Emotional intelligence and coping strategies as determinants of quality of life in depressed patient-caregiver dyads: An actor-partner interdependence analysis.

OBJECTIVE: Patients with major depressive disorder (MDD) and their natural caregivers experience major lifestyle difficulties. Little is known concerning dyadic (i.e., patient and natural caregiver) characteristics' impact on quality of life. In a sample of depressed patient-caregiver dyads, we examined quality of life (QoL) levels compared with the general population and whether QoL is influenced by emotional intelligence (EI) and coping strategies using the actor-partner interdependence model (APIM). METHODS: This cross-sectional study involved 79 patient-caregiver dyads. The self-reported data, completed by patients and their primary caregivers, included QoL (SF-36), EI (TEIQue-SF) and coping strategies (BriefCope). The QoL of patients and caregivers was compared with 158 French age-sex-matched healthy controls. The dyadic interactions were analyzed using structural equation modeling. RESULTS: Patients and their caregivers experienced lower QoL levels than French age-sex-matched controls. The EI findings showed actor (degree to which the person's EI was associated with his/her own QoL) and partner (degree to which the person's EI was associated with QoL of the other member of the dyad) effects for patients and caregivers. The coping strategies (i.e., problem solving, positive thinking, avoidance and social support) revealed only actor effects. CONCLUSION: QoL is seriously impaired in depressed patients and their primary caregivers and is associated with EI and coping strategies. Targeted interventions focusing on EI and coping strategies could be offered to improve QoL in dyads.

[Viral transmission and medically assisted procreation: the Herpesviridae case]. / Transmission virale et assistance médicale à la procréation: le cas des Herpesviridae.

Procreation with sperm donation is at present achieved by insemination either in the uterus or in vitro, always from ejaculated and washed spermatozoa. Then, the infectious risk only exists if the donor sperm is capable of transporting the virus or its DNA, either by adhesion or by integration. With CMV, HSV1 and HSV2, medically assisted procreation in couples (AI or IVF-ET) does not increase the risk of viral contamination as compared with natural procreation, except possibly the cases of surgical procedure to pick up testicular sperm to be used in ICSI. Animal experiments show that, even if viral material is introduced in the oocyte, it may be eliminated from the embryo, at least for CMV.

[Comparison of two methods of cryoconservation of sperm when in very small numbers]. / Comparaison de deux méthodes de cryoconservation de spermatozoïdes en très petit nombre.

OBJECTIVE: In case of severe oligozoospermia or following testicular biopsy in case of azoospermia, fertilization remains possible by intracytoplasmic sperm injection (ICSI). However, if there are only a few spermatozoa available to be preserved for a delayed ICSI, these gametes must be cryopreserved according to a specific method. We have found that, using the straw classical technique, less than 2 sperm were recovered at thawing when 20 sperm were frozen and no sperm were available following freezing-thawing of only 1 to 10 sperm per straw. Then, the feasibility of programmed ICSI is always uncertain in these cases and unnecessary medical acts (ovarian stimulation and egg collection) as well as patient disappointment are frequent. MATERIAL AND METHODS: We have tested a new technique by introducing (with an ICSI pipette) 1 to 100 sperm in a microdrop (0.5 microl) of freezing medium setting in a culture dish under paraffin oil. RESULTS: Following freezing-thawing the dish, all (100%) of the frozen spermatozoa were recovered. DISCUSSION AND CONCLUSION: Since only motile sperm were frozen, the sperm which are non motile after thawing (more than 50%) are nevertheless considered usable for ICSI.

Failure to infect embryos after virus injection in mouse zygotes.

BACKGROUND: The intracytoplasmic injection of sperm raises the problem that viral elements may be transported into the oocyte by the spermatozoon or the surrounding medium. It also raises questions about how the developing zygote will behave. METHODS: We used the murine model to microinject murine cytomegalovirus (MCMV) into the zygote ooplasm and followed the changes in these microinjected zygotes in vivo and in vitro over time. RESULTS: 80% of zygotes microinjected with viral suspension, and 80% injected with medium alone, survived. Although MCMV DNA was detected in 56% of injected embryos, up until the blastocyst stage, the mice born from these injected zygotes developed normally and did not contain MCMV DNA. When embryonic stem cells were co-incubated with MCMV and then transferred into healthy blastocysts, the offspring were normal and did not contain any MCMV DNA. CONCLUSIONS: Our observations suggest that even if MCMV DNA persists from the zygote to the blastocyst stage, its presence has no detrimental effect on pre-implantation or post-implantation development.

