[Evaluation of 2 years' experience with elective endoscopic sclerotherapy of hemorrhagic esophageal varices in cirrhotic patients]. / Bilan de deux années d'expérience de la sclérothérapie endoscopique élective des varices oesophagiennes hémorragiques chez le cirrhotique.

The authors report their 2-year experience of esophageal endoscopic sclerotherapy for prevention of recurrent variceal bleeding in patients with liver cirrhosis. Sixty-three alcoholic cirrhotics underwent sclerotherapy 10 +/- 6 days (SD) after hospital admission for variceal bleeding. Varices were successfully eradicated in 43 patients (68 p. 100), with an average of 3 injection sessions, over a mean period of 5 weeks. Unsuccessful treatment was due to abbreviated course of treatment because of early rebleeding and early mortality. Early rebleeding episodes after therapy occurred in 19 patients (30 p. 100): 10 in whom the esophageal varices were eradicated, 9 in whom sclerotherapy had failed. Recurrent hemorrhage was the cause of death in 6 patients. After variceal eradication had been achieved, new varices were observed in 7 p. 100 of patients after a mean follow-up of 8 months. The risk of further variceal bleeding was 0.008 hemorrhage/patient/month. Minor complications (thoracic pain, dysphagia, esophageal ulcers, pleural effusion) occurred in 60 p. 100 of patients. An esophageal stricture developed in 13 out of the 43 successfully treated patients (30 p. 100). Major complications occurred in 5 patients and was the cause of death in 4: mediastinitis, esophageal perforation, bronchoesophageal fistulae, cardiogenic shock and aspiration pneumonitis. The survival curve, assessed by cumulative life analysis, showed a 60 p. 100 survival rate after 12 months and 56 p. 100 after 18 months. It was significantly different (p less than 0.001) between groups of cirrhosis classified according to Child-Pugh's criteria (95, 52 and 9 p. 100 at 12 months for groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Morphology and function of the esophagus after sclerotherapy of esophageal varices in cirrhotic patients]. / Morphologie et fonction de l'oesophage après sclérothérapie des varices oesophagiennes chez le cirrhotique.

To assess the effects of endoscopic variceal sclerotherapy on esophageal symptoms and function, we prospectively studied 24 consecutive cirrhotic patients (group I), 60 days after variceal eradication had been achieved. Nine cirrhotics with varices (group II) and 16 normal volunteers (group III) were control groups. After sclerotherapy, 9 patients had persistent dysphagia and two others had heartburn. Nine patients developed an esophageal stricture, without dysphagia in 2 cases. Distal esophageal scars were observed in 8 out of 9 patients with stricture and 2 out of 15 patients without stricture. The percentage of patients with abnormal peristaltic waves (abnormal pattern, non propulsive contractions, respectively) was significantly (p less than 0.01) more important in group I (83 p. 100, 96 p. 100) than in group II (22 p. 100, 22 p. 100). A very particular manometric "en plateau" waveform pattern, never seen before, was observed in 75 p. 100 of patients in group I. Relaxation of lower esophageal sphincter (LES) was significantly (p less than 0.01) lower in patients with stricture (38 p. 100 median) than in the others (71 p. 100 median). Motility disturbances were observed in the 6 +/- 3 last centimeters of the esophagus, and were unchanged 9 months later in 5 patients who had further examination. The percentage of time below pH 4 and the Kaye's score did not differ between group I (n = 17) and group III on 3 hours postprandial esophageal pH monitoring. The percentage of time at pH less than 4 was more than 9 p. 100 in 31 p. 100 of group I patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlation between hemodynamic parameters of the portal circulation in cirrhotic patients]. / Corrélation entre les paramètres hémodynamiques de la circulation portale chez le cirrhotique.

