[Hepatitis C virus reinfection after an intravenous drug injection].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
J Puel
Publications and source records attributed to J Puel.
[Prevalence and management of major risk factors in 500 men with stable coronary disease].
Management of major risk factors (smoking, hypercholesterolaemia, hypertension), in the context of secondary prevention, has an impact on recurrence and life expectancy. However, there is a delay between the publication of therapeutic trials and their diffusion within the medical community. The objective of this study was to evaluate the prevalence and management of the main risk factors in a sample of 500 men, with a mean age of 55.1 +/- 7.5 years, presenting with stable coronary artery disease. 11% of subjects had a family history of premature myocardial infarction. Smoking was frequent: 21% of smokers, 60% of ex-smokers. Hypercholesterolaemia (LDL-C > 3.4 mmole/l or treatment) was present in 82% of subjects. Only 45% of treated subjects had an LDL-C < 3.4 mmole/l. Hypertension (systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg or treatment) was present in 61% of subjects. Only 33% of treated subjects were controlled. Non-insulin-dependent diabetes mellitus (blood glucose > or = 7.7 mmole/l or treatment) was present in 21% of subjects. Only 43% of treated subjects were controlled. Calculation of the distribution of major risk factors (smoking, pathological obesity, hypercholesterolaemia, hypertension, diabetes) showed that 90% of coronary patients presented at least two risk factors. Overall, the prevalence and management of risk factors in patients with stable coronary artery disease is far from optimal.
Adult↗
[If stent is indicated, which one should be chosen?].
Coronary stenting is justified by the prevention of acute angioplasty accidents (more or less occlusive, extensive dissection) and by their clearly established value in particular cases (chronic occlusion, venous graft, elastic recoil). Other clinical situations, such as prevention of restenosis are not absolute indications for first-line stenting and some techniques assessing the coronary functional appearance (Doppler, pressure) could select candidate patients for stenting. The choice of stent depends on the type of coronary lesion and each team's experience, bearing in mind that the ideal stent, which does not exist, should combine radial force, softness, good visibility, preservation of collateral vessels, and must be atraumatic and inexpensive. Finally, when the remodelling component of restenosis has been eliminated by stenting, the next step will be to limit or even prevent intrastent intimal hyperplasia by attractive techniques, which still need to be evaluated (intracoronary radiotherapy, gene therapy, etc.).
Angioplasty, Balloon, Coronary↗
Five-year outcome after coronary angioplasty versus bypass surgery in multivessel coronary artery disease: results from the French Monocentric Study.
BACKGROUND: The clinical benefit of percutaneous transluminal coronary angioplasty (PTCA) as compared with coronary artery bypass grafting (CABG) for patients with multivessel coronary artery disease (CAD) has not been established. To determine the outcomes of these treatments in patients referred for the first time for coronary revascularization, we conducted a 5-year prospective trial comparing the two procedures. METHODS: From June 1989 to June 1993, a total of 1939 patients with multivessel coronary disease were screened at a single clinical site, and 152 patients (29%) were randomly assigned to undergo CABG (76 patients) or PTCA (76 patients). Enrollment required that complete revascularization of at least two major vessels supplying different myocardial regions be deemed clinically necessary and technically feasible. RESULTS: After PTCA or CABG, the clinical success rates were, respectively, 82.9 and 84.2%, whereas in-hospital mortality did not differ significantly between the two groups (1.3% in each group). At 5 years, the proportions of patients in the CABG group who required repeated bypass surgery (0%) or angioplasty (9%) were significantly lower than the proportions in the PTCA group (14.5 and 14.5%, P<.01). Event-free survival was higher in the surgery group (82.9%) than in the PTCA group (68.4%) (P<.05). CONCLUSIONS: In a carefully selected population of patients with multivessel CAD, angioplasty may offer an effective alternative to bypass surgery. However, to achieve similar clinical outcomes, the patients treated with PTCA are more likely to require further interventions.
Aged↗
A new generation of serum anti-HIV antibody immunocapture assay for saliva testing.
