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Senéjoux A, Siproudhis L, Abramowitz L, Munoz-Bongrand N, Desseaux K, Bouguen G, Bourreille A, Dewit O, Stefanescu C, Vernier G, Louis E, Grimaud JC, Godart B, Savoye G, Hebuterne X, Bauer P, Nachury M, Laharie D, Chevret S, Bouhnik Y. Fistula Plug in Fistulising Ano-Perineal Crohn's Disease: a Randomised Controlled Trial. J Crohns Colitis 2016; 10:141-8. [PMID: 26351393 DOI: 10.1093/ecco-jcc/jjv162] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Anal fistula plug [AFP] is a bioabsorbable bioprosthesis used in ano-perineal fistula treatment. We aimed to assess efficacy and safety of AFP in fistulising ano-perineal Crohn's disease [FAP-CD]. METHODS In a multicentre, open-label, randomised controlled trial we compared seton removal alone [control group] with AFP insertion [AFP group] in 106 Crohn's disease patients with non- or mildly active disease having at least one ano-perineal fistula tract drained for more than 1 month. Patients with abscess [collection ≥ 3mm on magnetic resonance imaging or recto-vaginal fistulas were excluded. Randomisation was stratified in simple or complex fistulas according to AGA classification. Primary end point was fistula closure at Week 12. RESULTS In all, 54 patients were randomised to AFP group [control group 52]. Median fistula duration was 23 [10-53] months. Median Crohn's Disease Activity Index at baseline was 81 [45-135]. Fistula closure at Week 12 was achieved in 31.5% patients in the AFP group and in 23.1 % in the control group (relative risk [RR] stratified on AGA classification: 1.31; 95% confidence interval: 0.59-4.02; p = 0.19). No interaction in treatment effect with complexity stratum was found; 33.3% of patients with complex fistula and 30.8% of patients with simple fistula closed the tracts after AFP, as compared with 15.4% and 25.6% in controls, respectively [RR of success = 2.17 in complex fistula vs RR = 1.20 in simple fistula; p = 0.45]. Concerning safety, at Week 12, 17 patients developed at least one adverse event in the AFP group vs 8 in the controls [p = 0.07]. CONCLUSION AFP is not more effective than seton removal alone to achieve FAP-CD closure.
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Affiliation(s)
- A Senéjoux
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - L Siproudhis
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - L Abramowitz
- Hôpital Bichat, Université Diderot Paris 7, Paris, France
| | | | - K Desseaux
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - G Bouguen
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - A Bourreille
- Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France
| | - O Dewit
- Clinique Universitaire Saint Luc, Bruxelles, Belgique
| | - C Stefanescu
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - G Vernier
- Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - E Louis
- CHU Sart Tilman, Université de Liège, Liège, Belgique
| | - J C Grimaud
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | | | - G Savoye
- Hôpital Charles Nicolle, Université de Rouen UR, Rouen, Franc
| | - X Hebuterne
- Hôpital de l'Archet, Université Nice Sophia-Antipolis, Nice, France
| | - P Bauer
- GH Diaconesses-Croix Saint-Simon, Paris, France
| | - M Nachury
- Hôpital Jean Minjoz, Université de Franche-Comté, Besançon, France
| | - D Laharie
- Hôpital Sud, Université Bordeaux Segalen, Bordeaux, France
| | - S Chevret
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - Y Bouhnik
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
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Galmiche M, Alessandrini E, Eyrault E, Kotovtchikhine A, Palomba K, Dorigny B, Schneider S, Darmon P, Hebuterne X. O08: Influence de la concentration des compléments nutritionnels oraux sur leur observance et les apports protéino-énergétiques des patients hospitalisés : résultats d’une étude randomisée en cluster. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70584-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Galmiche M, Besnard I, Palomba K, Eyraud E, Frin AC, Ouvrier D, Piche T, Schneider S, Hebuterne X. P262: Évaluation du caractère prédictif de l’échelle visuelle analogique (EVA) pour la détermination des ingesta des malades atteints d’un cancer. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hebuterne X, Goldwasser F, Lacau Saint Guily J, Gyan E, Raynard B. PP080-MON: Evolution of the Prevalence of Malnutrition and its Treatment in Patients with Cancer. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Moureau-Zabotto L, Resbeut M, Gal J, Mineur L, Teissier E, Hebuterne X, Muyldermans P, Francois E, Chamorey E, Gerard JP. Management and clinical outcome of rectal cancer in patients ≥80 years treated in southern France (PACA region) between 2006 and 2008. J Surg Oncol 2013; 108:450-6. [DOI: 10.1002/jso.23428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | - M. Resbeut
