Hepatitis: Buffet C

Buffet C. · No affiliation provided · Presse Med. · Pubmed #16493333 No free full text.

This publication has no abstract.

Buffet C. · No affiliation provided · Presse Med. · Pubmed #12148376 No free full text.

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Buffet C. · Hépatogastroentérologie, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94270 Kremlin-Bicetre. · Bull Acad Natl Med. · Pubmed #19445377 No free full text.

Abstract: HBV cannot be fully eradicated from the body because of the persistence of covalently closed circular DNA (cccDNA) in the nucleus of infected hepatocytes. True cure is infrequent, but persistent suppression of HBV DNA slows liver disease progression and helps to prevent hepatocellular carcinoma. Treatment options for chronic hepatitis B include pegylated interferon and 4 licensed oral nucleosides/nucleotides (lamivudine, adefovir entecavir and tenofovir). Interferon is the only drug with a defined duration of treatment. It is effective in 30% to 40% of patients but is poorly tolerated. In contrast to interferon, nucleotide/nucleoside analogs have only minor adverse effects. However, a resurgence of the infection may occur when these drugs are withdrawn, implying that treatment may have to continue indefinitely. The onset of viral resistance to these agents also limits their long-term use but can be minimized by ensuring potent suppression of viral replication.

Thirot-Bidault A, Ben Mansour J, Lambotte O, Besson C, Bou-Farah R, Pallier C, Buffet C. · Service des maladies du foie et de l'appareil digestif, Hôpital de Bicêtre, Le Kremlin-Bicêtre. · Gastroenterol Clin Biol. · Pubmed #18166901 No free full text.

Abstract: Hepatitis B reactivation after chemotherapy is well known when Ag HBs is positive. Recommendation is to give preventive antiviral treatment before starting chemotherapy. The reactivation when there is only an anti-HBc antibody is rare. We report the case of a woman who developed an hepatitis B reactivation two weeks after the end of a chemotherapy for a high grade non Hodgkin lymphoma. Before chemotherapy, hepatitis B virus serology was positive only for anti-HBc antibody and viral load was negative. She had a fulminant hepatitis with fatal issue although a treatment by lamivudine and adefovir was rapidly started. In the literature, only 13 cases of patients with positive anti body anti-HBc alone who developed an hepatitis B reactivation after chemotherapy have been reported.

Buffet C. · Service des maladies du foie et de l'appareil digestif, centre hospitalier universitaire de Bicêtre, 97275 Le Kremlin-Bicêtre. · Rev Prat. · Pubmed #17002075 No free full text.

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Sobesky R, Buffet C. · Service des Maladies du Foie et de l'Appareil digestif, Hôpital de Bicêtre, 78, rue du Général Leclerc, F 94275 Le Kremlin-Bicêtre. · Presse Med. · Pubmed #11360728 No free full text.

Abstract: CHRONIC INFECTION AND CIRRHOSIS: In France, the prevalence of hepatitis C virus (HCV) infection reaches an estimated 1% of the general population. Careful management is required since about 75% of all infected subjects will develop chronic liver disease with the risk of progression to cirrhosis. The major improvements in the efficacy of treatments developed over the last decade should help reduce the incidence of cirrhosis-related complications. PRACTICAL STEPS: A liver biopsy should be performed in all HCV-positive patients in order to study the histological impact. An antiviral treatment should be prescribed for patients free of decompensated cirrhosis or contraindications who have moderate to severe histological lesions. STANDARD TREATMENT: Alpha-interferon (3 MU three times a week) in combination with ribavirin (1000-1200 mg/d) should be given for 6 to 12 months. Resent publications have reported promising results with pegylated interferon which would be more effective and only require one injection per week. This new interferon, given in association with ribavirin, will undoubtedly shortly become the gold standard treatment for patients with chronic hepatitis C, particularly those infected with treatment-resistant geno-types.

Buffet C, Perlemuter G. · Service des Maladies du Foie et de l'Appareil digestif, Hôpital de Bicêtre, 78, rue du Général Lederc, F 94270 Le Kremlin-Bicêtre. · Presse Med. · Pubmed #11225486 No free full text.

