Dramatic Increase in Incidence of Ulcerative Colitis and Crohn's Disease (1988-2011): A Population-Based Study of French Adolescents.

OBJECTIVES: Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period. METHODS: Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification. RESULTS: 1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/105 for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988-1990 to 2009-2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10-16 years): for CD from 4.2 to 9.5/105 (+126%; P<0.001) and for UC, from 1.6 to 4.1/105 (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC. CONCLUSIONS: In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

[A teaching medical simulator: phacoemulsification in virtual reality]. / Simulateur pédagogique médical: la phacoémulsification en réalité virtuelle.

INTRODUCTION: Improvements in computer technology have made it possible to design a cataract surgery teaching simulator in real time. MATERIAL AND METHODS: A computed representation of the lens was made with a mechanical model simulating the behavior of the lens, to which we added texture. The different models use mesh to make a section, which allowed us to make a section in real time using element removal or separation. Different models were used: a mass-spring mesh, a rigid model and a deformable model created using the finite element method. The contact with the lens is simulated by a collision sphere, which provides the interaction between the surgical instruments and the virtual environment. The surgical instruments viewed on the screen are controlled by a stylus with 6 degrees of freedom. DISCUSSION: We obtained the first step of phacoemulsification in real time with a good visual aspect. The surgeon views the procedure and can modify his movements instantaneously. This simulator provides the opportunity for students to safely learn phacoemulsification and improve their technique with an infinite number of procedures. CONCLUSION: The realism offered by this tool provides a rigorous teaching tool that might reduce the learning curve for phacoemulsification.

[Sultopride and agitation]. / Sultopride et agitation.

Sultopride, presented in this paper, was tried in five patients with psychomotor agitation and aggressiveness but with a variable underlying structure, from severe neurosis (borderline?) to chronic decompensated psychosis. These manifestations had failed to respond to the other neuroleptics used. Results with sultopride were excellent. This drug deserves a good position among sedative agents with no significant effect on vigilance used in aggressiveness.

[Who requests voluntary interruption of pregnancy?]. / Qui demande l'IVG?

PIP: The sense that abortion is the last resort for women placed in a distress situation by the continuation of the pregnancy should be preserved. No woman requesting abortion regards it as trivial, and postabortal depressions are more common than the banalization of the procedure might imply. Reasons for terminating the pregnancy are usually among the following: breakup of the couple, a recent loss, advanced age of existing children, emigration, or material difficulty. The psychological situation of pregnant adolescents is confused and sad, mixing the normal difficulties of adolescents with the affective problems of pregnancy and perhaps family problems as well. Pregnancy to an adolescent can symbolically represent a lack, a competition, or a selfpunishment; it can function as a proof of femininity, or a means of informing the parents of the girl's sex life. Pregnancy and abortion are experienced differently by adult women, who at a certain age feel a strong drive to realize the wish for maternity. Nevertheless, some women suffer a permanent conflict between the desire to have and the desire not to have children. Adult women may desire pregnancy, even accidental pregnancy, to prove their fertility, relive their own childhood, reassure themselves about menopause, fill a lack, or for numerous other reasons apart from wanting a child. Voluntary abortion can be defined as a strong unconscious desire for pregnancy tied to a conscious rejection of maternity. Interviews with women requesting abortions disclose the numerous conflicts that may exist with a maternal image, with the woman's own body, in the case of a recent loss, or at the breakup of a marriage. Studies have shown that the ambience in which the abortion is performed is of overwhelming importance for the later attitude of the woman; personnel involved should avoid adding to the trauma already experienced by the woman by making her feel guilty.^ieng

[Use of the computer in teaching rheumatology. Trial application in the diagnosis of an adult polyarthritis]. / Utilisation de l'ordinateur pour l'enseignement en rhumatologie. Essai d'application au diagnostic d'une polyarthrite de l'adulte.

The immense possibilities offered by the computer can be utilized in medical education, through a free dialogue between the student and the machine thanks to a terminal. A diagnostic simulation program has been carried out in diagnosing adult polyarthritis. This program neccesitates an analysis of diagnostic behavior and, on this basis, the preparing of a diagnostic tree or graph. The reasons leading to the plan adopted in constructing the graph, are discussed. Cases of increasing difficulty are proposed to the student, who must follow the course plan in order to arrive at a diagnosis. This teaching method, applied for thing pedagogical advantages both for the teacher and the student. The operating cost seems reasonable.