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Symposium: Actualités en Gastro-Entérologie, October 04, 2008

Sexually transmitted diseases and anorectum.

Price: €10,00

Sexually transmitted diseases (STD) are a major public health problem because their incidence is increasing worldwide despite prevention campaigns and because they raise the risk of HIV infection. Anorectal localisations of STD are common among men who have sex with men (MSM) but can also be seen among hetero - sexuals (men or women). Transmission of such infections is due to anal sex or to other sexual behaviours like “fisting”. Although some pathogens (like Human Papillomavirus-HPV) are common in gastroenterologist/proctologist consultations, others are not so well-known. Furthermore during the last years, sexual risky behaviours have led to resurgence of old affections (like syphilis) or to emergence of unknown diseases (like lymphogranuloma venereum) in our countries. This presentation tends to focus on clinical manifestation, diagnosis and treatment of different STD : HPV, Herpes Simplex Virus, Neisseria gonorrhoeae, Chlamydia trachomatis (in particularly lymphogranuloma venereum) and Treponema pallidum. (Acta gastro - enterol. belg., 2009, 72, 413-419). [Product Details...]

Usefulness of histopathological markers in diagnosing Barrett’s intraepithelial neoplasia (dysplasia)

Price: €10,00

The incidence of oesophageal adenocarcinoma has significantly increased in Europe over the last 30 years. The progression from normal mucosa to adenocarcinoma has been associated with genetic and morphological traits regrouped under the term “intra - epithelial neoplasia” (IEN) according to the Vienna classification. The early detection of such lesions represents the first step in the identification of high-risk patients. The morphological criteria of IEN are the gold standard to identify such patients. Firstly described by Riddell et al in 1983, IEN is based on morphological criteria including both cytological and architectural alterations and is classified into different stages of severity. However, large studies have clearly demonstrated the lack of reproducibility, with large inter-individual discrepancies for both discrete and severe lesions. Discrepancies between high grade IEN and adenocarcinoma can be minimized by using the Vienna classification, which groups both of these lesions under the “stage IV”. Discrepancies between low-grade IEN and uncertain lesions remain too important. Erroneous and overstated diagnosis of low grade IEN induces an unnecessary follow-up of patients with obvious psychological and economic consequences. Recent studies have demonstrated that the reading of the slides by 2 to 3 gastrointestinal (GI) pathologists significantly decreases interpretation mistakes. Because of these interpretation problems, scientists have looked for non-morphological criteria to confirm the pre-cancerous state. The current PubMed literature proposes many putative biomarkers. However, none of these has been correctly validated in large prospective case-control studies, which hampers their use in clinical routine. DNA quantification by flux cytometry and morphometry represent alternative methods of documenting IEN but these techniques are complex and expensive. The use of the proliferation marker Ki67 needs deep sampling with correct orientation and standardized cell counting. P504 S has been studied in Barrett’s disease and might be a novel tool. The only promising tool thus far is the overexpression of p53 as shown in prospective studies demonstrating a nice correlation with clinical evolution and is easy to use in clinical routine. (Acta gastro enterol. belg., 2009, 72, 425-432). [Product Details...]

Virological tools for optimal management of chronic hepatitis C

Price: €10,00

Serological and virological tests are useful in management of HCV patients, and include anti-HCV antibody assays, measurement of HCV RNA and HCV genotyping. They are used to diagnose infection, initiate treatment and assess the virological response to antiviral therapy. Monitoring of viral kinetics during the early phases of antiviral treatment is crucial in making treatment decisions concerning arrest of treatment and optimization of its duration. A 2-log drop in viral load at week 12 (early virological response) has good negative predictive value when assessing the sustained virological response (SVR), as most patients without a 2- log drop in viral load at week 12 will not attain a SVR. In contrast, undetectable HCV RNA at week 4 (rapid virological response) has good positive predictive value, as patients with undetectable HCV RNA at week 4 have high probability of reaching a SVR. Recent data suggest that some rapid responders can be treated for shorter periods than usually recommended without compromising their chance of a sustained response. On the other hand, slow virological responders infected with genotype 1 should be treated longer to increase the probability of viral eradication. Future studies should focus on identification of the earliest criterion which is both highly sensitive and highly specific in order to predict early SVR and nonresponse, as well as to avoid useless treatment prolongation. (Acta gastro enterol. belg., 2009, 72, 421-424). [Product Details...]

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