[Evaluation of the change process during treatment of adolescent psychotics]. / Evaluation des processus de changement au cours du traitement d'adolescents psychotiques.

This study rests on work comparing the processes of change in the mental functioning of eleven psychotic teenagers through two perspectives: a psychological perspective centered on the comparison of two psychological examinations carried out at intervals of one and a half and three years; a psychiatric perspective taking into account elements supplied by the doctor and the nursing staff in the facility and concerning the evolution of each patient between the first and second psychological examination. The evolution was judged according to three factors liable to explain the therapeutic effects: the ability of psychic movement through the appearance or the reappearance of a function in the primal process; setting up limits and defenses of a narcissistic order; the improvement in the ability to make bonds. In spite of the difficulties in regrouping the subjects, the comparative results between the tests and the clinical setting generally confirmed our initial hypotheses.

[Prevention of recurrent hemorrhage caused by the rupture of esophageal varices in cirrhotic patients. A controlled study of propranolol and clip ligation of the esophagus]. / Prévention de la récidive hémorragique par rupture de varices oesophagiennes chez le cirrhotique. Etude contrôlée comparant le propranolol et la ligature de l'oesophage sur clip.

Among the various treatments of ruptured oesophageal varices two seem to be effective: oral propranolol therapy and ligation of the oesophagus on clip. In this controlled study these two methods were compared in a series of 55 patients hospitalized for ruptured oesophageal varices. After haemodynamic stability was obtained, the patients were allocated at random to either propranolol therapy (n = 28) or surgery (n = 27). Twenty-one per cent of these patients belonged to group C of Child's classification and 54 per cent to group A. The parameters studied were similar in both groups. Five patients were excluded from the study: 2 in the medical group when it appeared that propranolol was contra-indicated and 3 in the surgical group who died before the operation; however, these 5 patients were taken into account in a second statistical evaluation. Nineteen out the 26 patients under propranolol (73 per cent) had rebleeding (within the first 10 days in 3 cases). In the surgical group recurrent bleeding was observed in 4 out of the 24 patients (17 per cent), and 4 other patients died post-operatively. The difference in favour of the surgical group was highly significant (P less than 0.001), and it remained significant (P less than 0.05) when the 5 patients who could not be treated were included into the calculations. Cox's multivariate analysis showed that patients in Child's C group had a poorer prognosis.

[Systemic scleroderma. Contribution of esophageal manometry]. / Sclérodermie systémique. Apport de la manométrie oesophagienne.

Oesophageal motor function was studied by oesophageal manometry in 48 patients with progressive systemic sclerosis: 25 with proximal scleroderma and 23 with diffuse scleroderma. Oesophageal lesions were noted in 70% (74% in diffuse scleroderma; 64% in proximal scleroderma). Classical manometric signs of scleroderma were found in only 31% of patients. Peristaltic modifications might begin at the junction of the two muscular coats, since a four centimeter long aperistaltic suspended area was noted in that region in 20% of patients, especially in the proximal scleroderma group. Oesophageal motility and low lower oesophageal sphincter pressure account for the gastro-oesophageal reflux and may compromise respiratory function, as suggested by the high frequency of concurrent oesophageal and respiratory dysfunction in diffuse scleroderma. Systematic prevention of gastro-oesophageal reflux should perhaps be advocated as soon as abnormalities in oesophageal motility are diagnosed.

Treatment of acute hepatic encephalopathy in cirrhotics with a branched-chain amino acids enriched versus a conventional amino acids mixture. A controlled study of 70 patients.

Acute hepatic encephalopathy in 70 cirrhotic patients was monitored during parenteral administration of amino acids between January 1979 and January 1984. The diagnosis of cirrhosis was confirmed by needle biopsy, and HE by conventional clinical and EEG parameters. The infusion of AA solutions was initiated 48 h after admission and during a 5-day period: 34 patients received a control aminoacid solution, a commercially available AA mixture (Azonutril), and 36 patients a modified solution enriched in BAA prepared from crystallized AA dissolved in distilled water. The calorie intake for both groups was 1600 calories per day from glucose and lipid emulsion. No significant difference was noted based on clinical evolution, even though the plasma AAA/BAA ratio was corrected using the modified AA solution. Of the 34 patients in Group 1: 10 improved, 14 were unchanged, 10 deteriorated and 7 died. Of the 36 patients in Group 2: 12 improved, 14 were unchanged, 10 deteriorated and 7 died. EEG tracing evolved in parallel fashion. The authors conclude that modified AA solutions are ineffective in the treatment of acute hepatic encephalopathy in cirrhotic patients.

[Value of the transjugular venous approach to the liver in the diagnosis of cirrhosis. 333 cases]. / Intérêt de l'abord veineux transjugulaire du foie dans le diagnostic de la cirrhose. 333 cas.

The transjugular technique is very useful for the diagnosis of cirrhosis since it makes it possible, in one single exploratory procedure, to perform a needle aspiration biopsy (despite coagulation disorders and ascites) and to measure the porto-caval pressure gradient. In our series cirrhosis was diagnosed by liver biopsy alone in 249 out of 333 patients (77%), and the porto-caval gradient was found to be elevated in 313 patients (97%).

[Sclerosing cholangitis following surgical treatment of hydatid cysts of the liver. Probable role of the formol injection of bile ducts]. / Cholangite sclérosante après traitement chirurgical de kystes hydatiques du foie. Rôle probable de la formolisation des voies biliaires.

Three cases of secondary sclerosing cholangitis which developed during the early postoperative phase of surgical treatment of hydatid liver cysts are reported. The cysts had ruptured into the biliary tree and the treatment consisted of infection of formol into the cysts. Evolution was pejorative since one patient died within 3 months and the remaining two underwent liver transplantation following biliary sclerosis. An experimental protocol using dogs has shown that the injection of 5, 10 and 20 p. 100 formalin into normal bile ducts rapidly causes sclerosing cholangitis which often leads to death. In man, it is very likely that the contact of 2 p. 100 formalin with mucosal tissue damaged by episodes of cholangitis could result in sclerosing cholangitis. These observations should be sufficient to discourage the use of formalin to sterilize hydatid cysts of the liver.

Unconjugated hyperbilirubinemia during treatment with chenodeoxycholic acid.

The authors describe a slight but significant increase in the serum levels of indirect-reacting bilirubin in gallstone patients after 3 and 6 mo of treatment with chenodeoxycholic acid. A return to pretreatment values was noted at 9 mo. The mechanism of this abnormality remains unclear. Two explanations are theoretically possible: a subclinical hemolysis or a modification of the hepatic transport and/or the conjugation of bilirubin.