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Hôpital-Camfrout, France

The usefulness of endoscopy in upper gastrointestinal bleeding is well established. It must be done within 24 hours of admission, according to the recommendations of scientific societies and the last international consensus conference. First of all, early endoscopy is not associated with an increased risk of complications. In addition, early endoscopy, in most studies, allows a decrease in the duration of hospitalization, the use of surgery and probably mortality. In the subgroup of patients with suspected digestive hemorrhage by variceal rupture, endoscopy is advocated within 12 hours of admission. Finally, in high-risk patients, early endoscopy has to be considered, because it would improve the prognosis. To minimize a possible negative impact of the weekend on the use of endoscopy and thus a worse prognosis, an on-call endoscopy seven days a week (a confirmed endoscopist and specialized assistance) seems necessary. © 2012 Springer-Verlag France. Source

Bacq Y.,Service dHepatogastroenterologie | Sentilhes L.,University of Angers | Reyes H.B.,University of Chile | Glantz A.,Gothenburg University | And 7 more authors.
Gastroenterology | Year: 2012

Background & Aims: We performed a meta-analysis to evaluate the effects of ursodeoxycholic acid (UDCA) on pruritus, liver test results, and outcomes of babies born to women with intrahepatic cholestasis of pregnancy (ICP). Methods: We performed a systematic review of 9 published, randomized controlled trials (3 double blinded) that compared the effects of UDCA to other drugs, placebo, or no specific treatment (controls) in patients with ICP. We analyzed data from 454 patients: 207 received only UDCA, 70 received only placebo, 42 received cholestyramine, 36 received dexamethasone for 1 week and then placebo for 2 weeks, 65 received S-adenosyl-methionine, and 34 received no specific treatment. To achieve consistency among end points, a standard questionnaire was sent to all corresponding authors. For each end point, we performed pooled analysis that compared the effects of UDCA with those of all controls and UDCA with those of placebos. Results: In pooled analyses that compared UDCA with all controls, UDCA was associated with total resolution of pruritus (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.07-0.74; P <.01), reduced pruritis (OR, 0.27; 95% CI, 0.13-0.55; P <.0001), normalization of serum levels of alanine aminotransferase (ALT) (OR, 0.23; 95% CI, 0.10-0.50; P <.001), decreased serum level of ALT (OR, 0.24; 95% CI, 0.11-0.52; P <.0001), reduced serum levels of bile acids (OR, 0.37; 95% CI, 0.19-0.75; P <.001), fewer premature births (OR, 0.44; 95% CI, 0.24-0.79; P <.01), reduced fetal distress (OR, 0.46; 95% CI, 0.25-0.86; P <.01), less frequent respiratory distress syndrome (OR, 0.30; 95% CI, 0.12-0.74; P <.01), and fewer neonates in the intensive care unit (OR, 0.49; 95% CI, 0.25-0.98; P =.046). In pooled analyses that compared the effects of UDCA with placebo, UDCA reduced pruritus (OR, 0.21; 95% CI, 0.07-0.62; P <.01), normalized (OR, 0.18; 95% CI, 0.06-0.52; P <.001) or decreased serum levels of ALT (OR, 0.12; 95% CI, 0.05-0.31; P <.0001), and reduced serum levels of bile acids (OR, 0.30; 95% CI, 0.12-0.73; P <.01). Conclusions: Based on a meta-analysis, UDCA is effective in reducing pruritus and improving liver test results in patients with ICP; UDCA therapy might also benefit fetal outcomes. © 2012 AGA Institute. Source

This paper describes 33 neoplastic colorectal lesions poorly elevated and under 1 cm in maximal diameter. The author names these lesions, usually neglected or missed at endoscopy, "flat adenomas". The macroscopic description includes a central depressed area evidenced at best using indigo-carmine dye. The histological definition was based on the lesion thickness less than twice that of the surrounding colonic or rectal mucosa. As mucosectomy (sub-mucosal injection of serum before snare resection) was not available at this time, the 33 lesions were treated using simple snare resection without complication. From these 33 flat adenomas 14 (42%) presented with high grade dysplasia (severe dysplasia at this time) or intramucosal cancer, 9 (27%) were in the proximal colon and 8 (24%) were associated with other adenomas or cancer. The degree of dysplasia was correlated with the lesion size. © 2012 Springer Verlag France. Source

Moal V.,Aix - Marseille University | Gerolami R.,Service dHepatogastroenterologie | Ferretti A.,Center Hospitalo University Timone | Ferretti A.,University of Lille Nord de France | And 3 more authors.
Journal of Clinical Microbiology | Year: 2014

Hepatitis E virus (HEV) is a leading cause of waterborne acute hepatitis in developing countries. In Europe, HEV causes a zoonotic disease and is hyperendemic in southern France. Four HEV genotypes (1 to 4) have been defined, and the most used classification divides them into 24 subtypes. Autochthonous European HEV strains belong in majority to genotype 3. Subtypes 3c, 3f, and 3e are representative of the HEV diversity in France. HEV causes chronic hepatitis in solid-organ transplant recipients in Europe, and viral characteristics associated with chronicity are poorly documented. We sequenced 343-nucleotide-long HEV genomic fragments from the serum of eight chronically infected kidney transplant recipients and a near-full-length genome in one case. We identified in four patients (50%) HEV of subtype 3i, not described previously in France. If shorter genomic fragments were used in phylogenetic analyses, these HEV sequences were clustered with open reading frame 2 (ORF2) fragments labeled as subtype 3c. At least five of the eight HEV 3i sequences recovered from humans in our phylogenetic analyses were from chronically infected kidney transplant recipients. These data show that the description of the prevalence and geographical distribution of HEV subtypes may be partially inaccurate and that criteria for classification as 3i and 3c should be clarified. Extended molecular virology analyses are required to improve knowledge of HEV epidemiology and determinants of chronic HEV infection. Copyright © 2014, American Society for Microbiology. All Rights Reserved. Source

The management of patients presenting with familial adenomatous polyposis begins before the age of 15 years and lasts a lifetime. This represents a long-term challenge with major aims: causing as few medical problems as possible and taking into account the quality of life both from a physical and from a psychological point of view. In 2011, colonic surgery can in most cases be less radical with better functional results. Endoscopic treatment may be initiated earlier and be more effective. The price to pay is a real but minor morbidity. The effectiveness of drug treatment of adenomas remains unconfirmed. Oncogenetics simplifies management and may provide a choice of whether or not to pass on the condition to one's children. Unresolved problems concern particularly desmoid tumours and also some rare tumours which are hard to detect (brain, pancreas). © 2011 Springer Verlag France. Source

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