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Kounis I, Renou C, Nahon S, Heluwaert F, Macaigne G, Amil M, Talom S, Lambare B, Charpignon C, Paupard T, Stetiu M, Ripault MP, Yamaga A, Ehrhard F, Audemar F, Ortiz Correro MC, Zanditenas D, Skinazi F, Agostini H, Coilly A, Roque-Afonso AM. Hepatitis E Virus Infection in Patients with Chronic Inflammatory Bowel Disease Treated with Immunosuppressive Therapy. Pathogens 2023; 12:pathogens12020332. [PMID: 36839604 PMCID: PMC9966788 DOI: 10.3390/pathogens12020332] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Medical treatment of inflammatory bowel disease (IBD) has evolved significantly, and treatment with immunomodulators is recommended. These medications may alter the patient's immune response and increase the risk of opportunistic infections. Our aim was to evaluate the prevalence and the incidence of acute or chronic HEV infection in IBD patients under immunomodulatory treatment. PATIENTS AND METHODS We conducted a retrospective, multicenter, observational study between 2017 and 2018. IBD outpatients hospitalized for the infusion of immunomodulators were included in 16 French centers. During their daily hospitalization, blood samples were drawn for HEV serology (IgM and IgG) and HEV RNA detection. RESULTS A total of 488 patients were included, of which 327 (67%) patients had Crohn's disease and 161 (33%) ulcerative colitis. HEV IgM was detected in 3 patients, but HEV RNA was undetectable in all patients. The HEV IgG seroprevalence rate was 14.2%. IgG-positive patients were older at sampling (p = 0.01) and IBD diagnosis (p = 0.03), had higher seafood consumption (p = 0.01) and higher doses of azathioprine (p = 0.03). Ileal and upper digestive tract involvement was more frequent in IgG-positive patients (p = 0.009), and ileocolic involvement was more frequent in IgG-negative patients (p = 0.01). Under multivariate analysis, age > 50 years [OR: 2.21 (1.26, to 3.85), p = 0.004] was associated with previous HEV infection. CONCLUSION Systematic screening for HEV infection is not needed among IBD patients on immunomodulatory medications. However, in the event of abnormal liver test findings, HEV should be part of the classic diagnostic assessment.
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Affiliation(s)
- Ilias Kounis
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, 94800 Villejuif, France
- Inserm, UMR-S 1193, Université Paris-Saclay, 94800 Villejuif, France
- Inserm, Physiopathogénèse et Traitement des Maladies du Foie, Université Paris-Saclay, 94800 Villejuif, France
- FHU Hepatinov, 94805 Villejuif, France
- Correspondence: (I.K.); (A.M.R.-A.)
| | | | - Stephane Nahon
- Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 78515 Le Raincy, France
| | | | - Gilles Macaigne
- Centre Hospitalier Marne-La-Vallée, 77420 Marne La Vallee, France
| | - Morgane Amil
- Centre Hospitalier Departemental Vendée, 85000 La Roche sur Yon, France
| | | | | | | | | | | | | | - Armand Yamaga
- Centre Hospitalier Intercommunal de Poissy-St-Germain-en-Laye, 78100 St-Germain-en-Laye, France
| | | | | | | | | | | | - Helene Agostini
- Clinical Research Unit, Université Paris-Sud, Université Paris-Saclay, 94800 Villejuif, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, 94800 Villejuif, France
- Inserm, UMR-S 1193, Université Paris-Saclay, 94800 Villejuif, France
- Inserm, Physiopathogénèse et Traitement des Maladies du Foie, Université Paris-Saclay, 94800 Villejuif, France
- FHU Hepatinov, 94805 Villejuif, France
| | - Anne Marie Roque-Afonso
- Inserm, UMR-S 1193, Université Paris-Saclay, 94800 Villejuif, France
- Inserm, Physiopathogénèse et Traitement des Maladies du Foie, Université Paris-Saclay, 94800 Villejuif, France
- FHU Hepatinov, 94805 Villejuif, France
- Département de Virologie, AP-HP Hôpital Paul-Brousse, 94800 Villejuif, France
- Correspondence: (I.K.); (A.M.R.-A.)