- Departement de Radiotherapie; Institut Paoli Calmettes; France
- Croix Rouge Francaise, Centre de Radiothérapie Saint Louis; Toulon France
| | - J. Gal
- Centre Antoine Lacassagne; Nice France
| | - L. Mineur
- Institut Sainte Catherine; Avignon France
| | - E. Teissier
- Centre Azureen de Cancérologie; Mougins France
| | | | - P. Muyldermans
- Centre de Radiotherapie du Pays d'Aix; Aix-en-Provence France
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Hofman P, Juhel T, Ilie M, Bordone O, Boyer O, Hebuterne X, Adriouch S, Vouret-Craviari V. L’activation du récepteur purinergique P2X7 protège les souris d’une carcinogenèse colique induite par l’inflammation. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stratton R, van Binsbergen J, Volkert D, Hebuterne X, Elia M. OP038 SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECTS OF ORAL NUTRITIONAL SUPPLEMENTS ON HOSPITAL ADMISSIONS. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1744-1161(11)70038-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vanbiervliet G, Giudicelli-Bornard S, Piche T, Berthier F, Gelsi E, Filippi J, Anty R, Arab K, Huet PM, Hebuterne X, Tran A. Predictive factors of bleeding related to post-banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case-control study. Aliment Pharmacol Ther 2010; 32:225-32. [PMID: 20412065 DOI: 10.1111/j.1365-2036.2010.04331.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Life-threatening bleeding caused by early spontaneous slippage of rubber bands has been described after variceal ligation in cirrhotic patients. AIM To determine the predictive factors of this complication in cirrhotic patients. METHODS Among 605 patients, 21 patients (mean age 56.6 +/- 13.5 years) developed 23 spontaneous band slippages with bleeding on post banding ulcer, as confirmed by endoscopy. Cirrhosis was alcoholic in 13 patients (62%), post viral hepatitis in three (14%) and from other causes in five (24%). A case-control study was performed comparing 17 from these patients who presented the complication after a first ligation with 84 of the 584 controls who underwent first endoscopic variceal ligation without bleeding complication. RESULTS Bleeding occurred 13.5 days +/- 7.3 (2-29) following ligation. Eleven patients died following the bleeding complication (52%). Using a multivariate analysis, previous upper variceal digestive bleeding [OR 12.07, 95%CI (2.3-63.43)], peptic oesophagitis [OR 8.9, 95%CI (1.65-47.8)], high platelet ratio index (APRI) score [OR 1.54, 95%CI (1.11-2.16)] and low prothrombin index [OR 0.54, 95% CI (0.31-0.94)] were independent predictive factors of bleeding. CONCLUSIONS Bleeding related to post-banding ulcer is a rare, but severe complication. The proposed predictive factors should be looked for and minimized before variceal ligation.
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Affiliation(s)
- G Vanbiervliet
- Faculté de Médecine, Université de Sophia-Antipolis, Nice, F-06107, France.
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Brest P, Corcelle E, Cesaro A, Chargui A, Belaïd A, Klionsky D, Vouret-Craviari V, Hebuterne X, Hofman P, Mograbi B. Autophagy and Crohn's disease: at the crossroads of infection, inflammation, immunity, and cancer. Curr Mol Med 2010; 10:486-502. [PMID: 20540703 PMCID: PMC3655526 DOI: 10.2174/156652410791608252] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 11/13/2009] [Indexed: 12/11/2022]
Abstract
Inflammatory bowel diseases (IBD) are common inflammatory disorders of the gastrointestinal tract that include ulcerative colitis (UC) and Crohn's disease (CD). The incidences of IBD are high in North America and Europe, affecting as many as one in 500 people. These diseases are associated with high morbidity and mortality. Colorectal cancer risk is also increased in IBD, correlating with inflammation severity and duration. IBD are now recognized as complex multigenetic disorders involving at least 32 different risk loci. In 2007, two different autophagy-related genes, ATG16L1 (autophagy-related gene 16-like 1) and IRGM (immunity-related GTPase M) were shown to be specifically involved in CD susceptibility by three independent genome-wide association studies. Soon afterwards, more than forty studies confirmed the involvement of ATG16L1 and IRGM variants in CD susceptibility and gave new information on the importance of macroautophagy (hereafter referred to as autophagy) in the control of infection, inflammation, immunity and cancer. In this review, we discuss how such findings have undoubtedly changed our understanding of CD pathogenesis. A unifying autophagy model then emerges that may help in understanding the development of CD from bacterial infection, to inflammation and finally cancer. The Pandora's box is now open, releasing a wave of hope for new therapeutic strategies in treating Crohn's disease.