Abstract: INTERFERON ALPHA AND LAMIVUDINE: Chronic hepatitis B is currently treated with interferon alpha and lamivudine. Lamivudine (marketed under the name Zeffix in France) is given in oral preparations and is excreted in the urine. It is rapidly effective against virus replication since, after a one-month treatment, hepatitis B DNA levels are negative in most of the treated patients. After 12 months, there is an improvement in liver histology. ADVANTAGES AND DISADVANTAGES: The probability of effective treatment is greatest for patients with highly elevated transaminase levels and low hepatitis B DNA levels prior to treatment. Another advantage of lamivudine is the extremely low rate of side effects. The risk of a rebound in viral replication after withdrawal is a drawback together with the possible development of viral mutations of the polymerase gene, particularly after more than one year of treatment. INDICATIONS: Lamivudine can be prescribed for patients with a contraindication or non-responsive to alpha interferon: liver transplantation candidates, organ graft recipients. For other cases, alpha interferon is the first line treatment of choice. If lamivudine is used too early, there is a risk the patients could no longer be transplanted after the development of mutations and major aggravation of liver function. Future perspectives include simultaneous or sequential use of antiviral agents.

Poynard T, Marcellin P, Bissery A, Myers RP, Moussalli J, Degos F, Dhumeaux D, Riachi G, Bronowicki JP, Brissot P, Buffet C, Serfaty L, Naveau S, Sogni P, Beaugrand M, Gayno S, Larrey D, Samuel D, Eugene C, Pol S, Bedossa P, Daurat V, Chaumet-Riffaud P, Anonymous00216. · Service d'Hepatogastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Université Paris 6, 47-83 Boulevard de l'Hôpital, CNRS ESA 8067, 75651 Paris Cedex 13, France. · J Viral Hepat. · Pubmed #12753338 No free full text.

Abstract: Interferon-alpha (IFN) monotherapy results in sustained virological clearance in a minority of patients with chronic hepatitis C. The aim of this study was to assess the effect of a reinforced regimen combining ribavirin and high-dose IFN for 48 weeks compared with a nonreinforced regimen combining a standard IFN regimen and ribavirin for 24 weeks in nonresponders with chronic hepatitis C. A total of 231 patients with chronic hepatitis C and previous nonresponse to IFN monotherapy were randomized. The reinforced group (n = 114) received IFN-2b 6 million units (MU) thrice weekly (TIW) and ribavirin for 48 weeks, and the nonreinforced group (n = 117) received IFN-2b 3 MU TIW and ribavirin for 24 weeks. The main outcome measure was a sustained virological response, defined as negative serum hepatitis C virus (HCV)-RNA 24 weeks following the end of treatment. This endpoint was determined in 98 patients of the reinforced group and 105 patients of the nonreinforced group. At the end of follow-up, a sustained virological response was observed in 29 of the 98 patients (29.6%) in the reinforced group vs 16 of the 105 patients (15.2%) in the nonreinforced group (P = 0.014). In multivariate analysis, factors associated with a sustained virological response were treated with a reinforced regimen [odds ratio (OR) 2.9; P = 0.06] and genotype 2 or 3 (OR 8.8; P < 0.0002). A total of 160 patients had paired biopsies before and after treatment. Histological activity improvement was observed in 32 of 80 patients (40%) and fibrosis worsening in 26 of 80 patients (33%) in the reinforced group vs 13 of 80 (16%) and 19 of 80 (24%) in the nonreinforced group (P = 0.30 and 0.20, respectively). Hence in nonresponders, a high-dose 48-week regimen of IFN and ribavirin combination was more effective than a regimen with interferon at lower dose and ribavirin for 24 weeks only.

Castéra L, Nègre I, Samii K, Buffet C. · Service des Maladies du Foie et de l'Appareil Digestif, H pital de Bicêtre, Université Paris-Sud, Le Kremlin-Bicêtre, France. · Am J Gastroenterol. · Pubmed #11374698 No free full text.

