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1.
Inflamm Bowel Dis ; 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38597799

RESUMO

BACKGROUND: Crohn's disease (CD) is a progressive, destructive, and disabling disorder. Our study aimed to assess changes over time in the Lémann index (LI) and the Inflammatory Bowel Disease Disability Index (IBD-DI) in a cohort of CD patients. METHODS: This was a single-center prospective cohort study of 130 consecutive CD patients with a follow-up of at least 4 years. The LI 1 and the IBD-DI 1 questionnaires were assessed in 2016 and again between September 2020 and October 2021 (LI 2 and IBD-DI 2). RESULTS: Of the 130 patients with assessment of both LI 1 and IBD-DI 1, 61 had calculation of the LI 2 and 98 patients answered the IBD-DI 2 questionnaire, with a median time between the 2 evaluations of 4.2 years. The LI increased for 16 (26%), decreased for 26 (43%), and remained unchanged for 19 (31%) patients. The median LI did not change over time (9.6 vs 9.3; P = .14). Clinical disease activity was significantly associated with bowel damage progression. A high initial LI (>7.9) was not associated with CD progression (surgery, drug dose escalation, or change of biologic). The IBD-DI decreased for 59 (60.2%), increased for 37 (37.8%), and remained unchanged for 2 (2%) patients. The median IBD-DI decreased significantly over time (23.2 vs 21.4; P = .006). There was no correlation between the 2 indexes. CONCLUSIONS: This is the first prospective cohort study assessing changes over time in both the LI and the IBD-DI in CD patients. After 4 years, the LI appeared to be stable and the IBD-DI decreased, with no correlation between the 2 indexes.


After a long period of follow-up (4 years) of patients with Crohn's disease, bowel damages (assessed by the Lémann index) appeared stable and disability (assessed by the Inflammatory Bowel Disease Disability Index) decreased, without there being any correlation between the 2 indexes over time.

2.
Dig Endosc ; 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38380564

RESUMO

OBJECTIVES: The aim of this study was to compare endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) vs. EUS-gallbladder drainage (EUS-GBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) for jaundice resulting from malignant distal biliary obstruction (MDBO). METHODS: This multicenter retrospective study included patients with obstructive jaundice secondary to MDBO who underwent EUS-GBD or EUS-CDS with lumen-apposing metal stents after failed ERCP. The primary end-point was clinical success rate. Secondary end-points were technical success, periprocedural adverse events rate (<24 h), late adverse events rate (>24 h), overall survival, and time to recurrent biliary obstruction. RESULTS: A total of 78 patients were included: 41 underwent EUS-GBD and 37 underwent EUS-CDS. MDBO was mainly the result of pancreatic cancer (n = 63/78, 80.7%). Clinical success rate was similar for both procedures: 87.8% for EUS-GBD and 89.2% for EUS-CDS (P = 0.8). Technical success rate was 100% for EUS-GBD and 94.6% for EUS-CDS (P = 0.132). Periprocedural morbidity (<24 h) rates were similar between both groups: 4/41 (9.8%) for EUS-GBD and 5/37 (13.5%) for EUS-CDS (P = 0.368). There was a significantly higher rate of late morbidity (>24 h) among patients in the EUS-CDS group (8/37 [21.6%]) than in the EUS-GBD group (3/41 [7.3%]) (P = 0.042). The median follow-up duration was 4.7 months. Overall survival and time to recurrent biliary obstruction did not significantly differ between the groups. DISCUSSION: After failed ERCP for MDBO, EUS-GBD and EUS-CDS show comparable clinical success rates and technical success. EUS-GBD appears to be a promising alternative for MDBO, even as a second-line treatment after failed ERCP. Further studies are needed to validate these findings and compare the long-term outcomes of EUS-GBD and EUS-CDS.

