J Dumortier

Publications (63)169.35 Total impact

• Article: La nasogastroscopie: place actuelle et future dans l’arsenal endoscopique; pourquoi se développe-t-elle lentement?

  J. Dumortier, A. de Leusse
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  ABSTRACT: La faible diffusion de la nasogastroscopie en France pourrait donc être expliquée par une moins bonne résolution de l’image des NG liée à la miniaturisation du capteur CCD et par l’absence de valorisation des E.O.G.D. sans anesthésie générale dans la T2A. Les nouvelles générations de NG associeront une amélioration de la résolution de l’image et une réduction de diamètre des appareils. Les problèmes rencontrés par la dégradation de la démographie des anesthésistes et les impératifs économiques font que l’E.O.G.D. sans anesthésie générale devrait être valorisée au cours des modifications à venir de la T2A.
  Acta Endoscopica 04/2012; 36:475-476. · 0.09 Impact Factor
• Article: Transcatheter local thrombolysis in patients with extensive TIPS thrombosis.

  J Dumortier, T Walter, O Guillaud, F Pietu, M Vallin, L Henry, F Pilleul
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  ABSTRACT: Transcatheter local thrombolytic therapy in patients with portosplanchnic venous thrombosis has been used in few cases. Here, we present our single-center experience with transcatheter thrombolytic therapy in three patients with extensive refractory portal and transjugular intrahepatic portosystemic shunt (TIPS) thrombosis. Thrombolytic therapy was successful for all three patients. Two patients developed minor procedure-related bleeding. Local thrombolysis could be proposed in case of TIPS thrombosis for patients in whom the venous flow cannot be restored by using conventional anticoagulant therapy and stent mechanical revision.
  Gastroentérologie Clinique et Biologique 10/2010; 34(12):721-5. · 0.80 Impact Factor
• Article: Liver transplantation for multiple angiomyolipomas complicating tuberous sclerosis complex.

  J Dumortier, O Guillaud, T Walter, C E Ber, C Partensky, O Boillot, J-Y Scoazec
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  ABSTRACT: Tuberous sclerosis complex is a genetic multisystem disorder characterised by widespread hamartomas in several organs, including the brain, heart, skin, eyes, kidney, lung, and liver. Hepatic multiple, bilateral angiomyolipomas are a rare and usually asymptomatic complication in patients with tuberous sclerosis. We report here the case of a patient who needed liver transplantation because of debilitating manifestations and mechanical complications of massive liver involvement by multiple angiomyolipomas (severe malnutrition, anorexia and abdominal pain). Seventeen tumors, from 2 to 16 cm in diameter, were identified at examination of the liver explant. No feature suggestive of malignant behaviour was identified at histological examination. In conclusion, this unusual indication of liver transplantation underlines the interest of this therapeutic approach for benign tumors for which the multiplicity of the lesions and their huge volume prevent any attempt at surgical resection.
  Gastroentérologie Clinique et Biologique 09/2010; 34(8-9):494-8. · 0.80 Impact Factor
• Article: Introduction of mycophenolate mofetil in maintenance liver transplant recipients: what can we expect? Results of a 10-year experience.

  J Dumortier, O Guillaud, G Pittau, J Salandre, M Adham, J-Y Scoazec, O Boillot
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  ABSTRACT: Mycophenolate mofetil (MMF) is a cornerstone immunosuppressive drug after liver transplantation (OLT). The aim of this study was to evaluate the long term results of the addition of MMF in maintenance OLT recipients. From 1996 to 2006, MMF was introduced because of (1) histologic features of rejection or (2) calcineurin inhibitor (CNI) toxicity in order to reduce CNI dosage. The study population included 208 patients (median, age 54 ± 9 years), with a median delay between OLT and MMF introduction of 54 ± 43 months. The median dosage of MMF was 1180 mg/d at the end of follow-up. After a median follow-up of 50 ± 26 months, 26.4% of the patients taking MMF did present ≥1 side effect and MMF discontinuation rate was 13.8% (transient in 3.8%). The main side effects were digestive disorders (45%), pruritus ± rash ± mucitis (12.7%), and myelosuppression (16.4%). MMF was withdrawn because of digestive disorders (17.2%), pruritus ± rash ± mucitis (17.2%), and myelosuppression (24.1%). The mean glomerular filtration rate as calculated by the Cockcroft-Gault formula value significantly increased after the introduction of MMF (58.1 vs 71.4 mL/min; paired t-test; P < .01). Improvement of renal function was significantly associated with initial association with tacrolimus (vs cyclosporine), initial trough level of cyclosporine (not tacrolimus), delay between OLT and MMF introduction, and age of renal impairment. Our results suggest that the introduction of MMF in OLT maintenance recipients is efficient and well-tolerated (one quarter of the patients presented significant side effects, leading to treatment discontinuation in 10% of the patients).
  Transplantation Proceedings 09/2010; 42(7):2602-6. · 1.00 Impact Factor
• Article: Extra-anatomical hepatic artery reconstruction following post-embolization iatrogenic dissection and arterial anastomotic rupture in two liver transplant recipients.

