RESUMEN

We report a case of a 15-year-old young man who was admitted for an acute hepatitis. Virological assessment showed both IgM anti-EBV and IgM anti-hepatitis A. IgG anti-EBNA and clinical history allowed to rule out the hypothesis of a recent EBV infection and confirmed the diagnosis of acute hepatitis A infection.

Asunto(s)

Virus de la Hepatitis A/inmunología , Hepatitis A/diagnóstico , Herpesvirus Humano 4/inmunología , Inmunoglobulina M/análisis , Enfermedad Aguda , Adolescente , Urgencias Médicas , Estudios de Seguimiento , Hepatitis A/inmunología , Humanos , Unidades de Cuidados Intensivos , Masculino , Factores de Tiempo

RESUMEN

UNLABELLED: Transjugular intrahepatic portosystemic shunt (TIPS) is a more effective treatment for refractory ascites than large volume paracentesis (LVP), but the magnitude of its effect in terms of control of ascites, encephalopathy and survival has not been established. AIM: This meta-analysis compare TIPS to LVP in terms of control of ascites at 4 and 12 months, encephalopathy and survival at 1 and 2 years. RESULTS: Five randomized controlled trials involving 330 patients were included. In the TIPS group, control of ascites was more frequently achieved at 4 months (66% vs 23.8%, mean difference: 41.4%, 95% confidence interval (CI): 29.5-53.2%, P < 0.001) and 12 months (54.8% vs 18.9%, mean difference: 35%, 95% CI: 24.9-45.1%, P < 0.001), whereas encephalopathy was higher (54.9% vs 38.1%, mean difference: 17%, 95% CI: 7.3-26.6%, P < 0.001). Survival at 1 year (61.7% vs 56.5%, mean difference: 3.2%, 95% CI: -14.7 to 21.9%) and 2 years (50% vs 42.8%, mean difference: 6.8%, 95% CI: -10 to 23.6%) were not significantly different. CONCLUSIONS: TIPS is a more effective treatment for refractory ascites than LVP. However, TIPS increase encephalopathy and does not improve survival.

Asunto(s)

Ascitis/cirugía , Encefalopatía Hepática/cirugía , Derivación Portosistémica Intrahepática Transyugular/métodos , Anciano , Ascitis/diagnóstico , Ascitis/mortalidad , Femenino , Estudios de Seguimiento , Encefalopatía Hepática/diagnóstico , Encefalopatía Hepática/mortalidad , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

AIM: To evaluate adjuvant modalities after curative resection for hepatocellular carcinoma using a meta-analysis of randomized and non-randomized controlled trials. METHODS: In a first step, a meta-analysis of randomized controlled trials was carried out. Sensitivity analyses after inclusion of non-randomized controlled trials were performed. Four therapeutic modalities were evaluated: pre-operative transarterial chemotherapy, post-operative transarterial chemotherapy, systemic chemotherapy and a combination of systemic and transarterial chemotherapy. RESULTS: Only post-operative transarterial chemotherapy improved survival significantly at 2 years [difference, 22.8%; confidence interval (CI), 8.6-36.9%; P = 0.002] and 3 years (difference, 27.6%; CI, 8.2-47.1%; P = 0.005), and decreased the probability of no recurrence at 1 year (difference, 28.8%; CI, 16.7-40.8%; P < 0.001), 2 years (difference, 27.6%; CI, 8.2-47.1%; P = 0.005) and 3 years (difference, 28%; CI, 8.2-47.9%; P = 0.006). In a sensitivity analysis after inclusion of non-randomized controlled trials, post-operative transarterial chemotherapy still improved survival at 1 year (difference, 9.6%; CI, 0.8-18.3%; P = 0.03), 2 years (difference, 13.5%; CI, 0.9-26%, P = 0.04) and 3 years (difference, 18%; CI, 7-28.9%; P < 0.001), and decreased the probability of no recurrence at 1 year (difference, 20.3%; CI, 7.7-33%; P = 0.002), 2 years (difference, 35%; CI, 21.4-46.3%; P < 0.001) and 3 years (difference, 34.5%; CI, 18.7-50.3%; P < 0.001). CONCLUSION: Post-operative transarterial chemotherapy improved survival and decreased the cumulative probability of no recurrence. New randomized controlled trials evaluating this modality are required.

