[Use of Eductyl(®) suppository for rectal preparation before prostate biopsy: an observational survey]. / Utilisation d'Eductyl(®) pour la préparation rectale avant biopsies de prostate. Une enquête de pratique.

BACKGROUND: Local preparation of rectum governs the possibly survenue of complications during transrectal ultrasound guided biopsies of prostate. OBJECTIVE: To determine the efficacy and acceptability of rectal preparation (Eductyl(®) suppository) in patients undergoing a transrectal prostate biopsy. PATIENTS AND METHODS: From May to August 2005, eight urologists (Bel-Air Urological Center, Bordeaux) included 137 patients (mean age 66.4 years) with an indication of prostate biopsies. All patients were administrated prophylactic antibiotic therapy. They used Eductyl(®) effervescent suppositories for local preparation, the day before and/or the morning of the exam. RESULTS: Rectal vacuity was satisfactory or very satisfactory for 99% of patients. Introduction of probe and tracking of prostate were easy or very easy in 99% of cases. Eight days after the exam, only 35% of patients had suffered anal or rectal pain during a mean of 2 days. Most of patients recovered bowel function without requiring treatment and without any difficulty or pain. The bowel function recovery occurred the day of prostate biopsy and the day after for 28.4% and 62.2% of patients, respectively. CONCLUSION: Urologists considered that the use of Eductyl(®) suppositories before prostate biopsies ensured a satisfactory rectal preparation and optimal conditions for the exam. Moreover, this preparation was well accepted by patients.

Treatments for pediatric achalasia: Heller myotomy or pneumatic dilatation?

AIM: The treatment of achalasia consists of reducing distal esophageal obstruction by either Heller myotomy surgery or endoscopic pneumatic dilatation. The aim of the present study was to evaluate the short- and middle-term results of these procedures in children. METHODOLOGY: For technical reasons, children under six years old (n=8) were treated by surgery only, whereas patients over six years old (n=14) were treated by either Heller myotomy or pneumatic dilatation. RESULTS: Of the children aged under six years, 75% were symptom-free at six months and 83% at 24 months of follow-up. Of the patients aged over six years, complete remission was achieved by Heller myotomy in 44.5% vs. 55.5% by pneumatic dilatation after six months, and in 40% vs. 65%, respectively, after 24 months. Both pneumatic dilatation and Heller myotomy showed significant rates of failure. CONCLUSION: These results suggest that pneumatic dilatation may be considered a primary treatment in children over six years old. Also, where necessary, Heller myotomy and pneumatic dilatation may be used as complementary treatments.

Acute exacerbation of pain in irritable bowel syndrome: efficacy of phloroglucinol/trimethylphloroglucinol. A randomized, double-blind, placebo-controlled study.

BACKGROUND: Abdominal pain is the predominant symptom in irritable bowel syndrome patients. Phloroglucinol and its methylated derivative are antispasmodic agents acting on smooth muscle. AIM: To evaluate the efficacy of phloroglucinol/trimethylphloroglucinol on pain intensity during an acute exacerbation of pain of irritable bowel syndrome over a 1-week period treatment. METHODS: Irritable bowel syndrome Rome II patients seeking medical advice for an acute exacerbation of abdominal pain were randomized to phloroglucinol/trimethylphloroglucinol (62.2 mg P + 80 mg TMP) two pills three times daily or placebo for 7 days. Patients were included if they had a pain with a minimal intensity of 40 on a 100-mm visual analogue scale, and if pain occurred at least 2 days during the week previous inclusion. RESULTS: Three hundred and seven patients were included by 78 general practitioners. The intent-to-treat population included 300 patients, aged of 46.9 +/- 14.8 years (73% female). The relative decrease of pain intensity at day 7 was 57.8 +/- 31.7% vs. 46.3 +/- 34.7% (Delta = 11.5 +/- 3.8%, [CI(95%): 4.0 ; 19.1], P = 0.0029) and the percentage of patients with at least a 50% decrease of pain intensity was 62% vs. 47% (Delta = 15.3 +/- 5.7%, [CI(95%): 4.1 ; 26.5], P = 0.0078) in phloroglucinol/trimethylphloroglucinol and placebo groups, respectively. CONCLUSIONS: A 1-week phloroglucinol/trimethylphloroglucinol treatment significantly reduces pain intensity in irritable bowel syndrome patients consulting their general practitioners for pain exacerbation.

Duodenal manometry in postobstructive enteropathy in infants with a transient enterostomy.

Intestinal motility was studied in 11 children with a transient enterostomy secondary to a neonatal organic small intestine obstruction (5 total colon Hirschsprung's disease, 2 necrotizing enterocolitis, 1 intussusception, 3 ileal atresia). Eight children presented with a postobstructive enteropathy (severe grade I [5], moderate grade II [3]) and three were considered as controls (grade III). They were assigned to one of the three groups on the basis of the duration of parenteral nutrition and constant rate enteral nutrition needed and the oral feeding tolerance. Barium small intestine transit showed no persistent partial obstruction or peritoneal adhesions. The abnormal inert marker transit times were statistically correlated with the clinical groups as well as duodenal manometric abnormalities. Manometric recordings were characterised by the absence (grade I) or abnormal phase III (grade II) of the migrating motor complex and decreased motility index (grades I and II). This study confirms that this enteropathy is due to a chronic alteration in motility induced by prenatal or postnatal obstructions.