  N Golse, A Spina, A Abdelaal, N Mennesson, P Feugier, J Dumortier, O Boillot, M Adham
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  ABSTRACT: When hepatic artery reconstruction is required during hepatic transplantation, this is generally performed with donor vessels. We describe two cases requiring a prosthesis. The first case was a 58-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. During transplantation, dissection of the celiac trunk occurred due to arterial embolization and the use of the patient's vessels was impossible. An extra-anatomical bypass between the infra-renal aorta and the donor hepatic artery was performed via the interposition of a graft tube. The second case was a 52-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. On day 16, a ruptured anastomosis was suspected and the patient underwent emergency revision laparotomy. Arterial revascularisation was performed with an aortohepatic bypass using a synthetic GoreTex((R)) graft. Patient follow-up was uneventful.
  Gastroentérologie Clinique et Biologique 02/2010; 34(2):111-4. · 0.80 Impact Factor
• Article: [Antitumoral effect of proliferation signal inhibitors].

  J Dumortier
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  ABSTRACT: The mammalian target of rapamycin (mTOR) is implicated in cell growth especially during cancer development and progression. Its action is dependent on well known oncogenic pathways that regulate tumor cell growth and cell cycle progression, in response to different stimuli. Sirolimus, temsirolimus and everolimus are specific inhibitors of mTOR that have originally been characterized by their antifungal and immunosuppressive properties, but also significantly inhibit cancer cells'proliferation, invasion, and metastasis, and promote apoptosis. In addition, mTOR inhibitors display potent antiangiogenic properties by the suppression of vascular endothelial growth factor signal transduction. The antitumoral effects of mTOR inhibitors, as a monotherapy or in combination with tyrosine kinase inhibitors or usual cytotoxic agents, have been extensively suggested in preclinical studies, including animal models. In a clinical setting, preliminary reports have demonstrated that mTOR inhibitors use is associated with an acceptable safety profile. Currently, mTOR inhibitors are tested in multiple trials and various cancer types, usually in intermittent schedules to avoid significant immunosuppression. Of particular interest is the use of mTOR inhibitors in the field of organ transplantation, including liver transplantation, in preventive or curative strategies, for the treatment of recurrent hepatocellular carcinoma and de novo post-transplantation malignancies.
  Gastroentérologie Clinique et Biologique 11/2009; 33 Suppl 4:S263-7. · 0.80 Impact Factor
• Article: Esophageal capsule endoscopy vs. EGD for the evaluation of portal hypertension: a French prospective multicenter comparative study.

