Publications (51)147.57 Total impact
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Article: Anaes practice guidelines for vaccination against hepatitis B virus: impact on general practitioners.
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ABSTRACT: In September 2003, Agency for Accreditation and Evaluation in Health (ANAES) published its consensus recommendations for vaccination practices against hepatitis B virus (HBV), one objective of which was to decrease the risk of HBV transmission to those in the environments of patients who are carriers of the HBs antigen. The aim of our survey was to measure the awareness and application of these recommendations among general practitioners (GPs) in the Loiret region. This retrospective survey analysed the decisions, using a semi-directed interview, made by all consenting GPs who, in 2004, had referred newly diagnosed HBs antigen-positive patients to the liver unit of the hospital of Orleans. Of the contacted GPs, 83% agreed to participate. Although only one-third of them were familiar with the recommendations, all identified the sexual partners and people living under the same roof as the patient targets for screening and/or vaccination. Also, 75% of the GPs had a consultation with some or all of the identified at-risk individuals in their patient's environment, but only 58% succeeded in vaccinating these at-risk people. Among the interviewed GPs, 71% were in favour of mass vaccination practices against HBV and all were in favour of vaccination targeting the at-risk individuals. Dissemination of the ANAES recommendations needs to be improved, even though the majority of the GPs included in the present study were in favour of mass vaccination against HBV and all were in favour of vaccination of at-risk individuals. However, one-third of the identified at-risk individuals eluded screening and/or vaccination, indicating the need for a specific organized program to make contact with these prone populations.Gastroentérologie Clinique et Biologique 11/2009; 33(12):1166-70. · 0.80 Impact Factor -
Article: [Endoscopic ultrasonography and biopsy of solid and pseudopapillary tumors of the pancreas: an alternative in difficult cases].
Gastroentérologie Clinique et Biologique 06/2009; 33(6-7):503-4. · 0.80 Impact Factor -
Article: [Exocrin pancreatic deficiency revealing an alpha-1-antitrypsin deficiency].
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ABSTRACT: There are genetic mutations taking part in the physiopathology of pancreatitis. The role of alpha-1-antitrypsin (AAT) deficiency in this pathology is debated. We report the case of a 60-year-old man with a pancreatic exocrine insufficiency. He was diagnosed with AAT deficiency. The phenotype was Pi SZ, with genotyping confirmation. The place of AAT deficiency in the midst of pancreatic diseases should be further studied.Gastroentérologie Clinique et Biologique 11/2008; 32(11):906-9. · 0.80 Impact Factor -
Article: [Impact of endoscopic ultrasonography for the diagnosis of solid pseudopapillary tumor of the pancreas].
Gastroentérologie Clinique et Biologique 07/2008; 32(10):813-5. · 0.80 Impact Factor -
Article: A national survey of acute hepatitis E in France.
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ABSTRACT: Few data are available on the incidence, risk factors and contamination pathways involved in acute indigenous hepatitis E in developed countries. To draw up an overall picture of hepatitis E cases, to confirm whether or not the majority of the cases were indigenous and to attempt to identify the risk factors and contamination pathways involved in hepatitis E. This study was performed in the framework of a national network (ANGH) including 96 participating centres. The 19 centres with at least one case of acute HEV reported a total number of 53 cases. A decreasing South-to-North geographic gradient was observed. A nonspecific clinical profile was observed in many cases. Acute hepatitis E was of indigenous origin in 90% of the patients. The most relevant and/or frequent possible risk factors among the 47 indigenous metropolitan cases were water consumption from a personal water supply, uncooked shellfish consumption and the recent acquisition of a pet pig. This national survey confirmed that acute indigenous hepatitis E is an emerging disease in developed countries such as France, and suggests that various risk factors are responsible for acute indigenous hepatitis E contamination in non-endemic countries.Alimentary Pharmacology & Therapeutics 07/2008; 27(11):1086-93. · 3.77 Impact Factor -
Article: Multicentre randomised phase III trial comparing Tamoxifen alone or with Transarterial Lipiodol Chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Fédération Francophone de Cancérologie Digestive 9402).