Abstract: OBJECTIVE: Although percutaneous liver biopsy (PLB) can be a painful procedure, common practice has not included intravenous sedation or analgesia. Patient-administered nitrous oxide/oxygen (N2O/O2) inhalation has demonstrated analgesic efficacy in various procedures associated with mild to moderate pain. The aim of this study was to investigate the safety and efficacy of analgesia with N2O/O2 inhalation for PLB. METHODS: One hundred consecutive patients undergoing a first PLB (for chronic hepatitis C: 56, for alcoholic liver disease: 23, for miscellaneous reasons: 21). Patients were randomly assigned to self-administrate from a facial mask with a demand valve, for 5 min before and during biopsy, either a breathing mixture of 50% N2O/O2 (N2O group, n = 51), or a breathing oxygen placebo (P group, n = 49). Liver biopsy was performed at bedside after adequate local anesthesia with xylocaine. At the end of the procedure, patients were asked to self-evaluate pain experienced using a visual analogue scale (VAS) with scoring from 0 to 100 mm. RESULTS: N2O/O2 administration resulted in the absence of pain in a significantly higher number of patients treated than in patients of the P group: 19 versus 2, respectively (p = 0.0001). Patients receiving N2O/O2 had significantly lower pain scores than those of the P group: 12+/-12 versus 28+/-19 mm (p < 0.0001). No serious complication was observed. Side effects of N2O/O2 were minor and reversible. The average cost per biopsy was 4 US dollars. CONCLUSIONS: Patient-administered N2O/O2 inhalation provides safe and effective analgesia, at a reasonable cost, for PLB. Its routine use could be useful for the management of patients with chronic liver disease undergoing PLB as it may enhance patients compliance with future biopsies.

Degos F, Pol S, Chaix ML, Laffitte V, Buffet C, Bernard PH, Degott C, Carnot F, Riffaud PC, Chevret S. · Service d'Hépatologie, Hôpital Beaujon AP-HP, 100 Boulevard du Gl Leclerc, F-92110 Clichy, France. · Nephrol Dial Transplant. · Pubmed #11328909 links to  free full text

Abstract: BACKGROUND: A prospective multicentre study was initiated in HCV-infected haemodialysis patients to assess the tolerance and efficacy of alpha-2b interferon. METHODS: We had planned to include 120 patients with HCV RNA detectable by polymerase chain reaction (PCR) (Amplicor Roche) and histologically documented chronic hepatitis. The dose of alpha-interferon was 3 million units (MU) three times weekly (TTW), to be reduced to 1.5 MU TTW in case of side-effects. Tolerance was evaluated monthly; virological efficacy was evaluated by PCR. A liver biopsy was performed at month 18 (M18). RESULTS: (a) TOLERANCE: After 37 patients had been included, the study was discontinued by the promoting institution because of severe side-effects requiring that treatment be stopped in 19 patients. The side-effects were: cardiac (4) neuropsychiatric (2), digestive (3), acute necrosis of the graft (1), severe asthenia (9), minor side-effects were observed in 22 patients. A complete 12-month course was completed in 12 patients for the 3 MU TTW dose and in six patients for the 1.5 MU TTW reduced dose. Normal ALT level (OR, 0.16; CI 95%, 0.03-0.89) at inclusion was associated with interruption of treatment (univariate analysis). (b) EFFICACY: Sustained virological response was observed in only seven (18.9%), of the 18 patients who completed the treatment (38%). Increased ALT at inclusion (OR, 1.04; CI 95%, 1.01-1.09) and cumulated doses of interferon (OR, 1.01; CI 95%, 1.004-1.026) were jointly associated with a sustained response, while positive PCR at M2 was strongly predictive of treatment failure. CONCLUSION: Tolerance of interferon is poor in haemodialysis patients. Sustained response is fairly high in patients who have 12 months of treatment and seems to be based on the immune status of the patients (ALT) and the cumulative doses of interferon.

Poynard T, Daurat V, Chevret S, Moussalli J, Degos F, Bailly F, Borotto E, Buffet C, Bartolomei-Portal I, Richardet JP, Riachi G, Calmus Y, Bréchot C, Vidaud M, Olivi M, Bedossa P, Riffaud PC, Chastang C. · Service d'Hépato Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. · J Viral Hepat. · Pubmed #10607254 No free full text.