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Gouriou C, Bouguen G, Lahmek P, Pelaquier A, Arotcarena R, Garioud A, De Montigny-Lenhardt S, Pauwels A, Zanditenas D, Charpignon C, Combes R, Nahon S, Quentin V. Outcomes of upper gastrointestinal bleeding are similar between direct oral anticoagulants and vitamin K antagonists. Aliment Pharmacol Ther 2021; 53:688-695. [PMID: 33400827 DOI: 10.1111/apt.16236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 06/18/2020] [Revised: 07/03/2020] [Accepted: 12/08/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The increased risk of upper gastrointestinal bleeding (UGIB) related to direct oral anticoagulants (DOACs) as compared to vitamin K antagonists (VKA) remains debated. AIMS To describe the epidemiology and outcomes of UGIB in patients treated with oral anticoagulants. METHODS A prospective, multicentre study in French general hospitals enrolled all consecutive patients with UGIB during one year. Patients treated with oral anticoagulants were retrieved from the cohort. Main outcomes were mortality and rebleeding during the first 6 weeks and need for non-endoscopic treatment (surgery or interventional radiology). RESULTS Among the 2498 patients included, 475 (19%) had an oral anticoagulant, mostly with VKA (267 patients [56.2%]). Baseline characteristics were similar between the groups except for renal failure and cirrhosis that were more prevalent in the VKA group. Gastroscopy was normal in 73 patients (15.3%); peptic lesions were the main cause of UGIB (n = 233, 49%). Endoscopic treatment was performed in 128 patients (26.9%), leading to bleeding resolution in 74% (n = 95). Mortality rate at 6 weeks was 12.4% (59 patients), and was higher in the VKA group compared to DOACs (16.1% vs 7.8%, P < 0.01). By multivariate analysis, only the Charlson index ≥ 5 and UGIB occurrring in in-patients were independently associated with mortality. Rebleeding (56 patients [11.8%]) and need for non-endoscopic treatment (18 patients [3.8%]) were not associated with the type of anticoagulant. CONCLUSION DOACs do not alter outcomes of UGIB as compared to VKA. Comorbidities and associated treatment are the most important factors worsening the prognosis of UGIB.
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Dong C, Condat B, Picon-Coste M, Chrétien Y, Potier P, Noblinski B, Arrivé L, Hauuy MP, Barbu V, Maftouh A, Gaouar F, Ben Belkacem K, Housset C, Poupon R, Zanditenas D, Chazouillères O, Corpechot C. Low-phospholipid-associated cholelithiasis syndrome: Prevalence, clinical features, and comorbidities. JHEP Rep 2020; 3:100201. [PMID: 33554096 PMCID: PMC7848766 DOI: 10.1016/j.jhepr.2020.100201] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/18/2020] [Accepted: 10/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background & Aims Low-phospholipid-associated cholelithiasis (LPAC) syndrome, a rare genetic form of intrahepatic cholelithiasis in adults, is still poorly understood. We report the results of the largest-ever case-control study of patients with LPAC syndrome aiming to assess the prevalence, clinical features, and comorbidities of the disease. Methods We included all LPAC cases diagnosed between 2001 and 2016 in 11 French centres. Controls consisted of all patients who underwent a cholecystectomy for common gallstone disease in a single non-academic centre over 1 year. A logistic regression analysis was used to identify the clinical features associated with LPAC syndrome across several patient strata with increasing levels of diagnostic confidence. The ratio between the incident cases of LPAC syndrome and the total number of cholecystectomies for gallstones was used to assess the relative prevalence of the disease. Results In this study, 308 cases and 206 controls were included. LPAC syndrome accounted for 0.5–1.9% of all patients admitted with symptomatic gallstone disease. Age at first symptoms <40 years, absence of overweight, persistence of symptoms after cholecystectomy, intrahepatic micro- or macrolithiasis, common bile duct (CBD) lithiasis, and no history of cholecystitis were independently associated with LPAC diagnosis. ATP-binding cassette subfamily B member 4 (ABCB4) variants, present in 46% of cases, were associated with CBD lithiasis, chronic elevation of gamma-glutamyltransferase (GGT), and personal or family history of hepato-biliary cancer. Conclusions In this case-control study, LPAC syndrome accounted for approximately 1% of symptomatic cholelithiasis in adults. In addition to pre-established diagnostic criteria, normal weight, CBD lithiasis, and no history of cholecystitis were significantly associated with the syndrome. ABCB4 gene variations in patients with LPAC were associated with CBD lithiasis, chronic cholestasis, and a personal or family history of hepato-biliary cancer. Lay summary In the largest case-control study ever conducted in patients with LPAC syndrome, a rare genetic form of intrahepatic cholelithiasis in young adults, LPAC syndrome was found in approximately 1% of all patients admitted to the hospital for symptomatic gallstones and, in addition to the pre-established characteristics of the syndrome (age at first symptoms <40 years, recurrence of symptoms after cholecystectomy, and/or imaging evidence of intrahepatic microlithiasis), was associated with lower BMI, higher prevalence of common bile duct stones, and lower incidence of acute cholecystitis. ABCB4 gene variants, which were detected in about half of cases, were associated with common bile duct stones and a personal or family history of hepato-biliary cancer. Low-phospholipid-associated cholelithiasis (LPAC) syndrome affects approximately 1% of adults with symptomatic cholelithiasis. Normal weight, common bile duct stones, and lack of cholecystitis are clinical features significantly associated with this syndrome. ABCB4 variants in patients with LPAC may be associated with an increased personal or family risk of hepato-biliary cancer.