3.
Orthop Traumatol Surg Res ; 110(2): 103792, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38081356

RESUMO

INTRODUCTION: The pelvis plays a major role in the orientation of total hip arthroplasty (THA) implants and consequently, on the postoperative stability of the new hip joint. The relationship between the spine and pelvis affects the functional orientation of the acetabular cup, although this relationship differs between individuals and the positions encountered in everyday life. We believe this should be factored in when planning the THA procedure. This led us to conduct an in vivo ultrasound study to document the values of pelvic tilt in standing, sitting and lying positions in patients who have advanced hip osteoarthritis, before and after they undergo THA. HYPOTHESIS: The pelvic tilt when standing, sitting and lying supine does not change significantly after THA. MATERIALS AND METHODS: The pelvic tilt, defined as the angle between the anterior pelvic plane and a vertical line was measured using an ultrasound device in 30 patients before the THA procedure and again 6 months later in standing, sitting and lying positions. The measurements were done during an office visit with the patient on an examination table for the lying position, on a chair for the sitting position and with the heels and occiput against the wall for the standing position. RESULTS: The preoperative and 6-month postoperative pelvic tilt were -5.6̊±10.4̊ [-30.6̊; 11.7̊] and -5.8̊±7.9̊ [-20.6̊; 10.4̊] (p=0.4129) when standing, -44.5̊±6.10 [-53.8̊; -23.9̊] and -43.5̊±6.9̊ [-54.4̊; -17.3̊] (p=0.5760) when sitting, -88.3̊±5.1̊ [-99.3̊; -78.7̊] and -87.9̊±5.9̊ [-97.6̊; -72.4̊] (p=0.6106) when lying supine, respectively. There was no significant difference in the pelvic tilt before and 6 months after THA procedure. Variations of±5̊; ±5-10̊; ±10-15̊ and 15-20̊ were found in 72% (18); 20% (5); 4% (1) and 4% (1) of patients when lying supine, 56% (14); 36% (9); 8% (2); 0% (0) of patients when standing and 76% (19); 24% (6); 0% (0); 0% (0) when sitting. The mean variation for each patient between the preoperative and 6 months postoperative measurement was 4.8±3.4̊ [0.8̊; 10.4̊] (p=0.4129), 3.5±2.3̊ [0.2̊; 9.1̊] (p=0.5760), and 4.6̊±3.2̊ [1.2̊; 15.4̊] (p=0.6106) for the standing, sitting and lying positions respectively. CONCLUSION: The pelvic tilt does not significantly change 6 months after THA. Taking into account the various positions used in everyday life may help to optimize the implant position. We have described the use of an affordable, accurate and non-irradiating device that provides fast and easy measurements of pelvic tilt in various positions. LEVEL OF EVIDENCE: IV.


Assuntos
Artroplastia de Quadril , Humanos , Artroplastia de Quadril/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Acetábulo/cirurgia , Postura , Coluna Vertebral
4.
Am J Gastroenterol ; 119(2): 378-381, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37734341

RESUMO

INTRODUCTION: When initial resection of rectal neuroendocrine tumors (r-NETs) is not R0, persistence of local residue could lead to disease recurrence. This study aimed to evaluate the interest of systematic resection of non-R0 r-NET scars. METHODS: Retrospective analysis of all the consecutive endoscopic revisions and resections of the scar after non-R0 resections of r-NETs. RESULTS: A total of 100 patients were included. Salvage endoscopic procedure using endoscopic submucosal dissection or endoscopic full-thickness resection showed an R0 rate of near 100%. Residual r-NET was found in 43% of cases. DISCUSSION: In case of non-R0 resected r-NET, systematic scar resection by endoscopic full-thickness resection or endoscopic submucosal dissection seems necessary.


Assuntos
Ressecção Endoscópica de Mucosa , Tumores Neuroendócrinos , Neoplasias Retais , Humanos , Tumores Neuroendócrinos/cirurgia , Cicatriz/etiologia , Cicatriz/patologia , Estudos Retrospectivos , Resultado do Tratamento , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Ressecção Endoscópica de Mucosa/métodos
5.
Gastrointest Endosc ; 99(3): 408-416.e2, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37793506

