Faibles perturbations des transaminases en médecine générale (analyse des pratiques et étude prospective descriptive des principales étiologies dans la région annécienne de mars à octobre 2010)

GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Panic attack with suicide: an exceptional adverse effect of infliximab.

International audienceNo abstract availabl

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients.

International audienceBACKGROUND: Bleeding recurrence rate after spontaneous haemostasis of colonic diverticular haemorrhage varies in the literature, and a small minority of patients will require endoscopic, radiological or surgical intervention. AIM: To study the natural history of colonic diverticular bleeding in consecutive patients. METHODS: We studied prospectively consecutive patients admitted for colonic diverticular bleeding from 1997 to 2005. Data on age, gender, 30-day mortality, therapeutic modality for bleeding management and subsequent rebleeding were collected. RESULTS: One hundred and thirty-three patients (mean age 75.7 years) were recruited. Bleeding stopped spontaneously in 123 patients (92.4%). A more interventional approach was necessary in 10 patients. Thirty-day mortality rate for first bleeding was 2.25%. Out of the 123 patients managed conservatively and submitted to an average follow-up of 47.5 months, 17 (13.8%) presented at least one recurrent diverticular bleeding. Spontaneous haemostasis was obtained in all recurrent cases except one, who died. The estimated bleeding recurrence rate was 3.8% at 1 year, 6.9% at 5 years and 9.8% at 10 years. CONCLUSIONS: The low estimated rebleeding rate and the fact that rebleeding can be treated conservatively in most cases suggest that an aggressive approach with intervention is not justified

MacDuffie syndrome and primary sclerosing cholangitis: an exceptional association.

International audienceNo abstrac

[Cytomegalovirus and cryptogenic inflammatory bowel disease]

International audienceCMV infection has been reported in association with some flares of IBD. Its prevalence varies with the method of diagnosis and the severity of IBD. Although the link between CMV and IBD is not clear, the immunomodulator properties of the virus may play a role in the evolution of IBD. Besides the necessity of immunosuppression to treat IBD, inflammation per se can maintain in situ viral replication. Antiviral treatment can be useful in some situations. New molecular methods will permit earlier and more sensitive diagnosis of CMV infection and a better evaluation of treatment efficacy

Management of Severe Bleeding in Patients Treated with Direct Oral Anticoagulants

International audienceThe use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants.METHODS:We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015.RESULTS:Bleeding was gastrointestinal or intracranial in 37% (212 of 732) and 24% (141 of 732) of the cases, respectively. Creatinine clearance was lower than 60 ml/min in 61% (449 of 732) of the cases. The plasma concentration of direct oral anticoagulants was determined in 62% (452 of 732) of the cases and was lower than 50 ng/ml or higher than 400 ng/ml in 9.2% (41 of 452) and in 6.6% (30 of 452) of the cases, respectively. Activated or nonactivated prothrombin complex concentrates were administered in 38% of the cases (281 of 732). Mortality by day 30 was 14% (95% CI, 11 to 16).CONCLUSIONS:Management of severe bleeding in patients treated with direct oral anticoagulants appears to be complex. The use of prothrombin complex concentrates differs depending on bleeding sites and direct oral anticoagulant plasma concentrations. Mortality differs according to bleeding sites and was similar to previous estimates