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Christine Silvain

Publications and source records attributed to Christine Silvain.

17 recordsLinked to original sources
PubMed2006

Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail.

BACKGROUND: The question of which colloid (albumin or synthetic colloids) used for plasma expansion following paracentesis or other complications requiring fluid loading in patients with cirrhosis remains controversial. AIMS: To compare outcome and hospital-related cost in patients with cirrhosis treated with 20% human albumin with those treated with a synthetic colloid (3.5% polygeline). METHODS: The primary end point was occurrence of a first liver-related complication. RESULTS: When the trial was prematurely discontinued because of safety concerns about bovine-derived products, 30 patients were assigned to receive albumin and 38 were assigned to receive a synthetic colloid. Sixty-three patients were included for ascites removal by paracentesis and five patients for ascites removal by paracentesis and renal impairment. The median time to first liver-related complication was not significantly longer in the albumin group (20 vs. 7 days). However, the total number of liver-related complications adjusted to a 100-day period was significantly lower in the albumin group. The median hospital cost for a 30-day period was significantly lower in the albumin group (1915 euros vs. 4612 euros). CONCLUSIONS: In patients with cirrhosis and ascites, human albumin appears to be more effective in preventing liver-related complications than synthetic colloid. This may be associated with decreased hospital costs.

Adult↗
PubMed2005

Treatment of chronic hepatitis C in patients unresponsive to interferon. Interest of re-treatment combining interferon induction therapy and ribavirin (a multicenter pilot study).

AIM: About 45% of patients with chronic hepatitis C are unresponsive to the present reference treatment combining pegelated interferon plus ribavirin; before pegylated interferon was available the non-response rate was around 60%. This open multicenter pilot study, initiated before pegylated interferon became available, was designed to evaluate, in patients unresponsive to interferon monotherapy, the rate of biological and virological response and side-effects of the ribivirin-alpha 2b interferon combination. METHODS: The combination protocol was ribavirin (1 to 1.2 g/d) plus alpha 2b interferon at induction doses (9 MU/d the first week; 4.5 MU/d the eleven following weeks; 3 MU/2 days the 36 following weeks). RESULTS: Among the 27 included patients, 17 (63%) were viremia-negative (PCR) after 12 weeks of treatment, 9 (33%) were complete responders (undetectable viremia and normal transaminases) at the end of treatment (48 weeks) and of follow-up (72 weeks). Patients with non-1, non-4 genotypes who derived full benefit from this therapeutic strategy (6/7 (86%) were complete responders: 4/5 with genotype 3 and 2/2 with genotype 5). Quality-of-life was impaired during treatment, especially during the first 12 weeks of high-dose interferon therapy. CONCLUSION: While waiting for new therapeutic possibilities, these good results suggest interferon induction at the beginning of treatment remains a valid option.

Adult↗
PubMed2005

Gender differences in vascular reactivity of aortas from rats with and without portal hypertension.

BACKGROUND: Inflammatory responses related to portal hypertension may be different in male and female rats. Most experimental studies of portal hypertension have involved male animals, and little information is available on gender differences in this setting. The aim of the present study was to compare aortic reactivity in female and male rats with and without portal hypertension. METHODS: Contraction response curves to phenylephrine were studied with aortic rings, with and without endothelium. For relaxation studies, rings were precontracted with phenylephrine 10(-7) mol/L and then exposed to acetylcholine 10(-4) mol/L. Portal hypertension was provoked by calibrated portal stenosis performed 2 weeks before experiments. RESULTS: In non-hypertensive conditions, the contractile response to increasing phenylephrine concentrations was significantly stronger in rings from male than female rats, both with and without endothelium. In male rats with portal hypertension, the phenylephrine concentration-response curves were lowered and shifted to the right in aortic rings both with and without endothelium. In female rats, portal hypertension did not induce significant changes in the phenylephrine concentration-response curves. In female rats, portal hypertension induced a marked increase in relaxation (157 +/- 123% vs 81 +/- 64% in controls); the increase was also stronger than that in male rats with portal hypertension (95 +/- 6%; P < 0.01). CONCLUSION: Clear gender differences were observed in vasoconstrictor responsiveness of aortic rings from rats with and without portal hypertension. Contrary that in male rats, portal hypertension did not induce vascular hyporesponsiveness in female rats. Further investigations are required to explain these differences.

Acetylcholine↗
PubMed2004

Prevention of viral hepatitis C: assessment of a comic strip-based information campaign targeting adolescents.

BACKGROUND: The risk of exposure to hepatitis C virus increases markedly in adolescence, and students are thus a preferential target for information campaigns. The aim of this study was to evaluate the results of a hepatitis C information campaign targeting secondary-school students. METHODS: The study was done in 52 classes of 11 general and vocational secondary schools. Before the information meetings and two months afterwards, the students received an anonymous questionnaire to test their knowledge of hepatitis C. The information session was backed up by a comic strip depicting scenarios involving hepatitis C. RESULTS: The students were aged from 14 to 24 years (mean 15.9 years, SD 0.9 years). Respectively 1509 and 1419 questionnaires were completed before and after the information session. Answers to the first questionnaire showed that the students' knowledge of hepatitis C was poor. Scores improved significantly after the information session, from an overall mean of 6.2 (SD 2.0) to 8.5 (SD 1.7) (p<0.001). The largest score improvement concerned transmission due to illicit drug use, the potential severity of the disease, and lack of a vaccine. The improvement was significantly larger among pupils who said they read the comic strip than among those who did not (p=0.02). CONCLUSIONS: General and vocational secondary school students in France have mediocre knowledge of hepatitis C, particularly its modes of transmission and the lack of a vaccine. Knowledge improved significantly when measured two months after an information session, suggesting that subsequent at-risk behaviours might be reduced.

