service de Gastroentérologie and INSERM U 290, Hôpital Saint-Lazare, 107 bis rue du Faubourg, Saint-Denis, 75010, Paris
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Trivin F, Garin L, Ménard D, Picot D. P058 Risque de carence sévère en cuivre lors de nutrition entérale exclusive par jéjunostomie. NUTR CLIN METAB 2007. [DOI: 10.1016/s0985-0562(07)78860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raoul JL, Trivin F, Lefeuvre C, Le Prise E, Boucher E. [Palliative treatment of esophageal carcinoma: chemotherapy and palliative care]. Gastroenterol Clin Biol 2005; 29:557-60. [PMID: 15980750 DOI: 10.1016/s0399-8320(05)82128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Jean-Luc Raoul
- Oncologie Médicale et Radiothérapie, Centre E Marquis, CS 44229, Rennes
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Raoul JL, Trivin F, Egreteau J, Boucher E. Chemotherapy for metastatic colorectal cancer: Why not take a break when it works? J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Maire F, Sauvanet A, Trivin F, Hammel P, O'Toole D, Palazzo L, Vilgrain V, Belghiti J, Ruszniewski P, Levy P. Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: an indirect evaluation of the usefulness of laparoscopy. Pancreatology 2004; 4:436-40. [PMID: 15249711 DOI: 10.1159/000079617] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2003] [Accepted: 02/17/2004] [Indexed: 12/11/2022]
Abstract
BACKGROUND The interest of laparoscopy in the preoperative staging of pancreatic head adenocarcinoma before curative pancreaticoduodenectomy is a matter of controversy and depends on the accuracy of preoperative imaging techniques. AIM To assess the potential value of laparoscopy when a standardised and optimal preoperative staging is performed, including spiral computed tomography (CT) and endoscopic ultrasonography (EUS). METHODS All consecutive patients operated on with a view to curative pancreaticoduodenectomy for pancreatic head or ampullary adenocarcinoma in our centre from January 1998 to August 2000 were retrospectively studied. All of them had preoperative spiral CT and EUS. Tumour resectability was considered as highly probable (HP) or uncertain (U) according to well-defined criteria. Operative records of patients were reviewed to indirectly assess the effective resectability rate and the criteria responsible for unresectability and which of them would have been identified by laparoscopy if initially performed. RESULTS 69 consecutive patients were studied. Resectability was HP (n = 56) or U (n = 13) after preoperative staging. Curative pancreatoduodenectomy was performed in 53 patients (77%) (48 HP, 5 U). Positive predictive value of preoperative imaging for highly probable resectability was 86% (48/56). Among the 16 unresectable tumours (8 HP, 8 U), the cause of non-resection would have been found at laparoscopy in 9 patients (56%) (6 HP, 3 U). Finally, if initially performed, laparoscopy would have avoided laparotomy in 9/69 patients (13%) (6/56 HP (11%); 3/13 U (23%)). CONCLUSIONS With accurate preoperative staging using spiral CT and EUS, laparoscopy would detect tumours which were unresectable in 13% of patients with pancreatic head cancer. Laparoscopy remains useful in selected patients, such as those with preoperative uncertain resectability, in whom it can prevent unnecessary laparotomy in one fourth of patients.
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Affiliation(s)
- Frédérique Maire
- Fédération Médico-Chirurgicale d'Hépato-Gastroentérologie, Hôpital Beaujon, Clichy, France.