  M G Lapalus, E Ben Soussan, M Gaudric, J C Saurin, P N D'Halluin, O Favre, B Filoche, F Cholet, A de Leusse, M Antonietti, J L Gaudin, P Sogni, D Heresbach, T Ponchon, J Dumortier
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  ABSTRACT: Esophagogastroduodenoscopy (EGD) is the standard method for the diagnosis of esophago-gastric varices. The aim of this prospective multicenter study was to evaluate the PillCam esophageal capsule endoscopy (ECE) for this indication. Patients presenting with cirrhotic or noncirrhotic portal hypertension underwent ECEfollowed by EGD at the time of diagnosis. Capsule recordings were blindly read by two endoscopists. A total of 120 patients (72 males, mean age: 58 years; mean Child-Pugh score: 7.2) were included. Esophageal varices were detected in 74 patients. No adverse event was observed after either EGD or ECE. Seven (6%) patients were unable to swallow the capsule. The mean recording time was 204 s (range 1-876). Sensitivity, specificity, negative predictive value, and positive predictive value of ECE for the detection of esophageal varices were 77%, 86%, 69%, and 90%, respectively. Sensitivity, specificity, negative and positive predictive values of ECE for the indication of primary prophylaxis (esophageal varices > or = grade 2 and/or red signs) were 77, 88, 90, and 75%, respectively, and 85% of the patients were adequately classified for the indication (or not) of prophylaxis. Interobserver concordance for ECE readings was 79.4% for the diagnosis of varices, 66.4% for the grading of varices, and 89.7% for the indication of prophylaxis. This large multicenter study confirms the safety and acceptable accuracy of ECE for the evaluation of esophageal varices. ECE might be proposed as an alternative to EGD for the screening of portal hypertension, especially in patients unable or unwilling to undergo EGD.
  The American Journal of Gastroenterology 03/2009; 104(5):1112-8. · 7.28 Impact Factor
• Article: Severe acute pancreatitis following endoscopic biopsy of the minor duodenal papilla.

  R Gincul, M Ciocirlan, J Dumortier, B Guerrier, J M Comte, A Faure, A Levrat, F Pilleul, B Napoleon, T Ponchon
  Endoscopy 02/2009; 41 Suppl 2:E195-6. · 5.21 Impact Factor
• Article: [Acute liver failure due to a treatment by nimesulide: another case and review].

  M Page, F Christin, D Hayi-Slayman, J-J Baillon, C-E Ber, B Delafosse, J Dumortier, T Rimmelé
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  ABSTRACT: Nimesulide is a non-steroidal anti-inflammatory drug available in several European countries. A hepatic toxicity due to nimesulide has been reported but fatal cases remain rare. We report the case of a 49-year-old woman treated by nimesulide during three days, admitted to the intensive care unit for an acute liver failure with encephalopathy. A temporary hepatic support by molecular adsorbent recirculating system (MARS) was performed and a hepatic transplantation was performed 12 hours after admission, allowing a rapid improvement and a discharge from intensive care unit four days after transplantation. Nimesulide induced hepatic toxicity is unpredictable and the intensity of symptomatology is variable. Clinical symptoms are often progressive, delayed from the onset of treatment. Our case draws attention to the risk of hepatic failure related to treatment with nimesulide, leading to hepatic transplantation or death. The question of risk/benefit ratio must be asked again for this widely used molecule.
  Annales francaises d'anesthesie et de reanimation 09/2008; 27(9):742-6. · 0.77 Impact Factor
• Article: Spontaneous esophageal perforation in eosinophilic esophagitis in children.

  C Robles-Medranda, F Villard, R Bouvier, J Dumortier, A Lachaux
  Endoscopy 08/2008; 40 Suppl 2:E171. · 5.21 Impact Factor
• Article: Transoesophageal echo-Doppler vs. thermodilution cardiac output measurement during hepatic vascular exclusion in liver transplantation.

  C Boucaud, Y Bouffard, J Dumortier, N Gaillac, P Sagnard, M C Graber, M Adham, O Boillot
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  ABSTRACT: Continuous monitoring of cardiac output during liver transplantation is essential to evaluate the patient's haemodynamic tolerance to acute volume variations. The aim of this study was to compare the cardiac output values obtained with a transoesophageal echo-Doppler and those obtained with a continuous thermodilution cardiac output pulmonary artery catheter. Twenty adult patients were prospectively studied during a 5 min hepatic vascular exclusion test performed at the end of the dissection phase. Echo-Doppler and continuous thermodilution cardiac output, mean arterial pressure and end-tidal CO2 were measured before and at the end of the test. Before the test, echo-Doppler cardiac output was 7.0 +/- 2.7 L min(-1) and thermodilution was 9.4 +/- 3.1 L min(-1), (R = 0.85, P < 0.001). The end test values were, respectively, 3.5 +/- 2.7 and 7.8 +/- 3.5 L min(-1) (R = 0.23, P = 0.34). Bland and Altman analysis showed a bias of -2.2 before the test, which increased to -4.4 at the end of the test. Mean arterial pressure decreased from 85.5 +/- 15 to 66.8 +/- 16 mmHg, end-tidal CO2 from 31.4 +/- 2.3 to 23.8 +/- 2.7 mmHg. Echo-Doppler cardiac output values are different from those measured by thermodilution cardiac output in these patients. Echo-Doppler cardiac output monitoring seems to detect the output changes, which can occur during acute haemodynamic changes more rapidly than thermodilution cardiac output in the course of liver transplantation.
  European Journal of Anaesthesiology 07/2008; 25(6):485-9. · 2.23 Impact Factor
• Article: [Bile duct involvement in autoimmune pancreatitis: classification and treatment].