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Affiliation(s)
- P. Brest
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
| | - E.A. Corcelle
- Apoptosis Department and Centre for Genotoxic Stress Research, Institute of Cancer Biology, Danish Cancer Society, Copenhagen, Denmark
| | - A. Cesaro
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
| | - A. Chargui
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
| | - A. Belaïd
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
| | - D.J. Klionsky
- University of Michigan, Life Sciences Institute, Ann Arbor, Michigan, USA
| | - V. Vouret-Craviari
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
| | - X. Hebuterne
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
- Centre Hospitalier Universitaire de Nice, Pôle Digestif, Hôpital L'Archet II, Nice, France
| | - P. Hofman
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France
| | - B. Mograbi
- Inserm ERI-21/EA 4319, Faculty of Medicine, University of Nice Sophia Antipolis, Nice, France
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Brest P, Corcelle EA, Cesaro A, Chargui A, Belaid A, Klionsky D, Vouret-Craviari V, Hebuterne X, Hofman P, Mograbi B. Autophagy and Crohn's Disease: At the Crossroads of Infection,Inflammation, Immunity, and Cancer. Curr Mol Med 2010. [DOI: 10.2174/1566210205407035240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Vibert J, Gelsi E, Vanbiervliet G, Dellamonica J, Tieulie N, Dahman M, Hastier P, Bernardin G, Tran A, Hebuterne X. [Severe acute pancreatitis revealing an antiphospholipid syndrome]. Gastroenterol Clin Biol 2010; 34:233-236. [PMID: 20219307 DOI: 10.1016/j.gcb.2009.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 10/31/2009] [Accepted: 11/27/2009] [Indexed: 05/28/2023]
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Lochs H, Dejong C, Hammarqvist F, Hebuterne X, Leon-Sanz M, Schütz T, van Gemert W, van Gossum A, Valentini L, Lübke H, Bischoff S, Engelmann N, Thul P. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clin Nutr 2006; 25:260-74. [PMID: 16698129 DOI: 10.1016/j.clnu.2006.01.007] [Citation(s) in RCA: 233] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 01/13/2006] [Indexed: 12/18/2022]
Abstract
Undernutrition as well as specific nutrient deficiencies have been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome (SBS). The present guideline gives evidence-based recommendations for the indication, application and type of formula of enteral nutrition (EN) (oral nutritional supplements (ONS) or tube feeding (TF)) in these patients. It was developed in an interdisciplinary consensus-based process in accordance with officially accepted standards and is based on all relevant publications since 1985. ONS and/or TF in addition to normal food is indicated in undernourished patients with CD or CU to improve nutritional status. In active CD EN is the first line therapy in children and should be used as sole therapy in adults mainly when treatment with corticosteroids is not feasible. No significant differences have been shown in the effects of free amino acid, peptide-based and whole protein formulae for TF. In remission ONS is recommended only in steroid dependent patients in CD. In patients with SBS TF should be introduced in the adaptation phase and should be changed with progressing adaptation to ONS in addition to normal food.
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Affiliation(s)
- H Lochs
- Department of Gastroenterology, Charité-Universitätsmedizin, CCM, Berlin, Germany.
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Lassalle S, Hofman V, Butori C, Venissa C, Mouroux J, Hebuterne X, Hofman P. Histiocytose langerhansienne pulmonaire et pseudo obstruction intestinale chronique (POIC) : une association non fortuite ? Ann Pathol 2004. [DOI: 10.1016/s0242-6498(04)94181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lassalle S, Hofman V, Bouadef A, Kalem K, Selva E, Hebuterne X, Hofman P. Corrélation entre l’infiltration des mastocytes et la densité de l’infection à Helicobacter pylori au niveau de la muqueuse gastrique antrale évaluée à l’aide de la technique des tissue arrays. Ann Pathol 2004. [DOI: 10.1016/s0242-6498(04)94102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kyle U, Schneider S, Hebuterne X, Pichard C. Late nutritional assessment in hospitalized patients is associated with moderate or severe nutritional depletion, determined by nutritional risk index (NRI). Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hebuterne X, Bozzetti F, Moreno Villares JM, Pertkiewicz M, Shaffer J, Staun M, Thul P, Van Gossum A. Home enteral nutrition in adults: a European multicentre survey. Clin Nutr 2003; 22:261-6. [PMID: 12765665 DOI: 10.1016/s0261-5614(03)00005-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS This study was undertaken to report indications and practice of home enteral nutrition (HEN) in Europe. METHODS A questionnaire on HEN practice was sent to 23 centres from Belgium (B), Denmark (D), France (F), Germany (G), Italy (I), Poland (P), Spain (S) and the United Kingdom (UK). This involved adult patients newly registered in HEN programme from 1 January 1998 to 31 December 1998. RESULTS A total of 1397 patients (532 women, 865 men) were registered. The median incidence of HEN was 163 patients/million inhabitants/year (range: 62-457). Age distribution was 7.5%, 16-40 years; 37.1%, 41-65 years; 34.5%, 66-80 years and 20.9% >80 years. The chief underlying diseases were a neurological disorder (49.1%), or head and neck cancer (26.5%); the main reason for HEN was dysphagia (84.6%). A percutaneous endoscopic gastrostomy (58.2%) or a naso-gastric tube (29.3%) were used to infuse commercial standard or high energy diets (65.3%), or fibre diets (24.5%); infusion was cyclical (61.5%) or bolus (34.1%). Indications and feeds were quite similar throughout the different centres but some differences exist concerning the underlying disease. There was greater variation in the choice of tubes and mode of infusion. In F, G, I, S, and UK, costs of HEN are fully funded. In B, D, and P patients have to pay part or all of the charges. CONCLUSIONS In Europe, HEN was utilised mainly in dysphagic patients with neurological disorders or cancer, using a standard feed via a PEG. However, there were important differences among the countries in the underlying diseases treated, the routes used, the mode of administration and the funding.
