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  • 1
    ISSN: 1432-1084
    Keywords: Key words: MR imaging ; Contrast enhancement ; Liver ; Neoplasm ; Focal nodular hyperplasia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to assess the efficacy of a superparamagnetic iron oxide, ferumoxides, in the detection and characterization of focal nodular hyperplasia (FNH) on MR conventional spin-echo (SE), fast spin-echo (FSE) and gradient-echo (GRE) images. Fourteen adults with 27 FNHs were evaluated at 1.5 T before and after injection of ferumoxides. T1-weighted and T2-weighted SE, T2-weighted FSE and T2*-weighted GRE sequences were used and analysed qualitatively and quantitatively. One hundred percent of FNHs showed a significant postcontrast decrease in signal intensity on T2- and T2*-weighted images. Heavily T2-weighted SE images showed the maximum decrease in FNH signal-to-noise ratio (S/N). Postcontrast GRE T2*-weighted images improved the detection of the central scar and the delineation of FNHs and demonstrated the best lesion-to-liver contrast-to-noise ratio (C/N). Postcontrast T1-weighted SE images showed the least lesion-to-liver C/N. Ferumoxides-enhanced MR imaging can help detect and characterize FNH. Conventional pre- and postcontrast T2-weighted SE images and postcontrast GRE T2*-weighted images should be used preferentially.
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  • 2
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; insulin ; artificial pancreas ; metformin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It has been suggested that biguanides should be used in Type 1 (insulin-dependent) diabetic patients in order to diminish insulin requirements and reduce the chances of insulin reactions. The efficacy of these compounds in such patients has been controversial. We have studied the effect of metformin (850mg) given at 08.00 h in diminishing insulin needs after a 60g carbohydrate mixed meal taken at 12.00 h, using an artificial pancreas and a sequential analysis of the results. The morning test dose of metformin or placebo was preceded by 48 h treatment with metformin (850mg twice daily) or placebo. After the eighth patient a 26% saving of insulin need was demonstrated in the metformin-treated group (p〈0.01). Metformin is thus effective in reducing post-prandial insulin needs in Type 1 diabetic patients, although its use in such circumstances requires consideration of several other issues.
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  • 3
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: There is now consistent epidemiological evidence for an association between chronic hepatitis C and diabetes. Important, although so far limited longitudinal data, have documented an increased risk for diabetes in patients infected by hepatitis C virus (HCV) especially in those with metabolic risk factors such as a high BMI and older age. HCV encoded proteins might alter insulin signalling thus explaining impaired insulin sensitivity and the occurrence of glycaemic dysregulation even before the cirrhotic stage. The consequences of the association between diabetes and HCV infection are an increased liver fibrosis stage and faster fibrosis progression rate. This article reviews recent human and experimental data on the HCV-diabetes association.
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  • 4
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim: To assess the efficacy of smooth muscle relaxants in the treatment of patients with irritable bowel syndrome, a meta-analysis of 26 selected double-blind randomized trials vs. placebo was performed.Methods: Five end-points were assessed: global assessment, abdominal pain, constipation, abdominal distension and the absence of adverse reactions. Analyses were performed according to the intention-to-treat method. For each end-point, the drug efficacy was assessed by the Der Simonian and Peto methods. When a significant difference was observed, sensitivity analyses were performed by successive stratifications according to the type of drug, the treatment duration, the prevalence of constipated patients, the trial design and the methodological quality.Results: All myorelaxants analysed were significantly better than placebo for the improvement of global assessment (62% improvement rate vs. 35% on placebo, that is 27% improvement rate, P 〈 0.01) and for pain improvement (64% improvement rate vs. 45% on placebo, that is 19% improvement rate, P 〈 0.01). No significant differences were observed for constipation and abdominal distension. The percentage of patients with adverse reactions was significantly higher in patients receiving myorelaxants than placebo (6% mean difference, P 〈 0.01).Conclusion: According to this overview five drugs have proved their clinical efficacy in patients with irritable bowel syndrome, without significant adverse reactions: cimetropium bromide, pinaverium bromide, trimebutine. octilium bromide and mebeverine.
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  • 5
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In order to estimate the rate of symptomatic relapse and to identify factors associated with this relapse, 1030 patients were included in a multicentre study. All patients included had clinically and endoscopically healed oesophagitis (grade I (erosion, 57%), grade II (confluent erosion, 33%) or grade III (circular erosion, 9%)) after treatment with an H2 blocker or omeprazole. Patients were given conservative advice and were told to take sodium alginate only in response to pain. Relapse was defined as pain justifying more than eight sodium alginate sachets over 48 hours or treatment with another drug, or the need for a new endoscopy. Forty risk factors were recorded initially and patients were seen every 2 months; they filled out diary-cards describing symptoms and drug consumption. Data were available for 883 patients during follow up. The cumulative percentage of patients without relapse at 6 months estimated by Kaplan Meier method was 76 ± 2 % (mean ± S.E.M.). Among these patients without relapse, 95% took less than two sachets per day. Only two factors were identified as associated with relapse—the grade of oesophagitis (P 〈 0.007), and the occurrence of stress during follow-up (P 〈 0.05). The percentage of patients free from relapse at six months was 85 ± 2% in patients with grade I oesophagitis, 69 ± 3% in patients with grade II, and 56 ± 6% in patients with grade III oesophagitis (P 〈 0.0001).
