Expectations of IBS patients concerning disease and healthcare providers: Results of a prospective survey among members of a French patients' association.

BACKGROUND AND AIMS: IBS patients have an impaired quality of life (QoL) and feel dissatisfaction with medical care. We aim to describe the expectations of members of the French Association of IBS patients (APSSII) concerning health care providers (HCPs) and a patients' organization. PATIENTS AND METHODS: From January to June 2013, APSSII members were asked to answer questionnaires on their expectations and experiences concerning IBS and HCP. RESULTS: 222/330 (67%) responded (women: 68.5%, 46.5±17.7 years, disease duration: 8.8±0.7 years, IBS-D 33.6%, IBS-C 26.7%, IBS-M 38.2%. IBS-SSS>300 in 53% and HAD score>19 in 45%). QoL impairment was correlated with disease severity and HAD score (r=-0.707 and r=-0.484, P<0.001 respectively), but not with IBS subtype. Expectations for IBS were "improved health", "better information on causes and treatments" (94%) and "better disease recognition" (86%). A significant gap was observed between expectations and experiences with HCPs. Better information, less isolation, recognition of the disease and a decrease in medical expenses were the main expectations for joining a patients' organization. CONCLUSIONS: French IBS patients have a severe disease with a significant psychological impact and impaired QoL in half of the patients, certain unsatisfied expectations concerning HCP and high expectations in joining a patients' organization.

Impact of Intragastric Balloon Before Laparoscopic Gastric Bypass on Patients with Super Obesity: a Randomized Multicenter Study.

BACKGROUND: Super obese patients are recommended to lose weight before bariatric surgery. The effect of intragastric balloon (IGB)-induced weight loss before laparoscopic gastric bypass (LGBP) has not been reported. The aim of this prospective randomized multicenter study was to compare the impact of preoperative 6-month IGB with standard medical care (SMC) in LGBP patients. METHODS: Patients with BMI >45 kg/m2 selected for LGBP were included and randomized to receive either SMC or IGB. After 6 months (M6), the IGB was removed and LGBP was performed in both groups. Postoperative follow-up period was 6 months (M12). The primary endpoint was the proportion of patients requiring ICU stay >24 h; secondary criteria were weight changes, operative time, hospitalization stay, and perioperative complications. RESULTS: Only 115 patients were included (BMI 54.3 ± 8.7 kg/m2), of which 55 underwent IGB insertion. The proportion of patients who stayed in ICU >24 h was similar in both groups (P = 0.87). At M6, weight loss was significantly greater in the IGB group than in the SMC group (P < 0.0001). Three severe complications occurred during IGB removal. Mean operative time for LGBP was similar in both groups (P = 0.49). Five patients had 1 or more surgical complications, all in the IGB group (P = 0.02). Both groups had similar hospitalization stay (P = 0.59) and weight loss at M12 (P = 0.31). CONCLUSION: IGB insertion before LGBP induced weight loss but did not improve the perioperative outcomes or affect postoperative weight loss.

Development of simulated-gas standards.

Multigamma simulated-gas standards were developed for monitoring the surrounding air at nuclear power plants by several commercial firms and laboratories. The main advantages of our simulated-gas standard consist of the easy preparation, gravimetrically spiking the matrix with a standardised multigamma radioactive solution. and that it does not require to be tested against actual gas standards. Self-attenuation correction factors for low gamma-ray energies were calculated. Original studies about the stability of the adherence of the dried radioactive residue to the matrix are presented and discussed.

[Treatment of metastatic carcinoid tumors with interferon-alpha. Five cases]. / Traitement des tumeurs carcinoïdes métastatiques par interféron alpha. Cinq observations.

OBJECTIVE: Interferon has been proposed in treatment of metastatic carcinoid tumours with varied results. METHOD: Five patients with metastatic carcinoid tumours were treated for 1 year with rIFN alpha 2b at a dose of 5 MU. three times a week during the first month and 10 MU. three times a week during the following months. Carcinoid syndrome was present in all cases. RESULTS: Clinical response with improvement of diarrhoea and flushs was obtained in all cases. Urinary excretion of 5 HIAA and blood serotonin were reduced in 2/5 and 4/5 patients respectively. IFN treatment led to a stabilization of the metastatic tumour in all cases. Recurrence of symptoms was observed within three months following the end of the IFN treatment. CONCLUSION: These findings confirm the contribution of IFN in the treatment of metastatic carcinoid tumours.

Fecal incontinence after pelvic radiotherapy: evidences for a lumbosacral plexopathy. Report of a case.

PURPOSE: Clinical manifestations of radiation-induced lumbosacral plexopathy remain a rare event. We report the case of a 62-year-old woman with neurogenic fecal incontinence that occurred after radiotherapy of cervical carcinoma. METHODS: Anorectal, bladder, and lower limb sensory-motor functions, as biologic and morphologic explorations, were performed on repeated occasions. RESULTS: Anorectal manometry, conduction times of pudendal nerves, sacral latencies, and pudendal nerve-evoked corticals disclosed lesions of the lumbosacral plexus that was confirmed by bladder manometry and electromyography of lower limbs. Biologic and morphologic explorations were within normal ranges. CONCLUSION: Because no other cause except radiation was demonstrated in this case, we suggest that plexopathy may be a late-occurring complication of radiotherapy.

Genetically determined oxidation polymorphism and drug hepatotoxicity. Study of 51 patients.

The influence of genetically determined oxidation polymorphism on drug hepatotoxicity has been poorly investigated and results are controversial. We studied drug oxidation capacity in 51 patients with hepatitis caused mainly by drugs undergoing oxidative metabolism, using dextromethorphan, a test compound recently proposed as a substitute for debrisoquine. Phenotyping was performed using the metabolic ratio (MR) calculated as MR = 0-10 h urinary output of dextromethorphan/0-10 h urinary output of dextrorphan (the main oxidative metabolite), after oral administration of 40 mg dextromethorphan hydrobromide. Dextromethorphan oxidation capacity was similar in patients and in 103 control subjects as judged by: (a) the prevalence of each phenotype (5.9% versus 3.9% for the poor metabolizer phenotype and 94.1% versus 96.1% for the extensive metabolizer phenotype; (b) the frequency distribution histograms of log metabolic ratio; (c) the mean values of dextromethorphan and dextrorphan urinary outputs and of log metabolic ratio for each phenotype. These results show that hepatotoxicity of several drugs, including amineptine, amodiaquine and Plethoryl, is related neither to an impairment in dextromethorphan oxidation capacity nor to an unusually high capacity to oxidize this drug.