Asunto(s)

Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Quimioterapia Adyuvante , Neoplasias Hepáticas/tratamiento farmacológico , Carcinoma Hepatocelular/cirugía , Ensayos Clínicos Controlados como Asunto , Quimioterapia Combinada , Humanos , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia/etiología , Cuidados Posoperatorios , Cuidados Preoperatorios , Ensayos Clínicos Controlados Aleatorios como Asunto , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To evaluate advantages and drawbacks of a controlled conservative management of patients with severe gastric caustic injuries. METHODS: Among 40 patients with severe caustic gastric burns (> IIb), 28 with stade III lesions (mosaic necrosis: n = 10, extensive or circumferential necrosis: n = 18) were managed prospectively from 1990 to 1998. Twenty-two patients had associated stage III oesophageal lesions and 6 had stage III duodenal lesions. All patients were followed up by daily surgical examination. Total gastrectomy with esophageal exclusion or stripping was performed in case of perforation. RESULTS: Five immediate and 7 secondary total gastrectomies, two associated esophagectomies and two jejunal resections were performed. Mortality rate was 18% (5/28). Sixteen gastric preservations (60%) were achieved, including 7 complete and 9 partial because of gastric stricture. Eighteen esophagoplasties for oesophageal strictures or after gastrectomy were performed without mortality. CONCLUSION: Stage III caustic injuries of the stomach, when they are not immediately life-threatening, do not systematically require total gastrectomy. A strict conservative attitude can be done with significant morbidity and acceptable mortality and significantly raises the numbers of preserved stomach.

Asunto(s)

Quemaduras Químicas/etiología , Quemaduras Químicas/terapia , Cáusticos/efectos adversos , Esofagectomía , Esófago/lesiones , Esófago/cirugía , Gastrectomía , Yeyuno/lesiones , Yeyuno/cirugía , Selección de Paciente , Estómago/lesiones , Estómago/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/mortalidad , Urgencias Médicas , Esofagectomía/efectos adversos , Esofagectomía/mortalidad , Gastrectomía/efectos adversos , Gastrectomía/mortalidad , Gastroscopía , Humanos , Persona de Mediana Edad , Morbilidad , Necrosis , Peritonitis/etiología , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Absceso Subfrénico/etiología , Resultado del Tratamiento

Asunto(s)

Citocinas/análisis , Citocinas/inmunología , Hepatitis C/inmunología , Hepatitis C/fisiopatología , Formación de Anticuerpos/inmunología , Moléculas de Adhesión Celular/inmunología , Quimiocinas/inmunología , Progresión de la Enfermedad , Hepatitis C/diagnóstico , Hepatitis C/metabolismo , Hepatitis C/terapia , Hepatitis C/virología , Hepatocitos/inmunología , Humanos , Inmunidad Celular/inmunología , Trasplante de Hígado/inmunología , Linfocitos/inmunología , Valor Predictivo de las Pruebas , Recurrencia , Inmunología del Trasplante , Resultado del Tratamiento

