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1.
Acta Gastroenterol Belg ; 85(1): 29-33, 2022.
Article in English | MEDLINE | ID: mdl-35304991

ABSTRACT

Background: PEG (percutaneous endoscopic gastrostomy) is a well established endoscopic procedure for enteral feeding. However, patients with a shorter life expectancy will not benefit from PEG tube placement. Furthermore, some specific evolving diseases will never benefit from PEG. The aim of the study focuses on short and long term mortality rates after PEG tube placement in a referral gastroenterology centre (Geneva University Hospital). 219 patients were enrolled in this study. Patients and methods: All patients scheduled for a PEG procedure between January 2011 and December 2014 were included. Nine patient parameters were collected for further analysis as well as the main underlying disease requiring PEG tube placement. Patients were subsequently divided into 4 groups according to underlying disease: Group 1) swallowing disorders of neurologic origin; Group 2) swallowing disorders associated with upper digestive tract neoplasia ; Group 3) nutritional support for a non GI reason ; Group 4) Other. Results: 219 patients had undergone a PEG tube placement. 33 patients died within 60 days after the procedure. After one year, 71 patients died. Global survival was 870 days. The nutritional support group had the better survival rate with 1276 days compared to the swallowing groups and others. The multivariate analysis has highlighted the underlying disease as the only associated parameter with short and long term mortality. Conclusions: PEG tube placement is associated with high short and long term mortality depending on the underlying disease. We outlined the potential role of PEG tube insertion as a supportive transient approach for nutritional support.


Subject(s)
Deglutition Disorders , Gastrostomy , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Enteral Nutrition , Gastroscopy , Gastrostomy/methods , Humans , Intubation, Gastrointestinal
2.
Endosc Int Open ; 4(6): E730-6, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27556085

ABSTRACT

INTRODUCTION: Self-expanding metal stents (SEMS) are commonly used in the palliation of dysphagia in patients with inoperable esophageal carcinoma. However, they predispose to gastroesophageal reflux when deployed across the gastroesophageal junction. The aims of this study were to: 1) assess the influence of the antireflux valve on trans-prosthetic reflux (primary outcome); and 2) compare the results of SEMS with and without antireflux valve in terms of reflux symptoms, quality of life (QOL), improvement of dysphagia and adverse events (secondary outcomes). PATIENTS AND METHODS: Thirty-eight patients were enrolled in nine centers. Carcinomas were locally advanced (47 %) or metastatic. After randomization, patients received either a covered SEMS with antireflux valve (n = 20) or a similar type of SEMS with no antireflux device but assigned to standard proton pump inhibitor therapy and postural advice (n = 18). Trans-prosthetic reflux was assessed at day 2 using a radiological score based on barium esophagography performed after Trendelenburg maneuver and graded from 0 (no reflux) to 12 (maximum). Monthly telephone interviews were conducted for Organisation Mondiale de la Santé (OMS) scoring from 0 (excellent) to 5 (poor), QOL assessment (based on the Reflux-Qual Simplifié scoring system) from 0 (poor) to 100 (excellent), dysphagia scoring from 0 (no dysphagia) to 5 (complete dysphagia) and regurgitation scoring from 0 (no regurgitation) to 16 (maximum). RESULTS: No difference was noted in terms of age, sex, size of lesion, prosthesis length or need for dilation prior to SEMS placement. No difficulty in placing SEMS nor complications were noted. Radiological scores of reflux were found to be significantly lower in patients with an antireflux stent compared to the conventional stent and associated measures. The regurgitation scores were significantly decreased in patients with antireflux stents during the first 2 months after stent placement and thereafter, they were similar in the two groups. QOL and dysphagia were improved in both groups. Survival rates were comparable in the two groups. CONCLUSIONS: No difference was observed between the two types of SEMS regarding the palliation of dysphagia and improvement of QOL. However, SEMS with an antireflux valve were more effective in preventing trans-prosthetic gastroesophageal reflux but at the cost of an increased likehood of minor adverse events (migrations and/or obstruction of the SEMS).