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ABSTRACT: The FFCD 9402 multicentre phase III trial was designed to compare the effects of the combination of Transarterial Lipiodol Chemoembolisation (TACE) and tamoxifen with tamoxifen alone on overall survival and quality of life in the palliative treatment of hepatocellular carcinoma with cirrhosis. From 1995 to 2002, 138 patients were randomised between the two groups. One hundred and twenty three patients were eligible including 61 in the Tamoxifen group and 62 in the TACE group. Baseline characteristics were similar: Child-Pugh class A: 70%, alcoholic cirrhosis: 76%, Okuda stage I: 71%, multinodular tumour: 70% and segmental portal vein thrombosis: 10%. At 2years, the overall survival was 22% and 25% in the Tamoxifen and TACE groups (P=.68), respectively. Multivariate analysis identified four independent prognostic factors for survival: alpha-fetoprotein (AFP)>400ng/mL (P=.008), abdominal pain (P=.011), hepatomegaly (P=.023) and Child-Pugh score (P=.032). The Spitzer Index level assessing the quality of life during follow-up did not differ between the two groups (P=.70). Amongst patients with stage Okuda I, the 2-year overall survival was 28% in the Tamoxifen group and 32% in the TACE group (P=.58). In this subgroup, two prognostic factors were statistically significant for survival: AFP>400ng/mL (P=.004) and Spitzer Index (P=.013) as shown by multivariable analysis. In conclusion, this study suggests that TACE improves neither the survival nor the quality of life in patients with HCC and cirrhosis.European Journal of Cancer 04/2008; 44(4):528-38. · 5.54 Impact Factor -
Article: [Hepatic splenosis: a rare etiology of hepatic nodules].
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ABSTRACT: Splenosis is the autotransplantation of splenic tissue, generally after traumatic splenic rupture. Usually, the peritoneal surface is affected. The viscera are rarely involved in this graft. We report a case of intrahepatic splenosis, which presented as a liver tumour on imagery in a 55-year-old man followed for lung carcinoma and chronic hepatitis C and who had undergone a splenectomy for trauma 22 years before. The different characteristics and diagnostic methods of 16 cases of hepatic splenosis are presented from the literature. These different reports emphasize the necessity of considering splenosis in the differential diagnosis of hepatic tumours.Gastroentérologie Clinique et Biologique 02/2008; 32(1 Pt. 1):83-7. · 0.80 Impact Factor -
Article: Epidemiology of chronic hepatitis B infection in France: risk factors for significant fibrosis--results of a nationwide survey.
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ABSTRACT: Epidemiological data concerning hepatitis B are scarce in France. To describe epidemiological, clinical, virological and histological features of HBsAg-positive patients followed at non-academic hospitals in France. Clinical, biological, virological and histological data of all HBsAg-positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed. Nearly 1166 HBsAg-positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 +/- 15 years. Twenty-nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg-positive and 57% HBeAg-negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years (P < 0.05), HBeAg-negative status (P < 0.02) and histological activity (P < 0.0001). Factors associated with cirrhosis: age (P < 0.0001), platelet count <150 000/mm(3) (P < 0.0001) and viral co-infection (P < 0.03). HBV infection represents a significant workload for hepatogastroenterologists at non-academic hospitals in France.Alimentary Pharmacology & Therapeutics 08/2007; 26(4):565-76. · 3.77 Impact Factor -
Article: Histological features and HLA class II alleles in hepatitis C virus chronically infected patients with persistently normal alanine aminotransferase levels.
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ABSTRACT: A significant proportion of individuals with chronic hepatitis C virus (HCV) infection have persistently normal alanine aminotransferase (ALT) levels. Although data are controversial, such patients usually have weaker histological damage and a lower progression rate of fibrosis. The aims of this study were: (1) to compare demographic, virological, and histological parameters of HCV patients with normal ALT values with those of HCV patients with elevated ALT levels; and (2) to determine whether HLA class II alleles contribute to the persistence of normal ALT levels in HCV patients. Eighty three patients with chronic HCV infection and persistently normal ALT values (group 1) and 233 patients with chronic HCV infection and elevated ALT levels (group 2) were studied. Histological features were expressed using Knodell and Metavir scores. HLA DRB1* and DQB1* genotyping was performed using hybridisation with sequence specific oligonucleotides after genomic amplification. The kappa2 and Fisher's exact tests were used to compare discrete variables and phenotype frequencies between the two groups, and Wilcoxon's test was used for continuous variables. A multivariate logistic regression model was used to determine which variables predicted normal ALT values. ALT levels were correlated with the severity of liver damage. In group 1, 93% of patients had an F0 or F1 Metavir index of fibrosis compared with 47% of patients in group 2 (p<0.001). A longer duration of infection (p<0.001) and increased DRB1*11 phenotype frequency (pc=0.03) were observed among patients with normal ALT. The two groups did not differ with regard to the mode of contamination or viral genotype. After logistic regression, young age (p=0.0008), female sex (p=0.01), long duration of infection (p=0.0001), and HLA DRB1*11 (p=0.050) were more strongly associated with persistence of normal ALT. Our study confirms that patients with chronic hepatitis C and normal ALT levels have less severe liver disease than those with elevated ALT levels. This particular biochemical outcome may be explained, at least in part, by host immunogenetic factors such as the presence of HLA-DRB1*11.Gut 10/2002; 51(4):585-90. · 10.11 Impact Factor -
Article: Minimally invasive management of insulinomas. A case report.
