Prevalence and associations of psychological distress in young adults with Type 1 diabetes.

AIMS: To determine the prevalence of psychological distress in young adults with Type 1 diabetes and to explore associated factors. METHODS: Ninety-two participants with Type 1 diabetes (46 male, 46 female) attending a young adult clinic completed two psychological self-report assessments; the Centre for Epidemiological Studies-Depression Scale (CES-D) and Adult Self-Report Scale (ASR). The mean age was 21.6 +/- 2.8 years (sd) and mean duration of diabetes was 9.3 +/- 5.4 years. A questionnaire identified the method of insulin delivery, the frequency of blood glucose monitoring and hypoglycaemia requiring third-party assistance. HbA(1c) was measured. RESULTS: Of the participants, 35.2% reported depressive symptoms (CES-D > or = 16), 23.1% indicating severe depressive symptoms (CES-D > or = 24), and 32.2, 40.4 and 35.5% of participants reported significant distress (ASR > or = 60) on the ASR total problem scales, ASR internalizing and ASR externalizing scores, respectively. Mean HbA(1c) levels were higher in participants with depressive symptoms compared with those with normal scores (CES-D > or = 16, HbA(1c)= 9.4% vs. CES-D < 16, HbA(1c)= 8.4%, P = 0.01). Factors associated with psychological distress included use of continuous subcutaneous insulin infusion (CSII) (P = 0.02) and increased frequency of hypoglycaemic episodes (P = 0.03). CSII users had higher CES-D (21.3 vs. 11.9, P = 0.001) and ASR-Total (59.7 vs. 53.0, P = 0.02) scores than non-CSII users. CONCLUSIONS: Approximately one-third of young adults with Type 1 diabetes experience psychological distress, which is associated with poorer glycaemic control. Psychological distress was related to frequency of hypoglycaemic episodes and method of insulin administration, with significantly greater distress being observed in those using CSII. These findings support inclusion of a psychologist in the diabetes team.

[Intractable vomiting, convulsions and megaloblastic anemia: anamnesis, key to diagnosis]. / Vomissements incoercibles, convulsions et anémie mégaloblastique: l'anamnèse, clé du diagnostic.

In July 1996 a 43-year-old illiterate Hispanic woman presented with uncontrollable vomiting, palpitations and confusion. In 1994, despite several hospitalisations in other medical centres where a cerebral CT-scan, oesogastroduodenoscopy, colonoscopy and abdominal ultrasound were performed, no satisfactory diagnosis could be found. A psychiatric origin was finally considered. On admission, the laboratory findings showed severe metabolic alkalosis with associated hypokalaemia, confirmatory evidence of vomiting. The ECG showed tremendous P waves (5 mV) in the standard derivations, which can be explained by the hypokalaemia, with multiple supraventricular extrasystoles. Echocardiography and pulmonary scintigraphy ruled out pulmonary hypertension and a pulmonary embolus. After additional discussion with her daughter we discovered that the patient had been treating chronic headaches for years with 4-5 Cafergot-PB suppositories per day. This drug contains 2 mg ergotamine tartrate, 100 mg butalbital, 100 mg caffeine and 0.25 mg belladona alkaloids. As is known, vomiting is a classical symptom of ergotamine intoxication. After rehydration we discovered a megaloblastic anaemia with a folate deficiency compatible with chronic barbiturate intoxication. Folate and iron supplementation allowed a rapid normalisation of the haemoglobin values. Five months after having stopped the Cafergot-PB, the patient was well and did not vomit anymore. The headaches were treated with chlorpromazine with a good result. Despite sophisticated technical means, the diagnosis could only be established after a thorough history taking. This message should be heard in times when high tech medicine tends to obscure the place of a good history taking!

[Cerebral hemorrhage and "ecstasy"]. / Hémorragie cérébrale et "Ecstasy".

We report the case of an acute cerebral hemorrhage after one "ecstasy" tablet in a 21 year old woman without any relevant medical or surgical history. The status showed a right sensorimotor syndrome. The CT-scan and the MRI revealed a left cerebral hemorrhage. The patient only partially recovered her neurological functions after one year. The discussion deals with the effects and dangers of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) which is systematically used in night parties or "raves".