3.
Rev Med Suisse ; 11(484): 1587-91, 2015 Sep 02.
Article in French | MEDLINE | ID: mdl-26502618

ABSTRACT

Achalasia is a rare disorder, whose diagnostic Gold standard is high-resolution cesophageal manometry. The proposed treatment must take into account the patient's health condition and the type of achalasia determined by HRM. Heller's laparoscopic myotomy and pneumatic dilation are the first line treatments for most of the patients, whereas Botulinum toxin injections and pharmacologic therapy are only indicated for patients with a high surgical risk who cannot undergo first line treatments. Peroral endoscopic myotomy (POEM) is a recent and promising endoscopic technique reserved for expert endoscopy centers, whose exact role is still to be determined by randomized prospective studies. Oesophagectomy has only a marginal role in rare patients with extremely advanced achalasia or at risk of neoplastic degeneration.


Subject(s)
Esophageal Achalasia/therapy , Algorithms , Humans
4.
Rev Med Suisse ; 11(475): 1130-5, 2015 May 20.
Article in French | MEDLINE | ID: mdl-26152088

ABSTRACT

In Europe, oesophageal cancers are diagnosed at an early stage in less than 10% of the cases. They are superficial tumours whose invasion is limited to the mucosae and the submucosa. Synchronous node invasion is the most important prognosis factor. Oesophagectomy is the benchmark treatment. Nowadays, endoscopic resection is a validated curative therapeutic alternative. Accurate endoscopic evaluation using chemical or virtual colouring as well as an echoendoscopy, followed by an expert pathological review, must be conducted beforehand. It can be realised for good prognosis tumours after evaluation of the synchronous node invasion or its risk. After completion, regular endoscopic follow-ups are compulsory to detect local relapse.


Subject(s)
Esophageal Neoplasms , Disease Progression , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/epidemiology , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Esophagoscopy , Europe/epidemiology , Humans , Monitoring, Physiologic/methods , Risk Factors
5.
Dis Esophagus ; 27(2): 176-81, 2014.
Article in English | MEDLINE | ID: mdl-23651038

ABSTRACT

Endoscopic evaluation after chemoradiotherapy (CR) is impossible with an esophageal stent in place. The main study objective was to evaluate self-expanding plastic stent (SEPS) removal post-CR. Secondary end-points were the improvement of dysphagia and patients' quality of life. From October 2008 to March 2011, 20 dysphagic patients who suffered from advanced esophageal cancer were enrolled in a multicenter, prospective study. SEPS was inserted prior to CR and then removed endoscopically. SEPS efficiency (dysphagia score) and tolerance, as well as the patients' quality of life (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire validated for the esophagus), were monitored. Continuous variables were compared using a paired t-test analysis for matched data. A P-value of less than 0.05 was considered statistically significant. Twenty patients (15 men and 5 women), aged 61.5 years (±9.88) (range 43-82 years), with adenocarcinoma (n = 12) and squamous cell carcinoma (n = 8), were enrolled. SEPS were successfully inserted in all patients (100%). There was one perforation and three episodes of migration. All of these complications were medically treated. The mean dysphagia score at the time of stent placement was 2.79 (0.6). Mean dysphagia scores obtained on day 1 and day 30 post-SEPS placement were 0.7 (0.9) (P < 0.0001) and 0.45 (0.8) (P < 0.0001), respectively. Quality of Life Questionnaire validated for the esophagus score showed an improvement in dysphagia (P = 0.01) and quality of oral feeding (P = 0.003). All SEPS were removed endoscopically without complications. In two patients, the stent was left in place due to metastatic disease. SEPS are extractable after CR of esophageal cancer. Early stenting by SEPS prior to and during CR may reduce dysphagia and improve quality of oral alimentation.


