Performance diagnostique des signes échographiques dans le diagnostic de fibrose sévère

Introduction : Les patients ayant une fibrose sévère doivent être détectés précocement afin de prévenir les complications telles que la rupture de varices ou le carcinome hépatocellulaire .L échographie largement utilisée pour des symptômes variés, pourrait permettre de détecter ces patients. Néanmoins pour atteindre ce but, les signes échographiques faisant suspecter la présence d une fibrose sévère doivent être simples et faciles à rechercher. Objectif : Le but de l'étude était de sélectionner et de valider dans une population de patients asymptomatiques suivie pour une hépatopathie chronique, les paramètres les plus performants dans la prédiction d'une fibrose sévère F>=3 et de proposer un algorithme permettant de spécifier les patients qui nécessiteront d'autres investigations.Méthode : Etude prospective de décembre 2001 à décembre 2009, incluant des patients asymptomatiques suivis pour une hépatopathie chronique. 7 paramètres échographiques ont été évalués. Résultats : Dans notre étude, la surface irrégulière du foie, la longueur de la rate et l altération du spectre des veines sus hépatiques, apparaissent répondre à notre étude et mériteraient d être validés dans la population générale.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

The Characteristics of Diverticular Disease in Caribbean Population: A Control Group Study

Background. Diverticulosis is not well characterized in the Caribbeans. Our aim was to compare the anatomical presentation of colonic diverticulosis in African Caribbeans (group AC) versus Europeans (group E) and severity. Methods. We conducted a prospective controlled study involving 274 patients admitted for lower gastrointestinal haemorrhage (LGIH) in France (center 1: Guadeloupe; center 2: La Roche-sur-Yon); 179 cases with diverticular haemorrhage, including 129 in group AC and 40 in group E. Exploration of the colon included a detailed assessment of diverticula using a dedicated endoscopic grid. Results. AC and E had similar characteristics in terms of age, gender, previous history of LGIH, body mass index, dietary habits, and medications, but AC had significantly poorer hemodynamic parameters at admission and required more blood transfusions (66.7% vs. 42.5%; p=0.01) during hospitalization. Out of the 169 patients included in the study, a complete exploration of the colon was achieved in 81% (N = 137) (AC, n = 106; E, n = 31), and revealed right-side diverticulosis in AC (in 90.6%, included into a pancolonic form in 73.6% vs. 35.5%; p=0.0002) and left-side diverticulosis in E (in 96.8%, isolated form in 58.1% vs. 9.4%, p=0.0002). These data were confirmed by a sensitivity analysis using an endoscopic grid in 92 patients, achieving a higher frequency and larger size of diverticula in AC. Conclusion. Our study has shown that diverticulosis was pancolonic in AC and more frequently associated with more severe haemorrhage than the left-sided diverticulosis of Europeans. This anatomical presentation may be driven by the genetic background more than the environment and diet

The Characteristics of Diverticular Disease in Caribbean Population: A Control Group Study

International audienceBACKGROUND: Diverticulosis is not well characterized in the Caribbeans. Our aim was to compare the anatomical presentation of colonic diverticulosis in African Caribbeans (group AC) versus Europeans (group E) and severity. METHODS: We conducted a prospective controlled study involving 274 patients admitted for lower gastrointestinal haemorrhage (LGIH) in France (center 1: Guadeloupe; center 2: La Roche-sur-Yon); 179 cases with diverticular haemorrhage, including 129 in group AC and 40 in group E. Exploration of the colon included a detailed assessment of diverticula using a dedicated endoscopic grid. RESULTS: AC and E had similar characteristics in terms of age, gender, previous history of LGIH, body mass index, dietary habits, and medications, but AC had significantly poorer hemodynamic parameters at admission and required more blood transfusions (66.7% vs. 42.5%; p=0.01) during hospitalization. Out of the 169 patients included in the study, a complete exploration of the colon was achieved in 81% (N = 137) (AC, n = 106; E, n = 31), and revealed right-side diverticulosis in AC (in 90.6%, included into a pancolonic form in 73.6% vs. 35.5%; p=0.0002) and left-side diverticulosis in E (in 96.8%, isolated form in 58.1% vs. 9.4%, p=0.0002). These data were confirmed by a sensitivity analysis using an endoscopic grid in 92 patients, achieving a higher frequency and larger size of diverticula in AC. CONCLUSION: Our study has shown that diverticulosis was pancolonic in AC and more frequently associated with more severe haemorrhage than the left-sided diverticulosis of Europeans. This anatomical presentation may be driven by the genetic background more than the environment and diet