Prospective 6 weeks follow-up post-cholecystectomy: the predictive value of pre-operative symptoms.

OBJECTIVE: Many patients with symptomatic cholelithiasis report persisting symptoms after elective cholecystectomy. The current prospective follow-up study aims at the identification and valuation of risk factors for negative symptomatic outcome at 6 weeks. METHODS: Consecutive patients (n = 183), age 18-65 years, indicated for elective cholecystectomy due to symptomatic cholelithiasis, completed a self-report questionnaire. At 6 weeks post-operatively, the same self-report questionnaires were completed (n = 129). Predictors of the persistence and emergence of biliary and dyspeptic symptoms at 6 weeks post-cholecystectomy were investigated using univariate and multivariate logistic regression. RESULTS: At 6 weeks post-operatively, the report of post-operative biliary symptoms was independently predicted by pre-operative dyspeptic symptoms (OR = 6.60) and bad taste (OR = 3.55). Pre-operative flatulence was an independent predictor of the report of biliary and dyspeptic symptoms ((OR = 3.33) and (OR = 3.27), respectively) and persisting biliary symptoms (OR = 4.21). Predictors of symptomatic outcome were only identified in women, not in men. CONCLUSION: Patients with pre-operative dyspeptic symptoms, notably bad taste and flatulence, have an increased risk of negative post-cholecystectomy outcomes at 6 weeks. A symptom-specific approach should lead to optimalization of the indication of cholecystectomy and information of patients. Known risk factors for long-term outcomes might be valuable in female patients only.

[Organisation of defence mechanisms in patients suffering from myocardial infarction (author's transl)]. / Organisation des mécanismes de défense chez des patients atteints d'un infarctus du myocarde.

This study was performed to determine the nature and organisation of specific defense mechanism in myocardial infarct patterns as compared to controls. It is also aimed at describing the organisation of these defenses and their relation to anxiety, depression and aggressivity. The samples consist in two populations of 112 male subjects with and without infarct and matched for age and socio-economic status. The EMO questionnaire of G.O. Baehr and M.E. Baehr and the COPE form from the FIRO scales of Schutz were used for psychological evaluation. The results show that the myocardial patients use more turning-against-self and that the other defence mechanisms do not discriminate between the subgroups. Furthermore, the scores for anxiety, depression, inferiority, hostility are similar in both groups. The patients state less sexual problems and use less fantasies than do normal controles. However, they use more somatic concern, but not significantly as compared to controls. This analysis was also concerned with the correlations between these defenses and affects. Furthermore, both subgroups were subdivided in three subsamples according to the score for turning-against self (high, median, low). Turning-against-self is associated with hostility in the patients while this mechanism is associated with a higher susceptibility to dayly events in normal subjects.