  R Gincoul, B Pujol, J Dumortier, J-Y Scoazec, V Hervieu, A Crombe-Ternamian, F Pilleul, B Napoléon, T Ponchon
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  ABSTRACT: Autoimmune pancreatitis is a rare disease characterized by inflammation of the pancreatic parenchyma, irregular narrowing of the pancreatic duct, periductal lymphoplasmacytic infiltration and fibrosis at histological examination, the presence of autoantibodies and hypergammaglobulinemia, as well as the possible association of cholangitis and other autoimmune diseases. There is a favorable response to steroid therapy. We report the case of a patient with autoimmune pancreatitis with bile duct involvement and peripheral eosinophilia, requiring long-term immunosuppressant treatment. The diagnosis of a diffuse form of AIP was made without direct histological evidence and based on indirect imaging, clinical and laboratory findings in an autoimmune context. The histological and imaging studies of bile duct involvement and the favourable response to steroids were additional arguments.
  Gastroentérologie Clinique et Biologique 06/2008; 32(11):914-21. · 0.80 Impact Factor
• Article: Long-term results of liver transplantation for Wilson's disease.

  V Pabón, J Dumortier, R Gincul, J Baulieux, C Ducerf, C Trépo, J-C Souquet, F Zoulim, P Paliard, O Boillot, M Bost, A Lachaux
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  ABSTRACT: Wilson's disease is a hereditary defect in hepatic copper metabolism, causing hepatic, neurological and/or psychiatric manifestations. For patients with severe disease, liver transplantation is the treatment of choice. The aim of this study was to report the long-term outcome of patients who underwent liver transplantation for Wilson's disease. Thirteen patients with Wilson's disease, transplanted in Lyon France between January 1987 and May 2006, were including in this study: eight women and five men, aged eight to 53 years (median 20 years, seven children and six adults). The diagnosis of Wilson's disease was established before liver transplantation. The indication for liver transplantation was chronic (69%) or fulminant liver failure (31%). The median follow-up after liver transplantation was 10 years with 100% patient survival. Copper metabolism returned to normal in all patients. None of the patients with exclusive liver disease required chelation treatment after liver transplantation and none developed neurological symptoms of Wilson's disease. Liver transplantation totally reverses the abnormalities of copper metabolism and subsequent hepatic failure, but the course of neurological symptoms remains unpredictable. Long-term patient survival can be excellent without occurrence of neurological complications.
  Gastroentérologie Clinique et Biologique 05/2008; 32(4):378-81. · 0.80 Impact Factor
• Article: Transnasal OGD: practice survey and impact of a live video retransmission.

  J M Dumonceau, J Dumortier, J Deviere, M Kahaleh, T Ponchon, M Maffei, G Costamagna
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  ABSTRACT: Unsedated transnasal oesogastroduodenoscopy significantly improves patient tolerance compared to unsedated conventional peroral oesogastroduodenoscopy. To assess the adoption of transnasal oesogastroduodenoscopy among endoscopists from various European countries and its determinants. A survey was distributed to 624 endoscopists attending a live course on digestive endoscopy; a poll was also performed immediately before and after live video retransmission of a transnasal oesogastroduodenoscopy. Answer rate was 48%; transnasal oesogastroduodenoscopy was practised by 31% of respondents. In multivariate analysis, practice of transnasal oesogastroduodenoscopy was associated with location in France and Netherlands (P<0.0001), availability of many gastroscopes (P<0.0001) and less frequent use of sedation (P=0.006). Endoscopists who did not practise transnasal oesogastroduodenoscopy cited doubts about its advantages over conventional oesogastroduodenoscopy and lack of training (34% each) as barriers to adoption. Seventy-four percent of endoscopists practicing transnasal oesogastroduodenoscopy did actually use it in <20% of eligible cases. Live video retransmission of a transnasal oesogastroduodenoscopy increased the proportion of endoscopists interested in this technique (P=0.006). Adoption of transnasal oesogastroduodenoscopy largely varies between European countries; endoscopists practicing this technique use it in a minority of eligible cases. Live case demonstration may decrease barriers to the adoption of this technique.
  Digestive and Liver Disease 04/2008; 40(9):776-83. · 3.05 Impact Factor
• Article: [Portal dissection during TIPS placement].

