Inteligencia emocional de las enfermeras de cuidados intensivos en un hospital terciario / Emotional intelligence of intensive care nurses in a tertiary hospital

Objetivo Analizar la inteligencia emocional del las enfermeras del área del paciente crítico. Metodología Estudio descriptivo, transversal, unicéntrico, realizado en las enfermeras en activo de las Unidades de Cuidados Intensivos (UCI) de un hospital terciario de Cataluña (septiembre 2016). Variables estudiadas: edad, sexo, experiencia laboral en la UCI (antigüedad en años), y puntuación mediana (rango) de las dimensiones de la escala de Rasgos Meta-Mood de 24 ítems (TMMS-24) con 3 dimensiones: 1) Atención emocional (soy capaz de sentir y expresar los sentimientos de forma adecuada); 2) Claridad de sentimientos (comprendo bien mis estados emocionales); 3) Reparación emocional (soy capaz de regular los estados emocionales correctamente). Se realizó un análisis descriptivo. Resultados Se propuso a todas las enfermeras en activo (n=103) participar en el estudio; 92 (89%) aceptaron y cumplimentaron el cuestionario: 75 (82%) mujeres y 17 (18%) hombres; 51 (55%) tenían una edad de 21 a 30años y una antigüedad (experiencia) superior a 6años. Las puntuaciones medianas (rango) de las diferentes dimensiones del cuestionario TMMS-24 por sexo (mujeres; hombres) fueron, respectivamente: 1) Atención emocional, 24 (12-37) [adecuada: 25 a 35]; 23 (18-31) [adecuada: 22 a 32]; 2) Claridad de sentimientos, 29 (15-40) [adecuada: 24-34]; 27 (18-34) [adecuada: 26-35]; 3) Reparación emocional, 28 (13-40) [adecuada: 24-34]; 29 (18-39) [adecuada: 24-35].Conclusiones La inteligencia emocional de las enfermeras fue adecuada en las dimensiones de claridad de sentimientos y de reparación emocional. Sin embargo, no fue adecuada en la dimensión de la atención emocional, por lo tanto es un área a mejorar.(AU)

Objective To analyse the emotional intelligence of nursing staff in the critical patient area. Methodology A descriptive, cross-sectional, single-centre study carried out in nursing staff of the Intensive Care Units (ICUs) of a tertiary hospital in Catalonia (September 2016). Variables studied: age, gender, work experience in ICU (years worked), and median score (range) of the dimensions of the Meta Mood Trait Scale (TMMS-24) with three dimensions: 1) Emotional attention (I am able to feel and express my feelings adequately); 2) Clarity of feelings (I understand my emotional states well); 3) Emotional repair (I am able to regulate emotional states correctly). A descriptive analysis was undertaken. Results All active nursing staff (n=103) were asked to participate in the study: 92 (89%) accepted and completed the questionnaire (75 (82%) women, 17 (18%) men); 51 (55%) were aged between 21 to 30 years-old, and had more than 6 years of working experience in ICU. The median scores (range) of the different dimensions of the TMMS-24 questionnaire by gender (women/men) were respectively: 1) Emotional attention: 24 (12-37) [adequate: 25 to 35]; 23 (18-31) [adequate: 22 to 32]; 2) Clarity of feelings: 29 (15-40) [adequate: 24-34]; 27 (18-34) [adequate: 26-35]; 3) Emotional repair: 28 (13-40) [adequate: 24-34]; 29 (18-39) [adequate: 24-35]. Conclusions The emotional intelligence of the nursing staff was adequate in the dimensions of clarity of feelings and emotional repair. However, it was not adequate in the dimension of emotional attention, therefore it is an area to improve. (AU)

Emotional intelligence of intensive care nurses in a tertiary hospital.