Abstract: The aim of this work was to assess the effect of a high-dose (10 million units, MU) short-duration (14 weeks) interferon-alpha2b (IFN-alpha2b) regimen in relapsers compared with the standard IFN regimen of 3 MU three times weekly (t.i.w.) for 6 months. Fifty-eight non-cirrhotic patients (who had relapsed after previous treatment with IFN) with chronic hepatitis were randomized: 29 to the high-dose, short-duration regimen and 29 to the standard regimen. By the end of IFN therapy, in the high-dose, short-duration group alanine aminotransferase (ALT) normalization was observed in 23 (79%) of 29 patients, and undetectable hepatitis C virus (HCV) RNA in eight (28%) vs 25 (86%) and 11 (38%) of the 29 patients in the standard group, respectively (P = NS). At the end of the 72-week follow-up, in the high-dose, short-duration group a sustained ALT normalization was observed in two (7%) patients, and undetectable HCV RNA in 0 (0%) vs five (17%) and four (14%) patients in the standard group (P = NS). There was less fibrosis improvement in the high-dose, short-duration group (two of 26 patients, 8%) than in the standard group (eight of 25 patients, 32%) (P = 0.04). Tolerance to IFN was good and similar in the two groups. In conclusion, in IFN relapsers, high-dose, short-duration treatment with IFN-alpha has no advantage when compared to a 6-month treatment with 3 MU IFN t.i.w.

Gelu-Simeon M, Burlaud A, Young J, Pelletier G, Buffet C. · Department of Hepatology and Gastroenterology, Bicetre Hospital, Le Kremlin-Bicetre, France. · World J Gastroenterol. · Pubmed #19140232 links to  free full text

Abstract: AIM: To study predictive factors of thyroid dysfunction associated with interferon-alpha (IFNalpha) therapy in chronic hepatitis C (CHC) and to describe its long-term evolution in a large population without previous thyroid dysfunction. METHODS: We performed a follow-up of thyroid function and detection of thyroid antibodies in 301 patients treated for CHC with IFNalpha from 1999 to 2004. RESULTS: Thyroid disorder developed in 30/301 (10%) patients with a mean delay of 6 +/- 3.75 mo: 13 patients had hyperthyroidism, 11 had hypothyroidism, and 6 had biphasic evolution. During a mean follow-up of 41.59 +/- 15.39 mo, 9 patients with hyperthyroidism, 3 with hypothyroidism, and 4 with biphasic evolution normalized thyroid function in 7.88 +/- 5.46 mo. Recovery rate of dysthyroidism was not modified by treatment discontinuation, but was better for patients with negative thyroid antibodies before antiviral treatment (P = 0.02). Women had significantly more dysthyroidism (P = 0.05). Positive thyroid peroxidase and thyroglobulin antibodies were more frequent before antiviral treatment in patients who developed dysthyroidism (P < 0.0003 and P = 0.0003, respectively). In a multivariate model, low fibrosis was found to be a predictive factor of dysthyroidism (P = 0.039). CONCLUSION: In this monocentric population of CHC, dysthyroidism, especially hyperthyroidism, developed in 10% of patients. Low fibrosis was found to be a predictive factor of dysthyroidism. Thyroid disorder recovered in 16/30 patients (53%) and recovery was better in the non-autoimmune form.

Fartoux L, Degos F, Trépo C, Goria O, Calès P, Tran A, Buffet C, Poynard T, Capron D, Raabe JJ, Roulot D, Naveau S, Grange JD, Poupon RE, Poupon R, Serfaty L. · AP-HP, Hôpital Saint-Antoine, Paris, France. · Clin Gastroenterol Hepatol. · Pubmed #17261383 No free full text.