Experimental inoculation of male mice with murine cytomegalovirus and effect on offspring.

BACKGROUND: Murine cytomegalovirus (MCMV) was used to examine aspects of viral infection in male mice, and its possible transmission to their offspring. METHODS AND RESULTS: FVB/N mice inoculated intratesticularly with 5x10(5) plaque forming units (PFU) of MCMV, developed peritoneal haemorrhagic exudates, spleen hypertrophy and acute local infection. Infectiousness was detected until 15 days post-inoculation (D15 PI) in the genital organs, and virus DNA up to D35 PI. Testicular endothelial and Leydig cells were infected, and peritubular cells severely damaged. Spermatogenesis was affected, but neither germ cells nor Sertoli cells were infected. No virus was found in the epididymal epithelial cells. Viral DNA was detected in cells extracted from vas deferens samples until D15 PI. Neither infectious virus nor viral DNA were found in spermatozoa recovered from uterine fluid, fertilized oocytes, blastocysts, fetal tissues or newborn animals following the mating of infected males with uninfected females. CONCLUSIONS: MCMV harboured in the male genital organs was not transmitted to their offspring, even when mating occurred during the acute phase of CMV disease. Although the infection may have had an impact on spermatogenesis, fertility was not affected. These results do not support the hypothesis of conceptus MCMV infection by the fertilizing spermatozoon in natural conception.

Traumatic subclavian artery pseudoaneurysm: periprocedural salvage of failed stent-graft exclusion using coil embolization.

PURPOSE: To report the exclusion of a subclavian pseudoaneurysm by a combination of covered stent implantation and coil embolization. CASE REPORT: A 30-year-old man presented with a posttraumatic pseudoaneurysm of the left subclavian artery. A covered Jostent was inserted via a percutaneous femoral approach and deployed in the injured subclavian artery. Because of tapering of the artery proximally, apposition of the covered stent to the arterial wall was insufficient, leading to persistent filling of the pseudoaneurysm. Exclusion of the pseudoaneurysm was achieved by coil embolization through a gap between the stent-graft and the arterial wall. CONCLUSIONS: This report illustrates that successful endovascular treatment of a left subclavian pseudoaneurysm may require a combination of catheter-based techniques.

Arterial erosions in acute pancreatitis.

Acute pancreatitis was observed in 492 patients. Fourteen (2.8%) developed an arterial erosion revealed by a haemorrhage either in the digestive lumen, in the peritoneum or via previously placed drainage. The eroded artery was the splenic artery in six patients, a pancreatico-duodenal artery in five patients. An initial haemostasis was attempted by: a) embolization in four patients: one died; the three others had bleeding recurrence. b) splenocorporeal pancreatectomy in four patients, three had bleeding recurrence. c) arterial ligature in four patients: three had bleeding recurrence. Secondary haemostatic procedures were performed in ten patients but a durable haemostasis was achieved in only five patients: two had a pancreatic resection and three were treated by a redo-binding. It is noteworthy that durable haemostasis could not be obtained neither by embolization nor by ligature in necrotic tissues. This could explain the difference in the results of arterial erosion treatments in chronic and in acute pancreatitis. Therefore, it is suggested that haemostatic procedures should be performed away from necrotic tissues, or eventually done after their removal.

[Acute acalculous cholecystitis following hepatic artery embolism in multiple trauma]. / Cholécystite aiguë alithiasique après embolisation de l'artère hépatique dans un contexte de polytraumatisme.

We have reported a case of acute acalculous cholecystitis occurring after hepatic artery embolization in a woman sustaining multiple traumatic injuries. Although many classical factors such as shock, sepsis, transfusion or narcotic administration may be involved in the genesis of gall-bladder necrosis, we have discussed the possible involvement of hepatic artery embolization in the ischaemic process. Indeed, this mechanism has already been reported in non traumatic patient following hepatic tumor chemoembolization.