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Delarue A, Gerhardt MF, Merrot T, Roquelaure B, Guys JM, Trivin F. The cholecystocolic bypass with jejunal interposition graft for bile acid depletion in bile and portal blood in guinea pigs. Pediatr Surg Int 2003; 19:371-5. [PMID: 12845456 DOI: 10.1007/s00383-003-1013-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2002] [Indexed: 11/29/2022]
Abstract
Ileal bypass and cholecystostomy are used in children with selected cholestatic diseases to lower the bile acid (BA) levels in bile and blood and improve outcome. The efficacy of a cholecystocolic bypass in achieving the same goals was investigated in guinea pigs. In the study group (n=7), a cholecystocolic bypass was performed using a jejunal graft interposed between the gallbladder and the cecum. In the control group (n=5), a cholecystojejunal bypass was performed with a similar graft implanted in the proximal jejunum. Total BA concentration was measured in bile and portal blood at surgery (D0) and 30 days later (D30) by pooling the concentrations of 7 individual BA. D30/D0 BA ratios were compared. All animals developed normally without clinical symptoms. A 76% reduction in the bile T-BA levels was observed in both groups (p<0.05). A 80% decrease of T-BA levels was observed in portal vein in study group (p<0.05), suggesting that ileal bile flow and BA ileal reabsorption were highly impaired. No change in portal vein BA levels was observed in control group. Cholecystocolic bypass led to a significant loss of bile acids in guinea pigs and might be considered for bile diversion in pediatric patients with selected cholestatic diseases.
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Affiliation(s)
- A Delarue
- Department of Pediatric Surgery, Hôpital d'Enfants de la Timone, 13385 Marseille Cedex 5, France.
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Trivin F. [60th anniversary of the French society of clinical biology]. Ann Biol Clin (Paris) 2003; 61:3-4. [PMID: 12604380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Che D, Chauffert M, Cisse A, Michel S, Trivin F. [Genetic polymorphism of pyruvate dehydrogenase kinase 4 (PDK4), paraoxonase 2 (PON2), and fatty acid binding protein 2 (FABP2) in the NIDDM population of Senegal]. Dakar Med 2002; 47:18-21. [PMID: 15776585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We reported a study about three candidate genes which may be involved in non-insulin dependent diabetes mellitus (NIDDM): Pyruvate Dehydrogenase Kinase 4 (PDK4), Paraoxonase 2 (PON2) and Fatty Acid Binding Protein 2 (FABP2). The reported mutation in the three candidate genes were tested for 179 black subjects from Dakar (Sénégal) by PCR-RFLP techniques. There was no significant difference between both control and NIDDM subjects. The genotype frequency in the senegalese population was quite similar as compared to reported frequency in white populations excepted for PDK4 polymorphism. These results suggest that none of these gene variants is a major NIDDM predisposing locus for the negroid population of Senegal.
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Affiliation(s)
- D Che
- Service de Biochimie, Fondation Hôpital Saint-Joseph, Rue Raymond Losserand, Paris, France
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Abstract
Iron has the capacity to accept and donate electrons readily. This capability makes it physiologically essential, as a useful component of cytochromes and oxygen-binding molecules. However, iron is also biochemically dangerous; it can damage tissues by catalyzing the conversion of hydrogen peroxide to free-radical ions that attack cellular membranes, protein and DNA. This threat is reduced in the healthy state where, because of the fine iron metabolism regulation, there is never appreciable concentration of 'free iron'. Under pathological conditions, iron metabolism and superoxide metabolism are clearly interactive. Each can exacerbate the toxicity of the other. Iron overload may amplify the damaging effects of superoxide overproduction in a very broad spectrum of inflammatory, both acute and chronic, conditions. Furthermore, chronic oxidative stress may modulate iron uptake and storage, leading to a self-sustained and ever-increasing spiral of cytotoxic and mutagenic events. The iron chelator deferroxamine is able to chelate 'free iron' even inside the cell. Its regular clinical use is to promote the excretion of an iron overload, when phlebotomy is harmful, and the dosage varies between 2-10 g/d. In conditions where deferroxamine is used to prevent the iron-driven oxygen toxicity, i.e., acute or chronic inflammatory diseases with oxidative stress, the dosage can be extremely reduced and the addition of antioxidants could be useful.
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Affiliation(s)
- J Emerit
- Service de Biochimie, Hĵpital Saint-Joseph, Paris, France.