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Affiliation(s)
- Catherine Dong
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Bertrand Condat
- Division of Gastroenterology and Hepatology, French Polynesia Hospital, Pirae, French Polynesia
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - Magalie Picon-Coste
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Division of Gastroenterology and Hepatology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Yves Chrétien
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Pascal Potier
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Division of Gastroenterology and Hepatology, Orléans Hospital, Orléans, France
| | - Béatrice Noblinski
- Radiology Department, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Lionel Arrivé
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
- Radiology Department, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Véronique Barbu
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
- Molecular Biology and Genetics Laboratory, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Anware Maftouh
- Visceral Surgery Department, Saint-Camille Hospital, Bry-sur-Marne, France
| | - Farid Gaouar
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Karima Ben Belkacem
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
| | - Chantal Housset
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Raoul Poupon
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
| | - David Zanditenas
- Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux de France (ANGH), Montfermeil, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Division of Gastroenterology and Hepatology, Saint-Camille Hospital, Bry-sur-Marne, France
| | - Olivier Chazouillères
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
| | - Christophe Corpechot
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Sorbonne University, Paris, France
- French National Cohort of Patients with LPAC syndrome (RaDiCo-COLPAC), RaDiCo, Inserm U933, Armand Trousseau Hospital, Paris, France
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, Paris, France
- Corresponding author. Address: Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN RARE-LIVER, Saint-Antoine Hospital, Assistance Publique–Hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. Tel.: +33149282836, Fax: +33149282107.
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Pariente A, Arpurt JP, Rémy AJ, Rosa-Hézode I, Causse X, Heluwaert F, Macaigne G, Henrion J, Renou C, Schnee M, Salloum H, Hommel S, Pilette C, Arotcarena R, Barjonet G, Lison H, Bourhis F, Jouannaud V, Pauwels A, Le eaBricquir Y, Geagea E, Condat B, Ripault MP, Zanditenas D, de Montigny-Lenhardt S, Labadie H, Tissot B, Maringe E, Cadranel JF, Hagège H, Lesgourgues B. Hepatitis C treatment with all-oral direct-acting antivirals: Effectiveness and tolerance in a multicenter, prospective, observational study from French general hospitals (APROVVIE, ANGH). Presse Med 2019; 48:e101-e110. [PMID: 30853287 DOI: 10.1016/j.lpm.2018.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND AIMS According to clinical trials, the treatment of patients with chronic hepatitis C (CHC) with second-generation direct acting antiviral agents (DAAs) is highly efficient and well tolerated. The goal of this study was to investigate the effectiveness and safety of various combinations of these drugs during their first 2 years of use in the real-world practice of French general hospitals. METHODS Data from patients treated with all-oral DAAs in 24 French non-academic hospital centers from March 1, 2014 to January 1, 2016, were prospectively recorded. The sustained virological response 12-24 weeks after treatment (SVR 12-24) was estimated and severe adverse events (SAE) were evaluated and their predictive factors were determined using logistic regression. RESULTS Data from 1123 patients were analyzed. The population was 69% genotype (G) 1, 13% G3, 11.5% G4, 5% G2, 49% with cirrhosis and 55% treatment-experienced. The treatment regimens were sofosbuvir/ledipasvir (38%), sofosbuvir/daclatasvir (32%), sofosbuvir/simeprevir (17%), ombitasvir+paritaprevir+ritonavir (5%) (with dasabuvir 3.5%), and sofosbuvir/ribavirin (8%). Ribavirin was given to 24% of patients. The SVR 12-24 was 91.0% (95% CI: 89.2-92.5%). Sofosbuvir-ribavirin was less effective than other regimens. The independent predictors of SVR 12-24 by logistic regression were body weight, albumin, previous hepatocellular carcinoma and treatment regimen (sofosbuvir/ribavirin vs. others). Sixty-four severe adverse events (SAE) were observed in 59 [5.6%] patients, and were independently predicted by cirrhosis and baseline hemoglobin. Serum creatinine increased during treatment (mean 8.5%, [P<10-5]), satisfying criteria for acute kidney injury in 62 patients (7.3%). Patient-reported overall tolerance was excellent, and patient-reported fatigue decreased during and after treatment. CONCLUSIONS Second generation DAAs combinations are as effective and well tolerated in a « real-world » population as in clinical trials. Further studies are needed on renal tolerance.
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Affiliation(s)
- Alexandre Pariente
- Service d'hépatogastroentérologie, centre hospitalier de Pau, 528, route de la Coustète, Calotis, 40240 Mauvezin d' Armagnac, France.
