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Guinet-Charpentier C, Lepage P, Morali A, Chamaillard M, Peyrin-Biroulet L. Effects of enteral polymeric diet on gut microbiota in children with Crohn's disease. Gut 2017; 66:194-195. [PMID: 26818618 DOI: 10.1136/gutjnl-2015-311058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 12/08/2022]
Affiliation(s)
- Chloé Guinet-Charpentier
- Unité d'Hépato Gastro-Entérologie et Nutrition Pédiatriques, Service de Médecine Infantile et Génétique Clinique, Hôpital d'Enfants, Inserm U954, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Patricia Lepage
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Alain Morali
- Unité d'Hépato Gastro-Entérologie et Nutrition Pédiatriques, Service de Médecine Infantile et Génétique Clinique, Hôpital d'Enfants, Inserm U954, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Mathias Chamaillard
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 8204-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France
| | - Laurent Peyrin-Biroulet
- Service d'Hépato-Gastro-Entérologie, Inserm U954, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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Weiner L, Garcia-Krafes E, Garcia S, Berthomier C, Morali A, Metzger JY, Weibel S, Javelot H, Bertschy G. [IDEM-depression: Characteristics and evaluation of an open group that combines psychoeducation and cognitive-behavior therapy]. Encephale 2016; 44:141-147. [PMID: 28029354 DOI: 10.1016/j.encep.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Depression is a highly prevalent mental illness that is associated with high rates of morbidity and functional impairment. At the psychiatric unit of the University Hospital of Strasbourg, France, we have developed an open group that combines psychoeducation and cognitive-behavior therapy (CBT), the information, discovery, exchange and mobilization for depression group (IDEM-depression). IDEM-depression is composed of 17 thematic, structured, and independent sessions, which address different aspects of depression (i.e., rumination, pharmacological treatments). Because of its flexible format, patients with varying degrees of depression severity (from remission up to severe depressive symptoms) and whose depression might be bipolar or unipolar, are able to participate in the group. Thus, the group is well suited to a large number of patients with major depression. In the present study we aimed at describing the IDEM-depression group and presenting results regarding patients' overall satisfaction, assessed via two self-report questionnaires (the Client Satisfaction Questionnaire, the CSQ-8, and the IDEM ad hoc questionnaire), as well as its effect on mood following each session assessed via a visual analog scale (VAS) ranging from 0 up to 100. METHOD Sixty-five patients participated in 50 sessions of the IDEM-depression group in two hospitals in Alsace. 61% of the patients had bipolar disorder, and 41% of them were inpatients. Sessions took place on a weekly basis, lasted 2hours and were proposed by a CBT-trained clinical psychologist. Patients were asked to fill-out the VAS at the beginning and at the end of each session. Moreover, they were asked to fill-out the CSQ-8 and the IDEM ad hoc questionnaire when they left the group. Other than one session ("yoga and mindfulness"), all the sessions (16 out of 17) were structured on a Powerpoint© presentation. During the first hour information was given regarding the topic (i.e., rumination), and a shared CBT conceptualization of the topic was formulated by the participants and the psychologist. For most sessions, the first hour was therefore communication and information-based, whereas during the second hour participants were asked to participate in in-session behavioral experiments and/or to evaluate specific aspects of their behavior (thoughts, emotions, activity, mindful behavior) during the last few days. The therapist manual and the slides for each session are available via e-mail to the first author. RESULTS Regarding the results, self-reported mood on the VAS was compared between the onset (225 VAS) and the end (225 VAS) of each session. Overall, results suggest that self-reported mood is significantly improved following the participation in sessions (t=-5. 87, P<0.001). Moreover, mean results on the CSQ-8 suggest that patients are highly satisfied with the group (M=24.46, SD=6.42). Among them, 82% reported a moderate-high satisfaction with the group. On the IDEM ad hoc questionnaire, patients reported an overall high satisfaction level regarding (i) the content of sessions, (ii) the duration of sessions, (iii) the frequency of sessions, (iv) how much they felt they could express themselves during sessions. In the qualitative comments of this questionnaire, patients reported that the group helped them to gain an understanding of the mechanisms involved in depression; to feel less isolated and guilty; and to learn about specific psychotherapeutic tools (i.e., mindfulness) and to try to implement them. CONCLUSION Our results suggest that an IDEM-depression group is well suited to a wide-array of clinical pictures associated with depression (varying severity, bipolar or unipolar, inpatients and outpatients). This is probably due to its open-group format which is particularly well-adapted to the dynamic symptomatology associated with major depression, and may stimulate decentering in patients who have different levels of severity of symptoms but participate in the same session. Moreover, its impact on mood improvement, and the high satisfaction level reported by patients, seem to be related to its CBT and psychoeducation-based content on the one hand, which has shown its efficacy in depression. On the other hand, IDEM's structured open-group format might have also contributed to the improvement in mood and the overall good satisfaction reported by patients, through the social support provided by the group, improved feeling of self-efficiency, and its effect on stigmatization. Thus, IDEM-depression group is an efficacious, flexible, low-cost, and easy to implement (in different clinical settings) psychotherapeutic option for major depression.
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Affiliation(s)
- L Weiner
- Service de psychiatrie II, clinique de psychiatrie, Inserm U 1114, CHU de Strasbourg, 1, porte de l'hôpital, 67000 Strasbourg, France.
| | - E Garcia-Krafes
- Hôpital civil de Colmar, 39, avenue de la Liberté, 68000 Colmar, France
| | - S Garcia
- Établissement public de santé Alsace Nord, 141, avenue de Strasbourg, 67170 Brumath, France
| | - C Berthomier
- Établissement public de santé Alsace Nord, 141, avenue de Strasbourg, 67170 Brumath, France
| | - A Morali
- Établissement public de santé Alsace Nord, 141, avenue de Strasbourg, 67170 Brumath, France
| | - J-Y Metzger
- Hôpital civil de Colmar, 39, avenue de la Liberté, 68000 Colmar, France
| | - S Weibel
- Service de psychiatrie II, clinique de psychiatrie, Inserm U 1114, CHU de Strasbourg, 1, porte de l'hôpital, 67000 Strasbourg, France
| | - H Javelot
- Établissement public de santé Alsace Nord, 141, avenue de Strasbourg, 67170 Brumath, France
| | - G Bertschy
- Service de psychiatrie II, clinique de psychiatrie, Inserm U 1114, CHU de Strasbourg, 1, porte de l'hôpital, 67000 Strasbourg, France
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Guinet-Charpentier C, Champigneulle J, Williet N, Peyrin-Biroulet L, Morali A. The association of autoimmune diseases with pediatric ulcerative colitis does not influence its disease course. Scand J Gastroenterol 2016; 51:33-40. [PMID: 26152794 DOI: 10.3109/00365521.2015.1058415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Ulcerative colitis (UC) is a chronic inflammatory condition. Previous reports suggested that UC may have a worse prognosis when associated with auto-immune diseases. We compared characteristics at diagnosis and natural history of the disease between classical ulcerative colitis (CUC) and UC associated with auto-immune diseases (CAI) in children. MATERIAL AND METHODS In this study, 67 children followed for UC at Nancy University Hospital between 1993 and 2012 were included: 45 patients in the CUC group and 22 in the CAI group. RESULTS Median follow-up was 4.8 years. Median age at diagnosis was 11.6 years in the CAI group and 9.8 years in the CUC group. Time between symptoms onset and diagnosis was broadly similar in the two groups (<3 months) and there were no significant differences regarding biological and histological findings. At 5 years, the need for corticosteroids and azathioprine did not differ between the CAI and the CUC groups. There was also no significant difference between the two groups regarding infliximab use at 1 and 5 years. CONCLUSIONS In this pediatric study, CAI had similar characteristics at baseline as CUC. The course of CAI does not seem to be influenced by the presence of concomitant auto-immune diseases.