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27
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Trivin F, Cellier C. [Diagnosis of symptom-free celiac disease in a patient with persistent hypertransaminasemia of obscur origin]. Gastroenterol Clin Biol 2001; 25:553-4. [PMID: 11521112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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28
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Bical OM, Fromes Y, Paumier D, Gaillard D, Foiret JC, Trivin F. Does warm antegrade intermittent blood cardioplegia really protect the heart during coronary surgery? Cardiovasc Surg 2001; 9:188-93. [PMID: 11250190 DOI: 10.1016/s0967-2109(00)00087-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Intermittent antegrade blood cardioplegia (IABC) has been standardized as a routine technique for myocardial protection in coronary surgery. However, if the myocardium is known to tolerate short periods of ischemia during hypothermic arrest, it may be less tolerant of warm ischemia, so the optimal cardioplegic temperature of intermittent antegrade blood cardioplegia is still controversial. The aim of this study was to compare the effects of warm intermittent antegrade blood cardioplegia and cold intermittent antegrade blood cardioplegia on myocardial pH and different parameters of the myocardial metabolism. METHODS Thirty patients undergoing first-time isolated coronary surgery were randomly allocated into two groups: group 1 (15 patients) received warm (37 degrees C) intermittent antegrade blood cardioplegia and group 2 (15 patients) received cold (4 degrees C) intermittent antegrade blood cardioplegia. The two randomization groups had similar demographic and angiographic characteristics. Total duration of cardiopulmonary bypass (108+/-17 and 98+/-21 min) and of aortic cross-clamping (70+/-13 and 65+/-15 min) were similar. The cardioplegic solutions were prepared by mixing blood with potassium and infused at a flow rate of 250 ml/min for a concentration of 20 mEq/l during 2 min after each anastomosis or after 15 min of ischemia. Intramyocardial pH was continuously measured during cardioplegic arrest by a miniature glass electrode and values were corrected by temperature. Myocardial metabolism was assessed before aortic clamping (pre-XCL), 1 min after removal of the clamp (XCL off) and 15 min after reperfusion (Rep) by collecting coronary sinus blood samples. All samples were analyzed for lactate, creatine kinase (MB fraction), myoglobin and troponin I. Creatine kinase and troponin I were also daily evaluated in peripheral blood during 6 days post-operatively. RESULTS The clinical outcomes and the haemodynamic parameters between the two groups were identical. In group 1, XCL off and Rep were associated with higher coronary sinus release of lactate (5.5 +/- 1.8 and 2.2 +/- 0.5 mmol/l) than in group 2 (2.0 +/- 0.7 and 1.6 +/- 0.3 mmol/l, P < 0.05). Mean intramyocardial pH was lower in group 1 (7.23 +/- 0.08) than in group 2 (7.65 +/- 0.30, P < 0.05). There were no significant differences between the two groups with respect of creatine kinase (MB fraction) either after Rep or during the post-operative period. Lower coronary sinus release of myoglobin was detected at Rep in group 1 (170 +/- 53 microg/l) than in group 2 (240 +/- 95 microg/l, P < 0.05). At day 1, a lower release of troponin I was found in group 1 (0.11 +/- 0.07 g/ml) compared to group 2 (0.17 +/- 0.07 ng/ml, P < 0.05). CONCLUSION With regards to similar clinical and haemodynamic results, myocardial protection induced by warm IAEX is associated with more acidic conditions (intramyocardial pH and lactate release) and less myocardial injury (myoglobin and troponin I release) than cold intermittent antegrade blood cardioplegia during coronary surgery.