RESUMO

BACKGROUND AND AIMS: We aimed to compare the long-term outcomes of patients with high-risk T1 colorectal cancer (CRC) resected endoscopically who received either additional surgery or surveillance. METHODS: We used data from routine care to emulate a target trial aimed at comparing 2 strategies after endoscopic resection of high-risk T1 CRC: surgery with lymph node dissection (treatment group) versus surveillance alone (control group). All patients from 14 tertiary centers who underwent an endoscopic resection for high-risk T1 CRC between March 2012 and August 2019 were included. The primary outcome was a composite outcome of cancer recurrence or death at 48 months. RESULTS: Of 197 patients included in the analysis, 107 were categorized in the treatment group and 90 were categorized in the control group. From baseline to 48 months, 4 of 107 patients (3.7%) died in the treatment group and 6 of 90 patients (6.7%) died in the control group. Four of 107 patients (3.7%) in the treatment group experienced a cancer recurrence and 4 of 90 patients (4.4%) in the control group experienced a cancer recurrence. After balancing the baseline covariates by inverse probability of treatment weighting, we found no significant difference in the rate of death and cancer recurrence between patients in the 2 groups (weighted hazard ratio, .95; 95% confidence interval, .52-1.75). CONCLUSIONS: Our study suggests that patients with high-risk T1 CRC initially treated with endoscopic resection may not benefit from additional surgery.


Assuntos
Neoplasias Colorretais , Recidiva Local de Neoplasia , Humanos , Estudos Retrospectivos , Recidiva Local de Neoplasia/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologia , Endoscopia/métodos , Excisão de Linfonodo , Fatores de Risco , Resultado do Tratamento
6.
Clin Res Hepatol Gastroenterol ; 46(2): 101837, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34801732

RESUMO

BACKGROUND: In France, it is mandatory that gastroenterology fellows have mastered the basic level of endoscopy by the end of training. The aim of this study was to assess improvement in the quality of fellows' endoscopy training in France during the last four years. METHODS: All fellows in France in training were eligible for participation. A 21-item questionnaire was sent out. The primary outcome was the completion by fourth year fellows of all the number of procedures recommended. Results were compared with those of a 2016 survey. RESULTS: Two-hundred-and-sixty-five fellows responded to the survey. The participation rate was 47.0%. The mean age was 27.3 ± 1.0 years and 56.4% were female. Access to theoretical courses (63.7% vs. 30.6%, p < 0.001) and simulation-based training (virtual reality simulator: 58.4% vs. 28.2%, p < 0.001, animal models: 29.4% vs. 17.2%, p < 0.001) was significantly higher in 2020. Although the number of procedures did not increase, significantly higher perception of skill acquisition in colonoscopy as well as diminished pressure to advance procedures were noted. CONCLUSION: Access to theoretical courses and simulation-based training and perceived acquisition of numerous skills has gotten better. However, the quality of training in endoscopy still needs improvement.


Assuntos
Bolsas de Estudo , Gastroenterologia , Animais , Competência Clínica , Endoscopia Gastrointestinal/educação , Feminino , Gastroenterologia/educação , Humanos , Inquéritos e Questionários
7.
J Thromb Haemost ; 19(2): 380-386, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33113216

RESUMO

BACKGROUND: Despite a high prevalence of angiodysplasia, no specific guidelines are available for the modalities of endoscopic exploration of gastrointestinal (GI) bleeding in von Willebrand disease (VWD). Whether VWD patients could benefit from video capsule endoscopy (VCE) looking for angiodysplasia eligible to endoscopic treatment or at high risk of bleeding is unknown. OBJECTIVES: To assess the diagnostic efficacy for angiodysplasia and the prognostic value of VCE on top of conventional endoscopy in VWD patients with GI bleeding. PATIENTS/METHODS: A survey was sent to the 30 centers of the French-network on inherited bleeding disorders to identify VWD patients referred for endoscopic exploration of GI bleeding from January 2015 to December 2017. Data obtained included patient characteristics, VWD phenotype/genotype, GI bleeding pattern, results of endoscopic investigations, and medical management applied including endoscopic therapy. We assessed by Kaplan-Meier analysis the recurrence-free survival after the first GI bleeding event according to endoscopic categorization and, in patients with angiodysplasia, to the presence of small-bowel localizations on VCE exploration. RESULTS: GI bleeding source localization was significantly improved when including VCE exploration (P < .01), even in patients without history of angiodysplasia (P < .05). Patients with angiodysplasia had more GI bleeding recurrences (P < .01). A lower recurrence-free survival was observed in patients with angiodysplasia (log-rank test, P = .02), and especially when lesions were located in the small bowel (log-rank test, P < .01), even after endoscopic treatment with argon plasma coagulation (log-rank test, P < .01). CONCLUSION: VCE should be more systematically used in VWD patients with unexplained or recurrent GI bleeding looking for angiodysplasia eligible to endoscopic treatment or at high risk of relapse.