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ABSTRACT: Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are. The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome. Tumor location was possible with endoscopic ultrasonography, which detected a hypoechoic 10 x 10-mm mass in the pancreatic tail. Tumor enucleation was accomplished laparoscopically. Insulinomas may be managed with videolaparoscopy, but this approach, which is not applicable for multiple or malignant tumors, must be contraindicated also in single insulinomas located on the posterior wall or deeply in the head of the pancreas. The disadvantages of the laparoscopic approach, as compared with conventional surgery, are the absence of palpation and difficulty exploring the whole pancreas, which is partly overcome, but not completely eliminated, by EUS. The advantages are the absence of a parietal incision and good postoperative comfort. The reported low-invasive EUS laparoscopy sequence may be successful in selected cases of pancreatic insulinomas. However, it seems this treatment could be proposed for many patients affected by this benign disease.Surgical Endoscopy 10/2001; 15(9):1042. · 4.01 Impact Factor -
Article: [Correction of immune thrombocytopenia associated with hepatitis C virus infection after combination therapy with interferon alpha and ribavirin].
Gastroentérologie Clinique et Biologique 05/2001; 25(4):429-30. · 0.80 Impact Factor -
Article: [Current decontamination procedures for digestive tract endoscopy equipment are effective against risk of hepatitis C virus transmission].
Gastroentérologie Clinique et Biologique 11/2000; 24(10):975-6. · 0.80 Impact Factor -
Article: Does HIV-infection influence the response of chronic hepatitis C to interferon treatment? A French multicenter prospective study. French Multicenter Study Group.
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ABSTRACT: The aim of this prospective study was to compare the response to alfa-interferon treatment of chronic hepatitis C in two groups of patients: coinfected with human immunodeficiency virus (HIV) (G I) or not (G II). One hundred and fifty-three patients with chronic hepatitis C had been enrolled in 30 French liver units or infectious diseases units between May 1992 and January 1995 (G I: 76, G II: 77) to receive alfa-2a interferon: 3 MU thrice weekly for 6 months. One hundred and twenty-seven patients (G I: 63, G II: 64) fulfilled all criteria for analysis. The two groups were comparable for all demographic data, while significantly more severe biological and histological (p=0.001) parameters attested to more serious hepatitis among HIV-HCV coinfected patients. HCV viremia was higher among HIV-coinfected patients (p=0.0169), while genotype repartition was identical among the two groups (more than 52% of genotype 1, more than 31% of genotype 3). ALT normalization was, respectively, (G I/G II) obtained in 17.46%/26.56% (not significant) of patients at the end of treatment and in 11.11%/12.5% (not significant) of patients after 6 months of follow-up. In a multivariate analysis, GGT level before therapy (relative risk 2.1, confidence interval 1.1-5.8) and body surface area (relative risk 1.9, confidence interval 1.1-3.7) were the variables independently associated with the response to alfa-interferon treatment (higher GGT and more elevated body surface area were associated with a risk of non-response). In our study HIV infection did not affect the alfa-interferon treatment response of chronic hepatitis C, and response could be achieved among HIV-coinfected patients. Present therapeutic anti-HCV schedules need to be proposed to HIV-HCV coinfected patients before severe immunosuppression occurs. On the other hand, more severe biological and histological parameters were observed among HIV-HCV coinfected patients, which suggests a need to study whether HIV infection is associated with a worsening course of chronic hepatitis C.Journal of Hepatology 07/2000; 32(6):1003-10. · 9.26 Impact Factor -
Article: [Severe mixed thrombopenia during interferon treatment for chronic viral hepatitis C].
