ABSTRACT
AIMS OF THE STUDY: The presence of colostomy has a major impact on quality of life that could potentially be improved by performing colonic irrigation (CI), yet few studies have assessed the impact of this technique on quality of life. The aim of this study was to assess the quality of life between two groups of patients having a colostomy; those practicing CI vs those not practicing CI. PATIENTS AND METHODS: The French Federation of Ostomy (FFO) members were evaluated by a self-questionnaire assessing their experience of CI. Quality of life as assessed by the Stoma-QOL questionnaire was compared between patients practicing CI or not. RESULTS: In total 752 patients were eligible for the study. The median age was 75 years, and 47.26% were men. The median duration between stoma surgery and questionnaire completion was 12.3 years. Forty-one percent of the patients practiced CI. The median quality of life score was significantly higher for the patients practicing the CI: (69.26 vs 58.33, P<0.001). In multivariable analysis, the risk factors for not performing CI were age, obesity, the presence of colostomy for less than six years, and a non-oncologic indication for operation. CONCLUSIONS: CI appeared to improve the quality of life of patients with colostomy. This care is a therapeutic education issue and should be proposed to all patients. Supervision by the enterostomal therapy nurse is recommended especially for patients with a high risk of failure.
Subject(s)
Quality of Life , Surgical Stomas , Aged , Child , Colostomy , Humans , Male , Surveys and QuestionnairesABSTRACT
The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet that has been employed as a nonpharmacologic therapy for intractable epilepsy. Several multicenter or randomized studies have demonstrated the anticonvulsive properties of the ketogenic diet. The reports on the clinical efficacy have described a greater than 50% reduction in seizure frequency for about 60% of patients on a ketogenic diet. Efficacy has been reported both for child-teenager and adult patients. Patients who were responders to the ketogenic diet exhibited a decrease in seizure frequency within two months of treatment onset. Underlying mechanisms remain unknown. The current hypotheses are: anticonvulsive properties of ketone bodies, variation in excitatory or inhibitory brain neurotransmissions, modulation of cell excitability or implication of polyunsaturated fatty acids. Ketogenic diet is a fastidious and restrictive therapy. Moreover, side effects have been reported. In order to facilitate patient tolerability and palatability, the diet protocols are gradually modified including changes in ratios of the fat versus non fat components, initiation of the diet with or without fasting, fatty acids composition. A modified Atkins diet seems to be a possible alternative diet with a comparable efficacy on intractable epilepsy. This diet induces ketosis without fluid, calorie or protein restriction, nor the requirement for fasting and food weighing. Furthermore, 10 to 20 grams carbohydrates are allowed per day to increase patient tolerability and palatability. New data suggest that ketogenic diet and its variants should not be considered like a "last chance" treatment.
Subject(s)
Diet, Ketogenic/methods , Epilepsy/diet therapy , Seizures/prevention & control , Taste , Adolescent , Adult , Brain/physiopathology , Child , Diet, Carbohydrate-Restricted , Diet, Protein-Restricted , Dietary Fats , Epilepsy/physiopathology , Humans , Synaptic Transmission/physiology , Treatment OutcomeABSTRACT
BACKGROUND: In 1994 we started recombinant human deoxyribonuclease (rhDNase) in every cystic fibrosis (CF) patient whatever his (her) clinical condition, provided they were aged more than 5 years and forced vital capacity (FVC) was > or = 40%. POPULATION AND METHODS: We reviewed retrospectively the effects of rhDNase in 69 CF children and adolescents during a 2-year follow-up. Patients (35 boys, 34 girls) received 2.5 mg of rhDNase once daily from a mean age of 8.5 years (range 5-16.4). Baseline spirometric values (% predicted) and nutritional status were as followed: FVC = 84.8 +/- 21.7; forced expiratory volume in 1 second (FEV1) = 80.8 +/- 22.2; peak flow = 89.7 +/- 34.2, forced expiratory fraction 25-75% (FEF 25-75) = 71.8 +/- 32.8; Z score weight/height = -0.41 +/- 1.14; Z score weight/age = -0.48 +/- 1.25, body mass index = 15.4 +/- 1.8; caloric intake = 107 +/- 25% of recommended dietary allowances (RDA). Patients had a Shwachman-Kulczycki's score of 87 +/- 9. Spirometric and nutritional data were analysed after 1, 3, 6, 12, 18 and 24 months of treatment and compared to baseline values (changes evaluated as percent change from mean baseline for spirometric data). Shwachman-Kulczycki's score was calculated after 24 months of rhDNase. RESULTS: An improvement of FVC (+10.7%, P < 0.001) and FEV1 (+12%, P < 0.01) was noted after one month of treatment and was maintained throughout the following 2 years around 8.7% (6.4-11.4) for FVC and 8.2% (7.3-9.1) for FEV1, P < or = 0.01. This was particularly observed in children aged 5 to 10 years, in boys and in patients with a baseline FVC under 70% predicted. There was no significant change in FEF 25-75. We observed an improvement of daily caloric intake from the third month (P < 0.05) and of body mass index from the sixth month (P = 0.02). This was particularly noted in girls. Z score weight/age was improved only during the first 3 months of treatment while Z score weight/height increased only after a 2 year follow-up. There was no significant change in Shwachman-Kulczycki's score after 24 months of rhDNase. CONCLUSION: rhDNase in CF children in effective on lung function as well as on nutritional status and the response to this treatment can be evaluated after the first 3 months.