Assuntos
Angiodisplasia , Doenças de von Willebrand , Angiodisplasia/complicações , Angiodisplasia/diagnóstico , Endoscopia , Hemorragia Gastrointestinal/diagnóstico , Humanos , Prognóstico , Doenças de von Willebrand/complicações , Doenças de von Willebrand/diagnóstico
8.
Orthop Traumatol Surg Res ; 106(8): 1523-1526, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33177007

RESUMO

Interest in the different surgical approaches to total hip arthroplasty remains high, but without any real consensus on which approach is the most beneficial. Several recent technical innovations have made it possible to reduce the risk of dislocation, therefore improving the efficacy of the posterolateral approach. Since 2003, we have been using a modified minimally invasive posterolateral approach called SPARTAQUUS (Spare the Piriformis And Respect The Active QUadratus femoris and gluteus mediUS), which spares the piriformis tendon, the quadratus femoris muscle and the gluteus medius muscle, and involves direct capsular repair. The "active posterosuperior hammock" effect of the piriformis tendon is therefore coupled with the "passive posterosuperior hammock" effect of the capsular repair, thus limiting the risks of posterior dislocation of the prosthetic hip joint.


Assuntos
Artroplastia de Quadril , Quadril , Nádegas/cirurgia , Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Músculo Esquelético/cirurgia , Tendões/cirurgia
9.
Am J Transplant ; 20(12): 3667-3672, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32428994

RESUMO

Human herpesvirus (HHV)-6A can be inherited and chromosomally integrated (iciHHV-6A), and donor-to-recipient transmission has been reported in solid organ transplant. However, when HHV-6A reactivation happens after transplant, the source of HHV-6A is often not evident and its pathogenicity remains unclear. Here, we present an exhaustive case of donor-to-recipient transmission and reactivation of iciHHV-6A through kidney transplant. The absence of HHV-6A genome from the nails of the recipient excluded a recipient-related iciHHV-6A. Viral loads > 7 log10 copies/106 cells in donor blood samples and similarities of U38, U39, U69, and U100 viral genes between donor, recipient, and previously published iciHHV-6A strains are proof of donor-related transmission. Detection of noncoding HHV-6 snc-RNA14 using fluorescence in situ hybridization analysis and immunofluorescence staining of HHV-6A gp82/gp105 late proteins on kidney biopsies showed evidence of reactivation in the transplanted kidney. Because HHV-6A reactivation can be life threatening in immunocompromised patients, we provide several tools to help during the complete screening and diagnosis.


Assuntos
Herpesvirus Humano 6 , Transplante de Rim , DNA Viral , Herpesvirus Humano 6/genética , Humanos , Hibridização in Situ Fluorescente , Transplante de Rim/efeitos adversos , Transplantados , Integração Viral
10.
Aliment Pharmacol Ther ; 51(9): 889-898, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32221985

RESUMO

BACKGROUND: The notion of Crohn's disease (CD) as a chronic, progressive and disabling condition has led to the development of new indexes: the Lémann Index measuring cumulative bowel damage and the Inflammatory Bowel Disease (IBD) Disability Index, assessing functional disability. AIMS: To measure the Lémann Index and the IBD Disability Index in a large prospective cohort of CD patients and to assess the correlation between these two indexes. METHODS: We performed a prospective study in a tertiary referral centre including all consecutive CD outpatients. We assessed the Lémann Index and the IBD Disability Index questionnaire in all patients. RESULTS: One hundred and thirty CD patients were consecutively included. The mean Lémann Index (±SD) was 11.9 ± 14.1 and ranged from 0 to 72.5 points. Factors associated with a high bowel damage score were: disease duration, anal location, previous intestinal resection, clinical and biological disease activity, exposure to immunosuppressants, and exposure to anti-TNF (P < 0.005). Among patients exposed to anti-TNF, the Lémann Index was lower in those who were exposed in the first 2 years of their disease (P = 0.015). The mean IBD Disability Index was 28.8 ± 6.3 and ranged from 0 to 71 points. The factors associated with high disability score were: female gender, anal location, extra digestive manifestations, clinical and biological disease activity and exposure to anti-TNF (P < 0.005). No correlation was observed between the Lémann Index and IBD Disability Index (P = 0.15). CONCLUSIONS: This is the first study to prospectively evaluate the Lémann Index and the IBD Disability Index in a large cohort of CD patients in a tertiary centre. Early introduction of anti-TNF treatment was associated with lower bowel damage scores, and no correlation was observed between the Lémann Index and the IBD Disability Index. Further dedicated prospective studies are necessary to confirm these results.