| | - Jean-Pierre Arpurt
- Service d'hépatogastroentérologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - André-Jean Rémy
- Service d'hépatogastroentérologie, centre hospitalier de Perpignan, Perpignan, 66000 France
| | - Isabelle Rosa-Hézode
- Service d'hépatogastroentérologie, centre hospitalier intercommunal de Créteil, 94100 Créteil, France
| | - Xavier Causse
- Service d'hépatogastroentérologie, centre hospitalier régional d'Orléans, 45000 Orléans, France
| | - Frédéric Heluwaert
- Service d'hépatogastroentérologie, centre hospitalier d'Annecy, 74000 Annecy, France
| | - Gilles Macaigne
- Service d'hépatogastroentérologie. centre hospitalier du grand Est parisien, 77600 Jossigny, France
| | - Jean Henrion
- Service d'hépatogastroentérologie, centre hospitalier d'Haine-Saint-Paul, 7100 Haine-Saint-Paul, Belgium
| | - Christophe Renou
- Service d'hépatogastroentérologie, centre hospitalier d'Hyères, 83400 Hyères, France
| | - Matthieu Schnee
- Service d'hépatogastroentérologie, centre hospitalier de La-Roche-sur-Yon, 85000 La-Roche-sur-Yon, France
| | - Hatem Salloum
- Service d'hépatogastroentérologie, centre hospitalier de Meaux, Meaux, 77100 France
| | - Séverine Hommel
- Service d'hépatogastroentérologie, centre hospitalier d'Aix-en-Provence, 13100 Aix-en-Provence, France
| | - Christophe Pilette
- Service d'hépatogastroentérologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - Ramuntxo Arotcarena
- Service d'hépatogastroentérologie, centre hospitalier de Pau, 528, route de la Coustète, Calotis, 40240 Mauvezin d' Armagnac, France
| | - Georges Barjonet
- Service d'hépatogastroentérologie, centre hospitalier de Montélimar, 26200 Montélimar, France
| | - Hortensia Lison
- Service d'hépatogastroentérologie, centre hospitalier de Creil, 60100 Creil, France
| | - François Bourhis
- Service d'hépatogastroentérologie, centre hospitalier de Chambéry, 73000 Chambéry, France
| | - Vincent Jouannaud
- Service d'hépatogastroentérologie, centre hospitalier de Montfermeil, 93370 Montfermeil, France
| | - Arnaud Pauwels
- Service d'hépatogastroentérologie, centre hospitalier de Gonesse, 95500 Gonesse, France
| | - Yann Le eaBricquir
- Service d'hépatogastroentérologie, centre hospitalier de Béziers, 34500 Béziers, France
| | - Edmond Geagea
- Service d'hépatogastroentérologie, centre hospitalier de Cholet, 49280 Cholet, France
| | - Bertrand Condat
- Service d'hépatogastroentérologie, centre hospitalier de Bry-sur-Marne, 94360 Bry-sur-Marne, France
| | - Marie-Pierre Ripault
- Service d'hépatogastroentérologie, centre hospitalier de Béziers, 34500 Béziers, France
| | - David Zanditenas
- Service d'hépatogastroentérologie, centre hospitalier de Bry-sur-Marne, 94360 Bry-sur-Marne, France
| | | | - Hélène Labadie
- Service d'hépatogastroentérologie, centre hospitalier de Saint-Denis, 93200 Saint-Denis, France
| | - Bertrand Tissot
- Service d'hépatogastroentérologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - Eric Maringe
- Service d'hépatogastroentérologie, centre hospitalier de Beaune, 21200 Beaune, France
| | | | - Hervé Hagège
- Service d'hépatogastroentérologie, centre hospitalier intercommunal de Créteil, 94100 Créteil, France
| | - Bruno Lesgourgues
- Service d'hépatogastroentérologie, centre hospitalier de Montfermeil, 93370 Montfermeil, France
| | -
- Service d'hépatogastroentérologie, centre hospitalier de Pau, 528, route de la Coustète, Calotis, 40240 Mauvezin d' Armagnac, France; Service d'hépatogastroentérologie, centre hospitalier d'Avignon, 84000 Avignon, France; Service d'hépatogastroentérologie, centre hospitalier de Perpignan, Perpignan, 66000 France; Service d'hépatogastroentérologie, centre hospitalier intercommunal de Créteil, 94100 Créteil, France; Service d'hépatogastroentérologie, centre hospitalier régional d'Orléans, 45000 Orléans, France; Service d'hépatogastroentérologie, centre hospitalier d'Annecy, 74000 Annecy, France; Service d'hépatogastroentérologie. centre hospitalier du grand Est parisien, 77600 Jossigny, France; Service d'hépatogastroentérologie, centre hospitalier d'Haine-Saint-Paul, 7100 Haine-Saint-Paul, Belgium; Service d'hépatogastroentérologie, centre hospitalier d'Hyères, 83400 Hyères, France; Service d'hépatogastroentérologie, centre hospitalier de La-Roche-sur-Yon, 85000 La-Roche-sur-Yon, France; Service d'hépatogastroentérologie, centre hospitalier de Meaux, Meaux, 77100 France; Service d'hépatogastroentérologie, centre hospitalier d'Aix-en-Provence, 13100 Aix-en-Provence, France; Service d'hépatogastroentérologie, centre hospitalier du Mans, 72000 Le Mans, France; Service d'hépatogastroentérologie, centre hospitalier de Montélimar, 26200 Montélimar, France; Service d'hépatogastroentérologie, centre hospitalier de Creil, 60100 Creil, France; Service d'hépatogastroentérologie, centre hospitalier de Chambéry, 73000 Chambéry, France; Service d'hépatogastroentérologie, centre hospitalier de Montfermeil, 93370 Montfermeil, France; Service d'hépatogastroentérologie, centre hospitalier de Gonesse, 95500 Gonesse, France; Service d'hépatogastroentérologie, centre hospitalier de Béziers, 34500 Béziers, France; Service d'hépatogastroentérologie, centre hospitalier de Cholet, 49280 Cholet, France; Service d'hépatogastroentérologie, centre hospitalier de Bry-sur-Marne, 94360 Bry-sur-Marne, France; Service d'hépatogastroentérologie, centre hospitalier d'Aubagne, 13400 Aubagne, France; Service d'hépatogastroentérologie, centre hospitalier de Saint-Denis, 93200 Saint-Denis, France; Service d'hépatogastroentérologie, centre hospitalier de Beaune, 21200 Beaune, France