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ABSTRACT: Thrombocytopenia occurred in a woman given alpha interferon for chronic hepatitis C without cirrhosis. Both central thrombocytopenia, clearly demonstrated, and peripheral thrombocytopenia, probably of autoimunne origin, were involved. A 55-year-old woman with active chronic hepatitis C (Metavir score A2, F2) was given alpha interferon. One month after treatment onset, she developed thrombocytopenia (32 G/L). A second bone marrow aspirate and osteomedullary biopsy evidenced megalokaryocytes and the platelet count responded to polyvalent immunoglobulins. Five months after discontinuing interferon, the platelet count progressively returned to normal. Central thrombocytopenia is classically described in patients given interferon and usually appears during the first weeks of treatment. In our case, the central mechanism was clearly demonstrated by the bone marrow aspirate and osteomedullary biopsy findings at a time when the platelet count was 32 G/L. A peripheral immunological participation was more difficult to prove but was strongly suggested by the persistence of thrombocytopenia despite the interruption of the interferon and the efficacy of immunoglobulins.La Presse Médicale 11/1999; 28(29):1572-4. · 0.67 Impact Factor -
Article: Cytomegalovirus gastritis simulating cancer of the linitis plastica type on endoscopic ultrasonography.
Endoscopy 12/1998; 30(9):S101-2. · 5.21 Impact Factor -
Article: Tenoxicam, a non-steroid anti-inflammatory drug, is unable to increase the response rate in patients with chronic hepatitis C treated by alpha interferon.
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ABSTRACT: The purpose of this study is to compare a combination of interferon (IFN)-alpha2a (Roferon) + Tenoxicam with IFN-alpha2a alone in the treatment of chronic hepatitis C. This prospective, randomized double-blind study included 149 patients, all of whom were diagnosed with active chronic hepatitis C but non-cirrhotic (ALT > or = 1.5 upper limit of normal, anti-hepatitis C virus (HCV) positive by enzyme-linked immunosorbant assay2 and RIBA3). The patients were randomized in two groups, as follows: G1 (n = 76): IFNalpha2a 3 million units times per week during 6 months + placebo; and G2 (n = 73): IFNalpha2a 3 million units three times per week + Tenoxicam (20 mg/day) during 6 months. Alanine aminotransferase (ALT) and HCV RNA were determined before and at months 6 and 12 of treatment. 2'5' oligoadenylate synthetase activity (2'5' AS) was dosed in mononuclear cells before and at 3-month treatment intervals in 28 patients. Liver biopsy was performed before and 6 months after the end of therapy. Parameters were similar before therapy for both groups. Biochemical and virological responses were similar for both groups at month 6 (49.3% vs. 42.9% and 43.3% vs. 38.3%, respectively) and month 12 (28.3% vs. 23.8% and 17.2% vs. 17.5%, respectively). HCV RNA level significantly decreased in both groups at month 6, with no difference whatever the therapy; however, the HCV RNA level returned to initial values at month 12 and was the only significant prognostic factor of a sustained response. No peak of 2'5' AS activity was observed during treatment in patients with dual therapy. A histological improvement was also noted in both groups without difference, regardless of therapy. The percentage of adverse events was identical for both groups. Paracetamol intake, assessed in 80 patients, was 49.1 g per 6 months in the G1 group and 22.5 g per 6 months in the G2 group (not significant). In conclusion, the non-steroid anti-inflammatory drug, Tenoxicam, does not increase IFNalpha efficacy in the treatment of chronic hepatitis C. This combination is well tolerated and partially lowers Paracetamol intake, but not preexisting alpha-IFN adverse events.Hepatology 03/1998; 27(3):862-7. · 11.66 Impact Factor -
Article: [Acute thrombosis of the portal system. Treatment with alteplase and heparin or with heparin alone in 10 patients].