[Gastroesophageal reflux treated by posterior hemifundoplication. 251 cases]. / Reflux gastro-oesophagien traité par hémifundoplicature postérieure. 251 observations.

Between September 1983 and March 1991, 251 consecutive patients with gastro-oesophageal reflux resistant to medical treatment underwent posterior hemifundoplication (modified Toupet procedure). One hundred and seventy-seven patients (71 percent) had peptic oesophagitis. pH monitoring showed a mean Kaye's score of 278 +/- 245 with a 29 percent part of total recording time at pH < 4. The mean low oesophageal sphincter pressure was 8.5 +/- 6.5 cm H2O. No patient died in the postoperative period. Morbidity consisted of 8 splenic injuries, as well as 8 pulmonary and 23 thromboembolic complications. Assessment of 199 patients (79 percent) with a mean follow-up of 32 +/- 21 months showed complete symptomatic relief in 96.5 percent, and complete endoscopic healing of oesophagitis was noted in 96 percent. Restoration of the pH profile to normal levels was obtained in 86 percent of the cases. The mean low oesophageal sphincter pressure had risen to 17 +/- 6 cm H2O. Early postoperative dysphagia was noted in 46 patients (18 percent); one of them required reoperation. Reflux symptoms persisted in 9 patients (4.5 percent). pH monitoring revealed abnormal levels in 3 patients. The results of this study demonstrate that effective gastro-oesophageal reflux control can be achieved with the modified Toupet procedure.

[Effect of phloroglucinol on rectosigmoid motility stimulated by a test meal. Study in patients with irritable bowel syndrome]. / Effet du phloroglucinol sur la réponse motrice du rectosigmoïde à l'alimentation. Etude chez des sujets atteints du syndrome de l'intestin irritable.

Twenty patients (15 women, 5 men, mean age: 46.3 +/- 11.82 years, mean weight: 70.9 +/- 8.83 kg) presenting with a 8.5 +/- 4.7 years' history of irritable bowel syndrome associated predominantly with postprandial abdominal pain were recruited into the study. They underwent, after an enema, a rectosigmoid manometry (4 channels, low compliant infusion pump and catheters) before and after a 1000 kcal standardized meal. At the end of the meal they were administered intravenously phloroglucinol (two 40 mg ampoules) or placebo (two ampoules). Both treatments were strictly similar and the order of administration was randomly assigned Motor activity at the rectum, rectosigmoid, lower sigmoid and sigmoid level was determined using a motor index calculated for each 15 min period. Three preprandial and four postprandial indices were calculated. Both groups were statistically similar for sex ratio, age and history of disease. A slight difference was noted for mean weight: the caloric instake per kg of weight was a little higher in the phloroglucinol group. Mean preprandial indices were comparable in both groups. Variance analysis showed that the increase in postprandial motor indices was statistically less pronounced in the phloroglucinol group than in the placebo group. In the placebo group a clear cut increase in motor activity was assessed, which was not observed in the phloroglucinol group. This variation of motricity, which was observed at every level, was more pronounced for the first two postprandial indices than for the last two ones. These results suggest that phloroglucinol is able to reduce rectosigmoid motor response after a test meal. This could explain its activity in abdominal pain associated with irritable bowel syndrome.

[Esophageal function tests: manometry, pH monitoring, pH monitoring combined with manometry and scintigraphy]. / Explorations fonctionnelles oesophagiennes: manométrie, pH-métrie, mano-pH-métrie et scintigraphie.

Conventional methods for exploration of the esophagus (radiology and fibroscopy) are not sufficiently sensitive to provide a precise diagnosis of minor lesions. New techniques have been developed that enable improved evaluation of the physiopathology of gastro-esophageal reflux and other esophageal motor disorders. These include esophageal manometry, pH monitoring, the association of these two procedures, and finally scintigraphy. Manometry is the most effective method of assessing esophageal motility, and it can assist in the diagnosis of motor disorders related to reflux, of dyskinesias such as in mega-esophagus, and of collagen diseases. The most reliable method for diagnosing gastro-esophageal reflux is by means of pH monitoring. More detailed physiological and physiopathological data can be obtained by combining the two investigational methods. Scintigraphy can sometimes determine the responsibility of pulmonary disorders in the development of reflux.

Effects of summer employment on student nurses: implications for recruitment and retention of staff nurses.

Nursing students often seek summer employment in hospital settings to practice and refine previously learned skills. Nursing administrators possibly view this employment as a means of relieving short-term staffing problems. However, if summer employment is seen as a potential strategy for recruiting future graduate nurses, then one needs to address the following: how to provide support for the student nurse to deal with the same concerns and issues as the new graduate (role confusion and reality shock); how to ensure that appropriate feedback is provided to enhance clinical skills. A pilot study of the effects of summer employment in a Quebec hospital on six second year CEGEP (diploma) nursing students explored these issues. The findings suggest actions which might suitably be taken by an agency in order to reinforce and facilitate the maintenance and promotion of excellence in patient care, as well as commitment to the profession and integration into the nursing culture.