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Affiliation(s)
- X Hebuterne
- Department of Gastroenterology and Nutrition, Hôpital de l'Archet, Nice, France
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Girard-Pipau F, Pompei A, Schneider S, Nano JL, Hebuterne X, Boquet P, Rampal P. Intestinal Microflora, Short Chain and Cellular Fatty Acids, Influence of a Probiotic Saccharomyces boulardii. Microbial Ecology in Health & Disease 2002. [DOI: 10.3402/mehd.v14i4.8245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Van Gossum A, Vahedi K, Staun M, Pertkiewicz M, Shaffer J, Hebuterne X, Beau P, Guedon C, Schmit A, Tjellesen L, Messing B, Forbes A. Clinical, social and rehabilitation status of long-term home parenteral nutrition patients: results of a European multicentre survey. Clin Nutr 2001; 20:205-10. [PMID: 11407866 DOI: 10.1054/clnu.2000.0380] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a lifesaving treatment in patients with intestinal failure. Dependency of nutritional support becomes permanent for the majority of patients who had received HPN for at least 2 years. The alternative to long term HPN in selected patients is intestinal transplantation. AIMS To study some of the clinical, social and rehabilitation aspects of long-term HPN treatment. METHODS A survey was performed in nine European HPN centres. The questionnaire covered epidemiologic data, underlying diseases, intestinal anatomy, nutritional support and status, marital status, rehospitalization rate, HPN complications, rehabilitation score, drugs use, coexistent diseases and interest in intestinal transplantation. For some items, data were collected within 12 months prior to the evaluation. RESULTS This survey included 228 patients with a median age of 49 years. The median duration of HPN was 7 years (range 2--24 years). Short bowel length less than 100 cm was reported in 65% of patients with a predominance of end-jejunostomy or jejuno-colonic anastomosis. Global subjective nutritional status was normal in 79% of the patients, who were supplied with a mean number of 5.6 bags of parenteral nutrition weekly. Rehospitalizations within the 12 months prior to evaluation accounted for a mean period of 23 days and were due to HPN complications in half of the cases. Catheter-related sepsis was the most frequent HPN-complication. Bone metabolism disorders, which seemed to be more common than liver diseases, were directly related to HPN duration. One-third of the HPN patients was regularly consuming analgesics or opiates. HPN impair complete rehabilitation status but may improve the status of patients who had a very low rehabilitation score before starting HPN. An interest of intestinal transplantation was noted in only 10% of medical teams and in 8% of HPN patients. CONCLUSIONS This study is the largest European survey on long-term HPN patients with long standing or permanent intestinal failure. Data enlighten clinical, social and rehabilitation aspects of patients who could face the option of intestinal transplantation in the future.
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Affiliation(s)
- A Van Gossum
- Medico-surgical Department of Gastroenterology Hôpital Erasme, ULB, Brussels
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Hebuterne X, Schneider S. [Screening and prognostic value of malnutrition in the hospital setting]. Ann Med Interne (Paris) 2000; 151:557-562. [PMID: 11139656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Many hospitalized patients are malnourished and the relationship between malnutrition, and outcome is well established. To determine which patients are at nutritional risks clinical scores are probably more accurate than evaluation using a single nutritional parameter. Among the numerous scores published, the Nutrition Risk Index and the Subjective Global Assessment are both well validated. One is based on objective measurements, whereas the second is based on medical history and physical examination. Effects of malnutrition on clinical outcome have been particularly well-demonstrated in surgical patients, and it is now recommended to treat malnutrition before surgery. In medical patients malnutrition has also been demonstrated to be predictive of poor outcome. Moreover it induces an increase of the diagnosis-related group length of stay and hospital charges. To prevent and to treat malnutrition is now essential and nutrition teams are needed in hospitals.
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Affiliation(s)
- X Hebuterne
- Service de Gastroentérologie et de Nutrition, Hôpital de L'Archet, 06202 Nice Cedex 3.
