[Interest of the use of the "MYDEFI" smartphone application to help reduce alcohol consumption in the involvement of pharmacists in the prevention of at-risk consumption: Results of a survey in the Hauts-de-France]. / Intérêt de l'utilisation de l'application smartphone « MYDEFI ¼ d'aide à la réduction de la consommation d'alcool dans l'implication des pharmaciens dans la prévention de la consommation à risque : résultats d'une enquête dans les Hauts-de-France.

OBJECTIVES: Evaluate the interest in the MyDéfi application as a tool to help pharmacists identify and manage excessive alcohol consumption, as well as their perception and knowledge of alcohol and their possible role in its management. METHODS: Prospective mixed qualitative and quantitative study, based on face-to-face semi-directive interviews. RESULTS: The 101 pharmacists interviewed in Hauts-de-France region considered that the detection of alcohol consumption was part of their mission, even if it is a difficult subject, and that they had received specific training in alcohology during their university training. Only 12% were aware of early screening and brief intervention on alcohol. Several obstacles were mentioned, such as the lack of training and confidentiality, and difficulties related to patient specificities. Forty-one percent said that the pharmacy was not suitable and almost 72% said that the MyDéfi application could be useful for screening and 91% would recommend the application as one of the best supports, easy to advise with a personalised follow-up. For 32%, the application is accessible to patients (40% think that the main drawback of the application is inaccessibility and 27% its cost). CONCLUSION: Pharmacists consider that excessive alcohol use is a major problem that should mobilise them but many do not feel ready to offer brief interventions. After seeing how the MyDéfi application worked, the majority considered that it could help them in their prevention mission.

Intervention study to improve smoking cessation during hospitalization.

OBJECTIVES: In France, hospitals have been smoke free since February 2007. A period of hospitalization may be a good time to enhance a smoker's motivation to quit. This study aimed to assess whether training medical staff in smoking cessation management might improve the rate of smoking cessation during hospitalization. STUDY DESIGN: Non-randomized intervention study. METHODS: Staff of the participating care units either received (intervention group) or did not receive (control group) training in smoking cessation management. The dependent variable was the proportion of inpatients that continued to smoke before (Period 1) and after (Period 2) the training session. RESULTS: In total, 358 patients were included. In Period 1, 55.6% and 50% of the smokers from the intervention and control groups stopped smoking, respectively; the corresponding rates in Period 2 were 64.3% and 48.1%. In Period 2, 36.4% and 31.8% of the smokers from the intervention and control groups claimed that they had received motivational counselling. In the intervention group, the request rate for nicotine replacement therapy (NRT) was higher (41.7%) compared with the control group (11.1%). In both groups, patients asked for NRT more often (P < 0.001) when they had received motivational counselling. CONCLUSIONS: This study was not able to demonstrate that training medical staff in smoking cessation management has a significant impact on smoking cessation in hospitalized smokers. The delivery of medium-intensity support to all smokers appears to be out of reach of physician/nurse teams. New strategies are needed, including a team specifically dedicated to the problems of addiction.

[Alcohol dependence: diagnosis and treatment]. / Alcoolodépendance: diagnostic et traitement.

PURPOSE: Prevalence of alcohol dependence remains stable across time between 5-7% in men and 2-3% in women, corresponding to at least 1.5 million patients in France. A review about alcohol dependence is warranted, not only as prevalence of this disease is high, but also because of recent significant improvement in caring for these patients. CURRENT KNOWLEDGE AND KEY POINTS: Management of alcohol withdrawal is well codified and chiefly entails the prescription of long half-life benzodiazepines, thiamin, and appropriate rehydratation. The objective is to prevent withdrawal syndrome, which can result in delirium tremens and seizures. Several drugs and therapies have proven efficacy to maintain abstinence. Cognitive behavioral therapies evaluate those factors triggering alcohol consumption, and involve behavioral techniques to promote a change. Motivational interviewing enhances individual effectiveness of treatment, and capacity to maintain abstinence. Three molecules used in France have proven efficacy through several mechanisms: acamprosate which interacts with GABAergic and glutamatergic central transmission; naltrexone, an antagonist of opiate receptors; disulfiram which has antabuse-like effect through inhibition of acetaldehyde dehydrogenase. FUTURE PROSPECTS AND PROJECTS: Main research strategies currently developed are: (i) investigating consumption of multiple psychoactive substances, and (ii) understanding the neurobiology of dependence, which may lead to new therapeutic discoveries.

