PRISE EN CHARGE DIAGNOSTIQUE ET THERAPEUTIQUE DES HEPATITES B (ETUDE DE POPULATION : COTE D'OR (1994-1998) ET DOUBS (1995-1997))

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Altération de l’état général, hyperéosinophilie et images nodulaires hépatiques très particulières

International audienc

Acute recurrent biliary pancreatitis associated with the ABCB4 gene mutation.

International audienceThe ABCB4 gene codes for a protein involved in the transport of phosphatidylcholine across the canalicular membrane of the hepatocyte. ABCB4 gene defects have been associated with progressive familial intrahepatic cholestasis type 3, intrahepatic cholestasis of pregnancy, adult biliary cirrhosis and the more recently described low phospholipid associated cholelithiasis syndrome. The present paper describes 2 probands with a long history of recurrent pancreatitis and cholelithiasis and the same heterozygous, as yet undescribed del 3683>3688 within exon 28 of the ABCB4 gene resulting in a loss of function. This report shows that ABCB4 mutations may cause acute recurrent biliary pancreatitis

Treatment of ulcerative colitis refractory to steroid therapy by oral microemulsion cyclosporine (Neoral).

International audienceBACKGROUND: Intravenous cyclosporine is active in 60% to 80% of patients with ulcerative colitis (UC) who failed to respond to intravenous corticosteroids. Several studies have suggested that cyclosporine in microemulsion form (Neoral) has some efficacy in this setting, but the optimal dose, blood level, time to response, and remission need to be better defined. The aim of this study was to evaluate the response to Neoral and its toxicity in active corticosteroid-refractory UC. METHODS: Between March 2002 and August 2005, 20 courses of Neoral [initial dose, 2.3 mg/kg (range, 1.8 to 2.8 mg/kg) every 12 hours] were prescribed in 19 consecutive patients for a UC attack that did not respond to intravenous methylprednisolone. All patients received prophylaxis against Pneumocystis carinii. RESULTS: Response was obtained in 17 of 20 attacks (85%) after 3.5 days (range, 1 to 7). Remission was obtained in 15 of 20 attacks (75%) after 13 days (range, 2 to 30 days). Four responders relapsed and underwent colectomy 21 to 900 days after the start of Neoral. Overall, 14 of 19 patients (74%) were colectomy free after a median follow-up of 8 months (range, 1 to 41 months). Cyclosporine blood levels were measured at fasting (C0) and 2 hours after Neoral administration (C2) in a subgroup of 10 responders. The results were 103 ng/mL (range, 32 to 240 ng/mL) for C0 and 761 ng/mL (183 to 1390 ng/mL) for C2. One severe bedridden patient with neonatal encephalopathy died. Main side effects observed were mild transient renal impairment (n = 2), hypertension (n = 1), cytomegalovirus infection (n = 2), and esophageal candidiasis (n = 1). CONCLUSIONS: In active corticosteroid-refractory UC, Neoral seems to have the same efficacy and toxicity as the intravenous form. Trough target cyclosporine blood levels should not exceed 100 ng/mL for C0 and 700 ng/mL for C2

The choledochal ring sign: a specific finding in acute biliary pancreatitis.

International audienceWe investigated a marked common bile duct wall contrast-enhancement in acute pancreatitis on CT scans as an accurate sign of biliary pancreatitis. Contrast-enhanced CT scans of 80 patients with clinically and biologically confirmed acute pancreatitis were reviewed by two gastrointestinal radiologists without knowledge of the cause of acute pancreatitis. Since this study was retrospective and then did not modify the CT examination routinely performed in acute abdomen, no institutional review board approval and informed consent was requested. A systematic measure of the difference between the CT number of common bile duct wall and the CT number of pancreatic parenchyma was performed. The "choledochal ring" sign, defined by a difference greater than 15 HU was specifically studied and compared to other factors often associated with biliary pancreatitis through univariate and multivariate analyses. Compared to other factors classically associated with acute biliary pancreatitis, the "choledochal ring" sign showed high specificity (100%) and high positive predictive value (100%). In patients with acute pancreatitis, the "choledochal ring" sign is a new and accurate finding of acute biliary pancreatitis on CT scans

The prognosis of patients having received optimal therapy for nonvariceal upper gastrointestinal bleeding might be worse in daily practice than in randomized clinical trials.