BACKGROUND: Epidemiological studies need easier tools to evaluate HIV prevalence, particularly in high-risk groups under difficult field conditions. Testing saliva antibody with accurate immunoassay could serve as an alternative to serum testing. OBJECTIVES: To evaluate performances on saliva of a novel commercially available assay for anti-HIV antibody. STUDY DESIGN: Samples of saliva from 530 patients were tested for the presence of HIV antibodies with a third generation commercially available serum-screening kit and the use of a sample diluent adapted to saliva. RESULTS: Compared with serum sampling the sensitivity and specificity of oral sampling were respectively, 100 and 99.8%. CONCLUSION: The ICE HIV-1.0.2 assay used on saliva could be an efficient and non-invasive epidemiological tool for HIV testing.
Adult↗
Genes of the major histocompatibility complex class II influence the outcome of hepatitis C virus infection.
BACKGROUND & AIMS: The host's immune response may influence the course of hepatitis C virus (HCV) infection. The aim of this study was to investigate the distribution of HLA class II alleles in white subjects who spontaneously recovered from HCV infection compared with that in patients with persistent infection. METHODS: HLA-DRB1 and -DQB1 typing were performed in 103 consecutive patients with persistent HCV infection (HCV antibody positive, HCV RNA positive) and in 25 subjects with transient HCV infection (HCV antibody positive, persistently negative HCV RNA). RESULTS: No significant differences between subjects with transient or persistent infection were observed for age, sex, source of infection, or HCV serotype. The frequency of DQB1*0301 and DRB1*1101 alleles was higher in patients with transient infection than in those with persistent infection (84% vs. 30.8%, 40% vs. 9.8%; P < 0.01 and P < 0.02, respectively [Bonferroni correction]). DRB1 and DQB1 alleles did not influence viral load as an independent factor. Mean Knodell's scores were lower in patients with DQB1*0301 allele (6.12 +/- 0.4) than in those negative for DQB1*0301 (7.37 +/- 0.3; P < 0.05). CONCLUSIONS: Our results suggest that host- rather than virus-related factors are probably involved in the spontaneous clearance of HCV.
Adult↗
High rate of hepatitis C virus clearance in hemodialysis patients after interferon-alpha therapy.
To gain insight into the long-term effect of interferon-alpha (IFN-alpha) therapy on hepatitis C virus (HCV) RNA-positive hemodialysis patients, 23 subjects were given 3 MU of IFN-alpha 3 times a week for 6 (n = 12) or 12 months (n = 11). They were followed for 19 months after cessation of therapy. Sustained serum HCV RNA clearance occurred in 42% of patients treated for 6 months and in 64% of those treated for 12 months. HCV was eradicated from 6 of 13 patients infected with HCV genotype 1b and from 2 of 6 patients also infected with hepatitis G virus. HCV RNA remained undetectable in both serum and a liver biopsy of 2 patients who were given cadaveric kidney transplants after IFN-alpha treatment. These data suggest that HCV RNA-positive dialysis patients can be considered for treatment while receiving dialysis, particularly those awaiting transplant.
Adult↗
Cytomegalovirus detection in cryopreserved semen samples collected for therapeutic donor insemination.
The presence of cytomegalovirus (CMV) in semen was retrospectively evaluated in 178 cryopreserved semen samples obtained from 97 donors recruited by two sperm banks. Thirty-three (34.0%) donors were CMV-seronegative, 51 (52.6%) were CMV-seropositive and 13 (13.4%) had an unknown serological status. CMV was detected in sperm specimens by cell culture and polymerase chain reaction (PCR). CMV was detected in five (2.8%) samples from two (2.0%) donors by cell culture and in 10 samples (5.6%) from five donors (5.1%) by PCR; all the samples which were positive by cell culture were also positive by PCR. Our data indicate that cryopreserved semen specimens obtained from healthy volunteer donors represent a potential source of CMV infection through therapeutic donor insemination. PCR, which is more sensitive than cell culture, should be used for direct and rapid identification of CMV in semen samples collected from volunteer donors. CMV detection in semen by PCR could be advantageously compared to CMV-antibody tests in serum which are only indicative of a former CMV infection.
Adult↗
Maternal virus load during pregnancy and mother-to-child transmission of human immunodeficiency virus type 1: the French perinatal cohort studies. SEROGEST Cohort Group.