Emotional intelligence is defined as "the ability to perceive, assimilate, understand and regulate one's own emotions and those of others, promoting emotional and intellectual growth." The published evidence on the emotional intelligence of nursing staff in charge of a critical area patient in a tertiary hospital is scarce. OBJECTIVE: To analyse the emotional intelligence of nursing staff in the critical patient area. METHODOLOGY: A descriptive, cross-sectional, single-centre study carried out in nursing staff of the Intensive Care Units (ICUs) of a tertiary hospital in Catalonia (September 2016). Variables studied: age, gender, work experience in ICU (years worked), and median score (range) of the dimensions of the Meta Mood Trait Scale (TMMS-24) with three dimensions: 1) Emotional attention (I am able to feel and express my feelings adequately); 2) Clarity of feelings (I understand my emotional states well); 3) Emotional repair (I am able to regulate emotional states correctly). A descriptive analysis was undertaken. RESULTS: All active nursing staff (n = 103) were asked to participate in the study: 92 (89%) accepted and completed the questionnaire (75 (82%) women, 17 (18%) men); 51 (55%) were aged between 21 to 30 years-old, and had more than 6 years of working experience in ICU. The median scores (range) of the different dimensions of the TMMS-24 questionnaire by gender (women/men) were respectively: 1) Emotional attention: 24 (12-37) [Adequate: 25 to 35]; 23 (18-31) [Adequate: 22 to 32]; 2) Clarity of feelings: 29 (15-40) [Adequate: 24-34]; 27 (18-34) [Adequate: 26-35]; 3) Emotional repair: 28 (13-40) [Adequate: 24-34]; 29 (18-39) [Adequate: 24-35]. CONCLUSIONS: The emotional intelligence of the nursing staff was adequate in the dimensions of clarity of feelings and emotional repair. However, it was not adequate in the dimension of emotional attention, therefore it is an area to improve.

Colorectal cancer (CRC) monitoring by 6-monthly 18FDG-PET/CT: an open-label multicentre randomised trial.

Background: [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18FDG-PET/CT) has high sensitivity for detecting recurrences of colorectal cancer (CRC). Our objective was to determine whether adding routine 6-monthly 18FDG-PET/CT to our usual monitoring strategy improved patient outcomes and to assess the effect on costs. Patients and methods: In this open-label multicentre trial, patients in remission of CRC (stage II perforated, stage III, or stage IV) after curative surgery were randomly assigned (1 : 1) to usual monitoring alone (3-monthly physical and tumour marker assays, 6-monthly liver ultrasound and chest radiograph, and 6-monthly whole-body computed tomography) or with 6-monthly 18FDG-PET/CT, for 3 years. A multidisciplinary committee reviewed each patient's data every 3 months and classified the recurrence status as yes/no/doubtful. Recurrences were treated with curative surgery alone if feasible and with chemotherapy otherwise. The primary end point was treatment failure defined as unresectable recurrence or death. Relative risks were estimated, and survival was analysed using the Kaplan-Meier method, log-rank test, and Cox models. Direct costs were compared. Results: Of the 239 enrolled patients, 120 were in the intervention arm and 119 in the control arm. The failure rate was 29.2% (31 unresectable recurrences and 4 deaths) in the intervention group and 23.7% (27 unresectable recurrences and 1 death) in the control group (relative risk = 1.23; 95% confidence interval, 0.80-1.88; P = 0.34). The multivariate analysis also showed no significant difference (hazards ratio, 1.33; 95% confidence interval, 0.8-2.19; P = 0.27). Median time to diagnosis of unresectable recurrence (months) was significantly shorter in the intervention group [7 (3-20) versus 14.3 (7.3-27), P = 0.016]. Mean cost/patient was higher in the intervention group (18 192 ± 27 679 € versus 11 131 ± 13 €, P < 0.033). Conclusion: 18FDG-PET/CT, when added every 6 months, increased costs without decreasing treatment failure rates in patients in remission of CRC. The control group had very close follow-up, and any additional improvement (if present) would be small and hard to detect. ClinicalTrials.gov identifier: NCT00624260.