Subject(s)
Adenocarcinoma/therapy , Carcinoma, Squamous Cell/therapy , Chemoradiotherapy , Deglutition Disorders/surgery , Device Removal , Esophageal Neoplasms/therapy , Quality of Life , Stents , Adenocarcinoma/complications , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/pathology , Deglutition Disorders/etiology , Esophageal Neoplasms/complications , Esophageal Neoplasms/pathology , Esophagoscopy , Female , Humans , Male , Middle Aged , Prospective Studies
6.
Rev Med Suisse ; 9(396): 1590-3, 2013 Sep 04.
Article in French | MEDLINE | ID: mdl-24066467

ABSTRACT

About 20% of colorectal cancers are complicated by intestinal obstruction. Self-expanding metallic stents (SEMS) permit desobstruction in over 90% of cases. In palliative setting, employing SEMS reduces hospitalisation time and permanent stoma rate with identical mortality rates compared to surgery. When using SEMS as bridge to surgery, higher primary and lower overall stoma rates are obtained with no significant mortality reduction by now. Of concern, procedure-related bowel perforation is frequent, especially among endoscopists lacking sufficient experience in colonic stenting.


Subject(s)
Colonic Diseases/surgery , Colorectal Neoplasms/complications , Intestinal Obstruction/surgery , Palliative Care/methods , Stents , Colonic Diseases/pathology , Hospitalization , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/pathology , Length of Stay , Prosthesis Design
7.
Colorectal Dis ; 15(5): e266-70, 2013 May.
Article in English | MEDLINE | ID: mdl-23350931

ABSTRACT

AIM: The study was performed to determine the prevalence of right-sided diverticular disease in a western population and whether it is more likely to bleed than disease on the left side. METHOD: From January 2004 to June 2005, 796 consecutive patients were referred for total colonoscopy to 17 physicians. Data obtained included age, gender, and presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding. RESULTS: Three-hundred and eighteen (40%) of the 796 patients presented with noncomplicated diverticulosis. Of these, 103 (32.4%) had right-sided diverticula. In univariate analysis, the presence of right diverticula in patients admitted for diverticular bleeding was about twice as frequent as in patients who had diverticula with no bleeding (65.2% vs 32.4%; P = 0.0001). In multivariate analysis, the right localization of the diverticulosis was associated with a risk of bleeding, which was independent of the patients' age (P = 0.0001, OR = 3.6). CONCLUSION: The prevalence of colonic diverticula increased from < 10% in adults under 40 years of age to about 75% in those over 75 years of age. Of these patients, nearly one-third presented with right-sided involvement. Right-sided localization was associated with a significant risk of bleeding, which was independent of the patients' age.


Subject(s)
Diverticulosis, Colonic/epidemiology , Gastrointestinal Hemorrhage/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Colon, Ascending , Colon, Transverse , Colonoscopy , Diverticulosis, Colonic/complications , Diverticulosis, Colonic/diagnosis , Female , France/epidemiology , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Risk Factors , Young Adult
8.
Endoscopy ; 45(1): 35-41, 2013.
Article in English | MEDLINE | ID: mdl-23136012

ABSTRACT

BACKGROUND AND STUDY AIMS: Uncovered self-expanding metal stents offer effective relief for colonic obstruction. The aim of this study was to determine the effectiveness of fully covered self-expanding metal stents (FCSEMSs) in the treatment of benign colonic strictures. PATIENTS AND METHODS: All patients presenting with a symptomatic benign colonic stricture (occlusion or subocclusion) during a 6-year study period were treated with FCSEMSs. The stents were placed and removed 4 - 6 weeks later at one of 10 endoscopy centers. The efficacy of the stent (clinical and radiological signs of colonic decompression within 48 hours), technical success, stent retrieval, safety, and recurrence of symptoms were evaluated during follow-up. Univariate and multivariate analyses were performed to identify variables associated with clinical success, stent migration, and symptom recurrence. RESULTS: The study included 43 patients (24 men, 19 women; mean age 67.6 ± 10.4) with occlusive (n = 18) or subocclusive symptoms (n = 25) due to anastomotic (n = 40), post-ischemic (n = 2), or post-radiation (n = 1) strictures. Insertion was successful in all patients. Clinical success was obtained in 35 patients (81 %). Migration was observed in 27 patients (63 %). The median duration of stenting was 21 days (95 %CI 17.8 - 35.4 days). Multivariate analysis showed that stents more than 20 mm wide migrated significantly less often. Recurrence of obstructive symptoms was observed in 23 patients (53 %), irrespective of migration. No predictive factors for recurrence or clinical efficacy were found. CONCLUSIONS: FCSEMSs for treatment of symptomatic benign colonic strictures are safe and effective, despite a high rate of spontaneous migration.


