The prevalence of right-sided colonic diverticulosis and diverticular haemorrhage.

AIM: The study was performed to determine the prevalence of right-sided diverticular disease in a western population and whether it is more likely to bleed than disease on the left side. METHOD: From January 2004 to June 2005, 796 consecutive patients were referred for total colonoscopy to 17 physicians. Data obtained included age, gender, and presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding. RESULTS: Three-hundred and eighteen (40%) of the 796 patients presented with noncomplicated diverticulosis. Of these, 103 (32.4%) had right-sided diverticula. In univariate analysis, the presence of right diverticula in patients admitted for diverticular bleeding was about twice as frequent as in patients who had diverticula with no bleeding (65.2% vs 32.4%; P = 0.0001). In multivariate analysis, the right localization of the diverticulosis was associated with a risk of bleeding, which was independent of the patients' age (P = 0.0001, OR = 3.6). CONCLUSION: The prevalence of colonic diverticula increased from < 10% in adults under 40 years of age to about 75% in those over 75 years of age. Of these patients, nearly one-third presented with right-sided involvement. Right-sided localization was associated with a significant risk of bleeding, which was independent of the patients' age.

[Vitamin C measurements in vulnerable populations: 4 cases of scurvy]. / Penser à doser la vitamine C : à propos de 4 cas...de scorbut.

Hypovitaminose C, at the origin of the scurvy, did not disappear. We report 4 cases of desocialized patients and whose very unbalanced diet was at the origin of the vitamin deficit. In addition to the hemorrhagic demonstrations described among 4 patients, one finds a modification of the superficial body growths. Physiologically, the vitamin C takes part in the stability of the collagen of the vascular wall and the bone. The biological assessment of the 4 patients was normal apart from the low ascorbemy, a syndrome of denutrition and anaemia related to the haemorrhage. The quality of the vitamin C determination requires to respect the recommended pre-analytical conditions. The treatment quickly effective, consists of an oral administration of ascorbic acid. The evolution for 3 of the 4 described patients was favorable without after-effects. The proportioning of the vitamin C should be more often prescribed in geriatrics, psychiatry and cancerology. It should systematically form part of the biological assessment of the people living alone and/or homelessness.

[Factors associated with hyperhomocysteinemia in inflammatory bowel disease: prospective study in 81 patients]. / Hyperhomocystéinémie et facteurs associés au cours des MICI: étude prospective chez 81 patients.

BACKGROUND: A high prevalence (52%) of hyperhomocysteinemia is observed in Crohn disease (CD), however it is not well documented in ulcerative colitis (UC). Furthermore, in the different works studying hyperhomocysteinemia the associated factors are different. AIM: Prospective evaluation of hyperhomocysteinemia in inflammatory bowel disease (IBD) patients, of the risk factors and the determination of a potential risk of colorectal carcinoma in case of hyperhomocysteinemia. PATIENTS AND METHODS: IBD patients followed in our department were prospectively recruited between November 2003-September 2004. To be included patients should have passed a coloscopy in the two years. Patients with kidney failure or drugs supposed, to interfere with homocystéine metabolism (folates, vitamin B12, methotrexate) were excluded from the study. The following parameters were analysed: age, sex, clinical activity indexes (CDAI for Crohn disease and CAI for ulcerative colitis), length-extent and type of the disease (CD or UC), smoking, plasma homocystein concentration, folates and vitamin B12. RESULTS: Eighty-one patients (60 CD, 21 UC, mean age 43.8 +/- 17.3) were included, 30 had an active disease at inclusion and 16 were smokers. The prevalence of high homocystein concentration was 55.6%. In univariate analysis a low rate of folates was the only risk factor for a high homocystein concentration (74 vs. 52.8%; P = 0.018). Smoking was almost an associated factor. In multivariate analysis, a low rate of folate was the only risk factor of hyperhomocysteinemia, OR = 3.59 [1.27-10.17]. Five endoscopic lesions considered as precancerous were described; these patients had all a hyperhomocysteinemia. CONCLUSION: The prevalence of hyperhomocysteinemia is high in UC and in CD. A low folate rate is the only risk factor observed in our study. There is a possible link between colorectal cancer and hyperhomocysteinemia. A high Plasma homocystein concentration must be search in inflammatory bowel disease patients and a substitutive treatment of folates and vitamin B12 is necessary in case of hyperhomocysteinemia.