Virus load in pregnancy and its relation to mother-to-child human immunodeficiency virus (HIV) transmission were studied prospectively. From 1989 to 1994, 320 HIV-infected women from 18 centers had plasma samples stored. Among women not receiving antiretroviral therapy, the polymerase chain reaction RNA level was 3.6 log at delivery, and 15% of women had levels below the detection limit. There was no variation during pregnancy. Women born in sub-Saharan Africa had lower RNA levels, although their CD4 cell distribution did not differ from that in other women. Among 236 evaluable children, 19% +/- 5% were infected. Transmission occurred in 12% of cases (confidence interval, 5%-22%) with <1000 copies/mL versus 29% +/- 10% of those with >10,000 copies/mL (P < .02). Maternal virus load appears strongly related to HIV transmission to the child.
Africa South of the Sahara↗
Kinetics of HCV viremia in kidney transplant recipients during and after alpha-interferon therapy.
Fifteen kidney transplant recipients with chronic hepatitis C were given 3 million units recombinant alpha2b-interferon for 142+/-35 days. There were significant decreases in hepatitis C virus (HCV) RNA 1 month after the initiation of treatment (p < 0.01), and at the end of treatment (p < 0.05). HCV RNA was undetectable by PCR analysis during treatment in 5 patients. But HCV RNA reappeared in all patients 1 month after the cessation of therapy, and the level of viremia returned to baseline. While all patients had normalized alanine aminotransferase (ALT) activities at the end of therapy, 11 experienced a relapse during the follow-up period (1 year). There was a correlation between the amount of HCV RNA at the end of treatment and the time of relapse. Serum IgM against core protein of HCV were detected in 7/15 patients. Anti-core IgM remained detectable during treatment and afterwards. There was no correlation between IgM status and other virological parameters, or ALT activity.
Adult↗
[Repolarisation anomalies simulating anterior myocardial infarction during ischemic cerebrovascular accident].
The authors report the case of a woman admitted to hospital for minor trauma of the left hip and who presented major ST segment elevation on the second day suggesting an acute anterior wall myocardial infarction at the same time as a cerebrovascular accident. Complementary investigations and follow-up excluded the diagnosis of myocardial infarction with normalisation of the ECG on the 5th day. ECG changes during cerebrovascular accidents may be very variable ranging from extrasystoles to ST elevation mimicking myocardial infarction. They carry a poor prognosis with an increased risk of sudden death necessitating continuous ECG monitoring until the ECG reverts to normal. The cardiac involvement is not ischaemic but due to disease of the insular cortex of the brain which induces myocytolysis (centered around the intra-cardiac nerve endings) due to the sudden liberation of catecholamines. These lesions may be treated by propranolol or phentolamine.
Adrenergic alpha-Antagonists↗
[Endo-coronary ultrasonography: significance of the images].
In addition to the assessment of the arterial lumen and coronary stenosis, endocoronary ultrasonography also provides information in vivo on the nature of atheromatous plaque. This study reports the preliminary correlations between the echographic appearances, the functional status of the patients and histological data of tissue obtained by directional atherectomy. The appearances of atheromatous infiltrations help distinguish stable forms of coronary disease with "hard", hyperreflective plaques, from acute forms with "soft" hyporeflective plaques. Ultrasonography confirms the clinico-pathological relationship of myocardial infarction and unstable angina with, in the acute forms, a similarity of the culprit plaques which appear vulnerable, hyporeflective and often complicated by the association of fissures and thrombus. The correlations with histological data are still incomplete. However, the "soft" nature of the plaque is an expression of its cellularity and lipid content whereas "hard" plaques correspond to increased fibrous tissue. These associations have no correlative values as yet. Nevertheless, they establish a parallelism which may eventually explain the functional variability and evolutivity of coronary artery disease. In the same way that visualisation of coronary stenosis led to the development of coronary artery surgery and later to angioplasty, observation of the plaque by ultrasonography should promote the development of pharmacological agents to treat the atheromatous lesions.
Adult↗
[HCV RNA clearance after treatment with interferon-alpha in chronic hemodialysis patients with or without coinfection by HGV/HGBV-C].