[Medical information system (PMSI) does not adequately identify severe trauma]. / La codification PMSI identifie mal les traumatismes graves.

BACKGROUND: Resource allocation to hospitals is highly dependent on appropriate case coding. For trauma victims, the major diagnosis-coding category (DCC) is multiple trauma (DCC26), which triggers higher funding. We hypothesized that DCC26 has limited capacity for appropriate identification of severe trauma victims. METHODS: We studied Injury Severity Score (ISS), Trauma Related Injury Severity Score (TRISS) and in-hospital mortality using data recorded in three level 1 trauma centers over a 2-year period. Patients were divided into two groups: DCC26 and non-DCC26. For non-DCC26 patients, two subgroups were identified: patients with severe head trauma and patients with spinal trauma. Clinical endpoints were mortality, ISS>15 and TRISS, IGS II. Use of hospital resources was estimated using funding and expenditures associated with each patient. RESULTS: During the study period, 2570 trauma victims were included in the analysis. These patients were 39±18 years old, with median ISS=14, and observed mortality=10 %. Group DCC26 had 811 (31 %) patients, group non-DCC26 1855 (69 %) patients. DCC26 coding identified a more severely injured group of patients. However, in the group non-DCC26, there was a high proportion of severe trauma (ISS>15: 35 %; TRISS<0.95: 9 %). CONCLUSION: DCC26 is not an appropriate coding for severe trauma patients. For these patients, expenditures will include intensive care and rare and costly resources. We propose to take into account the TRISS score to improve trauma coding.

[Organisational factors associated with the repetition of infections among children in Parisian day-care setting]. / Facteurs organisationnels associés à la répétition des épisodes infectieux des enfants accueillis en crèche à Paris.

OBJECTIVE: This study analyzes the organisational factors linked with episodes of infections in children attending child day-care setting in Paris. POPULATION AND METHODS: A sample of children who attended parisian municipal child day-care setting, stratified on the type and the size of the day-care setting, was achieved. This cohort was followed from September 2000 to June 2001. We compared the risk of repeated infections according to the type of day-care setting (family day-care or day-care centre), and for the day-care centre according to the size (< or =60 or >60 places) and the structure of groups (mixing age groups or not). The events studied were the occurrence of at least: 6 episodes of any infection, 2 otitis, 2 gastroenteritis, 2 conjunctivitis or 5 upper respiratory tract infections. RESULTS: Nine hundred and ninety-three children were included in this study. The 878 children attending a day-care centre had a significant higher risk of infections compare to children in family day-care (RR = 2.92[1.58-5.38]) except for gastroenteritis and conjunctivitis. This relationship between the type of day-care setting and the repeated infections was especially shown for children younger than 1 year. The mixing of ages only increased the risk of conjunctivitis (RR = 1.98[1.15-3.42]). No significant relationship between the size of the day care centre and the repetition of every studied infection was found. CONCLUSION: This study strengthens the orientation of the more vulnerable children towards the family day-care centers.

Human pancreatic mucinous cystadenoma is characterized by distinct mucin, cytokeratin and CD10 expression compared with intraductal papillary-mucinous adenoma.

AIMS: To examine cytokeratin, epithelial glycoprotein (mucin) and glycoprotein CD10 expression in benign mucinous cystdenomas (MCAs) in comparison with intraductal papillary mucinous adenomas (IPMAs). METHODS AND RESULTS: Thirty MCAs of the pancreas were analysed for immunohistochemical expression of cytokeratin (CK) 7, CK20, MUC1, MUC2, MUC5AC and CD10 and were compared with 16 IPMAs. CK7 was expressed in all neoplasms. CK20 was significantly more frequent in MCAs compared with IPMAs (56.66% versus 18.75%, P = 0.027). MUC1 was more frequent in MCAs (40% versus 12.5%, P = 0.0915), whereas MUC5AC was significantly less frequent in MCAs (33.33% versus 100%). MUC2 was expressed in goblet cells of seven MCAs. In MCAs, CD10 was observed both in epithelial cells and in the ovarian-type stromal cells (24/30). Epithelial expression of CD10 was significantly lower in IPMAs (66.66% versus 6.25%, p = 0.0001). CONCLUSIONS: MCA is characterized by a significantly greater frequency of expression of CK20 and CD10 when compared with IPMA, which preferentially expresses MUC5AC.

