Facteurs prédictifs de la récidive postopératoire après résection iléocæcale pour maladie de Crohn

Introduction

Although the proven efficacy of many biologic agents in inducing and maintaining remission in Crohn’s disease, near 80% of patients require intestinal resection during their lifetime. This surgery is not definitively curative. In fact, postoperative disease recurrence is common and is considered as a one of the major problems encountered when managing Crohn’s disease. Aims: to assess the risk factors for postoperative recurrence after ileocecal resection for Crohn’s disease.

Patients and methods

The study included all Crohn’s disease patients who underwent ileocecal resection between 2000 and 2009. Disease recurrence was defined as endoscopic evidence of disease activity with or without symptoms. To determine the risk factors for postoperative recurrence of Crohn’s disease; we performed univariate analysis of the different variables proposed in the literature for their influence on the postsurgical outcome followed by multivariate analysis by logistic regression.

Results

Fifty two patients were included. Fifteen patients (28.8%) patients developed disease recurrence within a mean follow up of 31.9 months [1–126]. In univariate analysis, familial history of chronic inflammatory intestinal disease (P = 0.007), ileocecal resection occurring during the first year after the diagnostic of Crohn’s disease (P = 0.004), length of the resected small bowel (P = 0.025) and presence of granulomas(P = 0.035)were associated with a high risk of postoperative recurrence. In multivariate analysis, surgery during the first year after the diagnostic of Crohn’s disease was the only independent variable correlated to postoperative recurrence.

Conclusion

After an ileocecal resection for Crohn’s disease, the recurrence is relatively common particularly in patients who underwent their surgery during the first year after the diagnostic of CD.     

Syndrome coronarien aigu et consommation de cannabis ; étude monocentrique rétrospective au Centre Hospitalier de Troyes

IntroductionAcute coronary syndrome (ACS) is the usual clinical entry point for coronary heart disease. France is the European country with the highest prevalence of cannabis use and an increase in serious cardiovascular complications, including infarction, related to cannabis. The main objective was to compare the clinical and cardiological profile of patients with ACS according to exposure to cannabis use.Population and methodsWe conducted a retrospective, single-centre, exposure-non-exposure cohort study of all adult patients (> 18 years) admitted for ACS in the ICU between January 1, 2012 and December 31, 2021 at the Centre Hospitalier de Troyes, with mention of cannabis use in the medical record. A matching was performed so that each patient identified in the exposed group was associated with a comparable unexposed patient on age, sex, period of hospitalisation and cardiovascular event typology (type of ACS and topography for ST+).Results2745 patients admitted to the ICU and the coronary angiography room presented an ST+ or ST? ACS from 01/01/2012 to 31/12/2021 at the CHT. For 31 patients of them (1.1%), we noted cannabis consumption, which concern 7,9% of SCA ST+ aged under 50.DiscussionThe link between cannabis use and ACS is established, but studies concerning the place of cannabis in the ACS pathway of an ICU are few in France. Our results show the interest of developing a specific pathway focused on the needs of patients and their specificities in post ACS management.     

Méningo-encéphalites : étude rétrospective sur 4 ans au CHRU Bretonneau de Tours

Introduction

Meningoencephalitis (ME) are central nervous system inflammations with many etiologies. The etiology remains unknown in nearly half of the cases. The last French study was performed in 2007. Besides some rare or emerging causes, such as limbic ME, which are curable, infectious ME are the most frequent. Long term ME outcome remains partly known. The study objectives were to assess etiologies and outcome of ME in a University hospital between 01/01/2011 and 31/12/2014.