RESUMEN

BACKGROUND AND OBJECTIVES: Information about the long-term efficacy of interferon alpha (interferon-alpha) in haemophilic patients with chronic hepatitis not co-infected with the human immunodeficiency virus (HIV-1) is still limited. Previous studies seemed to indicate a low rate of response. The aim of this study was to evaluate the safety and long-term efficacy of interferon treatment in multi-transfused haemophiliacs. METHODS: Fifty-eight haemophiliacs were scheduled to receive 3 MU of interferon-alpha 2b three times a week for 12 months. The patients were followed up for at least 24 months post-treatment. Response was assessed by measurements of serum hepatitis C virus (HCV) RNA. RESULTS: Twenty-four patients (41.4%) dropped out. Except for seven patients, the symptoms that led to interrupting interferon treatment would probably not have resulted in the same decision in non-haemophilic patients. One patient developed an inhibitor to the deficient clotting factor without haemorrhagic consequences. In an intent to treat, the sustained virological response rate was 14%. However, when considering only the 34 patients who received the full treatment, HCV-RNA was cleared in eight patients (23%). CONCLUSIONS: This study suggests that multi-transfused haemophiliacs with chronic hepatitis not co-infected with HIV-1 respond to prolonged treatment with interferon-alpha in a similar proportion to that observed in non-haemophiliacs. There was a high rate of patients who did not complete the interferon-alpha treatment, and this seems to be characteristic of this patient population.

Asunto(s)

Antivirales/uso terapéutico , Hemofilia A/complicaciones , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Adolescente , Adulto , Hepatitis C/genética , Hepatitis C Crónica/virología , Humanos , Interferón alfa-2 , Masculino , Persona de Mediana Edad , Proyectos Piloto , ARN Viral/sangre , Proteínas Recombinantes , Carga Viral

RESUMEN

Alpha1-antitrypsin (alpha1AT) deficiency is an autosomal recessive disorder that can cause pulmonary emphysema and liver disease. We report here the case of a 59-year-old woman who was admitted to hospital for evaluation of jaundice. She had no history of hepatitis or childhood liver disease. She had never received a blood transfusion, nor had she abused drugs or alcohol. Transjugular liver biopsy was then performed and revealed a micronodular cirrhosis. Ten months later, because of persistent liver cell failure and ascites, she underwent an orthotopic liver transplantation. Investigation of alpha1AT system in the proband revealed a substantial decrease in serum alpha1AT associated with a low elastase inhibitory capacity. The Pi phenotype revealed a PiM-like profile. Sequencing of exons 1-5 demonstrated the presence of the M3 allele. Moreover, a triple nucleotide deletion was detected in exon 2 of one allele. This caused an "in-phase" frameshift, coding for a protein deficient in a single Phe residue, which corresponded to the Mmalton variant. After liver biopsy, periodic acid-Schiff-positive acidophilic bodies resistant to diastase digestion were observed in the cytoplasm of hepatocytes. These results demonstrated that our patient had a heterozygous M3Mmalton alpha1AT genotype related to a deficiency phenotype. This observation is the first of a patient with heterozygous Mmalton genotype associated with an alpha1AT deficiency that induced severe liver disease requiring orthotopic liver transplantation.

Asunto(s)

Fallo Hepático/genética , alfa 1-Antitripsina/genética , Femenino , Heterocigoto , Histocitoquímica , Humanos , Hígado/patología , Fallo Hepático/patología , Fallo Hepático/cirugía , Trasplante de Hígado , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , alfa 1-Antitripsina/metabolismo

RESUMEN

Peristomal varices can occur in patients with gastrointestinal or urinary diversions associated with portal hypertension. It is now no longer rare to propose radical surgery for invasive bladder tumours in patients also suffering from hepatic cirrhosis, responsible for specific subsequent complications. Less than ten cases of varicose haemorrhages have been described on ileal bladders. The authors report the case of a patient with cirrhosis (Child B) treated surgically (radical cystoprostatectomy and Bricker transileal cutaneous diversion) for invasive bladder tumour. Episodes of bleeding varices occurred two months after surgery. Repeated and abundant haemorrhage led to the placement of an intrahepatic shunt (TIPS) allowing reduction of the portal hypertension and the severity of the bleeding. When local control of the bleeding is no longer possible, reduction of the portosystemic pressure gradient is required. TIPS is an effective alternative to surgical shunts, responsible for high morbidity and mortality in these debilitated patients.

