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Biomedical subjects

P Couzigou

Publications and source records attributed to P Couzigou.

At least 37 records · Page 2Linked to original sources
PubMed1999

Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study.

BACKGROUND: Endoscopic ultrasonography (EUS) appears to be the best imaging method for the diagnosis of choledocholithiasis. The aim of this preliminary, prospective, controlled study was to assess the accuracy of EUS and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of common bile duct stones. METHODS: From December 1995 through April 1997, all patients referred because of suspicion of the presence of common bile duct stones were included in the study. EUS and MRCP were performed. Each examination was performed by a different operator unaware of the result of the other procedure. The definitive diagnosis was established by means of endoscopic retrograde cholangiography with sphincterotomy or a surgical procedure. RESULTS: Forty-three patients (18 men, 25 women) with a mean age of 60.9 +/- 14.5 years (range 25 to 81 years) were included in the study. Eleven patients were excluded because of unavailability of magnetic resonance imaging(n = 5) or EUS (n = 6). Ten patients (31.2%) had choledocholithiasis. For this diagnosis, the sensitivity of EUS was 100%, the specificity was 95.4%, the positive predictive value was 90.9%, and the negative predictive value was 100%. The corresponding values for MRCP were 100%, 72.7%, 62.5%, and 100%, not significantly different from EUS results. The accuracy of EUS was 96.9%, and that of MRCP was 82.2%. CONCLUSION: This preliminary study confirmed EUS as an accurate and noninvasive procedure for the diagnosis of common bile duct stones. MRCP, which had a high sensitivity and high negative predictive value, might be an accurate technique for patients with a contraindication to EUS.

Adult↗
PubMed1999

A randomized trial of ribavirin and interferon-alpha vs. interferon-alpha alone in patients with chronic hepatitis C who were non-responders to a previous treatment. Multicenter Study Group under the coordination of the Necker Hospital, Paris, France.

BACKGROUND/AIM: Fifty percent of patients infected with hepatitis C virus (HCV) show no response to alpha-interferon, and no alternative therapy has thus far proven to be effective. Therapeutic combination with ribavirin and alpha-interferon has shown promising results in naive patients and in relapsers, but based on limited series, it was reported to be inefficient in non-responders. The aim of our study was therefore to explore and compare, in a randomized trial, the tolerance and potential efficacy of alpha-interferon alone with a sequential combination of ribavirin and the same alpha-interferon regimen in those patients. METHODS: Sixty-four non-responder patients were randomized in the alpha2b-interferon group (a 6-month course at a dosage of 6 MU followed by a 6-month course of 3 MU three times weekly subcutaneously) and 62 in the "combination" group (sequential combination of the same alpha2b-interferon therapy preceded by a 2-month course of ribavirin which was then associated for 2 months with alpha2b-interferon at a daily dosage of 1.0 or 1.2 g). RESULTS: Treatment withdrawal was necessary for six patients from the alpha-interferon and eight patients from the combination group. Normalization of aminotransferase activities was significantly more frequent after the 4-month course of ribavirin with 2 months of interferon than after 2 months of interferon alone (52.8 vs. 26.2%, p<0.01), but this difference was not maintained after ribavirin withdrawal. Disappearance of serum HCV RNA (PCR) was significantly more frequent at the end of treatment in the combination group (24.5 vs. 7.7%, p=0.02), but did not differ 6 months after the end of therapy (9.8 and 8.3%, respectively). The long-term response was not associated with liver status (cirrhosis vs. absence of cirrhosis) or genotype. Mean viremia was significantly lower in long-term responders than in non-responders or relapsers in both groups (p<0.001 for the interferon group and p<0.05 for the combination group), but the large extent of viral load precluded reliable prediction. The pre- and post-treatment hepatitis activity index did not differ between the two groups. While a crude histopathological improvement in the hepatitis activity index for a given patient was more frequently observed in the combination group (69.2 vs. 35.9%, p<0.01), improvement as defined by a decrease of at least 2 in the hepatitis activity index was significant only for lobular necrosis and degeneration. CONCLUSIONS: This study demonstrates the efficacy of the combination of ribavirin/alpha-interferon in non-responders. Indeed, (i) it is fairly tolerated; (ii) it increases the rate of the initial biological response, and of the virological response by decreasing breakthrough, though this benefit is not sustained; and (iii) it induces a significant histological improvement in necrosis. A simultaneous and prolonged combination of ribavirin/alpha-interferon should be further evaluated in non-responders.