Abstract: BACKGROUND & AIMS: The impact of interferon (IFN) treatment on the occurrence of complications related to hepatitis C virus (HCV)-related cirrhosis is debated because the majority of studies are retrospective. We designed a randomized controlled trial comparing the efficacy of prolonged IFN alfa-2a treatment vs nontreatment on complication-free survival in patients with compensated HCV cirrhosis. METHODS: A total of 102 patients (mean age, 60.5 +/- 9.5 y; male/female ratio, .82) with biopsy examination-proven HCV cirrhosis, Child-Pugh score A, who were hepatocellular carcinoma (HCC) free, and had at least 1 risk factor of complications were randomized to receive IFN or no therapy for 24 months. RESULTS: During the follow-up evaluation, the complication rate was 24.5%: HCC occurred in 12 and decompensation unrelated to HCC occurred in 13 patients. The number of HCC patients was similar in both groups. The probability of complication-free survival was not significantly different between treated and untreated patients (98% and 72.3% vs 90% and 70.7% at 12 and 24 mo, respectively, P = .59). The median time until complication occurrence was 17.1 months in the treated group vs 13.6 months in the untreated group (P = .2). CONCLUSIONS: This randomized controlled trial showed that a 2-year course of IFN has little or no impact on complication-free survival in patients with high-risk compensated HCV cirrhosis.

Dhalluin-Venier V, Besson C, Dimet S, Thirot-Bibault A, Tchernia G, Buffet C. · Hepatogastroenterology, Bicêtre Hospital, LeKremlin Bicêtre, France. · Eur J Gastroenterol Hepatol. · Pubmed #17033447 No free full text.

Abstract: Autoimmune hepatitis is a disorder of unknown aetiology. Imatinib belongs to a new class of anticancer agents with high selectivity toward a specific molecular target. Its main indications are chronic myeloid leukaemia and gastrointestinal tumours. We report here, for the first time to our knowledge, imatinib mesylate-induced hepatitis with autoimmune features.

Galula G, Buffet C, Robba L, Poissonnet M. · Direction régionale du Service Médical l'Assurance Maladie de la région Ile de France, Paris. · Gastroenterol Clin Biol. · Pubmed #16733373 links to  free full text

Abstract: OBJECTIVES: The aim of this study was to ascertain the reasons for the prescription of serological tests for viral hepatitis B (HBV) and C (HCV) in the Greater Parisian area, and to assess standards of prescription with respect to current guidelines. PATIENTS AND METHODS: The population studied comprised patients affiliated to the three main health insurance schemes in the Greater Parisian area, for whom at least one serological test for HBV or HCV was reimbursed on May 14th or 15th, 2002. Data was collected from prescribing and laboratory heads. RESULTS: The sample consisted of 1 046 prescription orders for HBV and/or HCV tests. The mean age of patients was 39 years, and 68% were females. The main medical indications declared by the prescribing physicians were: screening for HBV or HCV (40%), tests for pregnant women (19%), suspected hepatitis B or C (13%), pre- and post-vaccination tests for HBV (7%), medically assisted procreation (6%), follow-up of diagnosed chronic hepatitis (4%). Assessment of the standards of prescription orders showed a lack of compliance with guidelines for 71% of HBV tests, and 56% of HCV tests. CONCLUSIONS: The implementation of guidelines for the prescription of serological tests for HBV and HCV needs to be improved in clinical practice.

Bohbot NL, Young J, Orgiazzi J, Buffet C, François M, Bernard-Chabert B, Lukas-Croisier C, Delemer B. · Service d'Endocrinologie, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, France. · Eur J Endocrinol. · Pubmed #16498048 links to  free full text

Abstract: Autoimmune thyroid disease is a common side-effect of interferon-alpha (IFN-alpha) treatment of viral hepatitis C. We have described three patients with hepatitis C for whom IFN-alpha and ribavirin were prescribed and who developed two successive phases of silent thyroiditis followed by hyperthryroidism relapse due to Graves' disease. These three men had no known history of familial or personal thyroid disease. Destructive thyrotoxicosis appeared 4-6 months after starting IFN-alpha, followed by Graves' hyperthyroidism within 8 to 11 months. The thyrotropin (TSH) level was normal before IFN-alpha was started. The diagnosis of destructive thyroiditis was confirmed by anti-TSH receptor antibody (TSHRAb) negativity and the absence of radionuclide ((123)I or (99)Tc) uptake on thyroid scintiscans. Eight to eleven months after starting treatment, TSHRAb positivity and intense scintigraphic uptake confirmed the appearance of Graves' disease. IFN-alpha was continued in only one patient. Hence, hyperthyroidism induced by IFN-alpha could correspond to the first phase of silent thyroiditis, to Graves' disease or to the succession of both. Rigorous diagnostic procedures with repeated scintiscans and TSHRAb titering are necessary to avoid a false diagnosis and inappropriate therapy.

