Somatostatin in peptic ulcer bleeding--results of a double-blind controlled trial.

The aim of this work was to assess the usefulness of somatostatin in acute peptic ulcer bleeding. Sixty-four patients with endoscopic evidence of duodenal ulcer bleeding completed a double-blind trial to compare the effectiveness of somatostain (6 mg i.v. per day) with that of placebo; incidence of treatment failure (i.e., rebleeding or persistent haemorrhage) was not different in the somatostatin and in the placebo groups (respectively 24% and 23%). Because the efficacy of cimetidine had previously been demonstrated in gastric ulcer bleeding, somatostatin was tested against cimetidine (1.6 g per day) in 50 patients with gastric ulcer haemorrhage. The treatment failed to control bleeding in 15% of somatostatin and in 17% of cimetidine treated subjects (n.s.). Both treatments were well tolerated and blood requirements were not different in the trial groups. These results show that the efficacy of somatostain in peptic ulcer bleeding is not different from placebo in duodenal ulcers and not different from cimetidine in gastric ulcers.

[Photodynamic therapy by coloring laser. Can it represent a therapeutic alternative for small epidermoid cancers of the esophagus?]. / La photothérapie dynamique par laser à colorant. Peut-elle représenter une alternative thérapeutique pour les petits cancers épidermoïdes de l'oesophage?

Our aim was to assess the efficacy of photodynamic therapy in inoperable patients with small esophageal carcinoma. Eleven patients were treated for squamous cell carcinomas ranging in size from 1 to 3 cm2. Hematoporphyrin (between 3 and 5 mg/kg) was injected intravenously and then the tumor irradiated at endoscopy 72 hours later with a dye laser (630 nm) at an energy of 250 joules/cm2. Complete destruction of the lesion was obtained in 6 cases with negative biopsies at 1 month. In all 6 patients, no recurrence was seen after a median follow-up of 4 months (range: 2-38). Partial destruction of the tumor was obtained in 4 cases while treatment was a complete failure in the last patient. Two instances of mild cutaneous photosensitization occurred. Two patients treated for recurrence after radiotherapy, died of esophageal perforation directly related to the procedure. Photodynamic therapy appears to be a possible effective treatment for esophageal squamous cell carcinoma in inoperable patients when other curative treatment modalities are not possible.

Rapid assessment of the distribution of apolipoproteins C-II and C-III subspecies in triglyceride-rich lipoproteins by isoelectric focusing.

We describe an isoelectric-focusing method for rapidly separating and quantifying apolipoprotein (apo) C-II and C-III subspecies of triglyceride-rich lipoproteins. Concentrated very-low-density lipoproteins (VLDL) or delipidated apo VLDL are focused on dry acrylamide plates, after their rehydration with ampholytes and urea. Apo C-II and apo C-III in VLDL are resolved into four major bands--C-II (pI 5.01), C-III0 (pI 5.10), C-III1 (pl 4.92), and C-III2 (pI 4.84)--at the same pI values as for purified apo C. This precise technique can be used without delipidating VLDL. The relative percentage of C apoproteins found in VLDL from plasma of normal subjects agreed with previously published data. The ratio of apo C-II to apo C-III decreased in patients with chronic renal failure or with coronary artery disease.

Noncompetitive enzyme-linked immunoassay for apolipoprotein B in serum.

We used a noncompetitive enzyme-linked immunoassay to measure apolipoprotein B (apo-B) concentration in human plasma. Goat anti-lipoprotein B immunoglobulins were adsorbed to the surface of polystyrene balls. After washing, this solid-phase antibody was incubated with antigen (plasma from normal or hyperlipoproteinemic fasting subjects), washed, and then incubated with peroxidase-labeled goat anti-lipoprotein B IgG. After a last washing, we measured the bound label, which provided a direct measurement of the antigen. Under optimized assay conditions, the minimum detectable concentration was 50 ng per assay. The assay may be used to measure apo-B in different lipoprotein fractions (low- or very-low-density) and yields values that compared favorably with those obtained by electroimmunoassay (r = 0.86). The assay offers several advantages over existing techniques: sensitivity, specificity, simplicity, avoidance of radioisotopes, and potential for use with monoclonal antibodies.

[Sacrocoxitis due to common bacteria]. / Sacro-coxites à germes banals

The authors report 11 cases of sacro-coxitis due to pyogenic bacteria observed over a period of seven years and emphasize that this is a disease of young women recently in labour, usually due to staphylococci which enter through the genital tract. The other methods of contamination are urinary, cutaneous and dental. The onset is usually acute, pseudoembolic and bacteremia. Whereas the diagnosis is purely clinical as X ray remains normal until the 15th or 20th day, all steps should be taken to identify the germ. With antibiotics, a cure is obtained without sequelae within 3 months. Surgery is only justified if tuberculosis is suspected and in exceptional cases with abscess formation.

[Gastrointestinal haemorrhage related to alcoholic cirrhosis. Prognostical influence of digestive lavage (author's transl)]. / Hémorragies digestives des cirrhotiques. Rôle pronostique du lavage digestif.

During gastrointestinal bleeding associated with cirrhosis, the presence of blood within the lumen of the gut may cause or favorise the onset of hepatic coma. Digestive lavage by rapid intragastric infusion of an isotonic solution based upon mannitol may reduce the mortality due to hepatic coma. The value of this method was studied retrospectively by comparison of two series of haemorrhagic complications: Group I-1971-1976: 224 haemorrhagic complications treated in the usual manner; Group II-1976-1977: 127 haemorrhagic complications treated in accordance with a protocol which included digestive lavage. The results indicate the prognostic significance of certain clinical signs (ascites, jaundice, shock), and also made it possible to determine the cause of death and to demonstrate a reduction in mortality in the group treated by digestive lavage (p < 0.02), concerning only deaths as a result of hepatic coma (p < 0.01) above all in forms with a poor initial prognosis with shock or decompensation with jaundice and ascites.