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Affiliation(s)
- O M Bical
- Department of Cardiac Surgery, Foundation Hôpital Saint Joseph, 185 rue Raymond Losserand, 75674 Paris cedex, France
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29
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Abstract
The C24 bile acids (BA) in the serum of 22 healthy human fetuses between weeks 20 and 37 of gestation were determined by capillary GC-MS. Fetal blood samples were taken in utero from the umbilical cord monitored by echography. There was no correlation between total bile acids (TBA) and gestational age. The TBA concentration was 5.14 +/- 2.13 microM. Primary BA (cholic acid and chenodeoxycholic acid) were the main BA (66.78 +/- 13.47%) with chenodeoxycholic acid being the main one. There were low concentrations of secondary BA (deoxycholic acid and lithocholic acid) (10.28 +/- 7.85%), which formed by intestinal bacterial 7 alpha-dehydroxylation of primary BA in the adult, despite the germ-free gut. The tertiary BA (ursodeoxycholic acid) was also detected (12.06 +/- 9.64%). There was 6 alpha-hydroxylation of chenodeoxycholic acid and of lithocholic acid to produce hyocholic acid and hyodeoxycholic acid respectively. Two 1 beta-hydroxylated BA were detected at different times of gestation. Cholic acid was rarely found in the 6 alpha- and 1 beta-hydroxylated forms. These additional hydroxylations could help to protect the fetal liver against the accumulation of cytotoxic bile acids at a time when other detoxification pathways are poorly developed. Traces of unsaturated bile acids like 3 beta-hydroxy-5-cholenoic acid were detected, showing that 27-hydroxylation of cholesterol does occur.
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Affiliation(s)
- F Courillon
- Hôpital Saint-Joseph, Service de Biochimie, Paris, France
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30
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Alzieu M, Trivin F, Guglielminotti J, Guidet B, Offenstadt G. [Serious complication of an illegible prescription]. Presse Med 2000; 29:1263. [PMID: 10916541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- M Alzieu
- Service de Réanimation médicale, Hôpital Saint-Antoine, Paris
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31
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Gaillard D, Bical O, Paumier D, Trivin F. A review of myocardial normothermia: its theoretical basis and the potential clinical benefits in cardiac surgery. Cardiovasc Surg 2000; 8:198-203. [PMID: 10799828 DOI: 10.1016/s0967-2109(00)00008-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myocardial protection during cardiac surgery aims to preserve myocardial function while providing a bloodless and motionless operating field to make surgery easier. Myocardial protection is achieved by decreasing the oxygen needs using hypothermia and producing electromechanical cardiac arrest using potassium infusion which allows surgery to be performed on a non-beating heart. The deleterious effects of hypothermia include dysfunction of enzymatic systems, development of acidosis, a decrease in tissue oxygen delivery, an increase in blood viscosity and a decrease in erythrocyte deformability. Ninety percent of the decrease in oxygen consumption is obtained by inducing electromechanical arrest and inducing hypothermia has little additional benefit. Maintenance of systemic and myocardial normothermia reduces problems and provides a more physiological approach for cardiopulmonary bypass (CPB). The current results obtained using normothermic protection are very encouraging, and it is an easier inexpensive option. This review summarizes the current knowledge on the benefits of normothermia, based upon experimental and clinical studies.
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Affiliation(s)
- D Gaillard
- Departments of Cardiac Surgery and Clinical Biochemistry, Saint Joseph Hospital, 185 rue Raymond Losserand, 75014, Paris, France
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32
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Chevenne D, Trivin F, Porquet D. Insulin assays and reference values. Diabetes Metab 1999; 25:459-76. [PMID: 10633871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Insulin is produced by beta cells in pancreatic islets of Langherans via a complex process of proteolytic conversion. A precursor molecule, proinsulin, is transported to the Golgi apparatus where it is packed into secretory granules. Maturation of the secretory granules is associated with conversion of proinsulin to insulin and C-peptide by enzymatic cleavage. Secretion of insulin into the bloodstream is accompanied by the release of small amounts of proinsulins. Insulin immunoassays consist of radioimmunoassays using polyclonal antisera which cross-react with proinsulins, and two-site assays using monoclonal antibodies. These immunometric assays have led to improvements in specificity and sensitivity as compared to radioimmunoassays. To determine reference values and limits, insulinaemia must be measured in normoglycaemic subjects with a normal body weight. Moreover, as insulinaemia is most often measured during stimulation tests, reference values must also be determined for the most common tests such as the oral glucose tolerance test or the intravenous glucose tolerance test. We report the analytical characteristics of insulin assays and review reference values and their interpretation. Wide-scale use of insulin assays remains a subject of research rather than a diagnostic application. Spontaneous hypoglycaemia, a disorder which can be caused by hyperinsulinism, insulinoma, insulin autoimmune syndrome and non-insulin-mediated factors, is almost the only clinical indication for the measurement of plasma insulin. Diabetes is diagnosed solely on the basis of chronic hyperglycaemia. Thus, measurement of plasma insulin has no clinical value in the diagnosis or management of diabetic patients, with the exception of rare cases including the syndrome of severe insulin resistance and abnormalities in beta-cell secretory products. Otherwise, insulin measurement is used in experimental investigations to study the pathophysiology of various disorders, especially diabetes. The reference and range of plasma insulin values are not yet clearly established, and the range of concentrations reported in the literature remains unsatisfactory. There is a need to standardise results and thereby improve comparability among studies.