Lambotte O, Gelu-Simeon M, Maigne G, Kotb R, Buffet C, Delfraissy JF, Goujard C. · Department of Internal Medicine, Kremlin Bicêtre Hospital, AP-HP, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France. · J Infect. · Pubmed #16230187 No free full text.

Abstract: In this report, we describe an unusual and unreported complication with the new licensed form of pegylated interferon alpha2a (PEG-IFN-alpha2a). We report the first case of severe autoimmune cytopenias, an Evans' syndrome, in a patient with chronic hepatitis C, 2 months after PEG-IFN-alpha2a initiation. Haemolytic anaemia and thrombocytopenia developed, complicated by gastric bleeding and brain haemorrhage. Outcome was favourable under immunosuppressive treatment. Treatment with PEG-IFN-alpha2a requires careful follow-up, as IFNalpha can induce or exacerbate autoimmune diseases.

Di Martino V, Lebray P, Myers RP, Pannier E, Paradis V, Charlotte F, Moussalli J, Thabut D, Buffet C, Poynard T. · Service d'Hépato-Gastroentérologie, GH Pitié-Salpêtrière, Paris, France. · Hepatology. · Pubmed #15565616 No free full text.

Abstract: Female sex is a protective factor for the progression of fibrosis in patients with chronic hepatitis C virus (HCV) infection. Experimental data suggest that estrogens may have an antifibrotic effect. The objective of this study was to evaluate the influence of past pregnancies, oral contraceptives, menopause, and hormone replacement therapy (HRT) on liver fibrosis progression in HCV-infected women. Four hundred seventy-two HCV-infected women received a survey regarding prior pregnancies, menopause, and the use of oral contraceptives and HRT. The impact of these variables on liver fibrosis and its progression were evaluated using multivariate analyses considering all putative confounding factors. Two hundred one women completed the survey (43% response rate), 157 of whom had an estimated date of HCV infection (96 postmenopausal women, 96 women with previous pregnancies, and 105 women with past use of oral contraceptives). Through multivariate analyses, the estimated rate of fibrosis progression was higher in postmenopausal (P < .05) and nulliparous (P = .02) women and was associated with greater histological activity (P < .001). Prior use of oral contraceptives had no significant influence. Among postmenopausal women, the estimated rate of fibrosis progression (+/-SE) was lower in women who received HRT compared with untreated patients (0.099 +/- 0.016 vs. 0.133 +/- 0.006 METAVIR units/yr; P = .02) and was similar to that of premenopausal women (0.093 +/- 0.012 METAVIR units/yr; P value not significant). In conclusion, menopause appears to be associated with accelerated liver fibrosis progression in HCV-infected women, an effect that may be prevented by HRT. Pregnancies may have a beneficial impact on the long-term progression of liver fibrosis.

Prat F, Spieler JF, Paci S, Pallier C, Fritsch J, Choury AD, Pelletier G, Raspaud S, Nordmann P, Buffet C. · Service d'hépatogastroentérologie, Inserm U537, Stérilisation centrale, Service de Microbiologie, CHU Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France. · Gastrointest Endosc. · Pubmed #15278053 No free full text.