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ABSTRACT: We report the efficacy of alteplase (a recombinant tissue plasminogen activator) with heparin or heparin alone in the treatment of acute thrombosis of the portal venous system. Ten consecutive patients with acute portal venous system thrombosis were studied. Five patients were treated with alteplase and heparin, and the remaining 5 patients, who were asymptomatic or had a contraindication to alteplase, were treated with heparin alone. In 3 of the 5 patients treated with alteplase, ultrasonography showed total resolution of the thrombus; the remaining 2 had partial resolution of the thrombus. In 4 of the 5 patients treated with heparin alone, ultrasonography showed total resolution of the thrombus, and no change in one. No bleeding occurred. Treatment with heparin can result in complete recanalisation of acute portal venous system thrombosis. These data suggest that combined therapy with systemic alteplase does not increase the efficacy of heparin.Gastroentérologie Clinique et Biologique 02/1997; 21(12):919-23. · 0.80 Impact Factor -
Article: [Value of high-dose interferon-alpha in chronic viral hepatitis C patients non-responder to a 1st treatment. Pilot study prospective and randomized trial].
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ABSTRACT: The aim of this study was to evaluate the efficacy of two different doses of alpha interferon (IFN) for retreatment in chronic hepatitis C patients who were non responders to initial treatment by IFN at a dose of 3 MIU TIW for 6 months. This open, pilot, prospective, randomized and bicentric study included patients with biopsy-proven chronic hepatitis C. Non response was defined as serum ALT levels > 2 upper limit of normal for the entire first treatment period, HCV RNA positivity by PCR at the end of the first treatment period, and the persistence of histologically-proven chronic active hepatitis after the first treatment period. Patients were randomized into two groups: group I received IFN alpha 2b 10 MIU TIW for 2 months, then 6 MIU TIW for 4 months, group 2 received IFN alpha 2b 6 MIU TIW for 6 months. Twenty three patients (17 male, 6 female, mean age: 38.7 +/- 9.1 years) were included: 14 were randomized in group 1 and 9 in group 2. Both groups were similar for the main clinical, biochemical, and histological variables. At the end of retreatment, 2 patients (14.2%) had biochemical and virological response in group 1 and 4 in group 2 (44.4%) (non significant). Only one biochemical and virological sustained response was observed in group 2 (11.1%) (non significant). There was no difference between the groups for complete and sustained response. An overall statistical significant improvement of Knodell score was observed (7.8 +/- 3.8 vs 9.6 +/- 3.2, P < 0.02) in the 18 patients who had a second biopsy 6 months after the end of therapy, while the Knodell score did not change at the end of the first treatment period. This improvement was statistically significant in group 2 (5.4 +/- 3.0 vs 9.2 +/- 9.5 before treatment, P < 0.02) and concerned intralobular necrosis (P < 0.05). The Metavir index did not change. The number of side-effects was similar in both groups. These results suggest that histological improvement may be obtained after IFN retreatment in some patients who are non-responders to the first treatment, despite an absence of biochemical and/or virological response.Gastroentérologie Clinique et Biologique 01/1997; 21(12):924-8. · 0.80 Impact Factor -
Article: [Obstructive intramural hematoma of the esophagus after sclerotherapy].
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ABSTRACT: A case of obstructive intramural hematoma of the esophagus post variceal sclerotherapy is reported in a 44-year-old man who presented retrosternal pain and complete dysphagia. Endoscopy showed a bluish submucosal mass occupying the esophageal lumen. Diagnosis was confirmed by Computed Tomography. A favorable outcome was observed with symptomatic treatment.La Presse Médicale 10/1996; 25(28):1281-4. · 0.67 Impact Factor -
Article: Nonsteroidal anti-inflammatory drug-induced colonic strictures: two cases and literature review.
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ABSTRACT: We report two patients with large bowel submucosal diaphragm disease associated with nonsteroidal anti-inflammatory drugs (slow release form of diclofenac and phenylbutazone) who were admitted in 1990 and 1991 because of iron deficiency. At colonoscopy, the lumen of the ascending colon was divided into compartments by multiple thin circumferential mucosal membranes. Barium enema showed two short strictures in one patient. Right hemicolectomy was carried out on one patient. The other patient was simply advised to discontinue taking diclofenac and remains well. Such lesions are rare (10 cases have been reported) and resemble those previously described in the small bowel.The American Journal of Gastroenterology 12/1995; 90(11):2035-8. · 7.28 Impact Factor
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1993
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Agence de Médecine Préventive
Paris, Ile-de-France, France
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