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Affiliation(s)
- D Chevenne
- Laboratoire de biochimie-hormonologie, Hôpital Robert Debré, Paris, France.
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33
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Benhamou JP, Trivin F. [Liver diseases and biology]. Pathol Biol (Paris) 1999; 47:877-8. [PMID: 10609266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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34
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Affiliation(s)
- D Chevenne
- Laboratoire de Biochimie, Hôpital Saint-Joseph, Paris, France.
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35
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Trivin F, Chevenne D, Hautecouverture M. [Maillard reaction products and chronic diabetic complications]. Ann Biol Clin (Paris) 1999; 57:445-54. [PMID: 10432367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- F Trivin
- Service de biochimie, Hopital Saint-Joseph, 75674 Paris
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36
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Cisse A, Chevenne D, Chauffert M, Ndiaye MR, Wade A, Trivin F. [HLA-markers and diabetic retinopathy in the Senegalese population]. Dakar Med 1998; 43:29-33. [PMID: 9827151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Patients with IDDM often develop severe forms of retinopathy, supposed to be associated to risk factors such as hypertension, poor glycemic control and nephropathy. A controversial intervention of a genetic marker was evoked so as some diabetic patients have retinopathy in the absence of known risk factors. HLA-DR and DQ markers were compared in two groups of patients with IDDM respectively constituted of patients with and without severe retinopathy. HLA typing was carried out by polymerase chain reaction (PCR) and restriction fragments of length polymorphism (RFLP). DR9 (p < 10(-4); O.R. = 8.36) and DQA1*0301 (p < 0.05; O.R = 2.92) alleles were positively associated to diabetic retinopathy, at the opposite of DR3 (p < 10(-3); O.R: 0.01) and DQA1* (p < 10(-9); O.R = 0.15). Furthermore, among the genotypes previously considered as risk markers of IDDM in senegalese people, only DR4: DQA1*0301:DQB1*0302/DR9: DQA1*0301: DQB1*0201 was often observed in retinopathy.
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Affiliation(s)
- A Cisse
- Laboratoire de Physique Pharmaceutique, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
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37
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Cisse A, Chauffert M, Julier C, Chevenne D, Michel S, Trivin F, Diop SN, Sidibe EH, Sow AM. [HLA-DR:DQ genotypes and insulin-dependent diabetes in Senegal]. Dakar Med 1998; 41:75-8. [PMID: 9827098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
At the opposite of HLA-DR, HLA-DQ was not well documented in homogeneous negroïd populations. So, 93 IDDM and 115 control patients, all black senegalese people, were studied. The results showed three HLA-DQ IDDM-related susceptibility genotypes and also a high risk conferred by HLA-DR4/DR9 usually described in Mongoloïd people. Furthermore, DR:DQ associations allowed the identification of three IDDM predisposition genotypes, each of them with a characteristic mean age for disease diagnosis.