Selective loss of pallidal dopamine D2 receptor density in hepatic encephalopathy.

The binding parameters of [3H]SCH 23390 and [3H]spiperone (radioligands for dopamine D1 and D2 receptors, respectively) were investigated in autopsied frontal cortex, caudate nucleus and globus pallidus/putamen of cirrhotic patients who died in hepatic coma as well as in age- and sex-matched controls. Specific [3H]SCH 23390 binding site densities were unchanged in all regions; in contrast, specific [3H]spiperone binding site density was decreased (by 44%, P < 0.001) in the globus pallidus/putamen of patients with HE. Decreased densities of pallidal D2 binding sites could relate to the motor dysfunctions commonly encountered in human HE.

A prospective randomized study comparing high- and low-dose leucovorin combined with same-dose 5-fluorouracil in advanced colorectal cancer.

Although the efficacy of 5-fluorouracil (5-FU) modulated by leucovorin is well established for advanced colorectal cancer, the question of the most effective regimen and optimal dose of leucovorin remains unanswered. This prospective randomized trial compares low-dose (group 1) and high-dose (group 2) leucovorin, combined with the same dose of 5-FU to determine whether high-dose leucovorin was more beneficial than low-dose on overall survival. Inclusion criteria were: unresectable metastatic colorectal carcinoma, with or without evaluable tumor response; a performance status of less than grade 3 (World Health Organization classification); and no previous chemotherapy for metastases. Forty-two patients were randomized in group 1 (leucovorin, 20 mg/m2/day, days 1 through 5) and 41 patients in group 2 (leucovorin, 200 mg/m2/day, days 1-5). All the patients in the two groups received a 1-hour infusion of 400 mg/m2/day 5-FU every 4 weeks. The two groups were matched with no statistically significant differences in gender ratio, site of primary tumor, performance status, and tumor extent. Toxicity in the two regimens was low and not significantly different between the two groups. Overall median survival was 346 days in group 1 and 323 days in group 2 and was not significantly different between the two groups. At 1 year, the test of equivalence was significant (p < 0.01), demonstrating an absence of more than 20% benefit in 1-year survival for the high-dose regimen. The use of high-dose leucovorin combined with 5-FU in the 5-day regimen does not significantly improve overall survival for patients who have metastatic colorectal cancer.

[Prognostic factors of hepatocellular carcinoma: a multivariate analysis in 113 patients]. / Facteurs pronostiques du carcinome hépatocellulaire: étude multivariée chez 113 patients.

UNLABELLED: The aim of this study was to identify clinical, biological or morphological prognostic factors in 113 patients with HCC in terms of survival. All patients (100 men, aged 65 [28-85], 95% cirrhosis) were diagnosed between 1982-1990. Mean survival time was 21 +/- 3 weeks. Eleven (over 25) variables were isolated by univariate analysis. A multivariate survival analysis (Cox regression model) disclosed that serum creatinine (p = 0.0002), alkaline phosphatase (p = 0.02) and Okuda's stage (p = 0.025) were independent predictors of survival. Comparison of survival curves for different values of these prognostic variables allows division of patients in three groups of prognostic significance in terms of survival (p < 0.05). CONCLUSION: these results facilitate stratification of patients with HCC to design and evaluate future controlled trials.

[Spontaneous Listeria monocytogenes peritoneal infection complicating hepatic transplantation]. / Infection péritonéale spontanée à Listeria monocytogenes compliquant une transplantation hépatique.

The incidence of listeriosis is increased in immunosuppressed patients. We report a case of spontaneous bacterial peritonitis with bacteraemia caused by Listeria monocytogenes in a 47-year old woman with liver transplantation. Complete recovery was achieved after amoxicillin and amikacin therapy. High doses of corticosteroids and OKT3 monoclonal therapy may have favoured the occurrence of infection. In liver transplant recipients, regular stool screening could be proposed, and trimethoprim-sulfamethoxazole antibioprophylaxy could be used when Listeria monocytogenes is isolated in stool culture or immunosuppressive therapy is increased.