Assuntos
Doença de Crohn/diagnóstico , Indicadores Básicos de Saúde , Intestinos/patologia , Intestinos/fisiopatologia , Adolescente , Adulto , Estudos de Coortes , Doença de Crohn/tratamento farmacológico , Doença de Crohn/patologia , Doença de Crohn/fisiopatologia , Avaliação da Deficiência , Feminino , França , Humanos , Imunossupressores/uso terapêutico , Intestinos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Centros de Atenção Terciária , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia , Adulto Jovem
11.
Endosc Int Open ; 8(3): E415-E420, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32118115

RESUMO

Background and study aims Capsule endoscopy (CE) is the preferred method for small bowel (SB) exploration. With a mean number of 50,000 SB frames per video, SBCE reading is time-consuming and tedious (30 to 60 minutes per video). We describe a large, multicenter database named CAD-CAP (Computer-Assisted Diagnosis for CAPsule Endoscopy, CAD-CAP). This database aims to serve the development of CAD tools for CE reading. Materials and methods Twelve French endoscopy centers were involved. All available third-generation SB-CE videos (Pillcam, Medtronic) were retrospectively selected from these centers and deidentified. Any pathological frame was extracted and included in the database. Manual segmentation of findings within these frames was performed by two pre-med students trained and supervised by an expert reader. All frames were then classified by type and clinical relevance by a panel of three expert readers. An automated extraction process was also developed to create a dataset of normal, proofread, control images from normal, complete, SB-CE videos. Results Four-thousand-one-hundred-and-seventy-four SB-CE were included. Of them, 1,480 videos (35 %) containing at least one pathological finding were selected. Findings from 5,184 frames (with their short video sequences) were extracted and delimited: 718 frames with fresh blood, 3,097 frames with vascular lesions, and 1,369 frames with inflammatory and ulcerative lesions. Twenty-thousand normal frames were extracted from 206 SB-CE normal videos. CAD-CAP has already been used for development of automated tools for angiectasia detection and also for two international challenges on medical computerized analysis.

12.
Dig Dis Sci ; 65(5): 1445-1452, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31599389

RESUMO

INTRODUCTION: The aim of this study was to evaluate the association between serum ustekinumab (UST) trough levels and response to induction and maintenance UST treatment in refractory Crohn's Disease (CD) patients. METHODS: We performed a prospective study including CD patients who received UST from September 2015 to January 2017. Patients received 90 mg of UST subcutaneously at weeks 0, 4, and 12, then every 8 weeks. Two cohorts of patients were analyzed: an induction cohort and a maintenance cohort. We evaluated clinical, biological, and imaging/endoscopic response to UST treatment. UST trough levels and anti-UST antibodies were dosed at weeks 12 and 28 in the induction cohort, and at a single time point in the maintenance cohort. RESULTS: Forty-nine patients were enrolled in the maintenance cohort. Mean concentrations of UST were 1.88 ± 1.40 µg/mL. UST trough levels were not significantly different in patients with or without clinical, biological, or imaging/endoscopic responses to UST treatment (p > 0.11). Twenty-three consecutive patients were included in the induction cohort. At week 12, mean UST concentrations were 1.45 ± 1.15 µg/mL. Patients with a biological response to UST treatment had significant higher serum UST trough concentration (median 1.72 µg/mL) than non-responders (median 0.56 µg/mL, p = 0.02). A UST trough level ≥ 1.10 µg/mL at week 12 was associated with a biological response to UST treatment at 6 months. CONCLUSION: UST trough levels were associated with a biological response at the end of the induction phase. In patients with low levels of UST, optimization treatment may be necessary to obtain a sustained response.