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Affiliation(s)
- A Cisse
- Laboratoire de Physique Pharmaceutique-Faculté de Médecine et de Pharmacie, Université Cheikh Anta DIOP, Dakar, Sénegal
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38
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Cisse A, Chevenne D, Chauffert M, Diop Diouf RM, Diop SN, Sidibe EH, Sow AM, Trivin F. [Contribution of plasma C-peptide to the classification of sugar diabetes in Dakar, Senegal]. Dakar Med 1998; 42:11-4. [PMID: 9827110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
When diabetes has been diagnosed, its classification into different types is traditionally carried out according to clinical criteria. But with arising of new parameters, one of which is C-peptide, and various subtypes of diabetes, it became more difficult. So, in order to improve the accuracy of the classification, 270 diabetic patients and 269 controls, all black senegalese subjects, were submitted to a two-step oral glucose tolerance test (0 and 120 min.) with determination of plasma glucose and C-peptide concentrations. The majority of NIDDM were confirmed at the opposite of IDDM; furthermore, it has been pointed out a group corresponding with impaired glucose tolerance (IGT) among the initial controls. When comparing the two classification modes, before and after plasma C-peptide determination, it appeared statistically significant differences with p values of 10(-4) for both IDDM and NIDDM.
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Affiliation(s)
- A Cisse
- Laboratoire de Physique Pharmaceutique, Faculté de Médecine et de Pharmacie, Université Cheikh Anta DIOP, Dakar, Sénégal
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39
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Cisse A, Chauffert M, Diop SN, Chevenne D, Sidibe EH, Michel S, Sow AM, Trivin F. [Insulin-dependent diabetes in Senegal: HLA-DR combinations according to age of onset and sex]. Dakar Med 1998; 43:54-6. [PMID: 9827157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In insulin-dependent diabetes mellitus, HLA-DR markers are involved, namely DR3, DR4 and DR9 alleles, among black senegalese populations. Studying the different associations of these alleles showed a strong predisposition to insulin-dependent diabetes mellitus with DR3/4 (p > 10(-2); OR = 13.6); DR4/9 (p < 10(-2); OR = 8.32) and DR9/9 (p < 0.05; OR = 7.78). And then it was observed a tendency to an inverse relationship of DR3/4 frequency with age of onset in male patients.
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Affiliation(s)
- A Cisse
- Laboratoire de Physique Pharmaceutique, Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta DIOP, Dakar, Sénégal
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40
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Trivin F. [Role of Maillard products in the chronic complications of diabetes mellitus. Bioclinical applications]. Ann Pharm Fr 1998; 56:193-6. [PMID: 9805817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The formation of Maillard products is increased in the diabetes mellitus. These advanced glycated end products (AGEs) alter metabolic functions of macromolecules and increase free radical formation while decreasing free radical-scavenging enzyme activity. The elimination of AGEs is insured by the macrophage cells equipped with appropriate receptors (RAGE) and cleared by kidneys. The knowledge of these molecular mechanisms had allowed the emergence of biochemical analytes such as 3-deoxyglucosone, pentosidine, and carboxymethyl-lysine, as markers of the ris of micro- and macro-angiopathy, the main chronic complications of the diabetes mellitus.