  V Paoli, M Durieux-Courbière, J Dumortier, F Pilleul
  Journal de Radiologie 06/2007; 88(5 Pt 1):687-8. · 0.42 Impact Factor
• Article: Rejection under alpha interferon therapy in liver transplant recipients.

  T Walter, J Dumortier, O Guillaud, V Hervieu, P Paliard, J-Y Scoazec, O Boillot
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  ABSTRACT: Interferon alpha (IFN) is the corner stone drug for the treatment of recurrent hepatitis C (HCV) in liver transplant (LT) recipients. One of its serious potential adverse effects is acute and chronic rejection. The aim of this study was to review our experience using IFN-based therapy, in order to examine the incidence and the risk factors for rejection, and the outcome of patients who developed rejection. Between September 1990 and December 2004, 70 LT recipients were treated. Patients started antiviral treatment 16 (1-137) months after LT. Histological follow-up was available in all patients according to protocol biopsies. Rejection was diagnosed and graded according to Banff classification. Twenty-one percent of patients developed acute rejection (5 mild, 9 moderate and 1 severe) during IFN-based therapy. Patients were treated for 8 (1-15) months prior to rejection. Previous history of acute rejection before IFN therapy and treatment with pegylated-IFN was significantly associated with rejection (p = 0.04 and p = 0.02, respectively). The rejection was successfully treated in 87% of patients. No chronic rejection or graft losses were observed. Acute rejection under IFN-based therapy often occurs in LT recipients, but early diagnosis with protocol biopsies and early treatment can lead to a favorable outcome.
  American Journal of Transplantation 02/2007; 7(1):177-84. · 6.39 Impact Factor
• Article: Favorable outcome of liver transplantation despite a high hepatitis B virus replication: beyond the limits?

  J Dumortier, Y Le Derf, P Guillem, P Chevallier, O Boillot
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  ABSTRACT: Patients with end-stage liver disease due to chronic hepatitis B virus (HBV) infection with a persistent viral replication are generally denied liver transplantation (LT). We report the case of a patient who presented with the emergence of a YMDD escape mutant virus under lamivudine treatment, and developed terminal liver failure requiring LT. Pre-LT introduction of adefovir led to only a mild decrease in replication. The patient was treated with a combination of intravenous hepatitis B immune globulin (HBIG) that was started perioperatively, and also continued lamivudine and adefovir after LT. One year after LT, there was no evidence of HBV infection recurrence. This observation suggests that persistent high HBV replication might not be a contra-indication to LT, providing adequate and effective prophylaxis is given, using HBIG and antiviral drug combination therapy.
  Transplant Infectious Disease 10/2006; 8(3):182-4. · 2.22 Impact Factor
• Article: Plasma ribavirin concentrations during treatment of recurrent hepatitis C with peginterferon alpha-2b and ribavirin combination after liver transplantation.