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Tran A, Hastier P, Barjoan EM, Demuth N, Pradier C, Saint-Paul MC, Guzman-Granier E, Chevallier P, Tran C, Longo F, Schneider S, Piche T, Hebuterne X, Benzaken S, Rampal P. Non invasive prediction of severe fibrosis in patients with alcoholic liver disease. Gastroenterol Clin Biol 2000; 24:626-30. [PMID: 10962384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic accuracy of noninvasive markers of liver fibrosis in alcoholic liver disease. PATIENTS AND METHODS Fifty-four clinical and biochemical parameters including serum fibrosis markers (hyaluronate and transforming growth factor beta1) were analyzed in 146 consecutive heavy drinkers (106 men, 40 women; mean age 49.2 years). Following liver biopsy, fibrosis was evaluated using a semi-quantitative scoring system (no fibrosis (0) to severe fibrosis (3 + )). Multivariate analysis was performed to determine the markers that were best correlated with the fibrosis score. RESULTS Fifty-nine patients (40.4 %) had severe fibrosis (3 +) while 87 (59.6 %) had no fibrosis or moderate fibrosis (0 to 2 +). In multivariate analysis, serum hyaluronate and the prothrombin index were the best markers for the prediction of severe fibrosis. Hyaluronate and the prothrombin index had a diagnostic accuracy of 91.1 % and 89.7 %, respectively in the whole population. Finally, a significant negative correlation was found between hyaluronate and the prothrombin index (r =- 0.86, P <0.0001). CONCLUSIONS Using only hyaluronate and the prothrombin index, 9 out of 10 alcoholic patients can be correctly classified according to the severity of liver fibrosis.
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Affiliation(s)
- A Tran
- Service d'Hépato-Gastroentérologie, Hôpital de l'Archet 2, Nice
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Abstract
BACKGROUND AND AIMS Few data are available on the quality of life of home enteral nutrition (HEN) patients. This study was designed to assess both the quality of life of long-term HEN patients and the evolution of quality of life after initiation of HEN. METHODS Quality of life-related parameters were analysed in 38 patients (24M, 14F) aged 56 +/- 5 years who had been on HEN for more than 2 months (mean 25 +/- 5 months). Patients or close relatives were asked to answer a subjective assessment questionnaire, and patients with normal consciousness (n+ 24) answered the self-administered SF-36 and EuroQol questionnaires. RESULTS Since the initiation of HEN, patients had spent 1.9 +/- 0.5% of the time in the hospital, in 54% of cases because of HEN-related complications. Analysis of the generic questionnaires revealed poorer quality of life parameters in comparison to a general population, although better results were sometimes observed in younger patients (under 45 years), patients without cancer, and patients with more than one care-giver. Nevertheless, the patients' subjective assessment of the changes in their quality of life since beginning HEN was generally good, with most patients reporting improved or stable mental and physical well-being. CONCLUSIONS Quality of life is poor in HEN patients, but subgroups of patients who score better in some quality of life dimensions can be identified. Most patients describe an improvement in their quality of life following the initiation of HEN that needs to be confirmed by a prospective study.
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Affiliation(s)
- S M Schneider
- Service de Gastroentérologie et Nutrition, Hôpital de l'Archet, Nice, France
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22
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Abstract
Many hospitalized patients are malnourished, and the relationship between malnutrition and patient outcome is well established. To determine which patients are at nutritional risks, clinical scores are probably more accurate than using a single nutritional parameter. Among the numerous scores published, both the Prognostic Nutritional Index and the Subjective Global Assessment were prospectively validated. One is based on objective measurements, whereas the second is based on medical history and physical examination. The Nutritional Risk Index has been used in many studies including the "Veterans Study." The Mini Nutritional Assessment is a promising score for evaluating malnutrition in the elderly. The development of nutritional scores for use by nurses may facilitate screening of a large number of hospitalized patients.
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Affiliation(s)
- S M Schneider
- Department of Gastroenterology, Archet Hospital, Nice, France
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23
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Longo F, Hebuterne X, Tran A, Staccini P, Hastier P, Schneider S, Benzaken S, Tirtaine C, Rampal P. [Prevalence of hepatitis C in patients with chronic inflammatory bowel disease in the region of Nice and evaluation of risk factors]. Gastroenterol Clin Biol 2000; 24:77-81. [PMID: 10679588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To estimate the prevalence of viral hepatitis C markers and to determine independent risk factors in a population of patients with inflammatory bowel disease. METHODS We studied 117 consecutive out-patients (male/female, 53/64; mean age 41 +/- 16 yrs) with ulcerative colitis (43 patients) or Crohn's disease (74 patients). Anti-hepatitis C virus antibodies were tested with a third generation Elisa test. The following risk factors were tested for each patient: duration of inflammatory bowel disease, number of colonoscopies, history of surgical procedures, blood transfusions, intravenous drug abuse and immunosuppressive treatments. RESULTS The seroprevalence of hepatitis C virus was 5.98% (7/117). The only risk factor independently associated with serological markers for hepatitis C virus was blood transfusion (odds ratio: 7.77; confidence interval: 95% (1.63-49.09); P=0.012). CONCLUSIONS The prevalence of hepatitis C virus infection was high in patients with inflammatory bowel disease, mainly due to blood transfusions. Colonoscopies and surgical procedures were not found to be additional risk factors for infection with hepatitis C virus.