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Affiliation(s)
- F Trivin
- Service de Biochimie, Hôpital Saint-Joseph, Paris
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41
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Chevenne D, Trivin F. [Diabetes mellitus: proposal of new diagnostic and classification criteria]. Ann Biol Clin (Paris) 1998; 56:463-70. [PMID: 9754283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D Chevenne
- Hôpital Saint-Joseph, Laboratoire de biochimie, Paris
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42
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Bousquet B, Charret J, Dreux C, Gaudeau-Toussaint MF, Gruson A, Marcelli A, de Mouy D, Plaisance JJ, Sachs C, Trivin F, Valdiguié P, Zerah S. [Thoughts and recommendations concerning the accreditation of hospital and private medical biology laboratories. Working Group of the French Society of Clinical Biology]. Ann Biol Clin (Paris) 1998; 56:504-7. [PMID: 9841576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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43
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Trivin F. [More than diabetics?]. Ann Biol Clin (Paris) 1998; 56:385-6. [PMID: 9841575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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44
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Piriou V, Ross S, Bastien O, Pigott D, Trivin F, Foëx P. Cardiovascular effects of concomitant administration of isoflurane and nicorandil in dogs. Br J Anaesth 1998; 80:481-7. [PMID: 9640155 DOI: 10.1093/bja/80.4.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Nicorandil, a new KATP channel opener, is used in clinical practice for anti-anginal therapy. It exhibits vasodilator properties as does the halogenated anaesthetic isoflurane. We have examined the cardiovascular effects of increasing concentrations of isoflurane after administration of nicorandil in 10 adult beagle dogs anaesthetized with thiopental and whose lungs were ventilated mechanically. During surgery, anaesthesia was maintained with 1.0-1.5% isoflurane. A left thoracotomy was performed and the heart suspended in a pericardial cradle. Monitoring included: ECG; aortic, left ventricular, arterial, central venous and pulmonary artery pressures; cardiac output; coronary flow; and segmental length in the apical region. After surgery, isoflurane anaesthesia was set at an end-tidal concentration of 1.05% (1 MAC) and measurements obtained; these were repeated with 1.4%, 1.75%, 2.1% and 1.05% isoflurane concentrations after appropriate stabilization periods. Nicorandil (100 micrograms kg-1 bolus, 25 micrograms kg-1 min-1 infusion) was begun and a second dose-response study of isoflurane was obtained as before. Blood samples were obtained for measurement of concentrations of nicorandil. Systolic ventricular function was assessed by systolic shortening (%SS) and preload recruitable stroke work (PRSW). Increasing isoflurane concentration produced decreases in heart rate, systolic pressure, cardiac output, %SS and PRSW. Nicorandil produced a slight decrease in systolic arterial pressure (10 and 15 mm Hg after 1.05% and 2.05% isoflurane) and a slight increase in heart rate (10 and 5 beat min-1 after 1.05% and 2.05% isoflurane). Preload, assessed by end-diastolic length, decreased. Coronary blood flow increased with infusion of nicorandil. Left ventricular function was not affected by infusion of nicorandil. We conclude that nicorandil has only minor vaso/venodilatory effects in the presence of isoflurane. Ventricular function was not altered by infusion of nicorandil.
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Affiliation(s)
- V Piriou
- Nuffield Department of Anaesthetics, Radcliffe Infirmary, University of Oxford
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45
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Chevenne D, Fonfrède M, Ducrocq R, Chauffert M, Trivin F. Uremia and HbA1c measured by high-performance liquid chromatography. Diabetes Care 1998; 21:463-4. [PMID: 9540038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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46
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Chevenne D, Letailleur A, Trivin F, Porquet D. Effect of hemolysis on the concentration of insulin in serum determined by RIA and IRMA. Clin Chem 1998; 44:354-6. [PMID: 9474041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D Chevenne
- Hôp. Robert Debré, Lab. de Biochim.-Hormonol, Paris, France
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47
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Courillon F, Gerhardt MF, Myara A, Rocchiccioli F, Trivin F. The optimized use of gas chromatography-mass spectrometry and high performance liquid chromatography to analyse the serum bile acids of patients with metabolic cholestasis and peroxisomal disorders. Eur J Clin Chem Clin Biochem 1997; 35:919-22. [PMID: 9476620 DOI: 10.1515/cclm.1997.35.12.919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We have measured the bile acids in human serum as methyl ester-trimethylsilyl ethers by gas chromatography-mass spectrometry (GC-MS) using an electron ionization procedure. The overall method was validated and the detection limit (0.4 mumol/l), linearity (2-30 mumol/l), intra-day and inter-day precision, accuracy and recovery (96.2% for nor-23-deoxycholic acid as internal standard) were measured. Serum C24-bile acids profiles from 43 cholestatic patients were measured by GC-MS and by HPLC. The results obtained with the two methods were well correlated and the criteria for selecting either HPLC or GC-MS identified. The serum C24- and C27-bile acids and C29 dicarboxylic bile acid profiles for patients with generalized peroxisomal deficiencies, like Zellweger syndrome (n = 5), neonatal adrenoleukodystrophy (n = 1), infantile Refsum disease (n = 2) and from a single peroxisomal deficiency (n = 1) were also measured by GC-MS.