Role of integrins and evidence for two distinct mechanisms mediating human colorectal carcinoma cell interaction with peritoneal mesothelial cells and extracellular matrix.

Peritoneal carcinomatosis involves a series of events including tumor cell interactions with mesothelial cells and the extracellular matrix (ECM). We have studied the adhesive and invasive properties of four human colorectal carcinoma cell lines (Co115, HT29, SW480, SW620) confronted in vitro with a human mesothelial cell monolayer or with the ECM proteins collagen IV, laminin-1, fibronectin, tenascin-C and vitronectin. Quantitation was achieved following staining of tumor cells with the calcein-AM fluorescent dye. We found that all four cell lines rapidly adhered to a mesothelial cell monolayer. This adhesion event was not inhibitable by anti-integrin and anti-CD44 antibodies. Following initial attachment, the SW480 and SW620 cells invaded the mesothelial cell monolayer more aggressively than HT29 and Co115 cells. All cell lines adhered to ECM proteins with each one exhibiting an individual adhesion pattern. Adhesion to matrix was completely integrin-dependent. When tested in an invasion assay, HT29 and Co115 cells crossed Matrigel-coated filters while SW480 and SW620 cells did not. This invasion was inhibited by anti-beta 1 integrin antibodies. Taken together, our results demonstrate that the initial colorectal tumor cell-mesothelial cell interaction occurs through an integrin-independent mechanism while adhesion to matrix proteins and invasion through Matrigel are integrin-dependent events. Furthermore, the different invasive capacity of SW480 and SW620 versus HT29 and Co115 cells upon interaction with a mesothelial cell monolayer or Matrigel suggests that these two invasion events may be mediated by distinct mechanisms.

Patient perception of the diskus inhaler: a comparison with the turbuhaler inhaler.

Asthmatic patients who were regular and experienced users of the metered-dose inhaler (MDI) but with no history of powder inhaler use were interviewed by questionnaire. Most (71%) of the 159 adults recruited had suffered from asthma for more than five years; 89% had used an MDI for more than one year. In all, 153 (97%) found their current MDI easy or very easy to handle. Effectiveness in delivering the drug and ease of operation were the two features of the device they were most satisfied with. The two features 'of an ideal inhaler' rated most highly were the presence of a dose counter and ease of use during an attack (58% and 72% of respondents, respectively). Other important features included hygiene, sensation that a dose had been taken, and small size. When attitudes towards the Diskus inhaler and the Turbuhaler inhaler were compared, 108 (68%) would have been quite or very happy to have a Diskus inhaler prescribed for them, and 79 (50%) a Turbuhaler inhaler. The Diskus inhaler scored significantly better than the Turbuhaler inhaler for knowing how many doses were left, the presence of an attached cover, attractiveness (p < 0.001), hygiene, shape, weight (p = 0.001), and perceived ease of use (p = 0.002). The Turbuhaler inhaler scored significantly better in terms of size (p < 0.001). Overall, the Diskus inhaler was preferred by 104 of 159 patients (p < 0.001), with perceived ease of use, the dose counter, and shape cited as the main reasons for preference.

Prescribers' and users' perspective of CFCs: a market research survey.

Focus groups were conducted with physicians, pharmacists and patients prior to semi-structured interviews with physicians and patients. The survey was conducted in Spain, Germany and the UK. There were high levels of awareness of environmental issues, with ozone layer damage and global warming being of particular concern. Most respondents were aware of chlorofluorocarbon (CFC) use in aerosols and in refrigerators. However, their presence in asthma metered dose inhalers (MDIs) was much less widely known. German physicians had the highest awareness (78%) while only 1 in 10 of UK patients was aware. Patients expressed concern on learning that they inhale CFCs. Reaction to the concept of a non-CFC propellant was universally favourable, though sometimes qualified with the need for adequate safety and efficacy data. Patients expected to be informed of the change by doctors, pharmacists or patient information leaflets. Physicians expected to receive information as soon as possible but did not want patients informed until launch. Manufacturers and representatives would be the primary information sources for physicians. Pack changes should be minimised. Communicating the change to non-CFC propellants to physicians, pharmacists and patients is all important.