Antiviral Agents↗
PubMed1999

Segmented 5 versus nonsegmented flow quantitation: comparison of portal vein flow measurements.

RATIONALE AND OBJECTIVES: Times of acquisition, mean velocities, mean flows, and their respective standard deviations provided by segmented and nonsegmented flow quantifications (FQ) were compared in the main portal veins of ten healthy adults. METHODS: The segmented FQ performed five phase-encoding lines per segment. The authors successively applied the two electrocardiogram-triggered techniques in the same slice perpendicular to the portal flow direction. Their measurements were compared in particular by means of the statistical analysis proposed by Bland and Altman. RESULTS: The segmented 5 FQ reduced the acquisition time by two compared with the nonsegmented FQ. The mean velocity and mean flow values of the two techniques were not significantly different. The standard deviations were similar. CONCLUSIONS: The segmented 5 FQ showed its major advantage in the portal vein: the acquisition time was reduced without any loss of accuracy or any uncertainty enhancement.

Adult↗
PubMed1999

[Do general practitioners want to manage chronic hepatitis C and take part in hepatitis C health networks? A national survey].

OBJECTIVES: To assess information that general practitioners had on hepatitis C and on the hepatitis C network in hospitals and private practice. METHODOLOGY: A national telephone survey of 604 general practitioners was conducted between March 18 and 23, 1998. RESULTS: Screening and management of hepatitis C was important for 89% and 97% of general practitioners. Screening was performed in relation to the relative risk (IV drug users 89%, blood transfusion before 1991 88%). General practitioners wanted more information on treatment (54%), patient counselling (42%) and the potential risks of the disease (42%). Of 604 general practitioners, 6% were involved in a hepatitis C network, while 21% were involved in another network (drug users 9%, AIDS 8%). Of the 94% general practitioners who were not part of the network, 33% were willing to join a hepatitis C network. Only 56% were aware of a hepatitis C network (press article 30%, mailing 17% or local meeting 12%). The difficulties for the involvement of general practitioners were: lack of time, topics not adapted to daily practice and geographic constraints (74%), too few patients in their practice (52%), no need (38%), the idea itself of a network and lack of information (28%). CONCLUSION: General practitioners screen patients at risk of hepatitis C. They want to be better informed about treatment, patient counselling, and the potential risks of hepatitis C. They are less involved in hepatitis C networks than in other networks (drug, AIDS). However, one third of general practitioners would like to be involved in a hepatitis C network. These results could be useful for implementing post-graduate courses and general practitioner training.

Adult↗
PubMed1998

[Rapid progress of cirrhosis in hepatitis C: the role of age at the time of viral contamination].

OBJECTIVE: The aim of this study was to assess predictive factors for the progression to liver cirrhosis in hepatitis C. METHODS: One hundred thirty six patients (79 men; 57 women; mean age 39 years) with transfusion or intravenous drug use-associated hepatitis C virus (HCV) infection were studied. Sex, cause of infection, duration of contamination, and genotype were studied as predictive factors of progression to liver cirrhosis. RESULTS: One hundred twenty three patients presented with chronic hepatitis without cirrhosis and 13 had cirrhosis. At the time of liver biopsy, rates of cirrhosis were: 0% before 40 years, 10% between 40 and 60 years, and 47% after 60 years. (p < 0.05). Rates of cirrhosis according to the age at the time of contamination were as follows: 3% before 30 years; 16% between 30 and 50 years; 46% after 50 years even though duration of the disease was comparable in the three groups. In multivariate analysis, two independent factors were associated with liver cirrhosis: age at contamination and duration of infection. CONCLUSION: Duration of infection and especially age at contamination seem better correlated with the probability of cirrhosis than the route of transmission or the genotype 1b. The results of this study suggest that progression to cirrhosis is slower in cases of contamination before 30 years of age than later on. Age at the time of contamination is an important predictive factor of progression to cirrhosis.

Adolescent↗
PubMed1998

Hepatic uroporphyrinogen decarboxylase activity in porphyria cutanea tarda patients: the influence of virus C infection.