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Affiliation(s)
- Chloé Guinet-Charpentier
- a 1 Unité d'Hépato Gastro-Entérologie et Nutrition Pédiatriques, Service de Médecine Infantile et Génétique Clinique, Hôpital d'Enfants, CHU Nancy Brabois, Inserm U954, Université de Lorraine , rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Jacqueline Champigneulle
- b 2 Service d'Anatomopathologie, CHU Nancy Brabois , rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - Nicolas Williet
- c 3 Service d'Hépato-Gastro-Entérologie, CHU Nancy Brabois, Inserm U954, Université de Lorraine , rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- c 3 Service d'Hépato-Gastro-Entérologie, CHU Nancy Brabois, Inserm U954, Université de Lorraine , rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - Alain Morali
- a 1 Unité d'Hépato Gastro-Entérologie et Nutrition Pédiatriques, Service de Médecine Infantile et Génétique Clinique, Hôpital d'Enfants, CHU Nancy Brabois, Inserm U954, Université de Lorraine , rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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Fréling E, Poreaux C, Schmutz JL, Morali A, Guéant JL, Peyrin-Biroulet L, Barbaud A. IgE anti-infliximab, tests allergologiques et intérêt des inductions de tolérance dans les hypersensibilités immédiates à l’infliximab. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.410] [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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Lemoine R, Pachlopnik-Schmid J, Farin HF, Bigorgne A, Debré M, Sepulveda F, Héritier S, Lemale J, Talbotec C, Rieux-Laucat F, Ruemmele F, Morali A, Cathebras P, Nitschke P, Bole-Feysot C, Blanche S, Brousse N, Picard C, Clevers H, Fischer A, de Saint Basile G. Immune deficiency-related enteropathy-lymphocytopenia-alopecia syndrome results from tetratricopeptide repeat domain 7A deficiency. J Allergy Clin Immunol 2014; 134:1354-1364.e6. [PMID: 25174867 DOI: 10.1016/j.jaci.2014.07.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/04/2014] [Accepted: 07/12/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is one of the most common chronic gastrointestinal diseases, but the underlying molecular mechanisms remain largely unknown. Studies of monogenic diseases can provide insight into the pathogenesis of IBD. OBJECTIVE We thought to determine the underlying molecular causes of IBD occurring in 2 unrelated families in association with an immune deficiency. METHODS We performed genetic linkage analysis and candidate gene sequencing on 13 patients from a large consanguineous family affected by early-onset IBD, progressive immune deficiency, and, in some cases, autoimmunity and alopecia, a condition we named enteropathy-lymphocytopenia-alopecia. The candidate gene was also sequenced in an unrelated patient with a similar phenotype. We performed histologic analysis of patients' intestinal biopsy specimens and carried out functional assays on PBMCs. Gut organoids derived from a patient's biopsy specimen were analyzed. RESULTS We identified biallelic missense mutations in tetratricopeptide repeat domain 7A (TTC7A) in all patients from both families. The resulting TTC7A depletion modified the proliferation, adhesion, and migratory capacities of lymphocytes through inappropriate activation of the RhoA signaling pathway. Normal function was restored by wild-type TTC7A expression or addition of a RhoA kinase inhibitor. The growth and polarity of gut epithelial organoids were also found to be dependent on the RhoA signaling pathway. CONCLUSIONS We show that TTC7A regulates the actin cytoskeleton dynamics in lymphocytes through the RhoA signaling pathway and is required in both lymphocytes and epithelial cells for maintaining equilibrium between cell proliferation, migration, polarization, and cell death. Our study highlights variability in the phenotypic expression resulting from TTC7A deficiency and outlines that impairment of both epithelial cells and lymphocytes cooperatively causes IBD.
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Affiliation(s)
- Roxane Lemoine
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Jana Pachlopnik-Schmid
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Henner F Farin
- Hubrecht Institute for Developmental Biology and Stem Cell Research and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Amélie Bigorgne
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Marianne Debré
- Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Fernando Sepulveda
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Sébastien Héritier
- Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Julie Lemale
- Unité de Nutrition et Gastroentérologie Pédiatriques, Hôpital Trousseau, Paris, France
| | - Cécile Talbotec
- Service de gastroentérologie, hépatologie et nutrition pédiatriques, Hôpital Necker-Enfants Malades, Paris, France
| | - Frédéric Rieux-Laucat
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Frank Ruemmele
- Service de gastroentérologie, hépatologie et nutrition pédiatriques, Hôpital Necker-Enfants Malades, Paris, France
| | - Alain Morali
- Unité d'Hépato-Gastro-Entérologie et Nutrition Pédiatriques, Hôpital d'Enfants, CHU Nancy Brabois-F 54500 Vandoeuvre les Nancy et Unité INSERM U954, Paris, France
| | - Pascal Cathebras
- Service de Médecine Interne, CHU de Saint Etienne, Saint Etienne, France
| | - Patrick Nitschke
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | | | - Stéphane Blanche
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Nicole Brousse
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Laboratoire d'Anatomie Pathologique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Capucine Picard
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France; Centre d'Etudes des Déficits Immunitaires, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hans Clevers
- Hubrecht Institute for Developmental Biology and Stem Cell Research and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alain Fischer
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France; College de France, Paris, France
| | - Geneviève de Saint Basile
- INSERM, Unité U1163, Laboratoire Homéostasie normale et pathologique du système immunitaire, Hôpital Necker Enfants-Malades, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France; Unité d'Immunologie et Hématologie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France; Centre d'Etudes des Déficits Immunitaires, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Descatoire M, Weller S, Irtan S, Sarnacki S, Feuillard J, Storck S, Guiochon-Mantel A, Bouligand J, Morali A, Cohen J, Jacquemin E, Iascone M, Bole-Feysot C, Cagnard N, Weill JC, Reynaud CA. Identification of a human splenic marginal zone B cell precursor with NOTCH2-dependent differentiation properties. ACTA ACUST UNITED AC 2014; 211:987-1000. [PMID: 24733829 PMCID: PMC4010902 DOI: 10.1084/jem.20132203] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identification in humans of a bona fide marginal zone B cell population, which differentiates from a splenic marginal zone precursor through a NOTCH2 signaling pathway. Mouse splenic marginal zone precursors (MZPs) differentiate into marginal zone B (MZB) cells under a signaling pathway involving Notch2 and its ligand, delta-like 1 ligand (Dll1). We report the identification of an MZP subset in the spleen of young children. These MZPs differentiate into MZ-like B cells in vitro in the presence of OP9 cells expressing human DLL1, as demonstrated by the up-regulation of classical MZB cell markers. A set of diagnostic genes discriminating IgM+IgD+CD27+ blood and splenic MZB cells from switched B cells was identified (up-regulation of SOX7, down-regulation of TOX, COCH, and HOPX), and their expression during the induction assay mirrored the one of MZB cells. Moreover, Alagille patients with a NOTCH2 haploinsufficiency display a marked reduction of IgM+IgD+CD27+ B cells in blood, whereas their switched memory B cells are not affected. Altogether, these results argue in favor of the existence of a rodent-like MZB cell lineage in humans.
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Affiliation(s)
- Marc Descatoire
- Institut Necker-Enfants Malades, INSERM U1151-CNRS UMR 8253, Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine-Site Broussais, 75014 Paris, France
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Michaud L, Coutenier F, Podevin G, Bonnard A, Becmeur F, Khen-Dunlop N, Auber F, Maurel A, Gelas T, Dassonville M, Borderon C, Dabadie A, Weil D, Piolat C, Breton A, Djeddi D, Morali A, Bastiani F, Lamireau T, Gottrand F. Characteristics and management of congenital esophageal stenosis: findings from a multicenter study. Orphanet J Rare Dis 2013; 8:186. [PMID: 24289834 PMCID: PMC4222067 DOI: 10.1186/1750-1172-8-186] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/26/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Congenital esophageal stenosis (CES) is a rare condition frequently associated with esophageal atresia (EA). There are limited data from small series about the presentation, treatment, and outcomes of CES. METHODS Medical records of all patients with CES included in the French Network on Esophageal Malformations and Congenital Diseases were reviewed retrospectively with regard to diagnosis, treatment, and outcome. RESULTS Over 18 years, 61 patients (30 boys) had CES, and 29 (47%) of these patients also had EA. The mean age at diagnosis was 24 months (1 day to 14 years) and was younger in patients with CES and EA than in those with isolated CES (7 vs. 126 months, p < 0.05). Twenty-one of the 61 patients with CES had no clinical symptoms: in three patients, the findings were incidental, and in 18 of the 29 patients with associated EA, CES was diagnosed at the time of surgical repair of EA or during a postoperative systematic esophageal barium study. In the 40 other patients, at diagnosis, 50% presented with dysphasia, 40% with vomiting, 50% with food impaction, and 42% with respiratory symptoms. Diagnosis of CES was confirmed by esophageal barium study (56/61) and/or esophageal endoscopy (50/61). Sixteen patients had tracheobronchial remnants (TBR), 40 had fibromuscular stenosis (FMS), and five had membrane stenosis (MS). Thirty-four patients (56%) were treated by dilation only (13/34 remained asymptomatic at follow-up); 15 patients were treated by dilation but required later surgery because of failure (4/15 remained asymptomatic at follow-up); and nine patients had a primary surgical intervention (4/9 were asymptomatic at follow-up). Dilation was complicated by esophageal perforation in two patients (3.4%). At follow-up, dysphagia remained in 36% (21/58) of patients, but the incidence did not differ between the EA and the isolated CS groups (10/29 vs. 7/32, p = 0.27). CONCLUSIONS CS diagnosis can be delayed when associated with EA. Dilation may be effective for treating patients with FMS and MS, but surgical repair is often required for those with TBR. Our results show clearly that, regardless of the therapeutic option, dysphagia occurs frequently, and patients with CES should be followed over the long term.