[Amyloidosis of the gallbladder. An unusual localization]. / Amylose de la vésicule biliaire. Une localisation exceptionnelle.

We report a rare case of amyloidosis of the gallbladder in a 60-year-old man. This amyloidosis was associated with hepatic amyloidosis and pancreatic adenocarcinoma. To our knowledge, this is the second case reported in the literature and the first associated with neoplastic pathology.

[Needle-tract seeding after ultrasound-guided puncture of hepatocellular carcinoma. A study of 150 patients]. / Essaimages tumoraux sur le trajet de ponctions écho-guidées de carcinomes hépatocellulaires. Etude de 150 malades.

OBJECTIVES: To study the frequency of tumor seeding after percutaneous biopsy of hepatocellular carcinoma and to evaluate the impact on long-term survival. METHODS: Records of 150 patients with cirrhosis who underwent ultrasound-guided aspiration biopsy for hepatocellular carcinoma between 1989 and 1996 were reviewed in June 1998. Liver transplantation was performed in 7 patients. One to three needle passes were performed with 18 to 20 gauge needles. Follow-up included regular clinical examinations and ultrasonography or computerized tomography. RESULTS: Four cases (2.66%) of subcutaneous metastasis were noted at the needle insertion site; none in transplanted patients. All patients had viral cirrhosis, Okuda class I. Nodules were detected 4, 12, 22 and 24 months after biopsy. The second patient is alive 24 months after tumor seeding. For other patients, survival time was 4, 24 and 60 months respectively, without local tumor extension after surgical resection or radiotherapy. During a mean 11.8 months of follow-up, 127 patients died without tumor seeding. Eleven patients are still being followed and have no signs of needle tract implantation of hepatocellular carcinoma (mean follow-up 34.7 months). CONCLUSION: The prevalence of tumoral seeding after percutaneous biopsy of hepatocellular carcinoma was 2.66%, which is higher than in previous studies. After liver transplantation, no evidence of needle tract seeding was identified. Survival did not seem to be influenced by local evolution.

[Patients with alcoholic liver disease hospitalized in gastroenterology. A national multicenter study]. / Maladies alcooliques du foie hospitalisées en Hépato-Gastroentérologie. Enquête multicentrique nationale.

OBJECTIVES: To describe the characteristics of in-patients with alcoholic liver disease in Hepatogastroenterology and to evaluate whether geographic location was a risk factor for cirrhosis. METHODS: A French, national, multicenter, prospective investigation was performed in the last quarter of 1997. To be included in the study, patients had to have drunk at least 50 g of alcohol per day for the past year or to have cirrhosis. RESULTS: Seventeen centers included 802 patients, 20% had histologically proven cirrhosis or probable cirrhosis. Thirty-five percent had undergone liver biopsy. Twenty five percent of these patients had cirrhosis without acute alcoholic hepatitis and 37% had cirrhosis with acute alcoholic hepatitis. After dividing France along a Bordeaux-Strasbourg axis, there was more histologically proven or probable cirrhosis in the North (46%) than in the South (36%) (P<0.005) while daily alcohol intake was greater the South (150 +/- 6 g) than in the North (129 +/- 4 g) (P<0.0001). When the six variables (age, sex, daily consumption of alcohol over the past 5 years, presence of hepatitis B surface antigen and antibodies to hepatitis C virus, total duration of alcohol abuse) were considered together in stepwise logistic regression analysis, geographic location changed the prediction of cirrhosis. The odds ratio for cirrhosis in patients living to the North of the Bordeaux-Strasbourg axis was 1.9 (95% confidence interval range 1.1-3.2) (P<0.02), suggesting the role of nutritional factors.

[Detection of liver metastases from digestive cancer. Value of alkaline phosphatases, their macromolecular isoenzyme and of ceruloplasmin]. / Détection de métastases hépatiques d'un cancer digestif--intérêt des phosphatases alcalines, de leur isoenzyme macromoléculaire et de la céruléoplasmine.