  J Dumortier, E Ducos, J-Y Scoazec, P Chevallier, O Boillot, M-C Gagnieu
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  ABSTRACT: After liver transplantation (LT) for hepatitis C virus (HCV)-related cirrhosis, recurrence of HCV infection is universal. The efficacy of antiviral therapy in this indication is usually reduced because of its poor tolerability. We present herein the results of plasma measurement of ribavirin levels in transplanted patients when using increasing dosage of ribavirin, in comparison with a control cohort of nontransplanted patients. Seventeen control patients (nine women and eight men, median age 51.5 years) were compared with 12 liver transplant patients (2 women and 10 men, median age 55 years). In 76% of patients, HCV infection was genotype 1. All patients were treated by a combination of ribavirin and pegylated-interferon alpha-2b. A total of 54 blood samples were taken (1.8 per patient) for ribavirin level measurement. A virological response was obtained in 8/17 patients in the control group and in 6/12 LT patients. Ribavirin dose was lower in the LT group (8.79 vs 12.98 mg/kg/day), but plasma levels were the same in both groups (2.23 vs 2.43 mg/L for LT and non-LT groups, respectively). This was probably related to impaired renal function in the LT group (serum creatinine: 112.6 vs 73.6 micromol/L). No discontinuation of ribavirin therapy was observed and haemoglobin level was the same in both groups (109.5 g/L in LT patients vs 119.5 g/L in the control group). These results strongly support the interest in plasma measurement of ribavirin concentration during antiviral therapy in LT patients. Ribavirin dosage might be adapted without compromising its efficacy.
  Journal of Viral Hepatitis 09/2006; 13(8):538-43. · 4.09 Impact Factor
• Article: Esophageal capsule endoscopy versus esophagogastroduodenoscopy for evaluating portal hypertension: a prospective comparative study of performance and tolerance.

  M-G Lapalus, J Dumortier, F Fumex, S Roman, M Lot, B Prost, F Mion, T Ponchon
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  ABSTRACT: Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertension in cirrhotic patients, especially for screening purposes. The aim of this study was to assess the feasibility, safety, accuracy, and tolerance of PillCam ESO capsule endoscopy for this indication. In this prospective study, unsedated EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis. The patients quantified the tolerability (relative to pain, nausea, choking sensations, etc.) of the two procedures using a 100-mm visual analogue scale. The time required for the recording and for diagnosis with the capsule examination were documented, as were the patients' preferences in comparison with EGD. Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained. Twenty-one patients were included in the study (mean age 62, mean Model for End-Stage Liver Disease score 10.5, mean Child-Pugh score 7.3). The procedure was safe. One patient was unable to swallow the capsule. The mean recording time was 213 s (range 6 - 1200 s); the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients (84.2 %); and it correctly indicated a need for primary prophylaxis (esophageal varices of grade 2 or more and/or red signs) in 100 % of cases. The tolerability of the capsule endoscopy examination was significantly better, and all of the patients preferred capsule endoscopy to EGD (which was transnasal in 11 patients). Capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening for portal hypertension. This new technique requires further and more extensive evaluation, as well as assessment of its cost-effectiveness.
  Endoscopy 02/2006; 38(1):36-41. · 5.21 Impact Factor
• Article: Unresectable hepatocellular carcinoma: survival and prognostic factors after lipiodol chemoembolisation in 89 patients.

  J Dumortier, F Chapuis, O Borson, B Davril, J-Y Scoazec, G Poncet, L Henry, O Boillot, F Mion, F Berger, C Partensky, P Paliard, P-J Valette
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  ABSTRACT: The majority of patients with hepatocellular carcinoma are not eligible for surgical radical treatment (resection or liver transplantation) and lipiodol chemoembolisation is an efficient alternative procedure in this indication. To identify prognostic factors in patients treated with lipiodol chemoembolisation. During 10 years, 89 consecutive patients with unresectable hepatocellular carcinoma underwent lipiodol chemoembolisation as a single treatment. There were 80 males and 9 females, with a median age of 65 years. Treatment consisted of one to six courses of hepatic intra-arterial lipiodol with doxorubicine and gelatin sponge. The median survival was 13 months with a 13.6% survival rate at 4 years. Univariate analysis showed that serum levels of albumin, bilirubin, alkaline phosphatase and alpha-fetoprotein, Child's class, tumour type, tumour size and intensity of lipiodol capture after the first course of lipiodol chemoembolisation were significant prognostic factors of survival. In the multivariate analysis, four parameters remained associated with a significantly better outcome: Child's class A, largest lesion<5 cm, uninodular tumour and intense lipiodol capture. While lipiodol chemoembolisation is associated with good results only in some patients, in the absence of lipiodol capture, it should be ruled out.
  Digestive and Liver Disease 02/2006; 38(2):125-33. · 3.05 Impact Factor