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Affiliation(s)
- Laurent Michaud
- Reference Centre for Congenital and Malformative Esophageal Diseases, Lille, France.
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Dabadie A, Bellaiche M, Cardey J, Lachaux A, Michaud L, Morali A. [Current indications of ileocolonoscopy in children in 2012]. Arch Pediatr 2012; 19:1247-51. [PMID: 22995048 PMCID: PMC7133239 DOI: 10.1016/j.arcped.2012.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/31/2012] [Accepted: 08/06/2012] [Indexed: 01/29/2023]
Abstract
Les indications de l’iléo-coloscopie chez l’enfant ont été définies en 2002 par le Groupe francophone d’hépatologie gastroentérologie et nutrition. Ces recommandations sont mises à jour sous l’éclairage des nouvelles données et avancées technologiques de la dernière décennie. L’iléo-coloscopie reste essentiellement indiquée devant les hémorragies digestives (méléna ou rectorragies, anémie) et les suspicions de maladie inflammatoire chronique intestinale (MICI). Elle est désormais indiquée pour contrôler l’évolution des MICI, notamment pour contrôler la cicatrisation muqueuse sous traitement et l’absence de récidive postopératoire. Les indications d’iléo-coloscopie itérative sont surtout représentées par les polyposes génétiques avec des recommandations validées pour la polypose adénomateuse familiale. Les contre-indications n’ont pas été modifiées.
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Affiliation(s)
- A Dabadie
- Pôle de pédiatrie, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex, France.
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Baratta A, Javelot H, Morali A, Halleguen O, Weiner L. Place des antidépresseurs dans le traitement des auteurs d’infractions sexuelles. Sexologies 2012. [DOI: 10.1016/j.sexol.2011.11.011] [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: 10/14/2022]
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Donadieu J, Fenneteau O, Beaupain B, Beaufils S, Bellanger F, Mahlaoui N, Lambilliotte A, Aladjidi N, Bertrand Y, Mialou V, Perot C, Michel G, Fouyssac F, Paillard C, Gandemer V, Boutard P, Schmitz J, Morali A, Leblanc T, Bellanné-Chantelot C. Classification of and risk factors for hematologic complications in a French national cohort of 102 patients with Shwachman-Diamond syndrome. Haematologica 2012; 97:1312-9. [PMID: 22491737 DOI: 10.3324/haematol.2011.057489] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with the Shwachman-Diamond syndrome often develop hematologic complications. No risk factors for these complications have so far been identified. The aim of this study was to classify the hematologic complications occurring in patients with Shwachman-Diamond syndrome and to investigate the risk factors for these complications. DESIGN AND METHODS One hundred and two patients with Shwachman-Diamond syndrome, with a median follow-up of 11.6 years, were studied. Major hematologic complications were considered in the case of definitive severe cytopenia (i.e. anemia <7 g/dL or thrombocytopenia <20 × 10(9)/L), classified as malignant (myelodysplasia/leukemia) according to the 2008 World Health Organization classification or as non-malignant. RESULTS Severe cytopenia was observed in 21 patients and classified as malignant severe cytopenia (n=9), non-malignant severe cytopenia (n=9) and malignant severe cytopenia preceded by non-malignant severe cytopenia (n=3). The 20-year cumulative risk of severe cytopenia was 24.3% (95% confidence interval: 15.3%-38.5%). Young age at first symptoms (<3 months) and low hematologic parameters both at diagnosis of the disease and during the follow-up were associated with severe hematologic complications (P<0.001). Fifteen novel SBDS mutations were identified. Genotype analysis showed no discernible prognostic value. CONCLUSIONS Patients with Shwachman-Diamond syndrome with very early symptoms or cytopenia at diagnosis (even mild anemia or thrombocytopenia) should be considered at a high risk of severe hematologic complications, malignant or non-malignant. Transient severe cytopenia or an indolent cytogenetic clone had no deleterious value.
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Affiliation(s)
- Jean Donadieu
- AP-HP Registre Français des Neutropénies Congénitales, Hôpital Trousseau, Service d’Hémato-oncologie Pédiatrique, APHP, Paris, France.
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Jéru I, Le Borgne G, Cochet E, Hayrapetyan H, Duquesnoy P, Grateau G, Morali A, Sarkisian T, Amselem S. Identification and functional consequences of a recurrent NLRP12 missense mutation in periodic fever syndromes. ACTA ACUST UNITED AC 2011; 63:1459-64. [PMID: 21538323 DOI: 10.1002/art.30241] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [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: 11/07/2022]
Abstract
OBJECTIVE To gain insight into the molecular bases of genetically unexplained periodic fever syndromes (PFS) by screening NLRP12, a gene in which only a nonsense and a splice site mutation have so far been identified, and to assess the functional consequences of the identified missense variation. METHODS NLRP12 was screened for mutations by direct sequencing. Functional assays were performed in HEK 293T cells stably expressing the proapoptotic protein ASC and procaspase 1, in order to determine the effects of normal and mutated NLRP12 proteins on speck formation, caspase 1 signaling, and NF-κB activation. RESULTS A heterozygous NLRP12 missense mutation involving a CpG site (c.1054C>T; p.Arg352Cys) was identified in exon 3, which encodes the nucleotide-binding site (NBS) of the protein, in 2 patients from different countries and carrying different NLRP12 haplotypes. The mutation, which does not alter the inhibitory effect of NLRP12 on NF-κB activation, increases speck formation and activates caspase 1 signaling. To define this new class of PFS, we propose the term NLRP12-associated disorders (NLRP12AD). CONCLUSION Given the rarity of known NLRP12-associated disorders, the identification of this NLRP12 molecular defect contributes to the delineation of the clinical spectrum associated with mutations in this gene and highlights the importance of screening NLRP12 in patients presenting with unexplained PFS. This study also demonstrates, by means of functional assays, the deleterious effect of this recurrent missense mutation; the gain of function for speck formation and caspase 1 signaling associated with this NBS mutation is consistent with the inflammatory phenotype of PFS.
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Affiliation(s)
- Isabelle Jéru
- INSERM, U933, Université Pierre et Marie Curie, Paris 6, UMR S933, France
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13
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Begue B, Verdier J, Rieux-Laucat F, Goulet O, Morali A, Canioni D, Hugot JP, Daussy C, Verkarre V, Pigneur B, Fischer A, Klein C, Cerf-Bensussan N, Ruemmele FM. Defective IL10 signaling defining a subgroup of patients with inflammatory bowel disease. Am J Gastroenterol 2011; 106:1544-55. [PMID: 21519361 DOI: 10.1038/ajg.2011.112] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [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: 12/11/2022]
Abstract
OBJECTIVES Early onset inflammatory bowel diseases (EO-IBD) developing during the first year of life are likely to reflect inherited defects in key mechanism(s) controlling intestinal homeostasis, as recently suggested for interleukin 10 (IL10). Thus, we aimed to further elaborate the hypothesis of defective anti-inflammatory responses in patients with IBD. METHODS The capacities of transforming growth factor β (TGFβ) and IL10 to inhibit proinflammatory cytokine production by monocyte-derived dendritic cells (MoDC) or peripheral blood cells (PBMC) was analyzed in 75 children with IBD, including 13 infants with EO-IBD (in whom autoimmune diseases or classical immunodeficiencies were ruled out). IL10 receptor-A/-B expression, STAT3 activation in response to IL6, IL10, IL21, IL22 were analyzed by FACS and western blotting. IL10RA and B genes were sequenced. The response to IL22 was tested in ileal/colonic tissue cultures. Tissue gene expression was analyzed by Taqman real-time polymerase chain reaction. RESULTS Production of IL10 in response to bacterial motifs was normal in all IBD patients. In contrast to our original hypothesis, no defect of the anti-inflammatory potential of TGFβ and IL10 was observed in children with IBD or EO-IBD except two infants who presented with granuloma-positive colitis at 3 months of life: no response to IL10 was observed secondary to mutations in the α (p.R262C) or β (p.E141X) chain of IL10R, respectively, although a fully functional Jak-STAT3 pathway was present in both patients. When analyzing the regulation of intestinal bacterial clearance, we detected a defect in the patient with absent IL10 RB to upregulate protective transcripts in response to IL22, whereas all other EO-IBD patients, including the patient with an abnormal α chain, responded normally. CONCLUSIONS Impaired IL10 signaling characterizes a subgroup of IBD patients, whereas the majority of children with severe IBD including EO forms normally produces and responds to IL10. Defective IL22 signaling may additionally impair intestinal epithelial clearance. Our data point out the complexity of IBD, which represent a group of distinct diseases with several pathogenetic abnormalities.