Assuntos
Doença de Crohn/sangue , Ustekinumab/sangue , Adulto , Biomarcadores/sangue , Doença de Crohn/tratamento farmacológico , Feminino , Humanos , Quimioterapia de Indução , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Resultado do Tratamento , Ustekinumab/uso terapêutico
13.
Dig Dis Sci ; 65(9): 2664-2674, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31811438

RESUMO

BACKGROUND: The aim of the study was to identify factors associated with a radiological response and to assess the impact of radiological improvement in long-term outcomes in small bowel (SB) Crohn's disease (CD) patients. METHODS: We performed a retrospective study from June 2011 to June 2017 in the tertiary center, Claude Huriez Hospital in Lille, France. All SB CD patients, who underwent two magnetic resonance enterographies (MRE) 3-12 months apart, with at least 1-year follow-up after the second MRE, were included. Signs of radiological inflammation were identified by two expert radiologists in CD. Patients were classified as radiological responders (RR) and non-responders (NR). Hospitalization rates, adjustment of treatment, and surgical or endoscopic interventions were assessed and compared between RR and NR. Factors associated with a radiological response were also studied using the Cox model. RESULTS: One hundred and fifteen SB CD patients were included with a median follow-up of 17 months (IQR 11.6-28.3). There were 54 (47%) RR and 61 (53%) NR. The risk of surgical or endoscopic intervention was higher in NR than RR (p = 0.04), and the median delay until a surgical or endoscopic intervention was shorter in NR (p = 0.04). Multifocal disease, a hypersignal on diffusion-weighted or dynamic contrast-enhanced imaging, a stricture, or a fistula was significantly associated with a decreased probability of a radiological response (p < 0.05). CONCLUSION: This study shows that a radiological response is associated with a decreased risk of surgical or endoscopic intervention and should be considered as a therapeutic target in CD patients.


Assuntos
Doença de Crohn/diagnóstico por imagem , Doença de Crohn/terapia , Imagem de Difusão por Ressonância Magnética , Intestino Delgado/diagnóstico por imagem , Cicatrização , Adolescente , Adulto , Doença de Crohn/fisiopatologia , Progressão da Doença , Feminino , França , Hospitalização , Humanos , Intestino Delgado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
J Ultrasound Med ; 39(4): 667-674, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31665548

RESUMO

OBJECTIVES: A new ultrasound-based device is proposed to measure the patient-specific pelvic tilt in different daily positions. The aim of this study was to assess the accuracy of this device as well as the intraobserver and interobserver precisions. METHODS: The accuracy was assessed by performing several tilt measurements with the device on a testing mechanical bench. The error was defined as the difference between the tilt measured with the device and the tilt provided by this test bench. Three physicians, a novice, an intermediate, and an expert user, were also asked to perform 10 measurements on 3 healthy volunteers with low, medium, and high body mass indices to analyze the intraobserver and interobserver precisions. These 10 measurements were performed in the standing, sitting, and supine positions. RESULTS: The mean accuracy of the device ± SD was 1.1° ± 0.7° (range, 0°-4.0°). The interobserver and intraobserver precisions were excellent whatever the body mass index and good to excellent according to the positions. There was no learning curve, and the time required to complete the measurements was approximately 5 minutes. CONCLUSIONS: This study presents an accurate and precise noninvasive device for measurement of the pelvic tilt in different positions.


Assuntos
Ossos Pélvicos/anatomia & histologia , Ossos Pélvicos/fisiologia , Postura/fisiologia , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Adulto , Índice de Massa Corporal , Competência Clínica/estatística & dados numéricos , Humanos , Variações Dependentes do Observador , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes
15.
Endosc Int Open ; 7(10): E1197-E1206, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31579700

RESUMO

Introduction and study aims Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool. Methods A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 - 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones. Results A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively ( P  < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M ( P  < 0.001). Conclusion The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp.