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Pariente A, Arpurt JP, Remy AJ, Rosa-Hezode I, Causse X, Heluwaert F, Macaigne G, Henrion J, Renou C, Schnee M, Salloum H, Hommel S, Pilette C, Arotcarena R, Barjonet G, Lison H, Bourhis F, Jouannaud V, Pauwels A, Le-Bricquir Y, Geagea E, Condat B, Ripault MP, Zanditenas D, de Montigny-Lenhardt S, Labadie H, Tissot B, Maringe E, Cadranel JF, Hagege H, Lesgourgues B. Effects of Age on Treatment of Chronic Hepatitis C with Direct Acting Antivirals. Ann Hepatol 2019; 18:193-202. [PMID: 31113590 DOI: 10.5604/01.3001.0012.7912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/16/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Data on the efficacy and tolerance of interferon-free treatment in chronic hepatitis C (CHC) in elderly patients are limited in phase II-III trials. MATERIAL AND METHODS A prospective cohort of adult patients with CHC treated in French general hospitals. RESULTS Data from 1,123 patients, distributed into four age groups, were analyzed. Of these, 278 were > 64 years old (fourth quartile) and 133 were > 73 years old (tenth decile). Elderly patients weighed less, were more frequently treatment-experienced women infected with genotype 1b or 2, while they less frequently had genotype 3 or HIV coinfection, but had more frequent comorbidities and drug consumption. Half of the patients had cirrhosis, whatever their ages. The main treatment regimens were sofosbuvir/ledipasvir (37.8%), sofosbuvir/daclatasvir (31.8%), sofosbuvir/simeprevir (16.9%), sofosbuvir/ribavirin (7.8%); ribavirin was given to 24% of patients. The overall sustained virological response (SVR) rate was 91.0 % (95% CI: 89.292.5%) with no difference according to age. Logistic regression of the independent predictors of SVR were albumin, hepatocellular carcinoma and treatment regimen, but not age. The rate of severe adverse events (66 in 59/1062 [5.6%] patients) tended to be greater in patients older than 64 years of age (21/261,8.1%), but the only independent predictors of SAE by logistic regression were cirrhosis and baseline hemoglobin. Patient-reported overall tolerance was excellent in all age groups, and patient-reported fatigue decreased during and after treatment, independent of age. CONCLUSIONS The high efficacy and tolerance of interferon-free regimens is confirmed in elderly patients in real-life conditions.
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Affiliation(s)
| | | | - Andre-Jean Remy
- Hepatogastroenterology Unit. Centre Hospitalier de Perpignan, France
| | - Isabelle Rosa-Hezode
- Hepatogastroenterology Unit. Centre Hospitalier Intercommunal de Creteil, France
| | - Xavier Causse
- Hepatogastroenterology Unit. Centre Hospitalier Regional d'Orieans, France
| | | | - Gilles Macaigne
- Hepatogastroenterology Unit. Centre Hospitalier de Marne-la-Vallee, France
| | - Jean Henrion
- Hepatogastroenterology Unit. Centre Hospitalier d'Haine-Saint-Paul, Belgium
| | - Christophe Renou
- Hepatogastroenterology Unit. Centre Hospitalier d'Hyeres, France
| | - Matthieu Schnee
- Hepatogastroenterology Unit. Centre Hospitalier de La-Roche-sur-Yon, France
| | - Hatem Salloum
- Hepatogastroenterology Unit. Centre Hospitalier de Meaux, France
| | - Severine Hommel
- Hepatogastroenterology Unit. Centre Hospitalier d'Aix-en-Provence, France
| | | | | | - Georges Barjonet
- Hepatogastroenterology Unit. Centre Hospitalier de Montelimar, France
| | - Hortensia Lison
- Hepatogastroenterology Unit. Centre Hospitalier de Creil, France
| | - Frangois Bourhis
- Hepatogastroenterology Unit. Centre Hospitalier de Chambery, France
| | - Vincent Jouannaud
- Hepatogastroenterology Unit. Centre Hospitalier de Montfermeil, France
| | - Arnaud Pauwels
- Hepatogastroenterology Unit. Centre Hospitalier de Gonesse, France
| | - Yann Le-Bricquir
- Hepatogastroenterology Unit. Centre Hospitalier de Beziers, France
| | - Edmond Geagea
- Hepatogastroenterology Unit. Centre Hospitalier de Cholet, France
| | - Bertrand Condat
- Hepatogastroenterology Unit. Centre Hospitalier de Bry-sur-Marne, France
| | | | - David Zanditenas
- Hepatogastroenterology Unit. Centre Hospitalier de Bry-sur-Marne, France
| | | | - Helene Labadie
- Hepatogastroenterology Unit. Centre Hospitalier de Saint-Denis, France
| | - Bertrand Tissot
- Hepatogastroenterology Unit. Centre Hospitalier du Mans, France
| | - Eric Maringe
- Hepatogastroenterology Unit. Centre Hospitalier de Beaune, France
| | | | - Herve Hagege
- Hepatogastroenterology Unit. Centre Hospitalier Intercommunal de Creteil, France
| | - Bruno Lesgourgues