International audienceBACKGROUND: Combination of endoscopic haemostatic and high-dose intravenous proton-pump inhibitors is considered to be the standard care for patients with acute peptic ulcer bleeding. AIM: This study assessed predictive factors of rebleeding and death in unselected patients presented to our hospital. METHODS: Consecutive patients with nonmalignant bleeding ulcers and stigmata of recent haemorrhage who received optimal treatment, between 22 August 2003 and 15 October 2007, were studied retrospectively. RESULTS: Among 140 included patients, 45 (32%) rebled and 30 received another haemostatic endoscopy, which was successful in 20 cases. In multivariate analysis, the only significant predictive factor of rebleeding was duodenal site of the ulcer [adjusted odds ratio (OR): 2.75; 95% confidence interval (CI): 1.28-6.19]. In-hospital death occurred in 27 (19%) patients; with five deaths related to uncontrolled or recurrent bleeding. In multivariate analysis, predictors of in-hospital mortality were rebleeding (adjusted OR: 3.28; 95% CI: 1.17-9.16), a Rockall score higher than 6 (adjusted OR: 9.12; 95% CI: 2.57-44.29) and bleeding occurring in the intensive care unit (adjusted OR: 15.68; 95% CI: 4.41-55.82). CONCLUSION: In unselected patients, rebleeding and mortality rates are substantially higher than those found in prospective randomized clinical trials. Intensive care unit stay is an important predictive factor of hospital mortality and should be considered in further therapeutic trials in ulcer bleeding

Advanced biliary tract carcinomas: a retrospective multicenter analysis of first and second-line chemotherapy.

International audienceBackground:Gemcitabine/Cisplatin (Gem/CDDP) combination has demonstrated a clear survival advantage overgemcitabine alone and has become a new standard in advanced Biliary Tract Carcinoma (aBTC). However,Gemcitabine/Oxaliplatin (GEMOX) combination and Gemcitabine/Carboplatin (Gem/Carb) combination regimenshave shown efficacy in phase II trials and there is no comparative study between different platinum salts.We assessed the efficacy and safety of different platinum-based chemotherapies at first line in aBTC patients. Wealso analysed the second-line chemotherapy.Methods:Sixty-four consecutive patients with aBTC diagnosed between 1998 and 2010 were included for analysis.At first line chemotherapy, 44 patients received one day GEMOX regimen (gemcitabine 1000 mg/m2and oxaliplatin100 mg/m2Day 1, every 2 weeks), and 20 patients received Gem/Carb regimen (gemcitabine at 1000 mg/m2Days1 and 8 with carboplatin delivered according to an area-under-the-curve (AUC) 5 at day 1, every 3 weeks). Atsecond line, a total of 16 patients received a fluoropyrimidine-based chemotherapy.Results:With GEMOX regimen, median progression-free survival (PFS) was 3.7 months (95%CI, 2.4 to 5) and medianoverall survival (OS) was 10.5 months (95%CI, 6.4 to14.7). The main toxicity was peripheral neuropathy (20% grade 2and 7% grade 3). Grade 3/4 haematological toxicities were rare.With Gem/Carb regimen, PFS was 2.5 months (95%CI, 2.1 to 3.7) and OS was 4.8 months (95%CI, 3.7 to 5.8). Themain grade 3/4 toxicities were haematological: anaemia (45%), thrombocytopenia (45%), and neutropenia (40%).At second-line, fluoropyrimidine-based chemotherapy was feasible in only a fourth of the patients. The median OSwas 5.3 months (95%CI, 4.1 to 6.6), and median PFS was 4.0 months (95%CI, 2.6 to 5.5).Conclusions:One day GEMOX regimen has a favourable toxicity profile and could be an alternative to standardGem/CDDP regimen, in particular in unfit patients for CDDP.At second-line, selective patients may benefit from fluoropyrimidine-based chemotherapy