In order to improve the non aggressive diagnosis of hepatic metastasis from digestive neoplasm, the authors analyzed the following biological parameters: aminotransferases, alkaline phosphatase and lacticodehydrogenase isoenzymes, gammaglutamyl-transpeptidase, conjugated and total bilirubin, C-reactive protein, type A, G, M immunoglobulins, C3 complement factor, alpha-1 acidic glycoprotein (orosomucoid), haptoglobin, ceruloplasmin, transferrin, albumin, prealbumin, ferritin. This work included 54 patients with digestive tract cancer (esophageal, gastric, colic, rectal, anal localizations), divided in two groups: M- (n = 27), without hepatic metastasis), and M+ (n = 27, with histological confirmed hepatic metastasis). The Mann-Whitney test showed significant differences for 12 parameters between the 2 groups. With more than 60% sensitivity (Se) and specificity (Sp), according to the ROC curves, the following parameters can be selected: Total alkaline phosphatase (Se 89%, Sp 70%) and their macromolecular H2 fraction, lacticodehydrogenase fraction 4 (Se 63%, Sp 63%), gammaglutamyl-transpeptidase (Se 85%, Sp 82%), ceruloplasmin (Se 64%, Sp 65%), aspartate-aminotransferase determination (Se 63%, Sp 65%).

[Autoimmune biological anomalies in 35 patients with chronic viral hepatitis C treated over 6 months with interferon and followed-up over a year]. / Anomalies biologiques autoimmunes chez 35 malades atteints d'hépatite chronique viral C traités pendant six mois par interféron (IFN) et suivis pendant un an.

Several clinical or biological autoimmune disorders, particularly lupoid diseases, are associated with chronic hepatitis C. They may be exacerbated by alpha IFN, but they are not involved in the response to therapy.

[Chronic viral hepatitis C and interferon: results after a year and predictive factors of response (a multivariate study with 35 patients)]. / Hépatite chronique virale C et interféron: résultats à un an et facteurs prédictifs de réponse (étude multivariée sur 35 sujets).

Six months alpha IFN therapy was efficient for chronic viral hepatitis C in 31% patients after six months and in 17% after one year. Cirrhosis, low serum albumin or prealbumin levels and elevated IgA seric level were non responsiveness predictive factors.

[Spontaneous regression of a focal nodular hyperplasia]. / Involution spontanée d'une hyperplasie nodulaire focale.

The authors report a case of near complete regression of a focal nodular hyperplasia of the liver over a course of 10 years in a 39 year old woman. This presentation is atypical because of its imaging features (initially typically hypervascular, to eventually become a fibrous scar after undergoing a pseudo-angiomatous phase) and because of its near complete spontaneous regression.

[Secondary recurrent hepatitis in ventricular arrhythmia]. / Hépatite récurrente secondaire à une arythmie ventriculaire.

INTRODUCTION: A major episode of hepatic cytolysis, rapidly regressive and occasionally recurrent, evokes a bilary or toxic pathology. We report an exceptional case in which several episodes of cytolysis were secondary to a paroxystic cardiac rhythm disorder. OBSERVATION: A 44 year-old woman was hospitalized 3 times during 4 months for episodes of asthenia and rapidly regressive cytolysis. Lithiasic, viral, metabolic, autoimmune and toxic causes were eliminated. A cardiac rhythm disorder was revealed during the last two episodes and diagnosis was made of intermittent and asymptomatic ventricular tachycardia, secondary to arryhthmogenic right ventricular dysplasia, and was confirmed on the electrocardiogram, cardiac scan and magnetic resonance imaging. Treatment of the cardiac rhythm led to the absence of further relapse. COMMENTS: In our patient, the clinical and chronological imputability appeared highly probable. The responsibility of perturbed cardiac rhythm in the genesis of an ischemic hepatopathy is classical, but little documented. Our observation confirms that severe unexplained cytolysis requires systematic search for a cardiac rhythm disorder, even in the absence of a known or symptomatic cardiopathy.

[Acute pancreatitis caused by foreign bodies. 2 cases]. / Pancréatite aiguë à corps étrangers. 2 observations.

We report the cases of two patients with acute pancreatitis caused by the insertion of foreign bodies in the ampulla of Vater: vegetal residues in the first case and beltbuckle in the second case. The acute pancreatitis was revealed by severe epigastric pain, jaundice and a serum amylase increase to more than 9 times the upper limit of normal level. The presence of foreign bodies was detected by endoscopic retrograde cholangiography and pancreatography in the first case and by abdominal X-ray examination in the second case. Extraction of vegetal residues was performed by endoscopic route whereas that of the beltbuckle required surgery. From these 2 cases and 8 others previously reported cases, the clinical features and course of acute pancreatitis caused by foreign bodies have been analysed.