Subject(s)
Colonic Diseases/therapy , Endoscopy, Gastrointestinal , Intestinal Obstruction/therapy , Stents , Aged , Device Removal , Female , Foreign-Body Migration , Humans , Male , Metals , Recurrence , Retrospective Studies , Statistics, Nonparametric , Treatment Outcome
9.
Endoscopy ; 43(8): 664-70, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21623560

ABSTRACT

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is a technique for "en bloc" resection of superficial tumors of the gastrointestinal tract. In France, experience with this technique is still limited. We wanted to assess the development of ESD in France, with special attention to short term outcomes. PATIENTS AND METHODS: Members of the Société Française d'Endoscopie Digestive (SFED) who declared performing ESD reported their cases prospectively on a voluntary basis. Demographic, clinical, and technical data, and the results of immediate complications were collected. Case reports were completed prospectively by each investigator before pooled analysis. RESULTS: A total of 188 consecutive case reports were collected from 16 centers. The median case mix per center was 6 patients (range 1-43). The lesion sites treated by ESD were the stomach (n = 75), esophagus (n = 27), duodenum (n = 1), cecum (n = 2), right colon (n = 3), transverse colon (n = 5), sigmoid (n = 3), and rectum (n = 72). The median size of the lesions was 26 mm (range 2-150 mm). En bloc resection was achieved in 77.1% of cases, with complete R0 resection in 72.9%. Histopathology results showed high grade dysplasia or superficial cancer in 71.2%. The median duration of ESD was 105 minutes (range 20-450 minutes). The short term morbidity was 29.2% including 34 cases of perforation (18.1%), and 21 hemorrhages (11.2%) during the 24 hours following ESD, 89% of which were managed conservatively or endoscopically. CONCLUSION: In this early experience, the feasibility of ESD appeared to be good but R0 resection and complication rates did not match those reported by Japanese authors and must be improved by an extended practice.


Subject(s)
Dissection/methods , Endoscopy, Gastrointestinal/methods , Gastric Mucosa/surgery , Gastrointestinal Neoplasms/surgery , Intestinal Mucosa/surgery , Intestinal Perforation/etiology , Postoperative Hemorrhage/etiology , Adult , Aged , Aged, 80 and over , Blood Loss, Surgical , Dissection/adverse effects , Endoscopy, Gastrointestinal/adverse effects , Female , France , Gastrointestinal Neoplasms/pathology , Humans , Length of Stay , Male , Middle Aged , Time Factors
10.
Gastroenterol Clin Biol ; 32(2): 118-22, 2008 Feb.
Article in French | MEDLINE | ID: mdl-18387424

ABSTRACT

Migration, distal malposition or fracture of self-expanding metallic biliary or esophageal stents rarely occur but may lead to stent dysfunction, mucosal trauma secondary to impaction or friction on the digestive wall. We report our experience of using argon plasma to endoscopically cut three metallic biliary and esophageal self-expanding stents to restore permeability or to treat impaction of the stent after migration, malposition or fracture.


Subject(s)
Endoscopes, Gastrointestinal , Esophagus , Hepatic Duct, Common , Lasers, Gas/therapeutic use , Prosthesis Failure , Stents/adverse effects , Aged , Aged, 80 and over , Alloys , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Duodenal Ulcer/etiology , Duodenal Ulcer/therapy , Duodenoscopy , Esophagus/surgery , Foreign-Body Migration/etiology , Foreign-Body Migration/therapy , Gastroscopy , Hepatic Duct, Common/surgery , Humans , Male , Prosthesis Design , Silicones , Treatment Outcome
11.
Gastroenterol Clin Biol ; 32(3): 221-3, 2008 Mar.
Article in French | MEDLINE | ID: mdl-18343070

ABSTRACT

A 60-year-old man presented an oesophageal transmural necrosis fistulised in the trachea following curative photodynamic therapy (PDT) for a superficial recurrence of an oesophageal carcinoma, initially treated by radiochemotherapy. Two stents, a tracheal and an oesophageal one, were placed. Eight months later the patient is in complete remission with only mild swallowing problems. This complication, although unusual, has already been described by other teams with the association of radiochemotherapy and PDT. The present case study suggests that illumination dose should be lowered in this indication.