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Georges A, Bonneau J, Bonnefont-Rousselot D, Champigneulle J, Rabès JP, Abifadel M, Aparicio T, Guenedet JC, Bruckert E, Boileau C, Morali A, Varret M, Aggerbeck LP, Samson-Bouma ME. Molecular analysis and intestinal expression of SAR1 genes and proteins in Anderson's disease (Chylomicron retention disease). Orphanet J Rare Dis 2011; 6:1. [PMID: 21235735 PMCID: PMC3029219 DOI: 10.1186/1750-1172-6-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 01/14/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Anderson's disease (AD) or chylomicron retention disease (CMRD) is a very rare hereditary lipid malabsorption syndrome. In order to discover novel mutations in the SAR1B gene and to evaluate the expression, as compared to healthy subjects, of the Sar1 gene and protein paralogues in the intestine, we investigated three previously undescribed individuals with the disease. METHODS The SAR1B, SAR1A and PCSK9 genes were sequenced. The expression of the SAR1B and SAR1A genes in intestinal biopsies of both normal individuals and patients was measured by RTqPCR. Immunohistochemistry using antibodies to recombinant Sar1 protein was used to evaluate the expression and localization of the Sar1 paralogues in the duodenal biopsies. RESULTS Two patients had a novel SAR1B mutation (p.Asp48ThrfsX17). The third patient, who had a previously described SAR1B mutation (p.Leu28ArgfsX7), also had a p.Leu21dup variant of the PCSK9 gene. The expression of the SAR1B gene in duodenal biopsies from an AD/CMRD patient was significantly decreased whereas the expression of the SAR1A gene was significantly increased, as compared to healthy individuals. The Sar1 proteins were present in decreased amounts in enterocytes in duodenal biopsies from the patients as compared to those from healthy subjects. CONCLUSIONS Although the proteins encoded by the SAR1A and SAR1B genes are 90% identical, the increased expression of the SAR1A gene in AD/CMRD does not appear to compensate for the lack of the SAR1B protein. The PCSK9 variant, although reported to be associated with low levels of cholesterol, does not appear to exert any additional effect in this patient. The results provide further insight into the tissue-specific nature of AD/CMRD.
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Affiliation(s)
- Amandine Georges
- Service de Médecine Infantile 3 et Génétique Clinique, INSERM U954, Hôpital d'Enfants Brabois, CHU Nancy, Vandoeuvre les Nancy, 54511, France
| | - Jessica Bonneau
- INSERM U781, Université Paris Descartes, Hôpital Necker Enfants Malades, Paris, 75015, France
| | - Dominique Bonnefont-Rousselot
- UF de Biochimie des Maladies Métaboliques, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière (AP-HP), and Département de Biologie Expérimentale, Métabolique et Clinique, EA 4466, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, 75013, France
| | - Jacqueline Champigneulle
- Laboratoire d'Anatomie et de Cytologie Pathologiques, Hôpital de Brabois, Université Paris 13, Bobigny, 93000, France
| | - Jean P Rabès
- INSERM U781, Université Paris Descartes, Hôpital Necker Enfants Malades, Paris, 75015, France
- Service de Biochimie et Génétique Moléculaire, CHU A Paré, AP-HP et Faculté de Médecine (PIFO-UVSQ), Boulogne, 92104, France
| | - Marianne Abifadel
- INSERM U781, Université Paris Descartes, Hôpital Necker Enfants Malades, Paris, 75015, France
| | - Thomas Aparicio
- Service de Gastroentérologie, Hôpital Avicenne, 125 rue de Stalingrad, Université Paris 13, Bobigny, 93000, France
| | - Jean C Guenedet
- Laboratoire d'Anatomie et de Cytologie Pathologiques, Hôpital de Brabois, Université Paris 13, Bobigny, 93000, France
- Service de Microscopie Electronique, Hôpital de Brabois, CHU Nancy, Vandoeuvre les Nancy, 54511, France
| | - Eric Bruckert
- Service d'Endocrinologie-Métabolisme, Hôpital Pitié Salpêtrière, (AP-HP), Paris, 75013, France
| | - Catherine Boileau
- INSERM U781, Université Paris Descartes, Hôpital Necker Enfants Malades, Paris, 75015, France
- Service de Biochimie et Génétique Moléculaire, CHU A Paré, AP-HP et Faculté de Médecine (PIFO-UVSQ), Boulogne, 92104, France
| | - Alain Morali
- Service de Médecine Infantile 3 et Génétique Clinique, INSERM U954, Hôpital d'Enfants Brabois, CHU Nancy, Vandoeuvre les Nancy, 54511, France
| | - Mathilde Varret
- INSERM U781, Université Paris Descartes, Hôpital Necker Enfants Malades, Paris, 75015, France
| | | | - Marie E Samson-Bouma
- INSERM U781, Université Paris Descartes, Hôpital Necker Enfants Malades, Paris, 75015, France
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Lapeyre D, Gottrand F, Debray D, Bridoux L, Lachaux A, Morali A, Lamireau T. CL141 - Traitement de la maladie de Wilson par le zinc. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70362-6] [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: 11/17/2022]
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Ruemmele FM, Lachaux A, Cézard JP, Morali A, Maurage C, Giniès JL, Viola S, Goulet O, Lamireau T, Scaillon M, Breton A, Sarles J. Efficacy of infliximab in pediatric Crohn's disease: a randomized multicenter open-label trial comparing scheduled to on demand maintenance therapy. Inflamm Bowel Dis 2009; 15:388-94. [PMID: 19023899 DOI: 10.1002/ibd.20788] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [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: 01/11/2023]
Abstract
BACKGROUND Infliximab (IFX) is efficacious in inducing remission in severe forms of pediatric Crohn's disease (CD). Adult studies indicate that IFX is also safe and well tolerated as maintenance therapy. The present study aimed to evaluate in a prospective manner the efficacy and safety of IFX as maintenance therapy of severe pediatric CD comparing scheduled and "on demand" treatment strategies. METHODS Forty children with CD (nonpenetrating, nonstricturing as well as penetrating forms, mean age: 13.9 +/- 2.2 years) with a severe flare-up (Harvey-Bradshaw Index [HBI] > or =5, erythrocyte sedimentation rate [ESR] >20 mm/h) despite well-conducted immunomodulator therapy (n = 36 azathioprine, n = 1 mercaptopurine, n = 3 methotrexate) combined with steroids were included in this randomized, multicenter, open-label study. Three IFX infusions (5 mg/kg) were administered at week (W)0/W2/W6. At W10, clinical remission (HBI <5) and steroid withdrawal were analyzed and IFX responders were randomized to maintenance therapy over 1 year: group A, scheduled every 2 months; group B, "on demand" on relapse. RESULTS In all, 34/40 children came into remission during IFX induction therapy (HBI: 6.7 +/- 2.5 (WO) vs. 1.1 +/- 1.5 (W10); P < 0.001). At the end of phase 2, 15/18 (83%) patients were in remission in group A compared to 8/13 (61%) children in group B (P < 0.01), with a mean HBI of 0.5 versus 3.2 points (group A versus B, P = 0.011). In group A, 3/13 (23.1%) children experienced a relapse compared to 11/12 (92%) children in group B. No severe adverse event occurred during this trial. CONCLUSIONS IFX is well tolerated and safe as maintenance therapy for pediatric CD, with a clear advantage when used on a scheduled 2-month basis compared to an "on demand" basis.
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Affiliation(s)
- Frank M Ruemmele
- AP-HP, Hôpital Necker-Enfants Malades, Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Paris, France.
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Affiliation(s)
- J F Lesesve
- Services d'Hématologie biologique et de Médecine Infantile, Centre Hospitalier Universitaire, Inserm, Nancy, France.