The aim was to study the relationships between portal hemodynamic parameters in cirrhotic patients. Portal hemodynamics was assessed by scintisplenoportography and sonography, and the measurement of portohepatic gradient. Gradient between wedged and free hepatic venous pressures was 2.71 +/- 0.90 kPa (SD), and extrahepatic shunting was 49 +/- 31 p. 100 (SD) in 27 cirrhotic patients. Intrahepatic shunting was present in 17 p. 100 out of 23 cirrhotics. Portal blood flow was 0.582 +/- 0.196 l/min (SD) and hepatic resistance to portal blood flow was 4.84 +/- 2.62 kPa/l/min (SD). Portal blood flow correlated neither with the pressure gradient, nor with portosystemic shunting. The pressure gradient was significantly correlated with portal systemic shunting (r = 0.64, p less than 0.001). Hepatic resistance to portal blood flow was significantly (p less than 0.05) correlated with portal systemic shunting, however the value of the correlation coefficient was low (r = 0.433). The pressure gradient and portosystemic shunting were higher in patients with large esophageal varices than in those with small ones (respectively t = 2.665, p less than 0.02 and t = 3.00, p less than 0.01). Hemodynamic pattern was not correlated with the degree of hepatocellular failure, as assessed by the Child-Pugh index. In conclusion this study provides further evidence for the forward theory of portal hypertension in human liver cirrhosis.

[Scintigraphy with indium 111-labeled polynuclears: correlation with the extensiveness and activity of cryptogenetic enterocolitis]. / Scintigraphie aux polynucléaires marqués à l'indium 111: corrélation avec l'extension et l'activité des entérocolites cryptogénétiques.

We have studied prospectively the usefulness of indium 111 granulocytes scanning in patients with Crohn's disease and ulcerative colitis. Abdominal scans were performed 1 h, 3 h and 20 h after the injection of a pure autologous granulocyte preparation containing 3.7-5.5 MBq of radioindium. The extent of bowel involvement, evaluated on the 3-hour scan, was compared to the X-rays and endoscopic findings. The disease activity was assessed by the intensity of intestinal radionuclide uptake (IRU), the fecal indium 111 measurement (FIM) after a 4-day fecal collection, the decrease of the hepatic and splenic uptake (DHSU). It was compared to clinical and biological data as CDAI, sedimentation rate, albumin and alpha-2-globulin levels. Thirty-three examinations were performed in 26 patients, 16 with Crohn's disease and 10 with ulcerative colitis. The correlation of disease location between indium scan and other diagnosis procedures was good in 81 p. 100 of cases. CDAI was significantly correlated with radionuclide indexes: IRU, FIM, DHSU. FIM was not significantly different between mild and moderates diseases (respectively 1.5 +/- 1.0 p. 100 and 3.6 +/- 3.2 p. 100), but was different between moderate and moderately severe diseases (respectively 3.6 +/- 3.2 p. 100 and 23.6 +/- 16.7 p. 100, p less than 0.001). DHSU was significantly different between mild and moderate diseases (respectively 10.9 +/- 7.2 p. 100 and 22.5 +/- 10.7 p. 100, p less than 0.05) and between moderate and moderately severe diseases (respectively 22.7 +/- 10.7 and 42.4 +/- 7.3 p. 100, p less than 0.001). The radionuclide activity indexes were significantly correlated between themselves.(ABSTRACT TRUNCATED AT 250 WORDS)

[Shy and Drager syndrome. Physiopathological and pharmacological approach based upon one case (author's transl)]. / Syndrome de Shy et Drager. Approche physiopathologique et pharmacologique à propos d'un cas.

The authors report a new case of Shy and Drager syndrome characterized by the severity of the extrapyramidal signs as well as that of orthostatic hypotension and urinary dysfunction. Peripheral adrenergic disturbance was proven, associated with an abnormality of the renin-angiotensin system. The authors describe the various drugs tried experimentally in treatment of the three main symptoms of the disease. A combination of Trihexyphenidyl and Dibenzepine finally appeared to be the most effective. Six months later, there remained a marked improvement in extrapyramidal signs and orthostatic hypotension. By contrast there was no improvement in urological symptoms.