[Hemostatic embolization of hepatocellular carcinoma with portal vein thrombosis complicated by hemoperitoneum]. / Embolisation hémostatique d'un carcinome hépatocellulaire avec thrombose de la veine porte compliqué d'un hémopéritoine.

A 59-year-old chronic drinker (120 g alcohol/day) was hospitalized for sudden increase in abdominal volume found to be caused by a hemoperitonoff resulting from ruptured hepatocellular carcinoma with thrombosis of the portal vein. Emergency arterial embolization with gelatin sponge successfully stopped intraperitoneal bleeding. No surgical treatment could be attempted due the severity of the cirrhosis. This patient survived for 4.5 month. Based on this observation and a review of the literature, it can be suggested that hemostatic embolization is an effective treatment for spontaneous hemorrhage of hepatocellular carcinoma even in cases with portal vein thrombosis.

[Post-traumatic thrombosis of the portal vein]. / Thrombose de la veine porte post-traumatique.

Blunt trauma to the abdomen is an exceptional cause of portal vein thrombosis. To our knowledge, 8 cases have been reported in the literature. When thrombosis of the portal vein occurs, a complete search for all the known main causes must be carried out before entertaining this diagnosis. Other causes may be cirrhosis, tumors and inflammation of the abdomen, coagulation disorders and hematologic diseases including latent myeloproliferative syndrome. We report a case in a 25-year-old man with an uneventful past history who presented with thrombosis of the portal vein after a violent blunt trauma which occurred during a rugby play. In this young man, none of the other potential causes was found, in particular bone marrow culture on medium with low growth-factor concentration allowed us to eliminate a latent myeloproliferative syndrome. The only triggering factor remaining was the recent abdominal trauma. After an 18-month follow-up, no other element has been observed which could have caused thrombosis of the portal vein.

[Acute hepatitis due to ecstasy]. / Hépatite aiguë à l'ecstasy.

BACKGROUND: Ecstasy is a synthetic amphetamine which causes a wide variety of adverse effects. Hepatic toxicity was only recently demonstrated but can be quite severe. CASE REPORT: A 27-year-old male with no past medical or surgical history developed jaundice without fever. He was a regular user of ecstasy and had recently increased the number of doses consumed. No evidence of a viral, alcoholic, metabolic or autoimmune mechanism was found which could explain the hepatitis. Complete cure was obtained by discontinuing ecstasy. DISCUSSION: Few cases of ecstasy hepatic toxicity have been reported. Ecstasy was undoubtedly the causal agent in this case since other known causes of acute hepatitis were excluded, confirming the hepatotoxicity of ecstasy reported in the literature. The liver disease has been reported to range form acute regressive hepatitis to fatal liver failure. Iterative exposure can lead to fibrosis. The pathophysiological mechanism of this toxic effect is not well elucidated. Ischemia alone cannot explain all the clinical forms described, particularly cases without hyperpyrexia. Ecstasy must be added to the list of potential causes of acute hepatitis. Exposure must always be searched for in cases of acute hepatitis in young subjects.

[Collagen gastroenterocolitis]. / Une gastroentérocolite collagène.

INTRODUCTION: Collagenous gastroenterocolitis is a recently known rare cause of chronic diarrhoea, that raises numerous nosological and diagnostic problems. OBSERVATION: A 41 year-old woman was hospitalised for severe diarrhoea, diagnosed as collagenous gastroenterocolitis. Gastroscopy and ileocolonoscopy were macroscopically normal, but a 20 to 40 microns thick sub-epithelial collagenous band was revealed in the gastric, duodenal and colic biopsies. Parenteral nutrition and treatment with salazopyrine and prednisolone progressively normalised the transit. Three months later, only a 30 microns colic mucosa collagenous band persisted. All the biopsies taken during control gastro-colonoscopy 2 years later were histologically normal. After 5 years follow-up and absence of treatment, the patient no longer presented diarrhoea or biological abnormality. COMMENTS: This exceptional observation is a reminder that sub-epithelial collagen deposits are not always limited to the colon and therefore justify, in patients with collagenous colitis, systematic gastro-duodenal and ileum biopsies.