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Affiliation(s)
- F Longo
- Fédération des Maladies de l'Appareil Digestif, Hôpital de l'Archet II, CHU, Nice
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Bakker H, Bozzetti F, Staun M, Leon-Sanz M, Hebuterne X, Pertkiewicz M, Shaffer J, Thul P. Home parenteral nutrition in adults: a european multicentre survey in 1997. ESPEN-Home Artificial Nutrition Working Group. Clin Nutr 1999; 18:135-40. [PMID: 10451476 DOI: 10.1054/clnu.1999.0021] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A retrospective survey on home parenteral nutrition (HPN) in Europe was performed from January to December 1997. Data were compared to a similar study performed in 1993. A questionnaire of HPN practice was designed by the members of the ESPEN-HAN group. This involved adult patients (older than 16 years) newly registered in an HPN program between 1 January and 31 December 1997 and included: number of patients, underlying diseases and a 6-12 month outcome. Incidence and prevalence (at 1.1.1998) of adult HPN were calculated according to the estimated total population in 1997 for the countries in which more than 80% of HPN patients were reported.A total of 494 patients were registered in 73 centres from nine countries (Belgium (B), Denmark (D), France (F), Poland (P), Spain (S), Sweden (Sw), United Kingdom (UK), The Netherlands (N) and Germany (G). The underlying diseases for HPN in 494 patients were cancer (39%), Crohn's (19%), vascular diseases (15%), radiation enteritis (7%), AIDS (2%), other diseases with intestinal failure (18%). Incidence (patients/million inhabitants/year) were in N (3), F. (2.9), D. (2.8), B. (2.6), UK (1. 2), S (0.7) and P (0.36), respectively. Prevalence were in D. (12.7). U.K. (3.7), N. (3.7), F (3.6), B (3.0), P (1.1), S (0.65). After this 6-12 months follow-up (n=284), the mortality was respectively 4% in Crohn's disease, 13% in vascular diseases, 16% in others, 21% in radiaton enteritis, 34% in AIDS, 74% in cancer. Incidences and prevalences modestly increased in these seven European countries in 1997 in comparison to 1993. The percentages of underlying diseases in these countries remained similar except for AIDS that significantly decreased (from 7% to 2%). Outcomes did not significantly differ in the 4-year period except for AIDS (34% instead of 88% mortality) and could have been related to newer, more efficacious therapy.
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Affiliation(s)
- H Bakker
- Department of Gastroenterology, Hôpital Erasme, B1070 Bruxelles, Belgium
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25
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Chevallier P, Bahadoran P, Buckley MJ, Hebuterne X, Diaine B, Chevallier A, Coussement A. Hepatic multi-nodular focal fatty metamorphosis in acquired porphyria cutanea tarda. Sonographic, CT, and MRI features. Clin Imaging 1998; 22:418-21. [PMID: 9876911 DOI: 10.1016/s0899-7071(98)00069-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors report the sonographic, computed tomography (CT), and magnetic resonance imaging (MRI) findings in a patient with acquired porphyria cutanea tarda and hepatic multi-nodular focal fatty metamorphosis. There has only been one previous description of an association between these two conditions. The diagnosis was confirmed by histological analysis of a liver biopsy specimen. Symptomatology related to the hepatic abnormality may be due to an inflammatory reaction induced by the presence of uroporphyrin crystals in the liver. Each of the radiological techniques demonstrated unusual hepatic abnormalities and, in particular, MRI showed poorly defined areas in the liver which, on T2-weighted sequences, exhibited a hypersignal with fat saturation. Treatment of porphyria cutanea tarda led to clinical remission and resolution of radiological abnormalities.
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Affiliation(s)
- P Chevallier
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet II, France.
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26
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Abstract
Neurological complications of Crohn's disease due to involvement of the extradural space are extremely rare. A 40-yr-old woman with Crohn's disease affecting the terminal ileum presented with a right-sided sciatalgia. The patient did not complain of diarrhea or constipation. The serum fibrinogen and the C-reactive protein were elevated. Magnetic resonance imaging and computed tomography scan of the abdomen and pelvis demonstrated a mass in front of the sacrum up to but not including the first sacral vertebra. Surgical intervention, with resection of 15 cm of terminal ileum, led to the complete resolution of symptoms. In this case, the underlying cause of the neurological symptoms was most likely an infiltration of the right lumbosacral nerve caused by edema and inflammation of the terminal ileum in the vicinity of the presacral space. Unexplained lumbosacral neurological symptoms in a patient with Crohn's disease necessitate a magnetic resonance imaging or computed tomography scan to detect potential neurological compression.
