[Multidisciplinary consultation for patients with excess weight: observations following a 6-month pilot experience]. / Consultation pluridisciplinaire pour patients avec un excès de poids: quelques réflexions après six mois d'expérience pilote.

The evaluation and definition of excessive weight and obesity have greatly varied depending on the civilization and the era. These two themes have assumed importance under the influence of outside social pressures, and then medical criteria when obesity was associated with chronic illness and complications, for example, diabetes mellitus and hypertension. Everyday, articles appear taking this or that method for losing weight, methods where the effects are often described as miraculous in the short term, but uncertain in the medium-term and unsatisfying or unknown in the long term. This is mainly due to drop out rates, a ack of precise epidemiological data concerning obesity and its treatment, and lack of long-term follow-up of patients. Also in the long term at least, there does not seem to be a big difference in weight loss whatever the method chosen. Taking into account the importance of psychological and social factors frequently encountered in overweight patients, we have chosen an integrated approach (internist, psychiatrist, dietician). The following article describes the methods used and offers some reflections after a first period of six months.

Additional factors associated with plantar ulcers in diabetic neuropathy.

Patients can only examine and handle their own feet if they have adequate visual acuity and joint mobility. We therefore studied the physical capacity of patients with neuropathy to perform the preventive footcare measures previously taught. The study included three groups of diabetic outpatients, comparable for age and duration of diabetes: (1) 38 patients with neuropathic ulcers; (2) 21 patients with neuropathy, but no ulcers; (3) 30 patients without neuropathy. Visual acuity and joint mobility, expressed as minimum eye-metatarsum and heel-buttock distances, did not differ between uncomplicated neuropathic and non-neuropathic patients: visual acuity was sufficient in 95% of neuropathic patients without ulceration and in 87% of non-neuropathic patients; joint mobility was in the normal range in both groups. However, 71% of complicated neuropathic patients had insufficient visual acuity for correct foot examination, and their joint mobility was reduced compared with uncomplicated neuropathic and non-neuropathic patients.

Aspiration of solid food particles into lungs of patients with gastroesophageal reflux and chronic bronchial disease.

The existence of a relationship between upper digestive tract impairment and respiratory disturbance is generally accepted. The aim of this study was to determine whether pulmonary aspiration, documented by labeled meal and lung scans, could be a contributory factor. Thirty-two patients with chronic respiratory complaints (19 men, 13 women, mean age: 57.8 yr), 29 of whom had an FEV1 below 80 percent of predicted values, and 13 healthy subjects (six men, seven women, mean age 50.9 yr) took part in a prospective study. Scintiscans showed gastroesophageal reflux (GER) in 27 patients (84 percent) and in five control subjects (38 percent). Lung contamination was ascertained in 24 patients (75 percent) and in two control subjects (15 percent) (p less than 0.001) 15 hours after a labeled solid meal. Vegetal fibers were found in sputum smears after mouth rinsing the day after ingestion of 8.5 g wheat bran in 72 percent of patients and in 77 percent of control subjects. Although two associated phenomena are not necessarily causally related, pulmonary aspiration documented by pulmonary scintigraphy did significantly correlate with gastroesophageal reflux, suggesting that aspiration resulting from reflux may perpetuate, if not initiate, chronic bronchial disease.