Asunto(s)

Hemorragia/etiología , Ureterostomía/efectos adversos , Várices/etiología , Anciano , Humanos , Masculino , Recurrencia , Ureterostomía/métodos

Asunto(s)

Dolor Abdominal/etiología , Síndrome de Budd-Chiari/complicaciones , Adulto , Síndrome de Budd-Chiari/etiología , Femenino , Humanos , Policitemia Vera/complicaciones , Policitemia Vera/diagnóstico

RESUMEN

OBJECTIVE: Our aim was to compare the results of gadolinium-enhanced breath-hold MR angiography with those of conventional angiography for the study of mesenteric circulation. SUBJECTS AND METHODS: MR angiography and digital subtraction angiography were prospectively performed in 33 patients referred for hepatic, pancreatic, or mesenteric disease. MR angiography was performed with four three-dimensional acquisitions at 0, 30, 60, and 90 sec after injection of 0.1 mmol/kg of gadolinium. Selective conventional angiography was used as the standard of reference. RESULTS: A pure arterial angiogram (one on which veins could not be visualized) was obtained in 27 patients during the second or third acquisition. By subtracting the arterial phase from an arteriovenous phase (third or fourth acquisition) we obtained a pure venous angiogram (one on which arteries could not be visualized) in 28 patients. Agreement was good or excellent for the hepatic artery (kappa = 0.78), the superior mesenteric artery (kappa = 0.65), the splenic artery (kappa = 0.70), the portal vein (kappa = 1.0), the superior mesenteric vein (kappa = 0.88), and the splenic vein (kappa = 0.75). Agreement was poor, and vessels were better shown by conventional angiography, for the intrahepatic arteries (kappa = 0.006) and the branches of the superior mesenteric artery (kappa = 0.14). MR angiography and conventional angiography revealed 29 and 27 portosystemic collaterals, respectively. CONCLUSION: Dynamic breath-hold contrast-enhanced MR angiography compared favorably with conventional angiography in preoperative assessment of the proximal mesenteric arteries and in the evaluation of portal hypertension; however, conventional angiography is still necessary to evaluate distal arteries.

Asunto(s)

Angiografía por Resonancia Magnética , Mesenterio/irrigación sanguínea , Mesenterio/diagnóstico por imagen , Adulto , Anciano , Angiografía , Femenino , Gadolinio , Humanos , Masculino , Mesenterio/anatomía & histología , Persona de Mediana Edad , Estudios Prospectivos , Respiración , Circulación Esplácnica

Asunto(s)

Embolización Terapéutica , Enterostomía/efectos adversos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Derivación Portosistémica Intrahepática Transyugular , Várices/etiología , Várices/terapia , Anciano , Terapia Combinada , Humanos , Masculino

Asunto(s)

Hepatitis C Crónica/metabolismo , Interleucina-10/deficiencia , Hígado/metabolismo , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

BACKGROUND AND AIMS: Diffuse jejuno-ileitis of Crohn's disease may be a homogeneous clinical subgroup. The aim of this work was to compare the demographic and clinical data at diagnosis and the initial treatments of patients with diffuse jejuno-ileitis of Crohn's disease and to the ones without this localization. PATIENTS AND METHODS: For demographic and clinical studies, 48 (32M/16F) incident cases of diffuse jejuno-ileitis of Crohn's disease diagnosed between 1988 and 1994 in the EPIMAD register were compared with 96 (48M/48F) controls diagnosed the same year. As far as for the therapeutic management, the 48 incident cases were compared with 48 controls. RESULTS: Diffuse jejuno-ileitis constituted 3.3% of the total incident cases. Median age at diagnosis was significantly lower (20 vs 23 years, P = 0.01) and an upper digestive involvement was more frequent (56% vs 34%, P = 0.03) in patients with diffuse jejuno-ileitis. These patients were more often treated by total parenteral nutrition (43.8% vs 19.6%, P = 0.01) or azathioprine (50% vs 20.8%, P = 0.005). Azathioprine was also introduced earlier (20.7 vs 40.3 months, P = 0.009). Surgery for resection was less often required in diffuse jejuno-ileitis than in controls (65.2% vs 99.8%, P = 0.02) while more stricturoplasties were performed (52.9% vs 10%, P = 0.003); overall surgical rates did not significantly differ in the 2 groups. CONCLUSION: Our series suggest that diffuse jejuno-ileitis of Crohn's disease is a subgroup of patients characterized by a young age at diagnosis, with more frequent and earlier requirement for azathioprine.