Abstract: BACKGROUND: The choice between reusable and single-use devices for ERCP depends on various medical and economic criteria. This study evaluated the reliability and the safety (risk of cross-contamination) of reusable devices. A cost analysis of the use of reusable devices also was conducted. METHODS: All patients referred for ERCP that required use of a sphincterotome or a retrieval basket were eligible for inclusion in a clinical study of 4 different devices (3 types of sphincterotome, 1 type of retrieval basket). All devices were steam sterilized. Before each use, each device was subjected to bacteriologic and virologic tests (hepatitis C virus, hepatitis B virus markers). Devices were examined before and after each procedure. The numbers of safe and efficient procedures that could be performed with each device were assessed. Three strategies were compared in a cost analysis: internal reprocessing (strategy 1), external reprocessing (strategy 2), and single-use (strategy 3). Inputs used were the results of the clinical study, hospital data for 1 year of endoscopic activity, and market prices. RESULTS: A total of 342 patients underwent the following procedures: sphincterotomy (248 patients), stent insertion (59 patients), use of basket without sphincterotomy (14 patients), and diagnostic ERCP/unsuccessful cannulation (21 patients). At the time of ERCP, 36 patients had viral or bacterial infection. Fifty instruments were used (20 single-lumen sphincterotomes, 10 double lumen sphincterotomes, 20 retrieval baskets). Overall, the median number of efficient uses per device was 10. The median number of efficient uses by each type of device was the following: single-lumen sphincterotome, 12; double-lumen sphincterotome, 8; and, retrieval baskets, 10. All virologic and bacteriologic tests for all instruments were negative. The cost-optimization analysis found that strategy 1 is cost effective (euro37,283/y) compared with strategy 2 (euro40,101/y) and especially with Strategy 3 (euro115,210/y). CONCLUSIONS: Reuse of the sphincterotomes and baskets evaluated in this study during ERCP is safe in terms of infectious hazards. Because they endure numerous uses, reusable instruments are cost effective, especially when compared with single-use accessories.

Buffet C. · Service des maladies du foie et de l'appareil digestif, CHU de Bicêtre. · Presse Med. · Pubmed #15105790 No free full text.

This publication has no abstract.

Buffet C. · Service des maladies du foie et de l'appareil digestif, CHU de Bicêtre, France. · Presse Med. · Pubmed #15105775 No free full text.

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Buffet C. · Service des maladies du foie et de l'appareil digestif, CHU de Bicêtre (94). · Presse Med. · Pubmed #15026710 No free full text.

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Buffet C. · No affiliation provided · Presse Med. · Pubmed #13677875 No free full text.

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Perlemuter G, Cacoub P, Sbaï A, Hausfater P, Thibault V, Le TH, Wechsler B, Buffet C, Piette JC. · Service d'Hépatologie et de Gastroentérologie, Hôpital de Bicêtre, Kremlin Bicêtre, Paris, France. · J Rheumatol. · Pubmed #12858443 No free full text.

Abstract: OBJECTIVE: Viruses might be one of the elements that trigger systemic lupus erythematosus (SLE). Steroid therapy may influence the natural history of virus infections. The most frequent extrahepatic manifestations of hepatitis C virus (HCV) including arthralgia, myalgia, sicca syndrome, and antinuclear antibodies, may mimic a connective tissue disease, particularly SLE. Reports on the association between SLE and HCV infection are scarce. We investigated the association of HCV infection and SLE. METHODS: Retrospective case-control monocentric study of 19 patients with SLE and anti-HCV antibodies versus 42 randomized SLE patients without anti-HCV antibodies, matched for age and sex, coming from our cohort of 700 patients with SLE. SLE and HCV-infection features were reviewed. RESULTS: Mode of infection was blood product transfusion, drug addiction, or unknown. Prevalence of lupus clinical manifestations, antinuclear, anti-dsDNA, anti-extractable nuclear antigen antibodies, and complement levels was not different between HCV positive and negative SLE patients. Prevalence of cryoglobulin was higher in SLE patients with anti-HCV antibodies (p < 0.04), but none had a mixed cryoglobulinemia syndrome. ALT activity was increased in 11 HCV positive patients and 13 had detectable HCV RNA. Liver biopsy showed cirrhosis in 2 and mild fibrosis and activity in 5. One patient treated with interferon-alpha had a sustained virological response without SLE flare. Steroid therapy did not seem to alter HCV course. CONCLUSION: SLE in HCV positive patients shows higher prevalence of cryoglobulin without mixed cryoglobulinemia syndrome. HCV infection has moderate signs of biochemical and liver pathological severity. SLE by itself or treated with steroids does not seem to worsen HCV infection.

Buffet C. · No affiliation provided · Presse Med. · Pubmed #11826575 No free full text.

This publication has no abstract.