Porphyria cutanea tarda (PCT) is caused by a decreased activity of the hepatic enzyme uroporphyrinogen decarboxylase (URO-D). This deficiency causes overproduction, hepatic deposition, and increased excretion of uroporphyrin. Iron overload and hepatic viral infections are considered aggravating factors of the disease. Two forms of PCT have been described, as follows: a familial one with an inherited decrease of URO-D activity in all tissues and a sporadic one with a decreased activity of URO-D restricted to the liver. To assess whether the hepatic URO-D returns to normal during a remission of the disease, this activity was measured in liver biopsy samples in 24 sporadic PCT patients. The hepatic and urinary porphyrin concentrations were also measured. Viral status and histopathological findings were analyzed to assess their involvement in PCT. Six patients treated by phlebotomy to reduce hepatic iron and who were considered to be in clinical remission, characterized by a disappearance of cutaneous lesions, showed higher hepatic URO-D activities and lower hepatic porphyrin concentrations than did patients with overt PCT. The medians of these variables, however, did not achieve normal values. The hepatic URO-D activity showed a significant inverse relationship with both hepatic porphyrins and urinary uroporphyrin excretion. Hepatic URO-D activity was not reduced by hepatitis C virus (HCV) infection and liver damage. We conclude that the achievement of remission in PCT largely depends on the transient normalization of hepatic URO-D activity. A small increase in hepatic coproporphyrin in nonporphyric patients could reflect hepatic injury/iron/alcohol-induced oxidative stress oxidizing the accumulated heme precursors rather than a direct effect on hepatic URO-D enzyme.

Adult↗
PubMed1997

Laryngeal and oropharyngeal cancer, and alcohol dehydrogenase 3 and glutathione S-transferase M1 polymorphisms.

In this study the GSTmu phenotype and ADH genotype at the ADH3 locus were investigated in a group of 39 alcoholic men with upper respiratory/digestive tract cancer: 21 with oropharyngeal cancer and 18 with laryngeal cancer. The results are compared with those of a control group of 37 alcoholic men without alcohol-related medical complications. Of the control subjects, 48% were found to be GSTmu deficient [GSTmu(-)] and 19% carried the ADH(3)1/ADH(3)1 genotype. In the laryngeal cancer patients, a significantly elevated frequency of both the GSTmu(-) (78%) and ADH(3)1/ADH(3)1 genotype (56%) was observed, relative to the control group. On the basis of this result, the risk of laryngeal cancer associated with the GSTmu(-) and ADH(3)1/ADH(3)1 genotypic combination within the population of alcoholics was estimated to be 12.9 with a 95% confidence interval of 1.8-92 (P < 0.01) relative to alcoholic individuals who have GSTmu [GSTmu(+)] and are not ADH(3)1/ADH(3)1. Thus, alcoholics who are GSTmu(-) and ADH(3)1/ADH(3)1 have at least an 80% greater risk of developing laryngeal cancer than alcoholics who are GSTmu(+) and who are not ADH(3)1/ADH(3)1. In addition, the oropharyngeal cancer patients had excess frequencies of both GSTmu(-) (62%) and ADH(3)1/ADH(3)1 (43%) relative to the control group, but these excess frequencies were not statistically significant. The GSTmu(-) and ADH(3)1/ADH(3)1 genotypic combination may be a constitutional risk factor for laryngeal cancer among alcoholics.

Adult↗
PubMed1996

Prevalence and determinants of antibodies to hepatitis C virus and markers for hepatitis B virus infection in patients with HIV infection in Aquitaine. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine.

OBJECTIVE: To evaluate the prevalence of antibodies to hepatitis C virus and serological markers for hepatitis B virus infection in patients with HIV. DESIGN: Cross sectional survey. SETTING: Aquitaine, southwestern France, 1991-94. SUBJECTS: 1935 HIV positive patients seen at least once since June 1991. MAIN OUTCOME MEASURES: Presence of antibodies to hepatitis C virus were detected by second or third generation enzyme linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA) and markers for hepatitis B virus detected by ELISA. RESULTS: The prevalence was 42.5% (823) for antibodies to hepatitis C virus, 56.4 (507) for antibodies to hepatitis B core antigen, 6.9% (133) for hepatitis B surface antigen, 30.2% (584) for antibodies to hepatitis B core and surface antigen with no detectable surface antigen, 26.2% (507) for antibodies to core antigen only, and 4.8% (92) for antibodies to surface antigen only. The prevalence of antibodies to hepatitis C virus was 86.1% (726/843) in subjects who had bloodborne HIV infection and 7.3% (66/899) in those with sexually acquired infection. The prevalence of markers for hepatitis B was higher among homosexuals than in the other groups of patients, except for antibodies to surface antigen alone. The relation between markers for hepatitis B and hepatitis C virus was negative among men but positive among women. CONCLUSIONS: The results favour the hypothesis that hepatitis C virus is sexually transmitted much less commonly than either HIV or hepatitis B virus.