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Affiliation(s)
- J F Demarquay
- Department of Gastroenterology and Radiology, Archet II Hospital, C.H.U. Nice, France
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27
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Caroli-Bosc FX, Deveau C, Peten EP, Delabre B, Zanaldi H, Hebuterne X, Hastier P, Viudes F, Belanger F, Caroli-Bosc C, Harris A, Hardion M, Rampal P, Delmont JP. Cholelithiasis and dietary risk factors: an epidemiologic investigation in Vidauban, Southeast France. General Practitioner's Group of Vidauban. Dig Dis Sci 1998; 43:2131-7. [PMID: 9753282 DOI: 10.1023/a:1018879819301] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Dietary risk factors have been implicated in the development of cholelithiasis. The aim of this study was to determine in a homogeneous French population whether a particular type of diet may be lithogenic. Seventy-six subjects over 30 years of age (26 men, 50 women) with cholelithiasis detected by ultrasound were selected from a population sample of 830 subjects by drawing lots using the polling list. These were matched by 76 control subjects without cholelithiasis randomly selected from the same population. Univariate analysis was significant for a high calorie diet >2500 kcal/day (OR = 3.62, P = 0.0065), a diet rich in carbohydrates with a consumption > or = 55 g/day (OR = 2.98, P = 0.0067), and a diet rich in total lipids (OR = 4.97, P = 0.023) or saturated fatty acids (OR = 3.06, P = 0.0146). An alcohol consumption equivalent to 20-40 g/day was protective (P = 0.018). Multivariate analysis confirmed these results. Our study suggests that a change in dietary habits by limiting excess calories, saturated fats and carbohydrates could reduce the incidence of cholelithiasis.
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van Gossum A, Hebuterne X, Leon-Sanz M, Pertkiewicz M, Shaffer I, Staun M. O.16 Home parenteral nutrition (HPN) in adults: a multicentresurvey in Europe in 1997. Clin Nutr 1998. [DOI: 10.1016/s0261-5614(98)80084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schneider S, Hebuterne X, Rampal P. [Acute diarrhea in adults: diagnostic trends and management in emergencies]. Rev Prat 1998; 48:887-91. [PMID: 11767335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- S Schneider
- Service de gastro-entérologie et nutrition, CHU, hôpital de l'Archet, B.P. 3079, 06202 Nice
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Schneider S, Rampal A, Hebuterne X, Rampal P. [Microscopic colitis]. Gastroenterol Clin Biol 1998; 22:431-41. [PMID: 9762274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- S Schneider
- Service de Gastroentérologie et Nutrition, Hôpital de l'Archet, Nice
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Messing B, Barnoud D, Beau P, Bornet JL, Chambrier C, Constanzo JD, Gerard-Boncompain M, Guedon C, Hebuterne X, Heresbach D, de Ledinghen V, Lescut D, Reimund JM, Senesse P, Beliah M, Bouletreau P, Bretagne JF, Descos L, Duclos B, Kerjean A, Lerebours E, Leverve X, Morichau-Beauchant M, Paris JC, Rampal P. [A 1993-1995 epidemiological survey of home parenteral nutrition in approved centers for adults in France]. Gastroenterol Clin Biol 1998; 22:413-8. [PMID: 9762271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES A 1993-1995 three year epidemiological survey of home parenteral nutrition was performed through in France in approved centers for adults. METHODS Data were retrospectively collected each year on a standardized questionnaire focussing on indications and short term outcome. RESULTS All centers (n = 14) participated in the study and 524 new adult patients were recruited. The overall incidence was unchanged at 3.75 patients/10(6) adults. Indications for AIDS rose (8 to 18%) whereas other indications were stable. Prevalence increased by 19%: 4.40 adults/10(6) patients at 01.01.1996. At six months, the probability to stay on treatment was 19.5% for AIDS and cancer indications but 52% for others, whereas death rates were 59% and 9% respectively. CONCLUSIONS For both cancer and AIDS indications, short-term treatment was due to a poor prognosis. For other diagnosis, complicated with a short bowel in 51% of cases, prognosis was excellent but associated with treatment dependency. The latter point focuses on the need for additional treatments in irreversible intestinal failure.