Asunto(s)

Enfermedad de Crohn/terapia , Enteritis/terapia , Enfermedades del Íleon/terapia , Enfermedades del Yeyuno/terapia , Adolescente , Adulto , Envejecimiento , Azatioprina/uso terapéutico , Enfermedad de Crohn/patología , Enteritis/patología , Femenino , Humanos , Enfermedades del Íleon/patología , Enfermedades del Yeyuno/patología , Masculino , Persona de Mediana Edad , Nutrición Parenteral Total

RESUMEN

We present a case of a severe hepatitis associated with acute renal failure and anuria consequently to the ingestion of 112 mg of buprenorphine, 48 hours before. The normalisation of hepatic and renal functions is associated with discontinuation of buprenorphine administration and hemodialysis treatment. Buprenorphine seems to be directly responsible for this hepatonephritis as indicated by the high plasmatic levels of buprenorphine (224 ng/ml) and norbuprenorphine (30 ng/ml) never described until now. Buprenorphine toxicity could be due to the inappropriate ingestion mode (oral instead of sublingual) and could be increased by previous acetaminophen intake.

Asunto(s)

Lesión Renal Aguda/inducido químicamente , Analgésicos Opioides/sangre , Analgésicos Opioides/envenenamiento , Buprenorfina/sangre , Buprenorfina/envenenamiento , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Nefritis/inducido químicamente , Detección de Abuso de Sustancias/métodos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/terapia , Adulto , Biopsia , Buprenorfina/análogos & derivados , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Cefalea/tratamiento farmacológico , Humanos , Masculino , Nefritis/diagnóstico , Nefritis/terapia , Diálisis Renal , Factores de Tiempo

Asunto(s)

Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Neoplasias Hepáticas/terapia , Trasplante de Hígado , Adulto , Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Contraindicaciones , Doxorrubicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Trasplante de Hígado/mortalidad , Trasplante de Hígado/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Listas de Espera

RESUMEN

OBJECTIVE: The purpose of our study was to assess the efficacy of transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma using two different infusion schedules. MATERIALS AND METHODS: Chemoembolization with lipiodol-mediated injection of doxorubicin was performed in 160 patients. In the first group of 80 patients, conventional chemoembolization was initially planned to be repeated at least three times at 2-month intervals. In the second group of 80 patients, chemoembolization was used selectively and repeated only when necessary on the basis of follow-up CT or MR imaging. According to the Okuda classification, 72 patients were stage 1, 33 belonging to group 1 (subgroup 1, Okuda 1) and 39 belonging to group 2 (subgroup 2, Okuda 1). Eighty-eight patients were stage 2, 47 belonging to group 1 (subgroup 1, Okuda 2) and 41 belonging to group 2 (subgroup 2, Okuda 2). RESULTS: Complications of transcatheter arterial chemoembolization occurred in 19 patients from group 1 and six patients from group 2 (p < .001). The mean time between the first and the third courses was significantly different between group 1 (4 months) and group 2 (14 months) (p < .001). The 1-year, 2-year, and 3-year survival rates were significantly different between subgroup 1, Okuda 1, (58%, 28%, 11%) and subgroup 2, Okuda 1 (89%, 68%, 39%) (p <. 001), and between subgroup 1, Okuda 2 (19%, 0%, 0%), and subgroup 2, Okuda 2 (48%, 31%, 15%) (p < .001). CONCLUSION: The efficacy and tolerability of chemoembolization increase when it is used selectively and repeated only when necessary. Such technical considerations might explain some of the discrepancies of the results of chemoembolization in published data.