- Hepatogastroenterology Unit. Centre Hospitalier de Montfermeil, France
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6
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Condat B, Zanditenas D, Barbu V, Hauuy MP, Parfait B, El Naggar A, Collot V, Bonnet J, Ngo Y, Maftouh A, Dugué L, Balian C, Charlier A, Blazquez M, Rosmorduc O. Prevalence of low phospholipid-associated cholelithiasis in young female patients. Dig Liver Dis 2013; 45:915-9. [PMID: 23684896 DOI: 10.1016/j.dld.2013.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 08/28/2012] [Revised: 03/07/2013] [Accepted: 04/03/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We evaluated the prevalence of low phospholipid-associated cholelithiasis, a specific form of cholelithiasis associated with at least 2 of the 3 following criteria: first symptoms before the age of 40; intrahepatic comet tail artefacts, sludge or microlithiasis on ultrasound imaging; and recurrence of symptoms after cholecystectomy. METHODS We prospectively studied the cases of 60 consecutive female patients under 30 with symptomatic cholelithiasis. RESULTS A diagnosis of low phospholipid-associated cholelithiasis was made in 14/60 patients (23%). The molecular analysis showed ABCB4 (n=4) and ABCB11 (n=4) gene mutations. Low phospholipid-associated cholelithiasis was frequently observed in non-overweight patients [13/27 (48%)], was present in most patients whose biliary symptoms occurred before the age of 18 [7/10 (70%)] and was often associated with cholangitis or acute pancreatitis [9/14 (64%), p<0.05] while "common" cholelithiasis was mainly associated with cholecystitis [16/46 (35%), p<0.05]. CONCLUSION Nearly one quarter of the female patients under the age of 30 admitted for symptomatic cholelithiasis had low phospholipid-associated cholelithiasis; particularly if body weight was normal, the symptoms began before the age of 18 or in the presence of severe biliary complications.
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Affiliation(s)
- Bertrand Condat
- Services d'hépato-gastro-entérologie, de radiologie et de chirurgie viscérale, Hôpital Saint-Camille, Bry-sur-Marne, France.
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7
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Zidi SH, Zanditenas D, Gelu-Siméon M, Rangheard AS, Valla DC, Vilgrain V, Pelletier GM. Treatment of chronic portosystemic encephalopathy in cirrhotic patients by embolization of portosystemic shunts. Liver Int 2007; 27:1389-93. [PMID: 18036102 DOI: 10.1111/j.1478-3231.2007.01602.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 02/13/2023]
Abstract
UNLABELLED AIMS/BACKGROUNDS: Large spontaneous portal-systemic shunts can occasionally be the cause of chronic and disabling encephalopathy in cirrhotic patients. Shunt embolization has been proposed, however the clinical relevance of this technique remains uncertain. METHODS/RESULTS We report our results in seven patients treated by shunt embolization. Although the procedure was achieved and technically successful in all patients, the clinical results were poor as long-term improvement was obtained in only one patient. Three patients died within 3 months after the procedure from cirrhoses' end stage complications. CONCLUSION We believe that optimal management of these patients with chronic spontaneous encephalopathy is liver transplantation.
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Affiliation(s)
- Sémia H Zidi
- Hopital Bicetre, Hepatology and Gastroenterology, Le Kremlin-Bicêtre, France
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8
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Condat B, Asselah T, Zanditenas D, Estampes B, Cohen A, O'Toole D, Bonnet J, Ngo Y, Marcellin P, Blazquez M. Fatal cardiomyopathy associated with pegylated interferon/ribavirin in a patient with chronic hepatitis C. Eur J Gastroenterol Hepatol 2006; 18:287-9. [PMID: 16462543 DOI: 10.1097/00042737-200603000-00010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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
We report the case of a 45-year-old man with HCV treated with pegylated interferon-alpha/ribavirin, in whom fatal cardiomyopathy occurred. Cardiomyopathy is a rare complication of high dose of standard interferon but has never been reported with pegylated interferon. The relationship between pegylated interferon-alpha/ribavirin and the development of cardiomyopathy is highly probable for the following reasons: (1) a cardiologist consultation with specific investigations had been performed before treatment excluding a pre-existing cardiomyopathy; (2) symptoms of advanced dilated cardiomyopathy appeared immediately after the end of treatment; (3) other causes of cardiomyopathy have been ruled out. In all except one of the 21 reported cases with standard interferon, cardiomyopathy was reversible. In our patient, fatal cardiomyopathy occurred with a usual dose of pegylated interferon-alpha. Clinicians should be aware of this potential complication when evaluating the ratio benefit/risk of treatment in patients with chronic hepatitis C infection.