Subject(s)
Esophageal Neoplasms/therapy , Neoplasm Recurrence, Local/drug therapy , Photochemotherapy/adverse effects , Tracheoesophageal Fistula/etiology , Carcinoma, Squamous Cell/therapy , Chemotherapy, Adjuvant , Dihematoporphyrin Ether/adverse effects , Humans , Male , Middle Aged , Necrosis , Photosensitizing Agents/adverse effects , Radiotherapy, Adjuvant , Stents , Tracheoesophageal Fistula/pathology , Tracheoesophageal Fistula/surgery
12.
Eur J Gastroenterol Hepatol ; 11(7): 741-5, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10445794

ABSTRACT

OBJECTIVE: Beta-blockers have been shown to reduce portal pressure in patients with cirrhosis and limit the development of portosystemic shunts in portal hypertensive animals. Thus, a randomized double-blind trial was conducted to evaluate propranolol in the prevention of the development of large oesophageal varices in patients with cirrhosis without varices or with small varices. METHODS: One hundred and two patients received long-acting propranolol (160 mg/day) and 104 patients received a placebo. At inclusion, there was no significant difference between the two groups in terms of clinical characteristics or biochemical tests. At 2 years, the size of varices was estimated on video recordings. RESULTS: One-third of the patients were lost to follow-up, and 95%/97% of the remaining patients were compliant in the propranolol and placebo groups, respectively. At 2 years, the proportion of patients with large varices was 31% in the propranolol group and 14% in the placebo group (P< 0.05). Three and four patients bled in the propranolol and placebo groups, respectively, and nine and ten died, respectively. CONCLUSION: This trial suggests that propranolol administration cannot be recommended for the prevention of the development of large oesophageal varices in patients with cirrhosis; thus other studies are needed in selected subgroups of patients.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/prevention & control , Liver Cirrhosis/complications , Propranolol/therapeutic use , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Treatment Failure
14.
J Hepatol ; 21(5): 797-805, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7890897

ABSTRACT

Chronic active hepatitis B (CAH-B), anti-HBe (+) has been associated with a hepatitis B virus variant carrying a stop codon at the distal pre-C region that prevents HBeAg synthesis. We analyzed the HBV DNA pre-C region in five members of a Turkish family. The mother presented an anti-HBe (+) CAH-B and the four children different hepatitis B virus serological and clinical profiles. The pre-C region was analyzed by cloning after DNA amplification in sera and peripheral blood mononuclear cells. A method for rapid screening of a large number of cloned polymerase chain reaction products was developed for the presence of the most frequent pre-C mutations (G to A substitution at nucleotide position 1896 and 1899). At least 60 independent clones were tested for each patient by selective oligonucleotide hybridization using non-mutated (M0), one (M1) and two (M2) point-mutated probes. Results were confirmed by sequencing. The mutation 1896 was present in 91% of DNA clones from the mother. The same mutation was also found in 85% of the clones in the youngest child (D), but in less than 10% of the clones from children A and C. Only the pre-C wild-type strain was observed in child B. X gene deletions (3 to 20 nt) were also present in some clones from the mother and children A, B and C. No significant difference between serum and peripheral blood mononuclear cells concerning the viral population was observed.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Hepatitis Antibodies/analysis , Hepatitis B Surface Antigens/immunology , Hepatitis B/genetics , Mutation , Adolescent , Adult , Base Sequence , Blotting, Southern , Cloning, Molecular , Female , Hepatitis B/immunology , Hepatitis B virus/classification , Humans , Male , Middle Aged , Molecular Sequence Data , Oligonucleotide Probes/genetics , Polymerase Chain Reaction , Recombination, Genetic
15.
J Hepatol ; 21(1): 58-63, 1994 Jul.
Article in English | MEDLINE | ID: mdl-7525697

