La ligature de varices œsophagiennes dans le centre d'endoscopie digestive du CHU Aristide-Le-Dantec de Dakar: étude préliminaire de 60 cas

Very few studies have been done in sub-Saharan Africa about endoscopic variceal ligation. Objective: We report the experience of digestive endoscopy center of hospital Aristide-Le-Dantec in this procedure. Patients and method: It was a preliminary prospective study from July 2005 to June 2007. All patients having bled from esophageal varices were included. Results: Sixty patients were included during the period of the study. It concerned 17 women and 43 men (sex-ratio at 2.5). The mean age was 34 (extremes: 12 and 69 years). Esophageal varices were at stage 3 in 83.3% and at stage 2 in 16.7% of cases. The eradication of varices was successful in 30 patients (50% of cases). The mean number of sessions required to achieve eradication was 4. The interval time between sessions was of 3.5 weeks. Eight patients were lost of view after a single session of ligation (13%); five others gave up the treatment because of retrosternal pain (N= 3) and intolerance of endoscopy (N= 2). Rebleeding occurred in five patients (8.33%) after 6 to 26 days following the first session of variceal ligation. Two patients died of rebleeding (3.33%). Another patient died of hepatitic encephalopathy after three sessions. Conclusion: This preliminary study about variceal ligation in a digestive endoscopy center in Dakar shows the feasibility and effectiveness of this treatment, as well as its good tolerance in the majority of cases. © 2010 Springer Verlag France.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children.

Upper gastrointestinal bleeding (UGIB) remains a common disease affecting 100 to 170 per 100 000 adults per year and causing thereby a significant burden to healthcare resources. Despite the improvements in the management of this disorder, the associated mortality ranges from 5 to 14%. Since the general management of UGIB is not uniform, the main objective of this work is to provide guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture. METHODS: In the absence of evidence-based recommendations, these guidelines were proposed after expert opinions reconciliation and graded accordingly. They are based on the published literature up to September 2010 and graded according to the class of evidence. RESULTS: The current guidelines for the management of UGIB include recommendations for the diagnostic process, general supportive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension-induced bleeding.Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Prevention of acute and chronic allograft rejection with CD4+CD25+Foxp3+ regulatory T lymphocytes.

International audienceA major challenge in transplantation medicine is controlling the very strong immune responses to foreign antigens that are responsible for graft rejection. Although immunosuppressive drugs efficiently inhibit acute graft rejection, a substantial proportion of patients suffer chronic rejection that ultimately leads to functional loss of the graft. Induction of immunological tolerance to transplants would avoid rejection and the need for lifelong treatment with immunosuppressive drugs. Tolerance to self-antigens is ensured naturally by several mechanisms; one major mechanism depends on the activity of regulatory T lymphocytes. Here we show that in mice treated with clinically acceptable levels of irradiation, regulatory CD4+CD25+Foxp3+ T cells stimulated in vitro with alloantigens induced long-term tolerance to bone marrow and subsequent skin and cardiac allografts. Regulatory T cells specific for directly presented donor antigens prevented only acute rejection, despite hematopoietic chimerism. By contrast, regulatory T cells specific for both directly and indirectly presented alloantigens prevented both acute and chronic rejection. Our findings demonstrate the potential of appropriately stimulated regulatory T cells for future cell-based therapeutic approaches to induce lifelong immunological tolerance to allogeneic transplants