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Affiliation(s)
- B Messing
- Service d'Hépato-Gastroentérologie, Hôpital Saint-Lazare, Paris
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Bernard E, Carles M, Pradier C, Boissy C, Roger PM, Hebuterne X, Mondain V, Michiels JF, Le Fichoux Y, Dellamonica P. [Persistent diarrhea in HIV infected patients: role of Enterocytozoon bieneusi]. Presse Med 1995; 24:671-4. [PMID: 7770414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To determine the epidemiologic, clinical and aetiologic features of chronic diarrhoea in patients with human immunodeficiency virus (HIV) infection. METHODS Between January 1992 and April 1993, all HIV positive patients with chronic diarrhoea were enrolled in a prospective study. There were 46 patients in the study group including 33 (22 homosexuals) in stage C according to the 1993 Centers for Disease Control classification. RESULTS Thirty-four pathogenic agents were isolated in 26 of the patients (57%). Enterocytozoon bieneusi was the most frequently found pathogen (11 patients, 24%) followed by Cryptosporidium sp (8 patients). Enterocytozoon bieneusi was found in association with other pathogens in 7 patients. All patients with microsporidiosis were in stage C (p = 0.04) and had a longer duration of diarrhoea (19.6 vs 9.8 weeks, p = 0.03), greater weight loss (9.6 vs 2.1 kg, p = 0.0003) and a lower Karnofsky index (48% vs 67%, p = 0.01). Prophylaxy with dapsone or pyrimethamine during the 3 months prior to inclusion had been more frequent (p = 0.04 and p = 0.05 respectively) in patients without microsporidiosis. CONCLUSION Microsporidiosis should be suspected as a probable cause of chronic diarrhoea in HIV positive patients with a CD4 count < 100/mm3. Multiple infections may be a factor leading to treatment failure. Microsporidiosis seems to be linked to homosexual intercourse.
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Affiliation(s)
- E Bernard
- Service de Maladies infectieuses et tropicales, Hôpital de l'Archet, Nice
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35
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Wang XD, Marini RP, Hebuterne X, Fox JG, Krinsky NI, Russell RM. Vitamin E enhances the lymphatic transport of beta-carotene and its conversion to vitamin A in the ferret. Gastroenterology 1995; 108:719-26. [PMID: 7875474 DOI: 10.1016/0016-5085(95)90444-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIMS beta-Carotene and alpha-tocopherol may have either antagonistic or synergistic effects on each other's absorption and metabolism. The effects of both physiological and pharmacological concentrations of alpha-tocopherol on the absorption and metabolism of beta-carotene in ferret intestine were determined. METHODS A high concentration of beta-carotene was perfused through the upper portion of the small intestine of ferrets in vivo with varying levels of alpha-tocopherol. The effluent of a mesenteric lymph duct cannulation, the intestinal mucosal scraping, and portal vein blood were sampled and analyzed by high-performance liquid chromatography. RESULTS The lymphatic transport of beta-carotene was enhanced 4-fold by alpha-tocopherol at a physiological dose and 12-21-fold at a pharmacological dose. The lymphatic transport of alpha-tocopherol was linearly (r = 0.8; P < 0.05) related to the luminal alpha-tocopherol concentration even in the presence of a high concentration of beta-carotene. Furthermore, alpha-tocopherol increased the conversion of beta-carotene into retinol in the intestine in a dose-dependent manner. CONCLUSIONS alpha-Tocopherol has a positive effect on the intestinal absorption of intact beta-carotene and may modulate the metabolic conversion of beta-carotene into retinoids.
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Affiliation(s)
- X D Wang
- Gastrointestinal Nutrition Laboratory, U.S. Department of Agriculture Human Nutrition Research Center, Boston, Massachusetts
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36
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Peroux JL, Hastier P, Hebuterne X, Diez JL, Butori C, Rampal P. [The value of mycobacteria serology in the diagnosis of tubercular hepatitis]. Ann Gastroenterol Hepatol (Paris) 1994; 30:93-6. [PMID: 8067683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The causes of granulomatous hepatitis are often difficult to determine and standard diagnosis methods for tuberculous hepatitis lack sensitivity, which led us to evaluate the contribution of mycobacteria serology. The case is reported of a woman in whom a diagnosis of extrapulmonary sarcoidosis had been made on two occasions (1985, 1987) in the presence of granulomatous hepatitis. Liver histology remained identical in 1991 but the existence of positive mycobacteria serology led to the start of antituberculous treatment. The satisfactory response in terms of clinical, laboratory and histological findings confirmed this diagnostic hypothesis. When search for the etiology of granulomatous hepatitis proves negative, positive mycobacteria serology is sufficient to justify specific antituberculous treatment.
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Affiliation(s)
- J L Peroux
- Service de Gastroentérologie, Médecine interne et Nutrition, Hôpital de l'Archet, Nice
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37
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Quaranta J, Tran A, Benzaken S, Thiers V, Chau H, Hastier P, Sadoul J, Hebuterne X, Rampal P. Forte prévalence de la thyroïdite d'Hashimoto au cours de l'hépatite C chronique. Étude prospective avant traitement par interféron. Rev Med Interne 1992. [DOI: 10.1016/s0248-8663(05)80931-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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