16.
Obes Surg ; 29(2): 747-748, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30539515

RESUMO

BACKGROUND: The incidence of biliary lithiasis is increased after bariatric surgery due to rapid weight loss [1]. Trans-oral endoscopic management in cases of common bile duct gallstone complication is not possible in patients with Roux-en-Y gastric bypass (RYGB) due to the modified anatomy. Access to the biliary tree after RYGB with a classical direct surgical approach of common bile duct and choledocoscopy can be used, but may be complicated in situations of acute cholangitis because of the fragility of common duct, or in cases of previous cholecystectomy. Multiple alternatives have been described, such as percutaneous transhepatic cholangiography or laparoscopic transgastric endoscopic retrograde cholangiopancreatography (LTG-ERCP) [2, 3]. The aim of this video was to present the management of common bile duct gallstone complication after RYGB and the technical features of LTG-ERCP [4]. METHODS: We present the case of a 79-year-old woman (98 kg, BMI 40.2 kg/m2) with a 24-month history of RYGB, who presented with gallstone cholangitis and septic shock. Imaging revealed a 16-mm dilatation of the common bile duct upstream of a biliary gallstone. A previous history of laparotic cholecystectomy leads us to favor LTG-ERCP. RESULTS: We present the step-by-step LTG-ERCP technique. The laparoscopic procedure started with an excluded stomach dissection and gastrostomy on the great curvature at 10 cm from the pylorus with a 15-mm extra-long port. The placement of the gastrotomy should be carefully chosen with respect to the antrum, in order to provide straightforward access to the pylorus. The transgastric endoscopic procedure should include sphincterotomy (if not formerly performed) and gallstone removal. The patient experienced no specific complication of LTG-ERCP. Control of sepsis was favorable with adapted antibiotic treatment. Hepatic cytolysis and cholestasis normalized within postoperative day 3. Postoperative imaging showed a reduction of the common bile duct diameter to 12 mm. The patient required hemodialysis because of acute kidney injury. She finally left the hospital on postoperative day 16. CONCLUSIONS: LTG-ERCP is a safe and feasible alternative for gallstone cholangitis management in patients with RYGB. This procedure should be recommended for cases of cholangitis rather than laparoscopic choledocoscopy or a percutaneous transhepatic approach, especially in cases of prior cholecystectomy, or in patients where the BMI remains high. LTG-ERCP should be performed in a referral center by a skilled endoscopist and surgeon following a standardized technique.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangite/cirurgia , Cálculos Biliares/cirurgia , Derivação Gástrica , Laparoscopia , Idoso , Feminino , Humanos
17.
Eur J Gastroenterol Hepatol ; 30(10): 1247-1252, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30052539

RESUMO

Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology. The treatment of UC is challenging, especially when it is associated with primary sclerosing cholangitis (PSC), a chronic inflammatory disease of the bile ducts that affects around 5% of patients with UC, and leads to an increased risk of cholangiocarcinoma and colorectal cancer. Microbiota is considered to play an important role in the pathogenesis of UC, although the efficacy of antibiotics in this context is only limited and transient. Several studies have investigated the use of antibiotics for the treatment of PSC in adult and pediatric populations, with conflicting results. In this brief report, we describe the effect of oral vancomycin treatment in three patients with UC and PSC refractory to conventional and biologic therapies. All three patients achieved clinical remission and mucosal healing with vancomycin 500 mg twice a day administered orally. Maintenance treatment with oral vancomycin was well tolerated and led to sustained clinical and endoscopic remission in all three patients. Oral vancomycin also improved liver function tests in two patients who did not have pre-existing cirrhosis.


Assuntos
Antibacterianos/uso terapêutico , Colangite Esclerosante/tratamento farmacológico , Colite Ulcerativa/tratamento farmacológico , Vancomicina/uso terapêutico , Administração Oral , Idoso , Antibacterianos/administração & dosagem , Colangite Esclerosante/complicações , Colangite Esclerosante/fisiopatologia , Colite Ulcerativa/complicações , Feminino , Humanos , Masculino , Indução de Remissão , Retratamento , Vancomicina/administração & dosagem , Adulto Jovem
18.
Inflamm Bowel Dis ; 23(10): 1853-1859, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28837519