Patients on maintenance hemodialysis are frequently infected with hepatitis C virus (HCV). The long-term effect of alpha interferon therapy has not yet been assessed, or the influence of co-infection with the newly discovered hepatitis G/hepatitis GB virus-C (HGV/HGBV-C) upon therapy outcome. Eleven anti-HCV and HCV RNA-positive hemodialysis patients, 3 of whom had HGV/HGBV-C infection were given 3 mega-units of alpha 2b recombinant interferon subcutaneously 3 times weekly for six months. The mean follow-up after cessation of therapy was 24 +/- 8 months (range: 18-30 months). Sustained serum HCV RNA clearance, as assessed by PCR analysis, occurred in 5/11 patients (45.5%). Two had received a cadaveric kidney transplant at 16 and 18 months post-treatment and were treated by immunosuppressive therapy; HCV RNA remained undetectable in both serum and a liver biopsy. HCV was eradicated in 3 of the 6 patients infected with HCV genotype 1b, which is less sensitive to alpha-interferon than other HCV genotypes. Among the 3 patients infected with both HCV and HGV/HGBV-C, alpha-interferon cleared the HCV RNA from one patient, but not the HGV/HGBV-C RNA. In view of the high rate of HCV eradication after alpha-interferon therapy and its fair tolerance, we suggest that HCV RNA-positive dialysis patients should be treated before transplantation, regardless of their aminotransferase levels or liver histological score, since alpha interferon therapy after renal allografting is associated with an unacceptable rate of renal failure. Our preliminary data indicate that HGV/HGBV-C does not interfere with sustained HCV RNA clearance.
Adult↗
Neonatal characteristics in rapidly progressive perinatally acquired HIV-1 disease. The French Pediatric HIV Infection Study Group.
OBJECTIVE: To identify clinical and laboratory parameters at birth that are associated with the rapidly progressive form of human immunodeficiency virus type 1 (HIV-1) disease in children born to infected mothers. DESIGN: Multicenter, prospective study of infants born to HIV-seropositive mothers. SETTING: A total of 62 obstetric and pediatric centers in France. PARTICIPANTS: Of 1386 children born to HIV-1-seropositive mothers at least 18 months before the cutoff date, 267 were infected. Infection was defined as serological positivity at 18 months or death from HIV disease before the age. MAIN OUTCOME MEASURE: Category C events (including opportunistic infections, recurrent severe bacterial infections, cancers, specific encephalopathy, and wasting syndrome) in the new pediatric Centers for Disease Control and Prevention classification during the first year of life, according to clinical, immunological, and virological findings at birth. RESULTS: The risk of category C manifestations at 12 months was significantly higher when an infected newborn had liver and/or spleen enlargement and/or adenopathies (38.1% vs 15.1%; relative risk [RR], 2.5; 95% confidence interval [CI], 1.4 to 6.0; P<.02) or a low proportion (<30%) of CD4+ cells at birth (45.5% vs 15.0%; RR, 3.0; 95% CI, 1.4 to 6.4; P<.005). Similarly, HIV-1 culture and/or polymerase chain reaction positivity during the first week of life was associated with a higher risk of the early, severe form of HIV infection (26.4% vs 9.3%; RR, 2.8; 95% CI, 1.3 to 6.1; P<.006). In case of positive antigenemia at birth, the risk was 50.0% vs 14.4% (RR, 3.5; 95% CI, 1.9 to 6.2; P<.001). These parameters, determined at birth, were strongly interrelated and could reflect active disease onset in utero in some cases of early, severe HIV-1 disease in childhood. CONCLUSIONS: These prognostic markers, particularly virological parameters, are of value in monitoring children infected by HIV and might serve as a basis for early therapeutic intervention.
AIDS Serodiagnosis↗
Identification of coronary thrombus after myocardial infarction by intracoronary ultrasound compared with histology of tissues sampled by atherectomy.
This study compares the ability of intracoronary ultrasound (ICUS) to identify thrombus by means of actual criteria, with the histologic studies of tissues removed by directional atherectomy in patients treated previously with thrombolytic therapy. Coronary angiography and intravascular ultrasound imaging were performed before atherectomy in 34 patients who had received intravenous thrombolytic therapy for acute myocardial infarction a mean of 6 days before. The lesion morphology and the percentage of stenosis were defined on the angiogram. The ultrasound characteristics of the narrowing were described as intraluminal thrombus, mural thrombus, mixed plaque, and dense plaque. Thirty patients were studied. Thrombus was suspected in 8 patients on angiography. By ICUS, the presence of thrombus was predicted in 21 patients. Histologic studies of excised tissues found thrombus in 20 of the 30 patients. When ICUS was compared with histology, the true-positive rate was 80% and the false-positive rate was 50%; the true-negative rate was 50% and the false-negative rate was 20%. The correlation between observers was high. These observations suggest that ICUS may be useful in identifying fresh thrombus. The findings of this study help to confirm the criteria for diagnosing intraluminal thrombus by ICUS imaging.