AIDS-Related Opportunistic Infections↗
PubMed1996

Tolerance, effectiveness, and acceptability of sulfate-free electrolyte lavage solution for colon cleaning before colonoscopy.

BACKGROUND AND STUDY AIMS: The unpleasant taste of the solution used for preparation before colonoscopy may limit patients' compliance with the procedure. However, the published results concerning the acceptability of sulfate-free electrolyte lavage solution (SF-ELS) for colon cleansing before colonoscopy are conflicting. The aim of this study was to compare SF-ELS with the standard polyethylene glycol (PEG) solution with regard to tolerance, effectiveness, and acceptability. PATIENTS AND METHODS: In the first part of the study, 24 patients were assigned to receive either one liter of SF-ELS or one liter of the standard PEG solution. After two hours, the patients had to choose two further liters (of either the first or second solution), and preparation for colonoscopy was completed. In the second part, fifty further patients were randomized into two groups: 25 patients received four liters of standard solution, and 25 patients received four liters of SF-ELS. The patients' opinions regarding the preparation and their willingness to repeat the use of the same preparation were recorded by questionnaire. The quality of the colon preparation was assessed by the endoscopists. RESULTS: Seventeen patients (71%; P < 0.05) preferred SF-ELS. The compliance rate in the two groups was 96%, and the frequency of occurrence of adverse effects was also similar. Colonoscopy was completed in 24 of the 25 patients in the SF-ELS group and 22 of the 25 patients in the standard PEG group (the difference was not significant). Visualization of the mucosa in the areas explored was perfect in 20 of the 25 patients in the SF-ELS group and in 17 of the 25 patients in the PEG group (not significant). Patients had a significant preference for SF-ELS. Eighteen of the 25 patients in the SF-ELS group were willing to accept the same preparation for a further colonoscopy, compared with 11 of the 25 in the other group (P < 0.05). CONCLUSIONS: Improving the acceptability of colonic preparation before colonoscopy could improve patients' compliance and the quality of the follow-up. The results of this study justify further investigation of SF-ELS.

Colonoscopy↗
PubMed1996

[Conditions of practice of upper digestive endoscopy in ambulatory care. Results of a national survey (I)].

OBJECTIVES: The aim of the study was to describe the usual conditions of practice of esophagogastroscopy in ambulatory care by French gastroenterologists. METHODS: During a week, a questionnaire was filled out for each esophagogastroscopy performed in ambulatory or day care. RESULTS: Seven hundred and thirty nine gastroenterologists participated in the study (25.9% of French gastroenterologists) and enrolled 4585 patients. Intra-venous sedation was performed in 36.6% of endoscopic examinations, with diazepam (17.8%), midazolam (41.7%), propofol (14.9%), diazepam and propofol (2.1%) or midazolam and propofol (23.5%). A morphinomimetic was associated in 58.6% of cases. Monitoring equipment of endoscopy units was: aspiration (58.6%), pulse oxymeter (41.6%), electrocardiographic monitoring (37.7%). Recommendations about follow-up after ambulatory anaesthesia were not implemented in 7.3% of examinations with anaesthesia (patient discharged alone). Seventeen minor adverse events were recorded. CONCLUSION: The study underlines variability of practice, mainly about use of sedation, monitoring and follow-up of patients during esophagogastroscopy performed in ambulatory care in France. An improvement in quality of endoscopy practice is likely.

Adult↗
PubMed1996

[Patient's opinion following an upper digestive endoscopy in ambulatory care. Results of a national survey (II)].

OBJECTIVES: The aim of the study was to evaluate patient satisfaction after esophagogastroscopy performed in ambulatory care and to correlate it with conditions of usual practice. METHODS: Study was proposed to the French gastroenterologists. During a week, 2 questionnaires were filled out for each esophagogastroscopy performed in ambulatory care: one recorded conditions of examination and one was independently filled out by the patient one day after endoscopy. RESULTS: Seven hundred and thirty nine gastroenterologists and 4,585 patients participated in the study. Among the patients, 3,758 (82%) filled out the questionnaire. Sedation was performed in 36.6% of cases. Subsequent endoscopy would be accepted by 79.3% of patients in the same conditions. Acceptance was significantly better with use of sedation and use of propofol. Without sedation, independent factors associated with a better acceptance were: male gender, absence of habitual benzodiazepine medication, endoscopy performed in private practice or private hospitals, smaller size of endoscope. CONCLUSION: This study underlines factors associated with a good acceptance of esophagogastroscopy without sedation and could help to improve decision-making regarding use of sedation.

Adult↗