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Affiliation(s)
- Bertrand Condat
- Service d'hépato-gastroentérologie, Hôpital Saint-Camille, Bry sur Marne, France.
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9
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Condat B, Zanditenas D, Collot V, Legoupil N, Cazals-Hatem D, Hauuy MP, Bonnet J, Ngo Y, Roucoules J, Blazquez M. Une nouvelle cause de cholangite intra et extra-hépatique : le syndrome d’hypersensibilité médicamenteuse ou DRESS. ACTA ACUST UNITED AC 2006; 30:142-6. [PMID: 16514397 DOI: 10.1016/s0399-8320(06)73131-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
The DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) corresponds to a drug reaction generally including cutaneous eruption, fever, hematologic abnormalities such as eosinophilia and atypical lymphocytosis and one or more specific visceral lesions specially in the liver. We report a case of drug hypersensitivity syndrome or DRESS associated with intra and extra-hepatic biliary lesions. This syndrome was associated with sulfasalazine and naproxene therapy. A reactivation of HHV6 was documented in the continuations of the DRESS and could play a role in the symptomms.
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Affiliation(s)
- Bertrand Condat
- Services d'Hépato-Gastroentérologie, Hôpital Saint-Camille, Bry-sur-Marne.
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10
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Condat B, Dugué L, Zanditenas D, Gornet JM, Chouaïb S, Hauuy MP, Collot V, Diche T, Maftouh A, Benoist S, Valla D, Charlier A, Blazquez M. Difficultés du diagnostic d’appendicite aiguë en cas de thrombose portale aiguë : apport du scanner. Gastroentérologie Clinique et Biologique 2005; 29:1291-3. [PMID: 16518291 DOI: 10.1016/s0399-8320(05)82225-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute appendicitis can cause of portal vein thrombosis. Diagnosis of appendicitis can be difficult because its symptoms may be masked by those of acute portal vein thrombosis. We report 2 cases of appendicitis associated with acute portal vein thrombosis whose diagnosis was delayed by several months. The delayed diagnosis of acute appendicitis in the presence of acute portal vein thrombosis can be avoided by using spiral-computed tomography and careful investigation of signs of appendicitis.
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Affiliation(s)
- Bertrand Condat
- Services d'Hépato-Gastroentérologie, Hôpital Saint-Louis, Paris
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11
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Zanditenas D, Hagège H, Rosa I, Cattan P, Ratel-Saby S, Lons T, Chousterman M. Colite inflammatoire et granulomatose septique, à propos d’un cas de cortico-dépendance. ACTA ACUST UNITED AC 2004; 28:398-401. [PMID: 15146157 DOI: 10.1016/s0399-8320(04)94942-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic granulomatous disease may lead to inflammatory bowel disease with endoscopic and histological aspects similar to that observed in patients with Crohn's disease. Inflammatory symptoms are generally controlled by steroids, but resistant forms may need total colectomy. Therapeutic strategy in steroid-dependent cases is not yet established. We report here the case of a patient with chronic granulomatous enteritis dependent on steroids at a daily dose of 20 mg. Azathioprine made it possible to withdraw steroid therapy without relapse over twenty Months and without infectious complication during the follow up.
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Affiliation(s)
- David Zanditenas
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Intercommunal de Créteil
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12
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Nassif T, Zanditenas D, Lazure T, Paterne D, Kuhl E, Buffet C. [Osseous metaplasia in a colonic adenocarcinoma]. Gastroenterol Clin Biol 2003; 27:1035-7. [PMID: 14732851] [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: 04/28/2023]
Abstract
Osseous metaplasia is rare in tumors of the gastrointestinal tract. We report the case of a 76-year-old man presenting with an adenocarcinoma of the transverse colon containing osseous tissue. Calcifications were seen on the abdominal CT-scan. Pathogenesis of the osseous metaplasia is still unknown.
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Affiliation(s)
- Tania Nassif
- Service des Maladies du Foie et de l'Appareil Digestif, CHU de Kremlin Bicêtre.