Endocrine pancreatic tumours and helical CT: contrast enhancement is correlated with microvascular density, histoprognostic factors and survival.

PURPOSE: To assess the role of contrast-enhanced helical CT in the evaluation of tumour vascularity in endocrine pancreatic tumours (EPTs), and to determine the predictive factors of malignancy of EPTs at helical CT with CT-histopathological correlation. MATERIALS AND METHODS: Thirty-seven consecutive patients with histopathologically proven EPTs underwent dual-phase helical CT. For each tumour detected, its density relative to the surrounding parenchyma was scored on the pancreatic phase using a 5-point scale. Radiological findings were correlated with histopathological (vessel density count) and clinical follow-up findings. RESULTS: Thirty of 37 patients had non-functioning EPTs and overall 44 tumours were detected by helical CT (mean size 38, range 5-100 mm). CT showed calcifications in 10 tumours. Calcifications were associated with well-differentiated carcinomas (90%, p = 0.02). Vascular density assessed by light microscopy was significantly correlated with tumour enhancement at the pancreatic phase (p = 0.0001). Poorly differentiated carcinomas were less vascularised than well-differentiated tumours and carcinomas (34 vs. 264 vessels/mm2, p = 0.0073). Tumour differentiation also correlated with tumour enhancement at the pancreatic phase (p = 0.0044, trend test): poorly differentiated carcinomas were hypoattenuating (71%) and isoattenuating or weakly hyperattenuating (29%), compared with well-differentiated carcinomas and tumours that were mainly moderately or strongly hyperattenuating (53%). In univariate analysis, poor tumoral differentiation, hepatic metastasis, high mitotic index, poor tumoral enhancement at the pancreatic phase and less vascularised tumours were correlated with decreased survival rate. CONCLUSION: Enhancement of EPT at CT is correlated with tumour vascularity assessed by light microscopy. Low-enhancing EPT at CT are correlated with poorly differentiated EPT and with a decrease in overall survival.

[Otosclerosis surgical techniques and results in 150 patients]. / Otospongiose: techniques chirurgicales et résultats. A propos de 150 cases.

OBJECTIVES: To analyze outcome after otosclerosis surgery with stamedeotomy with blood clot sealing. PATIENTS AND METHODS: Otosclerosis surgery was performed in 150 adult patients between 1997 and 1999 by five surgical teams (70% of the procedures were performed by senior surgeons) and followed for 18 months. Stapedotomy was carried out under general anesthesia with an intrameatal approach in 96% of the cases. Stapedotomy (n=120, 80%) was performed with a drill in 141 cases and by laser in 9 (6%). Ninety percent of the Teflon prostheses had a 0.4 mm diameter and a 4.5 mm length. The footplate opening was sealed with blood clots. Venous interposition (n=30, 20%) was performed in the event of partial or total stapedectomy which occurred in spite of an initial stapedotomy attempt. RESULTS: The preoperative air-bone gap (ABG) was 32 +/- 10.3 dB. The gain in air conduction was 25 +/- 11.7 dB with 75% of the patients having more than 15 dB gain. The ABG was 10 +/- 5.4 dB with 73% of the patients having less than 5 dB gain. The interaural difference was 0.5 +/- 14.1 dB and the bone conduction (BC) variation was 1 +/- 7.5 dB. Functional failures were related to significant intralabyrinthine bleeding and revision procedure. The following factors had not effect on outcome: i) stapedotomy versus partial or total stapedectomy, footplate opening sealed by clots or vein, ii) diameter of the stapedotomy and/or the prosthesis, iii) surgical procedure performed by a junior surgeon. CONCLUSION: Sealing the stapedotomy opening with blood clots appears to provide reliable and reproducible functional outcome that remains stable over time. In this study, changing from partial to total stapedectomy with vein interposition did not modify the functional outcome.