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Georges A, Varret M, Bonnefont-Rousselot D, Champigneulle J, Guedenet JC, Abifadel M, Rabes JP, Bruckert E, Boileau C, Bouma-Samson M, Morali A. SFP-P057 – Hépatologie, gastro-entérologie et nutrition – La maladie d’Anderson : identification d’une nouvelle mutation du gène SARA2. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72190-0] [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: 10/21/2022]
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19
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Dumond P, Schmitz J, Baudon JJ, Lachaux A, Ginies JL, Lenaerts C, Chouraqui JP, Eckart JP, Born A, Huet F, Straczek J, Drai S, Vidailhet M, Morali A. SFP-19 – Hépatologie, gastro-entérologie et nutrition – Le déficit congénital en saccharase-isomaltase, étude rétrospective de 53 cas diagnostiqués de 1963 à 2003 : faisons-nous mieux qu’avant ? Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72086-4] [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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20
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Kimmoun A, Leheup B, Feillet F, Dubois F, Morali A. Hypercalcémie révélant une hypervitaminose A iatrogène chez un enfant atteint de troubles autistiques. Arch Pediatr 2008; 15:29-32. [DOI: 10.1016/j.arcped.2007.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
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21
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Dupont C, Leluyer B, Maamri N, Morali A, Joye JP, Fiorini JM, Abdelatif A, Baranes C, Benoît S, Benssoussan A, Boussioux JL, Boyer P, Brunet E, Delorme J, François-Cecchin S, Gottrand F, Grassart M, Hadji S, Kalidjian A, Languepin J, Leissler C, Lejay D, Livon D, Lopez JP, Mougenot JF, Risse JC, Rizk C, Roumaneix D, Schirrer J, Thoron B, Kalach N. Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr 2005; 41:625-33. [PMID: 16254521 DOI: 10.1097/01.mpg.0000181188.01887.78] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [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: 12/10/2022]
Abstract
OBJECTIVES To assess the safety of a polyethylene glycol (PEG) 4000 laxative without additional salts in pediatric patients. STUDY DESIGN This was a 3-month multicenter, randomized, double-blind, double-dummy, lactulose-controlled, parallel study enrolling 96 ambulatory constipated children aged 6 months to 3 years, treated daily with 4-8 g PEG or 3.33 g-6.66 g lactulose. Total protein, albumin, iron, electrolytes, and vitamins B9 (folates), A and D (25OHD3) were measured in blood before and after treatment (day 84) in a central laboratory. RESULTS The percentage of children with at least one value out of normal range at day 84 with respect to baseline status (with or without at least one value out of normal range), i.e. the primary endpoint, was 87% and 90% in the PEG and lactulose groups, respectively, without any difference between groups. The whole blood parameters showed no qualitative or quantitative treatment-related changes. Vitamin A values were above normal range in 56% and 41% of children at baseline versus 33% and 36% at day 84 in the PEG and lactulose groups, respectively. Iron values were similarly under normal range in 47% and 51% at baseline versus 42% and 51% at day 84. Clinical tolerance was similar for both treatments except for vomiting and flatulence, which were significantly higher with lactulose. Significantly higher improvements were evidenced with PEG regarding stool consistency, appetite, fecaloma and use of additional laxatives. CONCLUSION This 3-month study in 96 constipated children aged 6 months to 3 years confirms the long-term tolerance of PEG 4000 in pediatrics and indicates a PEG efficacy similar to or greater than that of lactulose.
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Affiliation(s)
- Christophe Dupont
- Hôpital Saint-Vincent-de-Paul, Service de Néonatologie, Paris, France.
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22
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Lamireau T, Cézard JP, Dabadie A, Goulet O, Lachaux A, Turck D, Maurage C, Morali A, Sokal E, Belli D, Stoller J, Cadranel S, Ginies JL, Viola S, Huet F, Languepin J, Lenaerts C, Bury F, Sarles J. Efficacy and tolerance of infliximab in children and adolescents with Crohn's disease. Inflamm Bowel Dis 2004; 10:745-50. [PMID: 15626892 DOI: 10.1097/00054725-200411000-00008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [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: 01/06/2023]
Abstract
Infliximab, a monoclonal antibody against tumor necrosis factor-alpha, has been shown to be effective for the treatment of refractory Crohn's disease in adult patients, but experience in pediatrics is limited. This retrospective study included 88 children and adolescents, 39 girls and 49 boys, with a median age of 14 years (range 3.3-17.9). Infliximab was indicated for active disease (66%) and/or fistulas (42%) that were refractory to corticosteroids (70%), and/or other immunosuppressive (82%) agents, and/or parenteral nutrition (20%). Patients received 1 to 17 infusions (median 4) of 5 mg/kg (range 3.8-7.3) of infliximab during a median time period of 4 months (1-17 months). Infusion reaction was noted in 13 patients (15%), with a total of 16 reactions in 450 infusions (4%). At Day 90 after the first infusion of infliximab, symptoms improved in 49% of patients, whereas 29% of patients were in remission and 13% of patients relapsed. From Day 0 to Day 90, Harvey-Bradshaw score decreased from 7.5 to 2.8 (P < 0.001), C-reactive protein from 36 to 16 mg/L (P < 0.01), and 1-hour erythrocyte sedimentation rate from 35 to 17 mm (P < 0.01). Dosage of corticosteroids decreased from to 0.59 to 0.17 mg/kg/d (P < 0.001); 53% of patients could be weaned of corticosteroids and 92% of parenteral nutrition. Treatment with infliximab is well tolerated and effective in most children and adolescents with Crohn's disease that is refractory to conventional immunosuppressive therapy. Nevertheless, long-term efficacy remains to be shown, and further studies are urgently needed to precisely determine the best modality of continuing treatment.
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Affiliation(s)
- Thierry Lamireau
- Unité de Gastroentérologie Pédiatrique, Hôpital des Enfants, Place Amélie Raba Léon, Cedex, France.
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Maria M, Lachauz A, Dabadie A, Roman C, Campeoto F, Maurage C, Fischbach M, Cezard J, Digeon B, Abely M, Prudent M, Molitor G, Amaud-Battandier F, Morali A. P3 Gastro-entérologie - Nutrition Evaluation de la prescription d'un melange nutritionnel riche en TGF béta dans la maladie de crohn (MC) de l'enfant 62 CAS. Arch Pediatr 2003. [DOI: 10.1016/s0929-693x(03)90517-3] [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: 10/26/2022]
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Donnais V, Salmon A, Walesch J, Vanier M, Feillet F, Vidailhet M, Morali A. P7 Gastro-entérologie - Nutrition Hepatomegalie et cytolyse hepatique revelant une maladie de niemann-pick (N.P.) de type A: A propos de 2 CAS. Arch Pediatr 2003. [DOI: 10.1016/s0929-693x(03)90521-5] [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: 10/26/2022]
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Mougenot JF, Faure C, Olives JP, Chouraqui JP, Codoner P, Gottrand F, Jacquemin E, Lenaerts C, Maherzi A, Morali A, Mouterde O, Roy P, Sarles J, Scaillon M, Tounian P. [Recommendations of the French Hepatology, Gastroenterology and Pediatric Nutrition Group. Current indications for digestive system endoscopy in children]. Arch Pediatr 2002; 9:942-4. [PMID: 12387178 DOI: 10.1016/s0929-693x(02)00041-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J F Mougenot
- Service de Gastroentérologie Pédiatrique, Hôpital Robert Debré, 48, boulevard Sérurier, 75935 Paris, France.
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Morali A, Vidailhet M. [Current topics in pediatric nutrition]. Arch Pediatr 2002; 9:726-32. [PMID: 12162162 DOI: 10.1016/s0929-693x(01)00974-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As main current topics in pediatric nutrition we have considered the results of the continuing research on the long term consequences of fetal malnutrition and intra-uterine growth retardation with the concept of metabolic imprinting leading to chronic disease in adulthood, the progresses of knowledge in the fields of iron metabolism and regulatory mechanisms of satiety, hunger and energetic balance, a better determination of recommended docosahexanoic and arachidonic acids intake in the first months of life for premature and term infants, and the studies on probiotics and prebiotics utilization for preventive and curative purposes. The concerns about vitamin D insufficiency in France have markedly decreased with the generalization ten years ago of cholecalciferol supplementation of infant formula, and more recently the authorization of dairy products supplementation. On the contrary the problem of iron deficiency in young children remains, as well as two major nutritional concerns: the very low percentage of breast-fed infants and the dramatic increase of childhood obesity which affects presently 14% of 10 year old children versus 5% in 1980.
