[Radical cystectomy and urinary diversion: assistance to patient choice]. / Cystectomie radicale et dérivation urinaire: assistance au choix du patient.

The patient who undergoes radical cystectomy requires a urinary diversion which will significantly impact on his everyday life. He will have to choose with his surgeon between three different types of diversions that enable urine to flow out of his body adequately. Hence, preoperative information is of paramount importance. The team providing it needs an iconographic support, unfortunately not readily available. In order to clearly explain to the patient the various types of diversions that he may benefit from, their everyday care and to have him/her share the experiences of previous patients, we have elaborated a multi-disciplinary information sequence associated with the creation of video support.

[Intestinal stoma: preoperative and postoperative management]. / Les stomies digestives: indications, complications, prise en charge pré et postopératoire.

The aim of this review is to present the management and indications of intestinal stomas. A stoma induces a body image alteration with important familial and social consequences. A preoperative visit to the stoma nurse prevents technical and/or psychological complications. Stoma nurses, surgeons and general practionners work together to help the patient in his/her new life. New stoma devices have also contributed to improve quality of life. Social and sexual activity can be maintain despite intestinal stoma with appropriate education.

Flavonoids as inhibitors of rat liver monooxygenase activities.

Flavanone and six hydroxylated derivatives, and cianidanol and eight ethers and esters thereof, were investigated as inhibitors of cytochrome P-450 mediated reactions in rat liver microsomes. The IC50 values towards aminopyrine N-demethylation varied over a 20-fold range and were shown to depend on the pattern of hydroxylation (flavanone derivatives) and on lipophilicity (cianidanol derivatives). In the latter case, a bilinear relationship exists, the optimal log P being 2.92. Using selected compounds, IC50, Km and Vmax values were determined for aminopyrine N-demethylation, biphenyl 4-hydroxylation, and biphenyl 2-hydroxylation. Depending on the inhibitor and on the activity examined, non-competitive, competitive, or mixed inhibition was seen. Interaction with cytochrome P-450 was also studied spectrally and was always found to result in a modified type II difference spectrum (ligand binding). A dual binding mode is postulated, involving electrostatic and lipophilic interactions.

Biological variation in free serum hydroxyproline concentration.

Improvements in the accuracy of single estimations of biochemical constituents such as the serum free hydroxyproline (FSHP) concentration can only result from control of biological variation as well as analytical variation. In this context two experiments were carried out to determine whether a significant diurnal rhythm in FSHP concentration exists in man, and whether a worthwhile reduction in intra-individual variance can be achieved by eliminating dietary sources of hydroxyproline. A significant (p < 0.001) diurnal variation in FSHP concentration was detected in a group of normal subjects, with a range of about 20% of the mean. In a second group of eight normal subjects, there was a substantial reduction in the within-subject variation after the start of dietary control. For the most precise determination of FSHP concentration therefore, dietary hydroxyproline sources must be controlled, preferably eliminated, and blood should be sampled at a standardised time of day.

[Multifocal fibrosclerosis. 3 cases with skeletal and nervous system involvement]. / Fibrosclérose multifocale. Trois cas avec atteinte du squelette et du système nerveux central.

Three cases of multifocal fibrosclerosis are reported. In the first case the clinical symptoms were diabetes insipidus associated with nodular pulmonary infiltrates and a retroperitoneal mass. In the second case, respiratory failure together with nodular pulmonary infiltrates dominated the picture. The third case was characterized principally by neurological symptoms and paraparesia secondary to the compression of the spinal cord by an intra-rachidial growth. In cases 1 and 3, X-ray studies of the skeleton showed a very peculiar involvement of bone shafts. Anatomical studies either by repeated biopsies or at autopsy showed that in all three cases the disease was characterized by disseminated fibrosclerosis. In the first two cases the involvement was most marked in the retroperitoneum, mediastinum, lungs and bones; in the third case the involvement was demonstrated in the intra-rachidial lumbar region, retroperitoneum and in bones. In the first case there was also involvement of the base of the cranium, which was responsible for the clinical symptoms of diabetes insipidus. In this case repeated biopsies and immunological studies suggested that disseminated fibrosclerosis might be related to Weber-Christian's disease.

The effect of cianidanol on rat hepatic monooxygenase activities.

The antinecrotic hepatoprotective agent cianidanol ((+)-catechin, (+)-cyanidan-3-ol, Catergen) has been tested for its ability to interfere with rat liver monooxygenase activities. In vitro, the drug was found to inhibit biphenyl 4-hydroxylation in microsomes from uninduced rats, and aminopyrine N-demethylase in microsomes from uninduced and PB-treated rats, with IC50 just below 1 x 10(-3) mol/l. The compound is less active in inhibiting biphenyl 2- and 4-hydroxylation and ethoxyresorufin 0-deethylation in microsomes from 3-methylcholanthrene-treated rats. Kinetically, cianidanol behaves as a non-competitive inhibitor in all reactions investigated. It binds to oxidized cytochrome P-450 as a ligand (modified type II binding spectrum). The drug does not decrease levels of cytochrome P-450, but rather protects the enzyme from lipoperoxidation-mediated destruction. In vivo, a single dose of cianidanol does not inhibit [14C]-aminopyrine metabolism. Only after 5 days administration a weak but statistically significant inhibitory effect is detected. The mechanism of action of cianidanol is discussed.

[The exhaled hydrogen test: its value in the quantitative diagnosis of carbohydrate malabsorption]. / Test de l'hydrogéne expiré: sa valeur dans l'appréciation quantitative des malabsorptions glucidiques.

A study has been conducted to determine the accuracy of breath-H2 measurements for quantitating the malabsorption of small amounts of carbohydrate. H2 pulmonary excretion was measured after an overnight fast at 30-min intervals for 4 h in 7 healthy subjects after ingestion of 4 doses of lactulose (2.5,5,10 and 50 g). In 3 subjects the test was repeated without lactulose. The volume of H2 excreted was directly proportional to the amount of ingested lactulose: mean cumulative H2 excretion over a 2-h period after 5, 10 and 50 g was 2.9, 6.6 and 37.6 ml H2 respectively; H2 response after the 2.5-g dose was not perceptible. Individual H2 excretion before lactulose ingestion was highly variable: 0.096 +/- 0.075 mlH2 (mean +/- 1 SD); the individual base line rate over a fasting period showed marked fluctuations. It is concluded that the inter- and intraindividual variations of H2 excretion limit the accuracy of the H2 breath test for quantitating malabsorption of small amounts of carbohydrate.