Adult↗
"T"-shaped stent placement: a technique for the treatment of dissected bifurcation lesions.
Despite operator experience and improved catheter technology, acute vessel closure is inherently associated with percutaneous transluminal coronary angioplasty (PTCA) of complex lesions. This case study describes a patient who developed an occlusive dissection post PTCA at the bifurcation of the left anterior descending artery (LAD) and its diagonal branch. The "T"-shaped Wiktor stent placement immediately re-establishes full flow, obviating the necessity for emergent surgery.
Angioplasty, Balloon, Coronary↗
Assessment of a standardized reverse-transcriptase PCR assay for quantifying HIV-1 RNA in plasma and serum.
The analytical variability of the new commercially available Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) assay, Amplicor HIV-1 Monitor, has been assessed to establish criteria for assessing the significance of HIV-1 RNA level measurements. Estimations of the standard deviations (SD) of log-copies in inter-assay (mean 0.09 log) and in inter-laboratory (mean 0.14 log) reproducibility experiments demonstrated that the assay can discriminate with 95% confidence between 3-fold (inter-assay) and 5-fold differences (inter-laboratory). The inter-lot reproducibility (mean 0.10 log) was similar to the inter-assay reproducibility. The HIV-1 RNA concentrations measured in plasma collected in potassium EDTA anticoagulant were slightly higher than those measured in plasma collected in sodium citrate. The HIV-1 RNA concentrations measured in sera were about 50% of the HIV-1 RNA concentrations measured in paired plasma samples. However, there was a strong correlation between these two measurements (P < 0.0001). The assay was used to measure viral RNA in the plasma of 50 HIV-1 positive individuals at different stages of infection. All the individuals had detectable HIV-1 RNA (300-957000 copies/ml). There was no correlation between HIV-1 RNA and Immune Complex Dissociated (ICD) p24 antigen, but HIV-1 RNA was correlated with CD4+ cell counts (P < 0.0001) and the clinical stage (P = 0.0042), with higher HIV-1 RNA concentrations in patients with a more advanced stage of the disease. The significant association of HIV-1 RNA with major markers of HIV infection and the reliability of this sensitive, easy-to-use RT-PCR assay indicate its suitability for use in clinical trials and suggest that this assay is appropriate for routine clinical applications.
Adult↗
Evaluation of a new sensor-based algorithm to protect against atrial arrhythmias.
UNLABELLED: The SmarTracking (ST) algorithm (Marathon 294-09, Intermedics Inc.) uses the sensor-calculated rate (SCR) to define a "variation band" for the intrinsic sinus rate. If the sinus rate exceeds the upper limit of the band, the ventricular pacing rate is limited by the ST rate (STR) and Wenckebach behavior is observed. The present study was aimed at evaluating the behavior of the ST mechanism in patients with healthy sinus node, during exercise and at rest. METHODS: Twenty-one patients (15 men; mean age 67.8 +/- 9.7 years) with normal sinus function were studied. Heart rate was recorded via the rate profile of the implanted pacemaker (Relay 294-03, Intermedics Inc.), and STR and SCR were obtained via a previously calibrated strap-on pacemaker. A 15-minute protocol was used during which subjects alternated periods of walking with periods of rest. RESULTS: The relative difference between the average STR and the average sinus rate (DST) was calculated for each phase of the protocol as well as the maximum number of patients showing inappropriate Wenckebach behavior (#W). At nominal settings, DST was always positive and did not fall below 20%. #W was maximum at rest (5) and during heavy exercise (3). By increasing the STR at rest to 95 ppm and the maximum pacing rate to 150 ppm, the #W was reduced to zero for all types of activity except during very fast walk where #W was 1. CONCLUSION: In general, there was no competition observed between the STR and the intrinsic rhythm. In some cases, the STR at rest and the maximum pacing rate had to be reprogrammed for optimal performance.
Acceleration↗