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Affiliation(s)
- A Morali
- Service de médecine infantile 3 et de génétique clinique, hôpital d'Enfants, rue du Morvan, 54511 Vandoeuvre-Les-Nancy, France
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Lacaille F, Micali N, Lachaux A, Morali A, Sarles J, Rieu D, Chouraqui JP, Maurage C, Gottrand F. [Treatment of chronic hepatitis C with interferon in children]. Arch Pediatr 2002; 9:339-40. [PMID: 11938548 DOI: 10.1016/s0929-693x(01)00773-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Morali A. [Celiac disease: clinical and subclinical forms]. Allerg Immunol (Paris) 2002; 34:100-2. [PMID: 12012789] [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: 02/25/2023]
Abstract
Coeliac disease is an intolerance to gluten that classically produces a chronic diarrhoea with a picture of malabsorption and a total villous atrophy. These elements regress completely in a sequential way under a prolonged strict gluten-free diet. The progress registered in the understanding of this affection depends on the individualization of the atypical forms (delayed isolated stature, constipation...) of asymptomatic forms thanks to the study of specific antibodies (anti-gliadin, anti-endomysium, and more recently anti-transglutaminase). The auto-immune nature of coeliac disease is well established. The diagnostic criteria are simplified allowing the commencement of a gluten-free diet which must be perfectly detailed. Finally, allergy to wheat flour merits individualization in the framework of coeliac disease (cf. article).
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Affiliation(s)
- A Morali
- Hôpital d'Enfants, CHU Nancy-Brabois, Allée du Morvan, 54500 Vandoeuvre-les-Nancy
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Stoll C, Morali A, Leheup B, Lucron H. Extrahepatic biliary atresia with laterality sequence anomalies. Genet Couns 2002; 12:157-61. [PMID: 11491311] [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: 02/21/2023]
Abstract
The patient was the first child of first cousin parents. He was born at term after an uneventful pregnancy with normal height, weight and head circumference. Jaundice appeared at 15 days of age. Ventricular septal defects and valvular pulmonary stenosis were diagnosed. An hepatic workup revealed extrahepatic biliary atresia and abdominal situs inversus. Hepatic biopsy showed cirrhosis with intrahepatic cholestasis. Genetic factors are suggested in extrahepatic biliary atresia. Analysis of segregation patterns suggested the existence of two major groups, one with various combinations of anomalies within the laterality sequence and the other with one or two anomalies mostly involving the cardiac, gastrointestinal, and urinary systems. This patient belongs to the first group.
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Affiliation(s)
- C Stoll
- Service de Génétique Médicale, Centre Hospitalo-Universitaire, Steasbourg, France.
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Gottrand F, Kalach N, Spyckerelle C, Guimber D, Mougenot JF, Tounian P, Lenaerts C, Roquelaure B, Lachaux A, Morali A, Dupont C, Maurage C, Husson MO, Barthélemy P. Omeprazole combined with amoxicillin and clarithromycin in the eradication of Helicobacter pylori in children with gastritis: A prospective randomized double-blind trial. J Pediatr 2001; 139:664-8. [PMID: 11713443 DOI: 10.1067/mpd.2001.118197] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [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: 12/17/2022]
Abstract
OBJECTIVES The aim of this multicenter prospective, randomized, double-blind study was to assess the efficacy of the combination of omeprazole, amoxicillin, and clarithromycin (OAC) for the treatment of Helicobacter pylori gastritis in children. STUDY DESIGN Seventy-three children with dyspeptic symptoms were included in the trial (mean age 10.8 years; range, 3.3 to 15.4). Patients were randomized to receive OAC or amoxicillin and clarithromycin (AC) for 7 days. H pylori status was assessed before and 4 weeks after eradication treatment, by use of the carbon 13-labeled urea breath test. RESULTS In intent-to-treat analysis (n = 63), eradication rates were 74.2% (95% CI, 58.7 to 89.6) in the OAC group and 9.4% (95% CI, 0 to 19.5) in the AC group. In per-protocol analysis (n = 53), the eradication rate increased to 80% (95% CI, 64.3 to 95.7), remaining significantly higher than in AC group (10.7%; 95% CI, 0 to 22.2). Resistance of strains to clarithromycin was rare (3/39 = 7.7%) and was not associated with failure of treatment. Adverse events were reported in 24.6% of patients and remained mild. CONCLUSION This study shows that 1-week OAC triple therapy results in successful eradication of H pylori in 75% of children with gastritis.
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Affiliation(s)
- F Gottrand
- Department of Paediatrics, Jeanne de Flandre Hospital, Lille, France
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31
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Viola S, Benlian P, Morali A, Dobbelaere D, Lacaille F, Rieu D, Ginies JL, Maurage C, Meyer M, Lachaux A, Larchet M, Lenearts C, Goulet O, Sarles J, Mouterde O, Girardet JP. Apolipoprotein B Arg3500Gln mutation prevalence in children with hypercholesterolemia: a French multicenter study. J Pediatr Gastroenterol Nutr 2001; 33:122-6. [PMID: 11568510 DOI: 10.1097/00005176-200108000-00005] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Familial defective apolipoprotein B-100, a dominantly inherited form of hypercholesterolemia caused by a single Arg3500Gln mutation, is silent in childhood but may confer a high risk of cardiovascular disease in adulthood. The objective was to determine the prevalence of familial defective apolipoprotein B-100 in hypercholesterolemic French children and to provide a basis for targeting screening efforts in this population. METHODS One hundred ninety children attending 13 pediatric clinics distributed throughout France were included based on the presence of type IIa hypercholesterolemia with a plasma low-density lipoprotein-cholesterol level of more than 130 mg/dL. The Arg3500Gln mutation was detected in dried blood spots using a polymerase chain reaction assay combined with enzymatic restriction. RESULTS Three hyperlipidemia phenotypes were found: monogenic dominant pure hypercholesterolemia (n = 117), polygenic hypercholesterolemia (n = 43), and combined hyperlipidemia (n = 11). Three unrelated children were heterozygous for the Arg3500Gln mutation; all three had monogenic dominant pure hypercholesterolemia (3/94 families; 3.2%), yielding a prevalence of 1.83% (3/164) in hypercholesterolemic children, which is similar to prevalences reported in European adults. CONCLUSIONS The familial defective apolipoprotein B-100 mutation was common (1/31) in children with a phenotype of familial hypercholesterolemia, supporting screening in this population with the goal of preventing premature cardiovascular events.
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Affiliation(s)
- S Viola
- Department of Pediatric Gastroenterology and Nutrition, Armand-Trousseau Children's Teaching Hospital, Paris, France
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32
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Cézard JP, Duhamel JF, Meyer M, Pharaon I, Bellaiche M, Maurage C, Ginies JL, Vaillant JM, Girardet JP, Lamireau T, Poujol A, Morali A, Sarles J, Olives JP, Whately-Smith C, Audrain S, Lecomte JM. Efficacy and tolerability of racecadotril in acute diarrhea in children. Gastroenterology 2001; 120:799-805. [PMID: 11231932 DOI: 10.1053/gast.2001.22544] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [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: 12/02/2022]
Abstract
BACKGROUND & AIMS Oral rehydration therapy is the only treatment recommended by the World Health Organization in acute diarrhea in children. Antisecretory drugs available could not be used because of their side effects, except for racecadotril, which is efficient in acute diarrhea in adults. METHODS The efficacy and tolerability of racecadotril (1.5 mg/kg administered orally 3 times daily) as adjuvant therapy to oral rehydration were compared with those of placebo in 172 infants aged 3 months to 4 years (mean age, 12.8 months) who had acute diarrhea. The treatment groups were comparable in terms of age, duration of diarrhea, number of stools, and causative microorganism at inclusion. RESULTS During the first 48 hours of treatment, patients receiving racecadotril had a significantly lower stool output (grams per hour) than those receiving placebo. The 95% confidence interval was 43%-88% for the full data set (n = 166; P = 0.009) and 33%-75% for the per-protocol population (n = 116; P = 0.001). There was no difference between treatments depending on rotavirus status. Significant differences between treatment groups were also found after 24 hours of treatment: full data set (n = 167; P = 0.026) and per-protocol population (n = 121; P = 0.015). Tolerability was good in both groups of patients. CONCLUSIONS This study demonstrates the efficacy (up to 50% reduction in stool output) and tolerability of racecadotril as adjuvant therapy to oral rehydration solution in the treatment of severe diarrhea in infants and children.
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Affiliation(s)
- J P Cézard
- Pediatric Gastroenterology Unit, Paris, France.
