Faecal steroids and bacteria and large bowel cancer in Hong Kong by socio-economic groups.

In a study of three socio-economic groups in Hong Kong, the high income group had a high faecal concentration of bile acids, especially the dihydroxy bile acids, compared to the low income group. The faecal bile acids were also more highly degraded. The faecal flora contained more bacteroides and fewer eubacteria. Very few of the clostridia able to dehydrogenate the steroid nucleus were isolated. An epidemiological study based on street blocks indicated that the high income group also have a higher incidence of cancer of the large bowel and of the breast. The results are discussed in terms of theories on the aetiology of large bowel cancer.     

Value of gastrostomy in the prevention of food inhalation]

Gastrostomy can have both a preventive and curative effect for patients particularly exposed to food inhaling, especially the heavy casualties with loss of initial consciousness and prolonged intubation or tracheotomy. In these patients stopping the forcible feeding led to frequent mishaps and to recurrent pulmonary complications. Gastrostomy prevents them while enabling the seriously injured patients to receive 2.500 calories daily. These cases showed the different circumstances where gastrostomy done rapidly under L. A. and with assisted ventilation gave good results.     

Idiopathic vasospastic angiopathy of the internal carotid arteries: A rarely recognized cause of ischemic stroke in young individuals

IntroductionIdiopathic vasospastic angiopathy of the internal carotid arteries is a rare and largely unknown cause of ischemic stroke.MethodsWe report the case of a 39-year-old man with migraine treated by beta-blockers, who had been suffering from progressive right visual impairment and headache for one week. He then experienced a seizure and left hemiparesis. Ophthalmological examination revealed right retinal ischemia and partial left homonymous hemianopia. MRI revealed a long stenosis of both carotid arteries and a recent ischemic stroke in the territory of the right middle cerebral artery. The diagnosis of vasospastic angiopathy of the internal carotid arteries was made based on a second MRI and colored duplex sonography which showed a decrease in the stenosis and no intraparietal hematoma confirming the vasospasm mechanism for stenosis. The clinical course was favorable with calcium channel blockers and aspirin. Use of vasoconstrictor treatments was contraindicated.Discussion/ConclusionIdiopathic vasospastic angiopathy of the internal carotid arteries has been rarely documented. Association with migraine has been mentioned but remains unclear in the literature. This etiology for stroke is probably under-diagnosed due to lack of rapid and repeated examinations of the cervical arteries (angio-MR and colored duplex sonography) to confirm the vasospasm mechanism. Recurrences have been reported justifying a specific secondary preventive treatment to induce vasodilatation. Vasoconstrictor treatments should be contraindicated.     

Les cliniques d’anticoagulants sont-elles efficaces en France ? Évaluation des performances de six cliniques dans la gestion des traitements par antivitamines K

Purpose

Recent data show that the quality of anticoagulation evaluated in patients receiving vitamin K antagonists (VKA) is not optimal in France. The aim of this retrospective study was to estimate the performances of six French anticoagulant clinics that manage VKA treatments over a 3-year period, from 2009 to 2011.

Methods

All clinics used the same rule based software. We determined the time spent in the therapeutic range (TTR), a surrogate end-point of quality of treatment with VKA.

Results

The overall duration of follow-up was 2755 patient-years concerning 2385 patients. The time spent in the therapeutic range 2 to 3 assigned for 89% of the patients, was 73%. On the other hand the time spent in the therapeutic range for the other two INR ranges (2.5–3.5 and 3–4.5) concerning 11% of patients with prosthetic heart valve was lower (63.7% and 68.8% respectively) with an imbalance in favour of the time below the range. In this study, warfarin (Coumadine^®) and fluindione (Previscan^®) allowed an equivalent quality of anticoagulation. The 1728 patients of age ranged from 60 to 100 years spent more time in TTR than the 651 younger patients. The percentage of time spent with an INR greater than 5 was extremely reduced which is a guarantee of safety.

Conclusion

These results prove that anticoagulant clinics in France have the same good performances as their counterparts abroad. It can be assumed that a high TTR contributes to a low incidence of both bleedings and thrombosis.