Risk of pancreatic adenocarcinoma in chronic pancreatitis.

BACKGROUND: The risk of pancreatic cancer in patients with chronic pancreatitis (CP) is difficult to assess. Previous studies, mostly case control studies or studies relying on data case registers, reported relative risks varying from 2.3 to 18.5. METHODS: We studied a prospective, single centre, medical-surgical cohort of 373 consecutive patients (322 (86%) men, median age 40 years) with proven CP (alcoholic origin 85%) and a follow up of at least two years (median follow up 9.2 years; range 2.0-34.8) in order to exclude pancreatitis revealing pancreatic cancer. We calculated the age and sex standardised incidence ratio (SIR) as the ratio of the number of observed cases of pancreatic cancer in this cohort to the number of expected cases, as provided by the French National Cancer Register. RESULTS: Four cases of pancreatic adenocarcinoma (1.1% of patients) were observed in 3437 patient years (expected number of cases 0.15; SIR 26.7, 95% confidence interval (CI) 7.3-68.3; p=0.00002). In a second analysis in which patients lost to follow up were considered to be followed up until the end point without having developed pancreatic adenocarcinoma (4762 patient years), SIR was 19.0 (CI 5.2-48.8; p=0.00007). CONCLUSION: Patients with CP have a markedly increased risk of pancreatic cancer compared with the general population.

Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma.

BACKGROUND: Although the prognosis in malignant resectable intraductal papillary mucinous tumours of the pancreas (IPMT) is often considered more favourable than for ordinary pancreatic ductal adenocarcinoma, the long term outcome remains ill defined. AIMS: To assess prognostic factors in patients with malignant IPMT after surgical resection, and to compare long term survival rates with those of patients surgically treated for ductal adenocarcinoma. METHODS: Seventy three patients underwent surgery for malignant IPMT in four French centres. Clinical, biochemical, and pathological features and follow up after resection were recorded. Patients with invasive malignant IPMT were matched with patients with pancreatic ductal adenocarcinoma, according to age and TNM stages; survival rates after resection were compared. RESULTS: Surgical treatment for IPMT were pancreaticoduodenectomy (n=46), distal (n=14), total (n=11), or segmentary (n=2) pancreatectomy. The operative mortality rate was 4%. IPMT corresponded to in situ (n=22) or invasive carcinoma (n=51). In the latter group, 17 had lymph node metastases. Overall median survival was 47 months. Five year survival rates in patients with in situ and invasive carcinoma were 88% and 36%, respectively. On univariate analysis, abdominal pain, preoperative high serum carbohydrate antigen 19.9 concentrations, caudal localisation, invasive carcinoma, lymph node metastases, peripancreatic extension, and malignant relapse were associated with a fatal outcome. Using multivariate analysis, lymph node metastases were the only prognostic factor (OR 7.5; 95% CI: 3.4 to 16.4). Overall five year survival rate was higher in patients with malignant invasive IPMT compared with those with pancreatic ductal carcinoma (36 v 21%, p=0.03), but was similar in the subset of stage II/III tumours. CONCLUSIONS: The prognosis of patients with resected in situ/invasive stage I malignant IPMT is excellent. In contrast, prognosis of locally advanced forms is as poor as in patients with pancreatic ductal adenocarcinoma.

[Audit procedure of radiology reports in a hospital service]. / Procédure d'audit des comptes-rendus radiologiques d'un service hospitalier.