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  • 6
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Randomized controlled trials testing flumazenil in hepatic encephalopathy have shown conflicting results.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To compare flumazenil and placebo in hepatic encephalopathy in patients with cirrhosis.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:An overview of randomized controlled trials comparing flumazenil and placebo in hepatic encephalopathy in patients with cirrhosis was performed. For each end-point, heterogeneity and treatment efficacy were assessed by Peto and Der Simonian methods. As most trials were crossover in nature, a sensitivity analysis was performed including the two treatment periods.〈section xml:id="abs1-4"〉〈title type="main"〉Results:Six double-blind randomized controlled trials, including 641 patients (326 treated with flumazenil and 315 with placebo), were identified. The treatment duration ranged from 5 min to 3 days. Heterogeneity tests between control groups were not significant. The mean percentages of patients with clinical improvement (five trials) were 27% in treated groups and 3% in placebo groups. This difference was significant by both methods (Peto: odds ratio=6.15; 95% confidence interval, 4.0–9.5; P 〈 0.001; Der Simonian: mean rate difference, 29%; 95% confidence interval, 17–41; P 〈 0.001). The mean percentages of patients with electroencephalographic improvement were 19% in treated groups and 2% in placebo groups. This difference was significant only with the Peto method (odds ratio=5.8; 95% confidence interval, 3.4–9.7; P 〈 0.001). The sensitivity analysis showed similar results.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:This meta-analysis shows that flumazenil induces clinical and electroencephalographic improvement of hepatic encephalopathy in patients with cirrhosis.
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  • 7
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To update previous overviews of placebo-controlled double-blind trials assessing the efficacy and tolerance of smooth muscle relaxants in irritable bowel syndrome.〈section xml:id="abs1-2"〉〈title type="main"〉Methods and trials:A total of 23 randomized clinical trials were selected for meta-analyses of their efficacy and tolerance. Six drugs were analysed: cimetropium bromide (five trials), hyoscine butyl bromide (three trials), mebeverine (five trials), otilium bromide (four trials), pinaverium bromide (two trials) and trimebutine (four trials). The total number of patients included was 1888, of which 945 received an active drug and 943 a placebo.〈section xml:id="abs1-3"〉〈title type="main"〉Results:The mean percentage of patients with global improvement was 38% in the placebo group (n=925) and 56% in the myorelaxant group (n=927), in favour of myorelaxants with a mean odds ratio of 2.13, P 〈 0.001 (95% CI: 1.77–2.58) and a mean risk difference of 22% P 〈 0.001 (95% CI: 13–32%). The percentage of patients with pain improvement was 41% in the placebo group (n=568) and 53% in the myorelaxant group (n=567): odds ratio 1.65, P 〈 0.001 (95% CI: 1.30–2.10) and risk difference 18%, P 〈 0.001 (95% CI: 7–28%). There was no significant difference for adverse events.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusion:Myorelaxants are superior to placebo in the management of irritable bowel syndrome.
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  • 8
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: This review attempts to identify meta-analyses performed in hepatogastroenterology, and to assess their quality and to identify simple criteria of good quality. Methods: Meta-analyses of randomized clinical trials in hepatogastroenterology published as full papers before 1993 were included. A quality score was defined as the sum of 27 items evaluated in each publication and coded 2 if adequate, 1 if partial and 0 if missing. Quality criteria were identified by discriminant analysis through three groups of meta-analyses defined by their quality score (poor, middle, high). Results: From 1981 to 1992, 62 publications were identified, including 42% in the last 2 years. Nineteen per cent concerned peptic ulcers, 18% oesophageal varices and 6% digestive cancers. They reported 180 meta-analyses. The quality score ranged from 14 to 40, the median was 29. Twenty-five per cent of the studies obtained a score lower than 23 and 25% a score higher than 34. Several stages of meta-analysis were poorly performed: identification and selection of trials, study of trial quality, data extraction and achievement of sensitivity analyses, subgroup and indirect analyses. Some of them led to biases and questions about the validity of results. Five criteria were significantly associated with high quality: presence of a protocol, assessment of trial quality, only randomized trials pooled, achievement of sensitivity analyses, and peer-reviewed publication. Conclusions: In hepatogastroenterology, there is an exponential increase in publication of meta-analyses but their quality is heterogeneous. In particular, the control of the biases has to be better performed.
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  • 9
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 10
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sixteen clinical and biological variables were recorded in 116 episodes of upper digestive tract hemorrhage of known cause in cirrhotic patients. One-dimensional analysis reveals a significant correlation between six variables and the rupture of esophagogastric varices, whereas multiple linear regression and partial correlation analysis reduces the significant variables to two: a history of digestive hemorrhage and the nonalcoholic etiology of the cirrhosis. A value of the discriminant function exists for which the specificity and, consequently, the positive predictive value are equal to 100%, but with a sensitivity of 39%. These results mean that, in an explanatory approach, partial correlation analysis seems to constitute an indispensable complement to analysis of clinical and biological variables, since it reduces the chances of unwarranted explanatory interpretation. However, in a pragmatic approach, the recording of 16 variables does not permit a clear discrimination between ruptured varices and nonruptured varices; this suggests that either other factor(s) remain to be discovered or else that those related to ruptured varices and to acute ulcerations are the same.
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