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Affiliation(s)
- F Courillon
- Service de Biochimie, Hôpital Saint-Joseph, Paris, France
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48
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Galezowski N, Jouanique-Bayrod C, Dazza F, Gehrig D, Trivin F, Herreman G. [Bisalbuminemia disclosing primary hyperparathyroidism with fistulized pancreatic false cyst]. Rev Med Interne 1997; 18:720-3. [PMID: 9365724 DOI: 10.1016/s0248-8663(97)83752-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Discovery on a protein electrophoregram of a bisalbuminemia can orientate according to its migration fast or slow to an hereditary mutation of an amino acid, or an acquired form by excess of beta lactamines due to renal insufficiency or by the rupture of a pancreatic pseudocyst in the peritoneum. This is this late mechanism that we report in this case of bisalbuminemia related to an opened pancreatic pseudocyst secondary to an adenoma of the parathyroid gland.
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Affiliation(s)
- N Galezowski
- Service de médecine interne, Fondation Hôpital-Saint-Joseph, Paris, France
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49
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Abstract
Three apolipoprotein B (apoB) genetic polymorphisms, the XbaI, MspI and EcoRI restriction fragment length polymorphisms (RFLPs), were analysed for 221 individuals in Senegal by polymerase chain reaction. Allelic frequency determination revealed that this population has 0.79 XbaI- (X-), 0.96 MspI+ (M+), and 0.89 EcoRI+ (E+). Major genotypes were X-/X- (0.62), M+/M+ (0.92) and E+/E+ (0.80). The XbaI allele frequency is different (p < 10(-9)) from that in Caucasians (0.47) and from that in Mongoloids (0.98). Significant differences between Senegalese and Caucasians, and between Senegalese and Mongoloids were also observed for the EcoRI and MspI alleles of the apoB genes.
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Affiliation(s)
- M Chauffert
- Service de Biochimie, Hôpital Saint-Joseph, Pairs, France
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50
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Wasserman E, Myara A, Lokiec F, Goldwasser F, Trivin F, Mahjoubi M, Misset JL, Cvitkovic E. Severe CPT-11 toxicity in patients with Gilbert's syndrome: two case reports. Ann Oncol 1997; 8:1049-51. [PMID: 9402181 DOI: 10.1023/a:1008261821434] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND CPT-11 is hydrolyzed to its active metabolite SN-38, which is mainly eliminated through conjugation by hepatic uridine diphosphate glucuronosyl transferases (UGTs) to the glucuronide (SN-38G) derivative. Preclinical studies showed that UGT*1.1 is the isozyme responsible for SN-38 glucuronidation. Patients with Gilbert's syndrome have deficient UGT*1.1 activity, therefore may have an increased risk for related CPT-11 toxicity. PATIENTS AND METHODS Two patients with metastatic colon cancer and Gilbert's syndrome were treated with CPT-11 based chemotherapy. CPT-11, SN-38 and SN-38G pharmacokinetics parameters were obtained. Serum bilirubin was analysed by alkaline methanolysis and HPLC. RESULTS Both patients presented grade 4 neutropenia and/or diarrhea (NCI-CTC) in every treatment cycle. Biliary index (after Gupta et al) values were well above 4000. CONCLUSION We present the first clinical evidence linking bilirubin glucuronidation status and CPT-11 related toxicity. The severe toxicity experienced by the two patients with Gilbert's syndrome treated with CPT-11 based chemotherapy has a genetic basis. Individuals with Gilbert's syndrome have an enhanced risk for CPT-11 toxicity. Unconjugated serum bilirubin could be predictive parameter of CPT-11 toxicity.
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