PURPOSE: Presentation of a clinical audit of the radiology reports in our institution. MATERIAL: and methods: This audit has been performed in several steps: launching the project, elaboration of the reference book, elaboration of the protocol, analysis of the results, improvements made. RESULTS: Several dysfunctions were detected: typing errors, the lack of sentences explaining the procedure of examination, the lack of negative pertinent elements, the lack of synthesis. Several interventions were made: checking on the screen of the computer the report before signing it, purchase of personal voice recorders, restructuring the interpretation room. Other interventions are considered: structured data entry, P.A.C.S. systems CONCLUSION: This audit has allowed the modification of the process for realisation of the radiology reports and the stimulation of the medical team, thus improving the quality of our work.

The influence of human immunodeficiency virus coinfection on chronic hepatitis C in injection drug users: a long-term retrospective cohort study.

In this study we analyzed the influence of human immunodeficiency virus (HIV) infection on the course of chronic hepatitis C through multivariate analysis including age, alcohol consumption, immune status, and hepatitis C virus (HCV)-related virologic factors. Eighty HIV-positive and 80 HIV-negative injection drug users included between 1980 and 1995 were matched according to age, gender, and duration of HCV infection and followed-up during 52 months. The progression to cirrhosis was the primary outcome measure. The impact of HIV on HCV-RNA load, histologic activity index, response to interferon therapy, and liver-related death was also considered. In HIV-positive patients, chronic hepatitis C was characterized by higher serum HCV-RNA levels (P =.012), higher total Knodell score (P =.011), and poorer sustained response to interferon therapy (P =.009). High serum HCV-RNA level was associated with low CD4-lymphocyte count (P =.001). Necroinflamatory score was higher in HIV-positive patients (P =.023) independently of the CD4-lymphocyte count, whereas increased fibrosis was related to decreased CD4-lymphocyte count (P =.011). The progression to cirrhosis was accelerated in HIV-positive patients with low CD4 cell count (RR = 4.06, P =.024) and in interferon-untreated patients (RR = 4.76, P =.001), independently of age at HCV infection (P =.001). Cirrhosis caused death in 5 HIV-positive patients. The risk of death related to cirrhosis was increased in heavy drinkers (RR = 10.8, P =.001) and in HIV-positive patients with CD4 cell count less than 200/mm(3) (RR = 11.9, P =.007). In this retrospective cohort study, HIV coinfection worsened the outcome of chronic hepatitis C, increasing both serum HCV-RNA level and liver damage and decreasing sustained response to interferon therapy. Age and alcohol were cofactors associated with cirrhosis and mortality. Interferon therapy had a protective effect against HCV-related cirrhosis no matter what the patient's HIV status was.

[One-stage surgery of middle ear cholesteatoma in adults: apropos of 180 cases]. / Chirurgie en un temps du cholestéatome de l'oreille moyenne chez l'adulte: à propos de 180 cas.

OBJECTIVES: In order to evaluate the results of tympanoplasty in one stage middle ear cholesteatoma surgery, a retrospective study of 180 consecutive cholesteatomas operated on was undertaken. METHODS: 150 single procedures and 30 revision surgeries realized between 1992 and 1997 were analysed by studying anatomical and functional results with a mean follow-up of 24 months. RESULTS: Among the 150 adult patients, 85 (57%) were previously operated on in other centres and presented a recurrence of cholesteatoma. Closed technique was performed in 110 cases (61%) and opened one in the remaining cases (41%). Ossiculoplasty was made in 101 cases (56%) with different materials (15 incus autografts, 14 teflon prosthesis, 35 hydroxyapatite (HA) composite prosthesis and 37 all in HA prosthesis): 91 cases in a one-stage procedure but 10 worse functional results required a closed revision procedure. Twenty cases were also revised after one year of follow up at least: six recurrences of cholesteatoma were operated on by using canal down mastoidectomy (4%), 14 limited residual cholesteatomas (9.3%) had a revision closed technique procedure. CT Scan followed up all the patients operated on by a closed technique. Postoperative air-bone gap (ABG) was 20 +/- 11.3 dB and 27 +/- 10.1 dB in closed and opened techniques, respectively (p < 0.05). ABG was 20 +/- 9.2 dB and 26 +/- 13 dB in type II and type III tympanoplasty, respectively (p < 0.05). CONCLUSION: If the tympanic and posterior cavities are reasonably safe, middle ear cholesteatoma in adults can be well cured by a one-stage procedure including ossicular chain reconstruction with hydroxylapatite prosthesis covered with cartilage graft who achieved a valuable hearing restoration.