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13
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Duvoux C, Zanditenas D, Hézode C, Chauvat A, Monin JL, Roudot-Thoraval F, Mallat A, Dhumeaux D. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study. Hepatology 2002; 36:374-80. [PMID: 12143045 DOI: 10.1053/jhep.2002.34343] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.6] [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: 12/14/2022]
Abstract
Treatment of hepatorenal syndromes (HRSs) is currently based on vasopressin analogs. The aim of this pilot study was to evaluate the efficacy and safety of noradrenalin (NA) in the treatment of type 1 HRS. Between 1998 and 2000, 12 consecutive patients with type 1 HRS (7 men, 5 women; mean age, 54 +/- 11 years; mean Child-Pugh score, 11.3 +/- 1.7) were treated with intravenous NA (0.5-3 mg/h), in combination with intravenous albumin and furosemide. NA was given for 10 +/- 3 days, at a mean dose of 0.8 +/- 0.3 mg/h. Reversal of HRS was observed in 10 of 12 patients (83%; 95% confidence interval, 52%-98%) after a median of 7 days (range, 5-10 days). Serum creatinine levels fell from 358 +/- 161 to 145 +/- 78 micromol/L (P <.001), creatinine clearance rose from 13 +/- 9 to 40 +/- 15 mL/min (P =.003), and urinary sodium output increased from 8 +/- 14 to 52 +/- 72 mEq/d (P =.002). Changes in renal function under NA treatment were associated with an increase in mean arterial pressure (MAP; 65 +/- 7 to 73 +/- 9 mm Hg, P =.01) and a marked reduction in active renin (565 +/- 989 to 164 +/- 196 ng/L, P =.001) and aldosterone plasma concentrations (1,945 +/- 1,931 to 924 +/- 730 ng/mL, P =.02). There was one episode of reversible myocardial hypokinesia (in a patient on 1.5 mg/h NA) that did not recur after a dose reduction. In conclusion, NA combined with albumin and furosemide appears effective and safe for the treatment of type 1 HRS.
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Affiliation(s)
- Christophe Duvoux
- Service d'Hépatologie et de Gastroentérologie, AP-HP, Hopital Henri Mondor, Créteil, France.
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14
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Patey O, Lacheheb A, Dellion S, Zanditenas D, Jungfer-Bouvier F, Lafaix C. A rare case of cotrimoxazole-induced eosinophilic aseptic meningitis in an HIV-infected patient. Scand J Infect Dis 1999; 30:530-1. [PMID: 10066062 DOI: 10.1080/00365549850161610] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A case of cotrimoxazole-induced meningoencephalitis in an HIV-infected patient without signs of AIDS is reported. The patient developed an apparently generalized seizure, of cotrimoxazole, 1 month after first taking a dose of this drug and a febrile coma after a second dose 3 weeks later. Lumbar puncture revealed eosinophilic aseptic meningitis. The patient quickly recovered without sequelae and was given antiretroviral therapy plus pentamidine aerosolized and pyrimethamine as prophylaxis for opportunistic infections. No other adverse effects were observed. The report describes the diagnosis of this case supported by a commentary, including a literature review.
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Affiliation(s)
- O Patey
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, Villeneuve St Georges, France
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15
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Lorino AM, Atlan G, Lorino H, Zanditenas D, Harf A. Influence of posture on mechanical parameters derived from respiratory impedance. Eur Respir J 1992. [DOI: 10.1183/09031936.93.05091118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The influence of posture on respiratory mechanics was investigated in 10 healthy volunteers, using the forced pseudorandom noise technique. Subjects were studied in four randomly selected positions: sitting; sitting with the head turned sideways; supine; and prone with the head turned sideways. Respiratory compliance (Crs), inertance (Irs) and resistance estimated at 4 Hz (R4), were calculated by fitting respiratory impedance by a 4 parameter model with a frequency dependent resistance. When subjects changed from sitting to lying, whilst maintaining the head in the same position in relation to the body, Irs increased and Crs decreased, probably due to gravitational effects. R4 was significantly higher in the supine position than in either of the sitting or the prone positions. These results demonstrate that changes in lung volume cannot completely explain the influence of posture on respiratory resistance, and indicate upper airway geometry as a determinant factor of respiratory resistance.
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16
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Lorino AM, Atlan G, Lorino H, Zanditenas D, Harf A. Influence of posture on mechanical parameters derived from respiratory impedance. Eur Respir J 1992; 5:1118-22. [PMID: 1426223] [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: 12/27/2022]
Abstract
The influence of posture on respiratory mechanics was investigated in 10 healthy volunteers, using the forced pseudorandom noise technique. Subjects were studied in four randomly selected positions: sitting; sitting with the head turned sideways; supine; and prone with the head turned sideways. Respiratory compliance (Crs), inertance (Irs) and resistance estimated at 4 Hz (R4), were calculated by fitting respiratory impedance by a 4 parameter model with a frequency dependent resistance. When subjects changed from sitting to lying, whilst maintaining the head in the same position in relation to the body, Irs increased and Crs decreased, probably due to gravitational effects. R4 was significantly higher in the supine position than in either of the sitting or the prone positions. These results demonstrate that changes in lung volume cannot completely explain the influence of posture on respiratory resistance, and indicate upper airway geometry as a determinant factor of respiratory resistance.
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Affiliation(s)
- A M Lorino
- INSERM U296, Département de Physiologie, Hôpital Henri Mondor, Créteil, France
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