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Baudon JJ, Dabadie A, Cardona J, Digeon B, Giniés JL, Larchet M, Le Gall C, Le Luyer B, Lenaerts C, Maurage C, Merlin JP, Morali A, Mougenot JF, Mouterde O, Olives JP, Rieu D, Schmitz J. [Incidence of symptomatic celiac disease in French children]. Presse Med 2001; 30:107-10. [PMID: 11225478] [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: 02/19/2023] Open
Abstract
OBJECTIVE The study was carried out by the GFHGNP to determine the annual incidence of symptomatic celiac disease in children. PATIENTS AND METHODS The diagnostic criteria were: symptomatic patients diagnosed under 15 years of age during 1996, villous atrophy and positivity of antigliadin and/or other antibodies. Cases were collected from referral centers, general hospital pediatric departments and private pediatricians with endoscopic practice. RESULTS The study involved roughly half of the French pediatric population in 41 out of the 95 French districts. In all, 124 patients were collected: 76 girls and 48 boys. By geographical areas, in 30 districts where collection of data was complete which counted 186,285 births, the yearly incidence varied from 1/1731 births to 1/3110. (0.57@1000 to 0.32@1000). On the whole there were 77 cases i.e. an annual incidence of 1/2419 or 0.41@1000 (confidence interval 95%: 0.32 to 0.50@1000). Lower incidences were observed in the district of Paris: 1/4865 (0.21@1000) and Lyon: 1/3310 (0.27@1000). Those lower incidences could be explained by the difficulties of collecting the data in the biggest urban areas. The first signs occurred before one year of age in 73% of the cases, during the second year of life in 20.5% and after 3 in only 6.5%. The diagnosis was made before 2 years of age in 77% of the cases and after 3 in only 13%. In order of frequency symptoms were: failure to thrive (80%), diarrhea (59%), anorexia (59%), abdominal distension (57%), weight under 2 standard deviations (43%), short stature (43%). CONCLUSION Compared with previous studies in two French districts between 1975 and 1990, the annual incidence of symptomatic celiac disease in children appears to be on the rise. The usual clinical signs continue to be observed.
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Affiliation(s)
- J J Baudon
- Hôpital d'Enfants Armand-Trousseau, 26, avenue du Dr Arnold-Netter, F 75571 Paris.
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34
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Diouf S, Morali A. [Chronic hepatitis C in children after perinatal infection]. Dakar Med 2001; 46:16-9. [PMID: 15773149] [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: 05/02/2023]
Abstract
This retrospective study was carried out in the "Medecine Infantile 3 et Genetique" service at Brabois University Hospital in Nancy (France). We collected 14 cases of chronic hepatitis C following perinatal infection via mother to child transmission (group 1: 5 cases) and blood transfusion (group 2: 9 cases). The mean age of patients at the time of first serological screening test was 9.1+/-4.7 years. In 12 cases, the screening test was performed in view of the mother seropositivity or a personal history of perinatal blood transfusion. Only two patients presented with hepatomegaly. ELISA3 test was positive in all patients. With RIBA3 test, antibody to hepatitis C core antigen was absent in one patient while antibody anti-NS3 was present in all of the cases. The mean level of serum transaminase SGPT was 1.9+/-0.9 N in group 1 patients (mother to child transmission) versus 1.4+/-0.7 N in group 2 patients (blood transfusion). In 9 cases out of 14, hepatocytolysis was variable with SGPT levels around 2 N. Total mean Knodell was 3+/-4.1 in the group 1 versus 4.6 + 2.6 in group 2. Using the Metavir score, the mean activity was found to be 0.5+/-0.1 in group 1 versus 1+/-0.6 in group 2, while the mean level of fibrosis in the two groups was 0.3+/-0.5 and 0.7+/-0.1 respectively. On the whole, this study shows that chronic hepatitis C following perinatal infection is commonly asymptomatic, with mild histological changes not relating to the level of hepatocytolysis.
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Affiliation(s)
- S Diouf
- Service de Pédiatrie - Hôpital Aristide Le Dantec - Dakar (Sénégal)
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35
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Abstract
BACKGROUND The dual capacity of stomach tissue to secrete acid and to respond to secretagogues is indicative of the terminal stages of gastric functional maturation. In this study 6- to 10-week-old human fetal stomachs xenografted into nude mice were used to study parietal cells' functional maturation. METHODS Thirty-four transplants were microsurgically grafted either inside a pouch created on the nude peritoneum (n = 15) or on the host stomach and esophagus (n = 19). The mucosa of transplanted tissues was analyzed by immunohistochemical techniques to detect gastric cells. Gastric cell secretions were collected before and after pentagastrin or omeprazole treatment. RESULTS Parietal, G, and D cells were detected immunohistochemically only after 1 month of grafting. All xenografts actively secreted acid after 1 or 2 months' transplantation at each graft site. Acid secretion was significantly stimulated by intraperitoneally injected pentagastrin (mean pH +/- SD, 3.2 +/- 0.7 vs. 2.0 +/- 0.5; n = 10, P = 0.005) and was dramatically inhibited by intragastrically administered omeprazole (2.3 +/- 0.6 vs. 6.5 +/- 0.7; n = 15, P = 0.0007) after 5 hours. CONCLUSION Stomach xenografts were able to develop normally. Parietal cells were physiologically mature with functional proton pumps and active gastrin receptors, as demonstrated after omeprazole and pentagastrin treatment, respectively. Because stomach xenografts matured very rapidly, it is possible that a stomach xenograft model can be used for further studies on the functional maturation of human gastric epithelial cells, as well as the factors that influence this maturation in humans.
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Affiliation(s)
- F Muhale
- Laboratoire de Microchirurgie Expérimentale, Faculté de Médecine de Nancy, Vandoeuvre-lès-Nancy, France
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Namour F, Morali A, Ilardo C, Abballe X, Maury F, Guéant JL. Comparison between serum alpha-glutathione S-transferase and aminotransaminases in detecting cytolysis in hepatitis C-infected children. J Pediatr Gastroenterol Nutr 1999; 28:534-7. [PMID: 10328133 DOI: 10.1097/00005176-199905000-00019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 01/10/2023]
Abstract
BACKGROUND alpha-Glutathione S-transferase (alphaGST) has been proposed as a more sensitive indicator than serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in detecting hepatocellular damage due to chronic hepatitis C virus (HCV) infection. METHODS The accuracy of alpha-GST was compared with that of ALT and AST in detecting cytolysis in 103 blood samples issued from 31 children positive for HCV RNA. RESULTS alpha-GST had a lower sensitivity than ALT or AST (32% vs. 54.4% for each aminotransferase). The sensitivity of ALT and/or AST was 60.2%, whereas that of ALT and/or alpha-GST and AST and/or alpha-GST was lower (58.3% and 57.3%, respectively). Among 41 serum samples with negative ALT and AST, only 2 had positive alpha-GST, whereas alpha-GST failed to detect cytolysis in 31 samples with elevated ALT and/or AST. No correlation was found between alpha-GST, ALT, or AST and the Knodell score. CONCLUSIONS The combination of ALT with AST is actually the best compromise in detecting cytolysis in untreated HCV-infected patients.
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Affiliation(s)
- F Namour
- Laboratoire de Biochimie des Protéines, Centre Hospitalier Universitaire de Nancy-Brabois, Vandoeuvre, France
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Ezzahir N, Cuzzi J, Morali A, Feillet F, Monin P, Vidailhet M. Interet de l'octreotide dans la prise en charge des hypoglycemies par hyperinsulinisme du nouveau-ne. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81744-8] [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: 11/24/2022]
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Viola S, Benlian P, Morali A, Dobbelaere D, Lacaille F, Rieu D, Ginies J, Maurage C, Meyer M, Lachaux A, Larchet M, Goulet O, Sarles J, Mouterde O, Girardet J. Prevalence de la Deficience Familiale En Apolipoproteine B100 Chez les Enfants Hypercholesterolemiques. Une Etude Multicentrique Franaise. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81528-0] [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: 10/25/2022]
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39
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Morali A. [Gastrointestinal hemorrhages in children]. Rev Prat 1998; 48:411-5. [PMID: 9781097] [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
Gastrointestinal bleeding is not rare in paediatric practice. Always impressive to the surrounding family, they reveal an underlying affection (portal cavernous haemangioma, ulcer) or complicate a progressing disease (oesophagitis, varix). Gastrointestinal endoscopy should be made rapidly in a paediatric setting. The main causes are: before 2 years of age and over 7 years, peptic oesophagitis; from 2 to 7 years, acute lesions of the gastroduodenal mucous membrane and ulcers. Lower tract bleeding (melaena or rectal bleeding) is mainly due to anal fissures, polyps, severe inflammatory colitis and enterocolitis.