ABSTRACT

Detection of hepatitis C virus RNA by polymerase chain reaction was performed in 26 patients with type II mixed cryoglobulinemia, and compared with anti-HCV antibody detection. The patients were divided into two groups according to etiology: 15 had essential type II mixed cryoglobulinemia and 11 had secondary type II mixed cryoglobulinemia. In the essential type II mixed cryoglobulinemia group, the prevalence of hepatitis C virus RNA detected by polymerase chain reaction was 60% in the supernatant and 93% in the cryoprecipitate. In the secondary type II mixed cryoglobulinemia group the prevalence of hepatitis C virus RNA was 45% in the supernatant and 55% in the cryoprecipitate. The differences between the two groups were not statistically significant. In both patient groups, detection of hepatitis C virus RNA in the cryoprecipitate was the most sensitive test for hepatitis C virus infection. These results suggest that hepatitis C virus might be involved in the origin of mixed cryoglobulinemia.


Subject(s)
Cryoglobulinemia/blood , Cryoglobulinemia/virology , Hepacivirus/isolation & purification , RNA, Viral/analysis , Aged , Aged, 80 and over , Cryoglobulinemia/etiology , Cryoglobulins/analysis , Female , Hepacivirus/immunology , Hepatitis Antibodies/blood , Hepatitis C Antibodies , Humans , Male , Middle Aged , Polymerase Chain Reaction
18.
Gastroenterol Clin Biol ; 18(3): 251-6, 1994.
Article in French | MEDLINE | ID: mdl-7926441

ABSTRACT

The purpose of this prospective work was to study a possible relationship between autoantibodies, cryoglobulinaemia and liver histologic lesions in chronic hepatitis C. Ninety three patients (mean age: 43.3 years) with histologically proven chronic hepatitis were studied. Chronic hepatitis was associated with cirrhosis in 18 cases. Auto-antibodies detection was performed in the serum of all patients and cryoglobulinaemia detection was performed in 47 patients. The prevalence of auto-antibodies was also studied in 45 blood donors (control group) and 30 patients with chronic hepatitis B. Histologic study included Knodell score and semi-quantitatively expressed histologic lesions considered as more specific of chronic hepatitis C. Twenty six of the 93 patients (28%) had at least an autoantibody with a level > or = 1/100. The autoantibodies prevalence was: smooth muscle: 15%, antinuclear: 15%, LKM 1: 1.2%, mitochondrial: 0. A mixed cryoglobulinaemia was present in 23 of 47 patients (49%). The prevalence of anti-smooth-muscle autoantibodies was significantly increased in hepatitis C patients compared with the control group (P < 0.05). The histologic Knodell score was 7.3 +/- 3.6. The histologic lesion prevalence was: portal tract lymphoid follicles: 97%, acidophil bodies: 85%, intra-sinusoidal lymphoid infiltrates: 71%, steatosis: 61%, microgranulomas: 54%, biliary duct tract damages: 53%. No statistical significant correlation was found between autoantibodies prevalence and liver histologic lesions. The Knodell score was only significantly increased in patients with mixed cryoglobulinaemia (8.4 +/- 3.6 vs 6.2 +/- 2.8) (P < 0.05). These results suggest that the autoantibodies presence in chronic hepatitis C does not change hepatic histologic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Autoantibodies/analysis , Cryoglobulinemia/complications , Hepatitis B/immunology , Hepatitis C/immunology , Hepatitis, Chronic/immunology , Adult , Aged , Antibodies, Antinuclear/analysis , Autoantibodies/immunology , Female , Hepatitis C/complications , Hepatitis C/pathology , Hepatitis, Chronic/complications , Hepatitis, Chronic/pathology , Humans , Liver Cirrhosis/complications , Male , Middle Aged , Mitochondria, Liver/immunology , Muscle, Smooth/immunology , Prospective Studies , Reference Values
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