[Elaboration of a tool for an audit of radiology reports]. / Elaboration d'un référentiel pour un Audit des comptes-rendus radiologiques.

PURPOSE: Elaboration of a tool for an Audit of radiology reports in a department of radiology. Materials and methods. We have made a grid and a guide to evaluate the relevance and the quality of the radiology reports. We have tested this tool on 120 reports from in-patients of the gastroenterology department. The test has been done by two radiologists (blinded test) to verify if the answers were identical. We have calculated for each item the Kappa coefficient (inter-observer agreement). RESULTS: This study has validated most of the items of our grid, some have been deleted, and others modified. CONCLUSION: Our study shows that our tool can evaluate the radiology reports of a radiology department, an audit can thus be conducted using that tool.

Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.

INTRODUCTION: The aim of this study is to report ten-year results of ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease for whom coloproctectomy and definitive end ileostomy was the only alternative. METHODS: 41 patients (22 females/19 males) with a mean age of 36 +/- 13 (range, 16-72) years underwent ileal pouch-anal anastomosis for colorectal Crohn's disease between 1985 to 1998. None had past or present history of anal manifestations or evidence of small-bowel involvement. Diagnosis of Crohn's disease was established preoperatively in 26 patients, on the resected specimen after ileal pouch-anal anastomosis, or after occurrence of Crohn's disease-related complication in 15 patients. RESULTS: Follow-up was 113 +/- 37 months, (18-174) 20 patients having been followed for more than 10 years. There was no postoperative death. Eleven (27 percent) patients experienced Crohn's disease-related complications, 47 +/- 34 months (8-101) after ileal pouch-anal anastomosis: 2 had persistent anal ulcerations with pouchitis and granulomas on pouch biopsy and were treated medically; 2 experienced extrasphincteric abscesses and 7 presented pouch-perineal fistulas which were treated surgically. Among them, 3 patients with persistent perineal fistula despite surgery required definitive end-ileostomy. Of the 20 patients followed for more than 10 years, 7 (35 percent) experienced Crohn's disease-related complications which required pouch excision in 2 (10 percent). CONCLUSIONS: Ten years after ileal pouch-anal anastomosis for colorectal Crohn's disease, rates of Crohn's disease-related complications and pouch excision were 35 and 10 percent, respectively. These good long-term results justify for us to propose ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease (i.e., no past or present history of anal manifestations and no evidence of small-bowel involvement) for whom the only alternative is definitive end ileostomy.

[Medical and economic evaluation of organ transplantation in France. The example of liver transplantation]. / L'évaluation médico-économique des greffes d'organe en France. L'exemple de la transplantation hépatique.

BACKGROUND: Organ transplantation is an expensive and risky medical procedure. Estimating the cost is difficult because the care is complex and involves many actors. We present a methodological framework for the economic evaluation of organ transplantation in France which include a detailed collection of all the direct costs and the simultaneous analysis of health status. It was applied to evaluate the cost of liver transplantation in France. METHODS: All consecutive adults transplanted or placed on the waiting list of liver transplantation in the Department of Surgery of Cochin Hospital, Paris, between 1994 and 1996 were included. All resource use was measured during one year: staff wages, pharmacy and blood, laboratory and radiology, supplies, overhead hospital services. Mean quality of life was estimated by the survival weighted by the Karnofsky index. RESULTS: Transplantation: 38 patients were included. The first year mean cost after transplantation was 561,000FF (included rehospitalizations cost of 120,000FF). Care outside the hospital induced 10% of the total cost. Mean quality of life was 63% (from 0% to 93%) and increased with time, whereas cost decreased. Waiting list: 26 of 33 patients on waiting list were transplanted. The first year mean cost was 95,000FF (included 32,000FF for first evaluation) and increased with time. 44% of cost was supported by another hospital than the transplanting one. Sickness allowance added 20% to the cost. The mean quality of life was 56% during the first year. CONCLUSIONS: This complete approach of organ transplantation cost respected the medical procedure over the time. Detailed costs take into account the care outside the hospital. This method can be used in other countries and generalised to all surgical or medical procedure as heavy as the organ transplantation.

