Quelles sont les indications du lipiodol marqué à l'I131 (Lipiocis®) dans le traitement palliatif du carcinome hépatocellulaire ?

Le Lipiocis est un traitement du carcinome hépatocellulaire avec thrombose porte. Le but de notre travail était d'évaluer son efficacité ainsi que sa tolérance, et d'identifier ses meilleures indications. 52 malades atteints de CHC étaient inclus entre 2003 et 2005. Le critère principal de jugement était la survie. Les critères secondaires étaient la réponse tumorale, l'évolution du Child et la survenue de complications. Les malades étaient cirrhotiques dans 86,5% des cas. Le score moyen de Pugh était 5,4. La taille moyenne de la plus volumineuse tumeur était 56mm. Une thrombose porte était présente dans 29% des cas. Une régression tumorale était observée dans 7,7% des cas et une stabilisation dans 30,8% des cas. Le taux d'AFP n'était pas modifié. Le score de Child était aggravé à 3 mois et 40% de décompensations œdémato-ascitiques étaient observées. La médiane de survie était de 9,1mois, la survie à 1 an était de 39%. Dans un modèle de Cox, un taux d'AFP>500 g/L et la thrombose porte étaient associés au décès. Les scores CLIP et Okuda étaient prédictifs de survie. Le Lipiocis permet 38,5% de contrôle tumoral. Il doit être limité aux malades sans insuffisance hépatique, dont le taux d'AFP<500 g/L et dont le score Okuda, CLIP<=1.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Analyse des pratiques de prescription des marqueurs sérologiques de l'hépatite virale B dans le bassin grenoblois

ST ETIENNE-BU Médecine (422182102) / SudocSudocFranceF

Sustained virological and biochemical responses to lamivudine and adefovir dipivoxil combination in a chronic hepatitis B infection despite mutations conferring resistance to both drugs.

International audienceABSTRACT: BACKGROUND: Sequential monotherapies of nucleotide analogs used in chronic hepatitis B treatment can lead to the selection of a resistance mutation to each antiviral drug. CASE PRESENTATION: A patient with chronic hepatitis B was successively treated with lamivudine monotherapy, lamivudine-adefovir dual therapy, adefovir monotherapy and again with an adefovir-lamivudine dual therapy. Lamivudine-associated mutations (rtL180M and rtM204V/I) followed by adefovir-associated mutations (rtN236T and rtA181V) emerged during the two monotherapy regimens. Despite the presence of rtM204V/I, rtA181V, and rtN236T mutations at the beginning of the second dual therapy, sustained biochemical and virological responses have been observed thus far after 23 months. CONCLUSION: This case illustrates that rtM204V/I, rtA181V, and rtN236T resistance mutations can coexist in a patient but do not preclude the recycling of lamivudine and adefovir in combination therapy, when no other therapeutic choices are available

MacDuffie syndrome and primary sclerosing cholangitis: an exceptional association.

International audienceNo abstrac

Prospective comparison of six non-invasive scores for the diagnosis of liver fibrosis in chronic hepatitis C.

International audienceBACKGROUND/AIMS: Non-invasive markers of liver fibrosis have recently been developed as an alternative to liver biopsy. The aim of this study was to compare the diagnostic performance of 6 scores (MP3, Fibrotest, Fibrometer, Hepascore, Forns' score and APRI). METHODS: We studied 180 chronic hepatitis C patients. Liver fibrosis was staged according to the METAVIR scoring system. RESULTS: Overall diagnostic performance of scores determined by AUROCs ranged from 0.86 for Fibrometer to 0.78 for Forns' score (NS) for discriminating F0F1 versus F2F3F4. For discriminating F0F1F2 versus F3F4, AUROCs ranged from 0.91 for Fibrometer to 0.78 for Forns' score (p<0.02). Significant or extensive fibrosis was predicted in 10-86% of patients with positive predictive value (PPV) ranging from 55% to 94%. Using logistic regression, statistical independence was demonstrated for MP3, Fibrotest and APRI. Diagnostic performance of paired-combination scores was then evaluated. The best combinations could select one-third of patients for whom either absence of significant fibrosis or presence of extensive fibrosis could be predicted with more than 90% of certainty. CONCLUSIONS: Current non-invasive scores give reliable information on liver fibrosis in one-third of chronic hepatitis C patients, especially when used in combination

Influence of Intention to Adhere, Beliefs and Satisfaction About Medicines on Adherence in Solid Organ Transplant Recipients

International audienceIntroduction Nonadherence to immunosuppressive (IS) therapy is associated with poor outcomes. Identifying factors predicting poor adherence is therefore essential. The primary objective of this study was to test whether parameters of a model adapted from the theory of planned behavior, and more specifically attitudes that are influenced by beliefs and satisfaction with medication, could predict adherence in solid organ transplant patients.Methods Adherence was assessed with a self-reported medication adherence scale and IS blood trough concentrations over 6 months, in four transplant units. Satisfaction and beliefs were assessed using the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and Beliefs about Medicines Questionnaire (BMQ), respectively. Theory of planned behavior was assessed with a specific questionnaire exploring intentions, subjective norms, attitudes and perceived behavioral control. Treatment characteristics and socioeconomic data were also collected.Results One hundred and fifty-three solid organ transplant patients were enrolled, including lung (n=33), heart (n=43), liver (n=42), and kidney (n=44) patients. Satisfaction and positive beliefs about medication were higher in adherent than those in nonadherent patients. Factors independently associated with an increased risk of nonadherence were negative general beliefs about medications (odds ratio [OR]=0.89 [0.83–0.97]), living alone (OR=2.78 [1.09–7.09]), heart transplantation (OR=3.49 [1.34–9.09]), and being on everolimus (OR=5.02 [1.21–20.8]).Conclusion Negative beliefs toward medications were shown to be an independent risk factor of poor adherence. Therefore, the BMQ could be an effective, easy to implement tool, for use in everyday practice, to identify patients needing interventions to improve adherence to IS

Natural History of Recurrent Alcohol‐Related Cirrhosis After Liver Transplantation: Fast and Furious

International audienceAlcohol-related liver disease (ALD) is one of the main indications for liver transplantation (LT). Severe alcohol relapse can rapidly lead to recurrent alcohol-related cirrhosis (RAC) for the graft. The aim of this study was to describe the natural history of RAC and the overall survival after LT and after an RAC diagnosis. From 1992 to 2012, 812 patients underwent primary LT for ALD in 5 French transplant centers. All patients with severe alcohol relapse and an RAC diagnosis on the graft were included. The diagnosis of cirrhosis was based on the analysis of liver biopsy or on the association of clinical, biological, radiological, and/or endoscopic features of cirrhosis. RAC was diagnosed in 57/162 patients (35.2%) with severe alcohol relapse, and 31 (54.4%) of those patients had at least 1 episode of liver decompensation. The main types of decompensation were ascites (70.9%), jaundice (58.0%), and hepatic encephalopathy (9.6%). The cumulative probability of decompensation was 23.8% at 5 years, 50.1% at 10 years, and 69.9% at 15 years after LT. During the follow-up, 36 (63.2%) patients died, the main cause of death being liver failure (61.1%). After diagnosis of cirrhosis, the survival rate was 66.3% at 1 year, 37.8% at 5 years, and 20.6% at 10 years. In conclusion, RAC is associated with a high risk of liver decompensation and a poor prognosis. Prevention of severe alcohol relapse after LT is a major goal to improve patient survival