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Affiliation(s)
- A Morali
- Médecine infantile 3 et génétique clinique Hôpital d'enfants CHU Nancy-Brabois, Vandoeuvre-lès-Nancy
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40
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Namour F, Morali A, Ilardo C, Aimone-Gastin I, Guéant JL, Vidailhet M. Évaluation de l'α-glutathione-S-transférase plasmatique comme marqueur de la cytolyse hépatique chez l'enfant. Arch Pediatr 1998. [DOI: 10.1016/s0929-693x(97)86901-1] [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: 10/18/2022]
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41
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Cézard J, Duhamel J, Meyer M, Pharaon I, Bellaiche M, Maurage C, Ginies J, Vaillant J, Girardet J, Lamireau P, Pujol A, Morali A, Sarles J, Olive J, Besnard M, Berard H, Lecomte J. Efficacité et tolérance de l'acétorphan dans le traitement des diarrhées aiguës de l'enfant. Étude multicentrique en double aveugle. Arch Pediatr 1996. [DOI: 10.1016/s0929-693x(96)89571-6] [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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Cézard J, Moutarde O, Morali A, Turck D, Lenaerts C, Girardet J, Belli D, Maurage C, Lachau A, Schmitz J, Vandenplas Y, Mary J, Munck A, Navarro J. Traitement d'entretien par la mésalamine (Pentasa®) dans la maladie de Crohn de l'enfant au décours d'une poussée. Étude multicentrique randomisée en double aveugle. Arch Pediatr 1996. [DOI: 10.1016/s0929-693x(96)89622-9] [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: 12/01/2022]
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43
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Vidailhet M, Favre E, Tricoire M, Paganessi V, Martin J, Saillour C, Morali A, Laine I. Impact d'une éducation nutritionnelle en collège d'enseignement secondaire (CES). Arch Pediatr 1996. [DOI: 10.1016/s0929-693x(96)89559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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44
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Morali A, Steschenko D, Bordigoni P, Chastagner P, Krier MJ, André JL, Lefacu A, Sommelet D, Vidailhet M. Hepatite chronique c chez l'enfant: Epidemiologie et evolution (46 cas). Arch Pediatr 1996. [DOI: 10.1016/0929-693x(96)86124-0] [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: 11/16/2022]
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45
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Olives JP, Baudon JJ, Dabadie A, Fontaine JL, Lamireau T, Morali A, Rieu D, Sarles J, Schmitz J, Touhami M. [Antigliadin, antireticulin, antiendomysium antibodies: value in the diagnosis and follow-up of celiac disease in children]. Arch Pediatr 1994; 1:181-5. [PMID: 7987448] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In recent years, the clinical spectrum of coeliac disease has changed and forms with mild aspecific symptoms are today frequent. Therefore many infants are submitted to jejunal biopsy in order to exclude coeliac disease or to allow an early diagnosis. This has led to a search for a simple and reliable diagnostic test of coeliac disease in order to limit the use of jejunal biopsy. Recent data suggest that the study of serum antigliadin, antireticulin and antiendomysium antibodies may possibly play the role. In this paper the working group on coeliac disease of the Groupe Francophone de Gastroentérologie et Nutrition Pédiatriques expresses its view on the place of the dosages of these antibodies in the diagnosis and follow up procedures of coeliac disease in infants and children. At the present time, although it allows a simplification of the procedures, these dosages are presently not sufficiently reliable to serve as a substitute of jejunal biopsy.
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Affiliation(s)
- J P Olives
- Service de médecine infantile D, CHU Purpan, Toulouse, France
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46
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Morali A. Manifestations digestives et nutritionnelles des déficits immunitaires congénitaux et acquis chez l'enfant. NUTR CLIN METAB 1993. [DOI: 10.1016/s0985-0562(05)80195-5] [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: 10/25/2022]
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47
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Le Luyer B, Mougenot JF, Mashako L, Chapoy P, Olives JP, Morali A, Chevallier B, Ginies JL, Dupont C, Dagorne M. [Multicenter study of sodium alginate in the treatment of regurgitation in infants]. Ann Pediatr (Paris) 1992; 39:635-40. [PMID: 1485782] [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: 12/27/2022]
Abstract
An open multicenter study was performed to assess the efficacy and safety of alginic acid in two different dosages in 76 pediatric patients with gastroesophageal reflux confirmed by pH monitoring. Among the 69 patients in whom endoscopy was carried out before treatment, 18 had erythematous esophagitis and 5 had erosive esophagitis. Irrespective of the dosage used, the frequency of regurgitation and vomiting decreased significantly (p < 0.00001 and p = 0.01, respectively). Clinical and biochemical tolerance were outstanding and no adverse effects were recorded. On the basis of these data, the recommended dosage is 1 to 2 ml/kg/day in divided doses after meals.
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Affiliation(s)
- B Le Luyer
- Département de Pédiatrie, Centre Hospitalier, Le Havre
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Sphakianaki E, Tsouderos I, Morali A, Kokkas B, Papadopoulos K, Kotoula M, Paradelis A. Interactions between digitoxin and some antiarrhythmic drugs. Methods Find Exp Clin Pharmacol 1992; 14:355-60. [PMID: 1513190] [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: 12/27/2022]
Abstract
In the present study the pharmacokinetic interactions between digitoxin and the antiarrhythmic drugs amiodarone, mexiletine and propafenone have been examined. Experiments were performed on rabbits in which serum digitoxin concentration was used as indicator to detect drug interactions. The radioimmunoassay "Coat-A-Count" procedure of DPC was used for the quantitative measurement of digitoxin. It was determined that in order to achieve a considerable level of serum digitoxin, it was necessary to administer a multiple dose rather than the one tolerated by humans. It was also observed that serum contained digitalis like immunoreactive factor(s) (DLIF) measured as digitoxin. The mean (+/- SE) digitoxin equivalent value of the DLIF, measured by the "Coat-A-Count" radioimmunoassay in the serum of rabbits (n = 34) was 4.15 +/- 0.059 ng/ml. Each of the three antiarrhythmic drugs increased serum digitoxin levels; its values were almost double in relation to the control group where only digitoxin was administered. This increased digitoxin value was detected one hour after administration of the first dose of the antiarrhythmic drug and remained at a higher level than that of the control group for 6-8 hours. Rabbits given a single high dose of digitoxin and some of the antiarrhythmic drugs and those given a small dose of digitoxin for only four days, presented a retrogressive increase of digitoxin level in serum 5-6 days later. This mechanism needs to be further investigated.
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Affiliation(s)
- E Sphakianaki
- Department of Pharmacology, Medical Faculty, Aristotelian University of Thessaloniki, Greece
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Le Luyer B, Mougenot JF, Mashako L, Chapoy P, Olives JP, Morali A, Chevallier B, Ginies JL, Dupont C, Dagorne M. [Pharmacologic efficacy of sodium alginate suspension on gastro-esophageal reflux in infants and children]. Arch Fr Pediatr 1990; 47:65-8. [PMID: 2322080] [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: 12/31/2022]
Abstract
Eighty-three children presenting with symptomatic gastro-esophageal reflux (GER) (48 males, 35 females, aged 15 days to 57 months (mean = 7 months) were assessed by pH monitoring. All showed acid pathological GER on the 3 hours post-prandial esophageal pH measurement (% of time at pH less than 4 greater than 4.2) and all had a second pH measurement within the following 3 hours after intake of a single (5 ml) dose of sodium alginate (AGS). AGS administration was followed by a highly significant reduction (p less than 0.00001) of all pH measurement variables: a) Percentage of time spent at pH less than 4 returned to normal with a mean 11.7% to 4.8%; that is a 52.5% improvement (median); b) Total number of reflux reduced on average from 8.9 to 5.0: that is a 35% improvement (median); c) Mean duration of reflux reduced on average for 4 to 2 min; that is a 60% improvement (median). In 76 patients hourly monitoring of % of time spent at pH less than 4 shows that hourly improvement persists.
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Affiliation(s)
- B Le Luyer
- Services de: Gastro-Entérologie pédiatrique, Centre Hospitalier, Le Havre
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Chastagner P, Morali A, Trechot JP, May I, Vidailhet M. [Allergy to mercurothiolate in an infant during heparinization of an intracaval catheter]. Presse Med 1988; 17:795-6. [PMID: 2968567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A 4-month old infant developed an immediate and proven systemic allergic reaction to mercurothiolate. The acute accident occurred while an intracaval catheter was being treated with a dry-frozen heparin which excipient contains mercurothiolate. This conservative agent is present in numerous pharmaceutical preparations for topical and systemic use.
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Affiliation(s)
- P Chastagner
- Service de Médecine infantile 3, CHRU de Brabois, Vandoevre
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