RESUMEN
OBJECTIVES: Hepatitis C virus (HCV) infection is a recognized public health issue in France. Institutional networks were created to improve healthcare practices and facilitate multi-disciplinary care for chronic diseases. The electronic medical file is one of the tools used by the networks to optimize patient care. METHODS: The main objective of this study was to determine what proportion of general practitioners in the Languedoc-Roussillon region of southern France would be interested in using the electronic medical files for patients with HCV infection. A random sample of 20% of the general practitioners in the region was selected and stratified by administrative district of practice. Among them, a telephone survey identified those interested in the hepatitis electronic medical files and following patients with hepatitis C. A more detailed questionnaire was sent to these interested physicians in order to obtain further information. RESULTS: Thirty-seven percent of the general practitioners concerned by the question followed patients with HCV infection. The advantages and disadvantages the physicians associated with use of these files were mostly related to the physician's age, attendance of continuing education courses and internet access. CONCLUSION: This study highlighted the fact that a significant number of general practitioners would be interested in accessing electronic medical files for patients with HCV infection. Considering these findings it might be useful to propose a working group including general practitioners and specialists in order to develop a concrete project for implementing electronic medical files for patients with HCV infection.
Asunto(s)
Actitud del Personal de Salud , Hepatitis C/epidemiología , Sistemas de Registros Médicos Computarizados , Médicos de Familia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Educación Médica Continua , Femenino , Francia , Humanos , Internet , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Sixty two patients with a gastrointestinal carcinoma were evaluated pre-operatively by ultrasonography, CT scan and laparoscopy to seek liver metastases and/or peritoneal carcinomatosis. Performance levels of laparoscopy, ultrasonography and CT scan were comparable regarding the diagnosis of liver metastases. Laparoscopy was markedly better than CT scan and ultrasonography in the diagnosis of peritoneal carcinomatosis. Thus the investigation of choice for the detection of liver metastases is a single imaging technique. In contrast, if excision surgery is envisaged, all gastrointestinal carcinomas should be assessed by ultrasonography and/or CT scan and laparoscopy to definitely eliminate peritoneal carcinomatosis or small superficial liver metastases, in such a way as to avoid unnecessary laparotomy.
Asunto(s)
Carcinoma/diagnóstico , Carcinoma/secundario , Neoplasias del Sistema Digestivo/diagnóstico , Laparoscopía , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Peritoneales/diagnóstico , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Neoplasias del Sistema Digestivo/diagnóstico por imagen , Neoplasias del Sistema Digestivo/patología , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/patología , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Portal angiographic and manometric studies were prospectively carried out in 9 cirrhotic patients with spontaneous chronic portal-systemic encephalopathy. Hepatic encephalopathy presented as coma in 8 patients, and was the first manifestation of chronic liver disease in 6 cases. Hemodynamic studies showed a) a large single spontaneous portacaval anastomosis (gastrorenal, splenorenal, gradient (mean +/- SD = 16.3 +/- 5.4 mm Hg); c) a wedge hepatic venous pressure higher than portal pressure in 8 cases (difference: 1-11 mm Hg).