Adolescent↗
PubMed2003

Cirrhosis and bleeding: the need for very early management.

BACKGROUND/AIMS: Retrospective studies suggest that the prognosis of patients with cirrhosis and variceal hemorrhage has improved in more recent decades. In a prospective cohort study in which the choice of prophylactic therapy was left to each practitioner, we followed cirrhotic patients with medium/large varices to determine factors predictive of bleeding and death. METHODS: Three hundred fourteen patients with grades 2 or 3 esophageal varices (Child A and B/C: 218 and 96) were enrolled. One hundred seventy-three patients had no previous history of variceal bleeding. Only 245 patients (100% of patients with prior variceal hemorrhage, 61% of patients without prior hemorrhage) were receiving some form of prophylactic therapy. The median follow-up was 18 months. RESULTS: There were 76 bleeding events and 14 related deaths (18%); nine of these deaths occurred within 24 h of bleeding onset (two at home, two during hospital transfer, and five in hospital, a mean of 2.5 h after onset; six involved Child C patients). Twenty-five deaths were not due to bleeding but were closely related to cirrhosis. In a Cox model, the presence of tense ascites (relative risk 3.4, 95% confidence interval, CI 2.5-5.9) and a prior history of hemorrhage (relative risk 4.4, 95% CI 2.6-7.5) were independent predictors of variceal hemorrhage. In patients without a prior history of bleeding, bleeding risk was higher with more prolonged prothrombin time and lower when patients were receiving propranolol. CONCLUSIONS: Despite the advent of effective drugs and endoscopic therapy for variceal bleeding, about a quarter of deaths occur very early after bleeding onset, confirming the need for rapid specific management.

Adrenergic beta-Antagonists↗
PubMed2003

Antiviral effect of ribavirin in early non-responders to interferon monotherapy assessed by kinetics of hepatitis C virus RNA and hepatitis C virus core antigen.

BACKGROUND/AIMS: To evaluate the efficacy of ribavirin, given in second intention in non-responders to interferon alone, by studying viral kinetics. METHODS: We conducted a trial including 203 patients with chronic hepatitis C, naïve of treatment. Patients were treated with interferon three times a week with or without ribavirin and amantadine according to response. Viral kinetics were assessed by serial measurements of HCV RNA (bDNA 3.0 and Monitor 2.0) and a new assay, trak-C, able to quantify total Hepatitis C virus (HCV) core antigen. RESULTS: A significant initial drop in HCV RNA or HCV core antigen, under interferon alone, was associated with response to therapy, -4.85+/-1.33 log for HCV RNA in sustained responders versus -1.86+/-1.53 log for others groups, P<0.001. In patients receiving ribavirin in second intention, we also observed a similar drop in HCV RNA and HCV core antigen, predictive of sustained response, -2.67+/-1.26 log for HCV RNA in sustained responders versus -0.44+/-0.49 log in non-responders, P<0.001. CONCLUSIONS: Ribavirin has probably an additional antiviral effect in interferon treated patients. Kinetics of HCV RNA and HCV core antigen under treatment are highly predictive of a sustained virological response.

Adult↗
PubMed2003

[Epidemiology and management of care of hepatitis C infection in the Poitou-Charentes region in 1997 and 2000].

OBJECTIVES: A repeat cross-sectional survey was performed in 1997 and 2000 in the Poitou-Charentes district of France to compare screening and management of hepatitis C virus infection. METHODS: The "Hepatitis C Network" asked the biological laboratories in the region to provide anonymous results of serology tests performed during two two month periods at a 3 year interval. An epidemiological and follow-up questionnaire was sent to the medical practitioner who prescribed the test for all positive tests. RESULTS: More serology tests were prescribed in 2000 (7074) than in 1997 (6168). The access to screening differed significantly between the 4 counties of the district (P<0.0001). Sixty-nine and 58 patients were first diagnosed respectively in 1997 and 2000. In 2000, these patients were younger (P=0.05) and were infected later (P=0.03). The risk factors were similar for the two periods. Respectively 23% and 26% underwent a liver biopsy, and 12% were treated. CONCLUSION: Screening improved after a press campaign, but there was no increase in the number of newly detected patients. In 2000, one third of patients were still inadequately cared for.

Adult↗
PubMedDate not supplied

[EUS results of malignant rectal giant condyloma acuminatum (Buschke-Loewenstein tumor)].

Giant condyloma acuminatum is a large, exophytic, cauliflower-like lesion that usually affects the anogenital region. Localisation in the rectum is uncommon and has a high rate of malignant transformation but does not lead to develop distant metastases. For the time, we report the endosonographic appearance of a malignant intrarectal giant condyloma acuminatum.

Aged↗