[Inflammatory abdominal aortic aneurysm. Role of corticosteroid therapy]. / Anévrismes inflammatoires de l'aorte abdominale. Place de la corticothérapie.

For more than 20 years it has been generally acknowledged that operation for inflammatory abdominal aortic aneurysm (IAAA) using the common in-lay-graft procedure will induce the regression of peri-aortic fibrosis. However in prospective studies, after a 2 years follow-up, no regression appeared in approximated 8% of the cases (table I). Moreover in some IAAA a corticosteroid treatment (CS) was prescribed and it produced a regression of fibrosis and therefore facilitated the operation. Nevertheless the usefulness of the CS remains debated. We report 4 new cases of IAAA with CS. Based on our cases and an analysis of the literature we conclude that when there is no urgency to operate (diameter inferior to 50 mm) CS is the best option in IAAA with either severe inflammation or ureter involvement. Due to the regression of the fibrosis it can facilitate the surgical procedure. However it needs to be conducted with an adequate dose and duration. Finally the CS is the only possibility when the inflammation persist following the treatment of the IAAA.

Cecostomy is a useful surgical procedure: study of 113 colonic obstructions caused by cancer.

PURPOSE: There is a large choice of treatment for obstructing carcinoma of the left colon. We report our experience of tube cecostomy as the initial treatment for obstructing colonic carcinoma followed by elective resection. METHODS: From 1975 to 1995, 113 patients presenting with colonic obstruction caused by cancer were initially treated by tube cecostomy. RESULTS: The cecostomy was performed under local anesthesia in 26 cases (23 percent) and general anesthesia in 87 cases (77 percent). In the postoperative period 15 patients died (13 percent) and 26 (23 percent) had wound infection in the area around the cecostomy. A second operation performed on the 98 surviving patients comprised 74 left colonic resections with anastomosis, 9 without anastomosis (Hartmann's operation), 1 right colectomy, 3 total colectomies eliminating the cecostomy, 3 internal bypasses, and 8 proximal lateral colostomies. Surgical closure of the cecostomy was performed during six of the second operations. No deaths occurred from any of the second operations. The cecostomy closed spontaneously in 78 patients (89 percent). In ten cases (11.4 percent) a third operation was performed to close the cecostomy, without mortality. CONCLUSIONS: Comparison our cecostomy results with published studies of proximal diverting loop colostomies for the same indications showed comparable mortality after the first operation. Cecostomy decrease mortality of the second operation. This retrospective study suggests that cecostomy is a useful and less invasive surgical procedure for patients presenting with colonic obstruction caused by cancer.

[Investigations on the human embryo]. / Investigaciones sobre el embrión humano.

In this article the author examines the different proposals by researchers and doctors who for years have addressed the issue of the urgent need for research using human embryos. The proposals from France in 1994 are reviewed, together with new projects for embryo research.

Usefulness of video thoracoscopy in the management of spontaneous and postoperation chylothorax.

BACKGROUND: The aim of this study was to evaluate indications and results of video thoracoscopy (VATS) in the management of nine chylothorax cases. METHODS: Four spontaneous chylothorax cases were treated by VATS and talc pleurodesis with immediate positive results. Among five postoperation chylothorax cases, two were treated early by VATS and selective lymphatic clipping (VATS group), and three had medical treatment (MT group). RESULTS: Duration of drainage was 4 days for the VATS group versus 15.3 days for MT group. Amount of collected chyle was 2.4 l versus 5.7 l, respectively. CONCLUSIONS: We suggest that VATS should be considered the treatment of choice for spontaneous chylothorax and could be indicated earlier in postoperation chylothorax.

Motility of the Roux-en-Y hepaticojejunostomy in asymptomatic patients.