RESUMO

BACKGROUND: Infliximab (IFX) is effective in inducing and maintaining remission in patients with luminal and anoperineal Crohn's disease (CD). However, treatment failure within 12 months after initiating IFX is observed in a significant proportion of patients. The aim of the present study was to determine whether the body mass index (BMI) affects response to IFX during the first year of treatment in patients with CD. METHODS: All patients with luminal CD who began IFX between January 2010 and May 2014 were prospectively included. BMI was calculated before IFX treatment was begun, and patients were divided into 3 groups: normal BMI (BMI < 25 kg/m), overweight patients (BMI of 25.0-30 kg/m), and obese patients (BMI > 30.0 kg/m). The primary outcome was to evaluate the rate and delay of IFX optimization during the first year of treatment among normal weight, overweight, and obese patients. RESULTS: One hundred forty patients were included. Demographic and clinical characteristics at IFX initiation were comparable among the 3 groups. Within 12 months after the initiation of IFX, the rate of IFX optimization was significantly higher in overweight and obese patients than in the normal BMI group: 52%, 56%, and 20%, respectively (P = 0.0002). The median time until optimization of IFX was significantly shorter in overweight and obese patients than in the normal BMI group: 7, 7, and 10 months, respectively (P = 0.03). A BMI >25 kg/m was significantly associated with IFX optimization within 12 months on multivariate analysis. CONCLUSION: This is the first study to show that optimization of IFX is more frequent and faster in obese and overweight patients with CD and occurs within 12 months after beginning IFX, suggesting that an induction regimen with higher doses of IFX and a tight control of IFX concentrations may be needed in these patients.


Assuntos
Índice de Massa Corporal , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Infliximab/uso terapêutico , Obesidade/complicações , Adulto , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Falha de Tratamento , Adulto Jovem
19.
Materials (Basel) ; 10(5)2017 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-28772882

RESUMO

This work studies the tensile properties of Ti-6Al-4V samples produced by laser powder bed based Additive Manufacturing (AM), for different build orientations. The results showed high scattering of the yield and tensile strength and low fracture elongation. The subsequent fractographic investigation revealed the presence of tungsten particles on the fracture surface. Hence, its detection and impact on tensile properties of AM Ti-6Al-4V were investigated. X-ray Computed Tomography (X-ray CT) scanning indicated that these inclusions were evenly distributed throughout the samples, however the inclusions area was shown to be larger in the load-bearing plane for the vertical specimens. A microstructural study proved that the mostly spherical tungsten particles were embedded in the fully martensitic Ti-6Al-4V AM material. The particle size distribution, the flowability and the morphology of the powder feedstock were investigated and appeared to be in line with observations from other studies. X-ray CT scanning of the powder however made the high density particles visible, where various techniques, commonly used in the certification of powder feedstock, failed to detect the contaminant. As the detection of cross contamination in the powder feedstock proves to be challenging, the use of only one type of powder per AM equipment is recommended for critical applications such as Space parts.

20.
Dig Liver Dis ; 49(2): 163-169, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27899263

RESUMO

BACKGROUND: Although adalimumab is effective in Crohn's disease, most patients experience a loss of response over time. The aim of the present study was to evaluate efficacy and safety of adalimumab dose escalation and identify predictors of a clinical response in Crohn's disease patients with a secondary loss of response. METHODS: We performed a retrospective and observational study including all Crohn's disease patients who underwent dose escalation of adalimumab after a secondary loss of response from 2007 to 2015. RESULTS: A clinical response was observed in 99/124 (79%) patients at 3 months and in 62/107 (61%) patients at 12 months. The predictive factors of response to ADA dose escalation at 12 months on multivariate analysis were: maintenance therapy of 40mg every week rather than 80mg every other week (OR 3.64, 95% CI: 1.28-10.37) and a CRP level≤5mg/L at adalimumab dose escalation (OR 6.64, 95% CI: 1.40-27.53). Adalimumab was withdrawn in 4 patients due to side effects. CONCLUSIONS: Adalimumab dose escalation is an effective and well-tolerated therapeutic option in patients with secondary loss of response. A 40mg every week optimized regimen was predictive of a response to ADA dose escalation.


Assuntos
Adalimumab/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Doença de Crohn/tratamento farmacológico , Tolerância a Medicamentos , Adulto , Relação Dose-Resposta a Droga , Feminino , França , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Quimioterapia de Manutenção , Masculino , Análise Multivariada , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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