Airway and Esophageal Stenting in Patients with Advanced Esophageal Cancer and Pulmonary Involvement

BACKGROUND: Most inoperable patients with esophageal-advanced cancer (EGC) have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. METHODS AND FINDINGS: The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\-8 years of age) with esophageal stenting indication were investigated. Seven patients (group 1) were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression). Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2): stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication). Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks) than in group 2 (28+/-11 weeks), p<0.001). Scheduled double stenting significantly improved symptoms (95% at day 7) with a low complication rate (13%), and achieved a specific cancer treatment (84%) in most cases. CONCLUSION: Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased airways complications related to esophageal stent. Emergency procedures were rarely efficient in our experience

Epidémiologie et prise en charge du carcinome hépatocellulaire au Groupe hospitalier Sud Réunion (étude rétrospective du 1er janvier 2000 au 31 décembre 2006)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les parasitoses à tropisme hépato-gastro-entérologique (étude de cas rencontrés au groupe hospitalier Sud Réunion entre 2001 et 2006)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hémochromatose HFE 4 à transmission autosomique dominante (étude à partir d'une nouvelle famille française porteuse de mutation V162DEL de la ferroportine)

L'hémochromatose est une maladie génétiue de transmission autosomique récessive dans sa forme classique.Ell est due à une mutation portant sur le gène HFE, la mutation C282Y étant la plus fréquente. D'autres types d'hémochromatose non liée à HFE sont maintenant connus, telle HFE, résultat de mutations sur le gène de la ferroportine. Cette protéine joue un rôle essentiel dans le métabolisme du fer. La famille de Monsieur A. est porteuse de la mutation V162del du gène SCL11A3 de la ferroportine. Comme pour les autres cas porteurs de cette mutation, ils se caractérisent par une ferritinémie élevée tandis que la saturation de la transferrine est normale. La famille de Monsieur A.ne présente aucun symptôme clinique ni de fibrose hépatique. Les autres familles porteuses de la mutation V162del présentent, comme Monsieur A. et ses enfants, une surcharge en fer hépatique prédominante sur les cellules de Kupffer. On connaît maintenant 12 mutations du gène de la ferroportine. On peut ressortir des points communs à tous ces patients : une clinique frustre, une hyperférritinémie qui apparaït tôt dans la vie tandis que la saturation de la transferrine ne s'élève que secondairement, une surcharge en fer hépatique prédominante sur les cellules de Kupffer et les macrophages. La tolérence au traitement est en gnéral moins bonne que dans l'hémochromatose classique. Les découvertes récentes de nouvelles mutations sur la ferroportine laissent penser qu'il en existe probablement d'autres et que l'incidence de l'hémochromatose est aujourd'hui sous estimée.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge des tumeurs stromales digestives à la Réunion (à propos de treize cas)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Tumeurs desmoïdes abdomino-pelviennes (à propos de cinq cas récents diagnostiqués dans le sud de la Rénion)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus.

BACKGROUND: Epidemiologic data suggest that infection with herpes simplex virus type 2 (HSV-2) is associated with increased genital shedding of human immunodeficiency virus type 1 (HIV-1) RNA and HIV-1 transmissibility. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of HSV suppressive therapy with valacyclovir (at a dose of 500 mg twice daily) in Burkina Faso among women who were seropositive for HIV-1 and HSV-2; all were ineligible for highly active antiretroviral therapy. The patients were followed for 24 weeks (12 weeks before and 12 weeks after randomization). Regression models were used to assess the effect of valacyclovir on the presence and quantity of genital and plasma HIV-1 RNA and genital HSV-2 DNA during treatment, adjusting for baseline values, and to evaluate the effect over time. RESULTS: A total of 140 women were randomly assigned to treatment groups; 136 were included in the analyses. At enrollment, the median CD4 cell count was 446 cells per cubic millimeter, and the mean plasma viral load was 4.44 log10 copies per milliliter. With the use of summary-measures analysis, valacyclovir therapy was found to be associated with a significant decrease in the frequency of genital HIV-1 RNA (odds ratio, 0.41; 95% confidence interval [CI], 0.21 to 0.80) and in the mean quantity of the virus (log(10) copies per milliliter, -0.29; 95% CI, -0.44 to -0.15). However, there was no significant decrease in detection of HIV (risk ratio, 0.93; 95% CI, 0.81 to 1.07). HSV suppressive therapy also reduced the mean plasma HIV-1 RNA level by 0.53 log(10) copy per milliliter (95% CI, -0.72 to -0.35). Repeated-measures analysis showed that these effects became significantly stronger during the 3 months of follow-up. CONCLUSIONS: HSV suppressive therapy significantly reduces genital and plasma HIV-1 RNA levels in dually infected women. This finding may have important implications for HIV control. (ClinicalTrials.gov number, NCT00158509 [ClinicalTrials.gov].)