Asunto(s)

Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Adulto , Anciano , Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/mortalidad , Quimioembolización Terapéutica/efectos adversos , Doxorrubicina/administración & dosificación , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND: Classic morphological techniques are of limited value for imaging endocrine duodenopancreatic tumors, and invasive procedures such as intraarterial stimulation are often used. Two noninvasive procedures, endoscopic ultrasonography (EUS) and somatostatin receptor scintigraphy (SRS), were recently described with promising results. METHODS: In this study we correlated the results of preoperative EUS (n = 34) and SRS (n = 30) with operative findings in patients with histologically proven insulinoma (n = 20) or gastrinoma (n = 21). RESULTS: The sensitivity and positive predictive value (PPV) of EUS were respectively 77% and 94% for pancreatic tumors (insulinomas and gastrinomas), 40% and 100% for duodenal gastrinomas, and 58% and 78% for metastatic lymph nodes. The sensitivity and PPV of SRS for insulinoma were 60% and 100%, respectively. In patients with gastrinoma, the sensitivity and PPV of SRS were respectively 25% and 100% for pancreatic gastrinomas, 72% and 100% for duodenal gastrinomas or periduodenal metastatic lymph nodes, and 67% and 80% for liver metastasis. In patients with multiple endocrine neoplasia, neither one of the two techniques detected all tumors. Overall sensitivity of combined EUS and SRS was 89% for insulinoma (n = 9) and 93% for gastrinoma (n = 14). CONCLUSIONS: EUS and SRS for gastrinomas and insulinomas should be considered as the initial preoperative imaging procedures and may render invasive procedures unnecessary for most patients.

Asunto(s)

Endosonografía , Gastrinoma/diagnóstico por imagen , Insulinoma/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Receptores de Somatostatina/análisis , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Cintigrafía , Sensibilidad y Especificidad

Asunto(s)

Enfermedades de los Conductos Biliares/diagnóstico , Conductos Biliares/patología , Imagen por Resonancia Magnética , Páncreas/patología , Enfermedades Pancreáticas/diagnóstico , Colangiografía , Humanos

Asunto(s)

Gangrena de Fournier/etiología , Gangrena de Fournier/terapia , Oxigenoterapia Hiperbárica , Perineo , Cuidados Preoperatorios/efectos adversos , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Anaerobiosis , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Pronóstico , Radioterapia Adyuvante/efectos adversos , Neoplasias del Recto/complicaciones

RESUMEN

OBJECTIVES: A 1993-1995 three year epidemiological survey of home parenteral nutrition was performed through in France in approved centers for adults. METHODS: Data were retrospectively collected each year on a standardized questionnaire focussing on indications and short term outcome. RESULTS: All centers (n = 14) participated in the study and 524 new adult patients were recruited. The overall incidence was unchanged at 3.75 patients/10(6) adults. Indications for AIDS rose (8 to 18%) whereas other indications were stable. Prevalence increased by 19%: 4.40 adults/10(6) patients at 01.01.1996. At six months, the probability to stay on treatment was 19.5% for AIDS and cancer indications but 52% for others, whereas death rates were 59% and 9% respectively. CONCLUSIONS: For both cancer and AIDS indications, short-term treatment was due to a poor prognosis. For other diagnosis, complicated with a short bowel in 51% of cases, prognosis was excellent but associated with treatment dependency. The latter point focuses on the need for additional treatments in irreversible intestinal failure.

Asunto(s)

Encuestas de Atención de la Salud , Nutrición Parenteral en el Domicilio , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adolescente , Adulto , Anciano , Certificación , Francia , Humanos , Persona de Mediana Edad , Neoplasias/complicaciones , Nutrición Parenteral en el Domicilio/normas , Pronóstico , Calidad de la Atención de Salud , Estudios Retrospectivos