[Pregnancy outcome in inflammatory bowel diseases]. / Pronostic de la grossesse au cours des maladies inflammatoires intestinales.

OBJECTIVE: To assess pregnancy outcome in relation to disease activity and maintenance therapy in patients with inflammatory bowel disease. METHODS: A postal questionnaire was sent to every woman of child-bearing age followed for inflammatory bowel disease in three referral centers (Rothschild, Saint-Lazare, Saint-Louis). Response rate was 65%. RESULTS: One hundred and forty-four pregnancies (153 fetuses) in 138 women (122 had Crohn's disease) were reported. Outcome of pregnancy was normal (baby > 2500 g, without malformation) in 115 cases (77%). There were 17 cases of preterm birth (11.5%), 3 cases of hypotrophy, and 14 pregnancy losses (9 miscarriages (6%), 4 therapeutic abortions for major malformation (2.8%)). Percentages of normal pregnancy outcome were not different between patients who continued maintenance therapy and those who stopped: respective percentages were 75 vs 73% in patients receiving mesalamine or olsalazine (n = 30), and 60 vs 75% in patients receiving azathioprine (n = 22). CONCLUSION: In a selected series of women with inflammatory bowel disease, pregnancy outcome is approaching that observed in a normal population, except for an elevated rate of preterm births. There is no need to stop maintenance therapy with 5-aminosalicylates or azathioprine during pregnancy.

Foetal outcome in women with inflammatory bowel disease treated during pregnancy with oral mesalazine microgranules.

BACKGROUND: Little information is available about the safety of high doses of mesalazine during pregnancy. AIM: To study the fate of pregnancy and foetal outcome in women taking 1-4 g/day of mesalazine microgranules for inflammatory bowel disease. PATIENTS AND METHODS: Case reports were collected from the Pharmacovigilance Department of Ferring SA, France, from a survey conducted in three gastroenterology units, and from a teratology information service. The evolution of pregnancy and foetal outcome were assessed by questionnaire. RESULTS: The study covered a total of 123 pregnancies (126 foetuses). Ninety-six women took mesalazine during the first trimester, 85 during the second and 83 during the third. The mean daily dose was 2.1+/-0.8 g; 86 women received <3 g/day (low-dose group), 37 women received > or =3 g/day (high-dose group). The following abnormalities were observed in the low-dose and high-dose groups, respectively: ectopic pregnancy (1/0), spontaneous abortions (1/1), foetal death (0/1), premature deliveries (3/5, P < 0.05), congenital malformations (3/1) and one case of lethal oxalosis. Abnormalities were not considered to be related to mesalazine. CONCLUSIONS: The use of oral mesalazine microgranules during pregnancy is safe at doses < or =2 g/day, and probably also at a dose of 3 g/day.

Endoscopic sphincterotomy in patients with liver cirrhosis.

BACKGROUND: Nonsurgical alternatives in biliary diseases have not been studied in large series of patients with cirrhosis. Our aim was to determine the indications and results of endoscopic treatment in this subset of patients. METHODS: Fifty-two patients (36 men, 16 women-Child-Pugh Class A, 18; B, 22; C, 12) aged 63 +/- 18 years underwent endoscopic sphincterotomy (ES) between 1988 and 1993. Antibiotic prophylaxis was routinely carried out and coagulopathy was corrected before ES when required. The data were collected retrospectively up to 30 days after ES. RESULTS: ES succeeded in 98% of the patients (12 cases of needle-knife papillotomy). Twenty-nine patients (55.7%) had choledocholithiasis, 18 had biliary strictures (12 malignant), and 5 had pancreatic or other biliary diseases. Five days after ES, morbidity was 13.5% and mortality was 7.7%. At 1 month, morbidity was 22.9% and mortality 12.5%. Only endoscopic procedures and Ineffective drainage were seen to be significant risk factors or morbidity. The results of the subgroup of cirrhotic patients with choledocholithiasis (n = 29) were compared with those of matched noncirrhotic patients (n = 58). The cirrhotic and noncirrhotic patients treated for choledocholithiasis showed similar results for stone clearance, morbidity, and mortality. CONCLUSION: ES is a safe and effective procedure for treating choledocholithiasis in cirrhotic patients. ES can therefore be considered as an alternative to surgery in Child class A and B patients and must be preferred for Child class C patients with life-threatening biliary complications.

[Autoimmune dysthyroidism induced by alpha interferon in two female patients with chronic non-A, non-B hepatitis]. / Dysthyroïdies auto-immunes induites par l'interféron alpha chez 2 femmes atteintes d'hépatite chronique non-A, non-B.

We report two cases of autoimmune thyroid disorders which appeared after 6 months of recombinant alpha interferon therapy given for chronic non-A, non-B hepatitis. There was no family or personal history of thyroid disease, or had the patients taken any hepatic or thyroid toxic drugs. The other causes of hepatic and thyroid diseases were ruled out. The first case concerned a 33-year-old woman with sporadic hepatitis C. Therapy was complicated by the appearance of antimicrosomal thyroid antibodies and hypothyroidism. At 22 months, substitutive therapy was still necessary in one case. The second case involved a 37-year-old woman with post-transfusional non-A, non-B hepatitis which was complicated by transient hypothyroidism preceding thyrotoxicosis (with TSH-receptor antibodies). We observed a return to euthyroidism and loss of associated antibodies after withdrawal of interferon and institution of hormonal therapy.

Plastic surgery on children with Down syndrome: parents' perceptions of physical, personal, and social functioning.

Plastic facial surgery is being carried out on children with Down syndrome with the objective of improving these children's physical, personal, and social functioning. This study investigated the effect of such surgery on parents' perceptions, both of the current status of their children's functioning and of changes in this functioning. Perceptions of parents of children who had undergone this surgery in Israel in the years 1982 and 1983 were compared with perceptions of parents of children who had not undergone the operation. This comparison produced little evidence for the positive impact of the surgery on parents' perceptions of their children's physical, personal, and social functioning.

[Treatment of tumors of the small intestine in Peutz-Jeghers' syndrome. Value of a combined endoscopic and surgical approach. Apropos of 2 familial cases, one of which with a 15-year follow-up]. / Traitement des tumeurs du grêle du syndrome de Peutz-Jeghers. Intérêt d'une approche combinée, endoscopique et chirurgicale. A propos de 2 cas familiaux, dont l'un suivi 15 ans.

We report two cases of Peutz-Jeghers syndrome who underwent intraoperative enteroscopy. In the first case, the fiberscope was sterilized with ethylene oxide, while in the second, an electronic colonoscope was decontaminated with glutaraldehyde plus phenate. The endoscope was introduced through an enterotomy. This led to the discovery of several hamartoma greater than 10 mm which had gone undetected by the surgeon and guided the surgical procedure. In a case with approximately 30 hamartoma, associated endoscopic polypectomy and surgical removal of polyps by eversing the mucosa through enterotomies allowed the medicosurgical team to obtain a "clean small bowel" without resection.