Trimebutine-induced phase III-like activity in infants with intestinal motility disorders.

Duodenal manometric recordings were performed in five male children (mean age 11.7 +/- 6.8 months) suffering from severe digestive pathology with clinical findings of dysmotility; they required total parenteral nutrition: one case of enteropathy following intestinal resection for congenital small bowel atresia, and four cases of intestinal pseudoobstruction. The basal 3-h fasting recordings showed complete disorganization of interdigestive activity characterized by an absence of migrating motor complexes and a marked basal hypomotility with motor indices lower than in control subjects. Intravenous trimebutine (3 mg/kg) produced a phase III-like activity 88 +/- 121 s after administration in four cases. The activity lasted 236 +/- 105 s and had a mean frequency of 11.75 +/- 0.86 waves/min. It was propagated aborally in the two patients having two duodenal recording sites. Trimebutine-induced phase III activity was followed by signs of peristalsis in two patients.

[Value of digestive manometry in scleroderma of childhood]. / Intérêt de la manométrie digestive dans la sclérodermie de l'enfant.

The authors report a case of systemic scleroderma in a 7 year-old boy, with digestive, cardiac and cutaneous involvement. They stress for the first time the pediatric significance of esophageal and recto-anal manometry from an etiologic topographic point of view.

[The association of megaesophagus, Binder's syndrome and dysautonomia: a new neurocristopathy]. / Association méga-oesophage, syndrome de Binder et dysautonomie: une nouvelle neurocristopathie?

A case of esophageal achalasia is reported in a 12 year-old child. Nasal hypoplasia (Binder syndrome) and dysautonomia were associated. This may be explained by the common embryologic origin (neural crests) of nasal bud, autonomic nervous system and digestive intramural neurons. Such a neurocristopathy suggests exploration of the autonomic nervous system in cases of esophageal achalasia.

[Esophageal motility in cases of chest pain with normal coronarography]. / Motricité oesophagienne en cas de douleurs thoraciques avec coronarographie normale.

The aim of this study was to assess the incidence of oesophageal abnormalities and to determine their nature in patients with retrosternal chest pain and normal coronary angiography with a negative coronary spasm provocation test. Oesophageal manometry was carried out in all cases with or without a spasm provocation (usually alkalosis) test. Forty consecutive patients were studied: 19 men (47.7 +/- 10.0 years) and 21 women (54.7 +/- 7.5 years). A history of gastro-intestinal disorder was obtained in 57 p. 100 of cases (hiatal hernia and/or gastro-oesophageal reflux, biliary lithiasis and/or cholecystectomy, gastritis). Seventeen patients had broad based powerful oesophageal contractions which are an established cause of pain; they were recorded under basal conditions in 5 cases and after a provocation test in 12 cases. Two patients had a megaoesophagus without giant waves. Thirteen patients had manometric signs of reflux (malposition and hypotonia of the lower oesophageal sphincter) of whom 7 had giant waves on provocation. In addition, three patients experienced pain during gastro-oesophageal reflux (1 case) or hypotonia of the lower oesophageal sphincter (2 cases). In all, a very probable oesophageal origin of the chest pain was demonstrated in 22 patients (55 p. 100 of cases).

Duodenal and esophageal manometry in total colonic aganglionosis.

Eleven children with total colonic aganglionosis were studied by esophageal and duodenal manometry. They were separated into two groups: group 1, with ileal involvement, and group 2, without ileal involvement. The results of the digestive motility studies were compared with the extent of ileal involvement of the aganglionosis and with the amount of artificial nutritional support required. All children showed abnormalities on both esophageal and duodenal manometry, suggesting complete digestive tract motility involvement. Recent advances in understanding Hirschsprung's disease and manometrial abnormalities suggest a primary motility disorder in children with total colonic aganglionosis.

Manometrical evaluation in visceral neuropathies in children.

Manometrical recordings were made at three levels of the digestive tract in 20 children with chronic intestinal pseudoobstruction (CIPO) defined clinically and histopathologically by deep biopsies showing a neuropathic process. Duodenal manometry showed severe abnormalities with hypomotility in all cases and absence of migrating motor complex in 13 of 20 cases. There was no relation between the histopathologic type and the motility pattern, but the most severe abnormalities were seen in the patients with extensive involvement of the digestive tract and the most severe clinical course. Esophageal manometry was abnormal in 18 of 19 patients, with altered peristalsis consisting of simultaneous, short-lasting, or low-amplitude waves. Rectoanal manometry showed the presence of the rectosphincteric inhibitory reflex in all patients. In conclusion, there is a high frequency of small bowel manometrical abnormalities in CIPO which seem to correlate with the extent of the pathological process and the prognosis of the disease. Esophageal manometry is useful for defining the extent of dysmotility and confirming the diagnosis of CIPO in some cases.