[Tympanic grafts: surgical techniques and results of 260 cases]. / Les greffes tympaniques: techniques chirurgicales et résultats. A propos de 260 cas.

PURPOSE OF STUDY: The aim of this retrospective survey was to define factors which may influence tympanic grafts results. METHODS: 260 surgical procedures were retrospectively analyzed between 1992 and 1997 by studying anatomical and functional results with a mean follow-up of 18 months. RESULTS: Global rate of tympanic grafts reperforation was 9.2%. At 18 months, the air conduction gain was 9.5 +/- 11.5 dB, with an 13 +/- 7.7 dB air-bone gap (ABG) and 80% ABG inferior to 20 dB, the change in air bone gap was 9 +/- 10.3 dB. Several factors influencing the results were identified: second hand surgical procedures (40%) had worse functional results than patients from first hand procedures, inflammatory atrial mucosa or obstruction of the eustachian tube (more graft retraction), retracted malleus handle and/or stuck to the promontory (worse auditory results), temporal aponeurosis placed under malleus handle (more reperforation of the graft without hearing difference as to graft placement above malleus handle), association of canal wall-down technique (poor auditory results), surgeon experience (better auditory results). CONCLUSION: A first surgical procedure, normal malleus handle and atrial mucosa, no mastoidectomy or canal wall-up technique, a temporal aponeurosis graft placed above malleus handle are predictive factors for anatomical and/or functional good results.

[Practices of transcutaneous liver biopsies in France. Results of a retrospective nationwide study]. / Pratiques de la ponction-biopsie hépatique transpariétale en France. Résultats d'une étude nationale.

OBJECTIVES: Few nationwide studies have evaluated the number of transcutaneous liver biopsies performed for diffuse parenchymal liver diseases and the practices of this procedure. The aims of this retrospective nationwide survey were to precise these data. METHODS: In 1997, a confidential questionnaire was mailed to all AFEF and ANGH members. Parameters studied were annual number of transcutaneous liver biopsies performed by center for diffuse parenchymal liver diseases, sedation and/or premedication, haemostasis parameters required for choosing transcutaneous liver biopsy route, fasting liver biopsy, use of venous access, ultrasonography use during liver biopsy (determination of puncture site), modalities of follow-up after liver biopsy, number of biopsies performed as day-care procedure. RESULTS: Sixty seven centers were involved in the study. About 12 000 transcutaneous liver biopsies are performed each year in France for diffuse liver parenchymal diseases. Mean number of biopsies per center is 130 (median 70, ranges 5-600). Sedation is routinely used before liver biopsy in 31% of centers; APTT is not measured in 20% of centers and bleeding time is measured in 30% of centers before liver biopsy. Ultrasonography for determination of puncture site is used in 41% of centers. Venous access is implemented in 36% of centers. Outpatient liver biopsies are performed in less than 15% of cases by 64% of centers whereas 30% of centers practice outpatient liver biopsy of more than 50% of cases. Heterogeneity of biopsy practices are related to individual choices rather than the type or location of medical practice. CONCLUSIONS: Many transcutaneous liver biopsies are performed each year in France for diffuse parenchymal liver diseases, and practices vary greatly. Ultrasonography use and outpatient liver biopsy should be developed.