OBJECTIVE: The aim of our study was to describe the motility in the limb, the duodenum, and the jejunum distal to the limb after Roux-en-Y hepaticojejunostomy in patients who remained asymptomatic postoperatively. Our objective was to obtain reference manometric recordings for interpretion of recordings in symptomatic patients. METHODS: Manometric recordings were obtained in the Roux-en-Y limb in 13 patients 15.6 +/- 1.1 days postoperatively, using a probe inserted into the limb during surgery and coming out through the abdominal wall. The recording openings were positioned in the limb itself in eight patients, and also in the jejunum immediately distal to the limb in five patients. In four of eight patients, limb manometry was combined with duodenal manometry using a second probe introduced nasally. RESULTS: Phase IIIs were recorded in all 13 patients, either spontaneously or after trimebutine stimulation (100 mg i.v.). Phase IIIs occurred spontaneously in 12 patients. They always migrated throughout the Roux-en-Y limb, and were also most often observed in the distal jejunum; migration stopped in the distal jejunum in three of five patients. Phase IIIs in the limb occurred independently from duodenal phase IIIs. In the limbs, the duration of phase IIIs was longer (p < 0.02), and the migration slower than in the duodenum (p < 0.001) and in controls (p < 0.02). In nine of 13 patients, injection of trimebutine (100 mg i.v.) initiated phase III in the Roux limb or in the distal jejunum within 2 min. During the combined recordings, trimebutine initiated phase III simultaneously in the duodenum and in the limb. The response to meals in the limb was poorer than in controls. Interruption of phase IIIs was shorter, and the area under the postprandial curve was smaller (p < 0.01) for each postprandial half-h. Postprandial motility was poorer in the limb than in the distal small bowel (p < 0.01). CONCLUSIONS: In asymptomatic patients, interdigestive motility is present in the hepaticojejunostomy Roux-en-Y limb, but it is abnormal because of slow migration of phase IIIs. The second abnormality observed in the limb is a response to meals that is both short and of low amplitude.

Bacterial resistance of refrigerated and cryopreserved aortic allografts in an experimental virulent infection model.

PURPOSE: The bacterial resistance of refrigerated and cryopreserved aortic allografts in a highly virulent infection in a dog model was studied. METHODS: The infrarenal aorta of 12 dogs was replaced with either a cryopreserved aortic allograft (group I, n = 6) or a refrigerated aortic allograft (group II, n = 6) in infected sites. Allografts were harvested from dogs and stored for 1 week, either by cryopreservation (-140 degrees C) or refrigerated method (4 degrees C), in a preservation medium. At the time of implantation, induction of infection was achieved with an infected piece of knitted Dacron placed just beneath the allograft. The Dacron was contaminated in vitro by soaking it in a solution with Staphylococcus aureus PR209. All 12 dogs received no adjunct antibiotic or antithrombotic therapy. Four weeks after implantation, the animals were killed to recover the grafts for bacteriological and histological analyses. Bacterial results were expressed as colony-forming units (CFU)/cm2 of graft material. RESULTS: In group I, only one allograft grew bacteria at 2. 16 x 10(6 )CFU/cm2, with a blood culture positive for S aureus. In group II, one dog died at 3 weeks from a false septic aneurysm rupture, all the allografts were infected (P <.05) with a mean bacterial count of 9.41 +/- 6.8 x 10(4) CFU/cm2, and three blood cultures were positive for S aureus. The patency of the grafts was analyzed at the time of recovery. Three laminar thrombi without occlusion were present in group I; none were present in group II. A better preserved endothelium in group I was revealed by means of histologic analysis staining with factor VIII antibody before implantation. After 4 weeks of implantation in the infected site, infected allografts presented polynuclear infiltrates in the media with a high degree of inflammatory reaction, and endothelial recovery was more significant in group I, with numerous young plump cells. CONCLUSION: This study demonstrates that cryopreserved allografts implanted in infected sites in a dog model can produce greater bacterial resistance.

Prosthetic reinforcement of varicose saphenous vein grafts for infrainguinal bypass.

Use of varicose saphenous veins for infrainguinal bypass is often contraindicated because of the risk of immediate rupture or long-term aneurysm. In this report we describe four cases in which prosthetic reinforcement allowed successful femoropopliteal bypass grafting using highly varicose saphenous veins while preserving normal endothelium. No thrombosis or any other complication was observed after a mean follow-up of 41 months.