Randomised clinical trial: once- vs. twice-daily prolonged-release mesalazine for active ulcerative colitis.

BACKGROUND: Aminosalicylates are first-choice treatment for mild-to-moderately active ulcerative colitis (UC); however, multi-dosing regimens are inconvenient. AIM: To compare the efficacy and safety of once- (OD) vs. twice- (BD) daily prolonged-release mesalazine (Pentasa, Ferring, Saint-Prex, Switzerland) for active mild-to-moderate UC in a non-inferiority study. METHODS: Eligible patients (n = 206) were randomised to 8 weeks of mesalazine (4 g/day), either OD with two sachets of 2 g mesalazine granules in the morning (n = 102) or BD with one 2 g sachet in the morning and one in the evening (n = 104). Patients also received 4 weeks of mesalazine enema 1 g/day. Disease activity was assessed at randomisation, weeks 4, 8 and 12 using the UC Disease Activity Index (UC-DAI). Clinical and endoscopic remission (primary endpoint) was assessed after 8 weeks. Patients recorded stool frequency and rectal bleeding in a daily diary. RESULTS: The primary endpoint, non-inferiority in clinical and endoscopic remission with OD vs. BD mesalazine at 8 weeks, was met (intent-to-treat population: 52.1% vs. 41.8%, respectively, 95% confidence interval -3.4, 24.1; P = 0.14). Improvement of UC-DAI score (92% vs. 79%; P = 0.01) and mucosal healing (87.5% vs. 71.1%; P = 0.007) were significantly better, time to remission significantly shorter (26 vs. 28 days; P = 0.04) and safety similar with OD vs. BD dosing. CONCLUSIONS: When combined with mesalazine enema, prolonged-release mesalazine once-daily 4 g is as effective and well tolerated as 2 g twice-daily for inducing remission in patients with mild-to-moderately active ulcerative colitis (Clinicaltrials.gov: NCT00737789).

Results of a national survey on quality of life in inflammatory bowel diseases.

AIMS: Inflammatory bowel diseases (IBD) have a negative impact on patients' quality of life. The aims of this survey were to learn more about patients' concerns, and to compare their feelings with the beliefs of their close relations and physicians. PATIENTS AND METHODS: A specific questionnaire, including the RFIPC and the MFI-20, was used. Patients' answers were compared with those given by their close relations and attending physicians. RESULTS: This national survey included 2424 French patients. At the time of diagnosis, 73% of patients expressed having fears, but were also relieved to understand their symptoms. IBD was responsible for fatigue and weariness, and had a negative impact on daily, occupational, leisure, family and personal life. The main fears concerned unpredictable flare-ups followed by need for an ostomy bag and risk of surgery. The answers provided by close relations and physicians matched those of the patients, but physicians overestimated the patient's knowledge and underestimated disease impact. CONCLUSION: IBD has a deleterious effect on quality of life. Close relations of the patient realize the impact the disease has on the patients' life, but attending physicians still tend to minimize patients' symptoms.

[Do general practitioners want to manage chronic hepatitis C and take part in hepatitis C health networks? A national survey]. / Les médecins généralistes souhaitent-ils prendre en charge l'hépatite chronique virale C et participer aux réseaux ville-hôpital?

OBJECTIVES: To assess information that general practitioners had on hepatitis C and on the hepatitis C network in hospitals and private practice. METHODOLOGY: A national telephone survey of 604 general practitioners was conducted between March 18 and 23, 1998. RESULTS: Screening and management of hepatitis C was important for 89% and 97% of general practitioners. Screening was performed in relation to the relative risk (IV drug users 89%, blood transfusion before 1991 88%). General practitioners wanted more information on treatment (54%), patient counselling (42%) and the potential risks of the disease (42%). Of 604 general practitioners, 6% were involved in a hepatitis C network, while 21% were involved in another network (drug users 9%, AIDS 8%). Of the 94% general practitioners who were not part of the network, 33% were willing to join a hepatitis C network. Only 56% were aware of a hepatitis C network (press article 30%, mailing 17% or local meeting 12%). The difficulties for the involvement of general practitioners were: lack of time, topics not adapted to daily practice and geographic constraints (74%), too few patients in their practice (52%), no need (38%), the idea itself of a network and lack of information (28%). CONCLUSION: General practitioners screen patients at risk of hepatitis C. They want to be better informed about treatment, patient counselling, and the potential risks of hepatitis C. They are less involved in hepatitis C networks than in other networks (drug, AIDS). However, one third of general practitioners would like to be involved in a hepatitis C network. These results could be useful for implementing post-graduate courses and general practitioner training.

[Treatment of human brucellosis with rifampicin]. / Traitement de la brucellose humaine par la rifampicine.

Rifampin, which exhibits good intracellular diffusion and in vitro bactericidal activity on brucella, is effective in experimental brucellosis in mice, without selection of resistant strains. It was therefore legitimate to use rifampin in man since conventional treatment of acute brucellosis is followed by recurrence in 15% (tetracycline alone) or 3.7% (streptomycin-tetracycline combination) of cases. Rifampin was given to 13 patients with brucellosis (acute brucellosis in 8, osteoarticular brucellosis in 3 and chronic brucellosis in 2). Rifampin was given as sole therapy in a daily dosage of 600 to 1 200 mg. A tetracycline was subsequently needed in three cases, in combination with rifampin in two, and as replacement therapy in one. Treatment lasted 20 to 60 days in acute brucellosis and 2 to 15 months in other forms. Only one failure was recorded among the 11 cases of acute or localized brucellosis. Conversely, effectiveness of rifampin proved incomplete (1 case) or null (1 case) in chronic forms. The satisfactory effectiveness of rifampin is confirmed by a review of the literature which found 17 reports addressing the subject. These include 324 cases of brucellosis treated by rifampin, as sole therapy in 255 patients, with only 24 failures ascribable to faulty dosage. Indeed, rifampin must be given for at least 30 days, in a minimal daily dosage of 600 mg or 10 mg per kg, in a single dose. Cotrimoxazole is an antagonist and should not be associated with rifampin. Conversely, tetracyclines are synergistic and their association, which is useless in acute brucellosis, is helpful in localized and chronic forms.

[Cardiac localizations of lymphomas. A case report and review of the literature (author's transl)]. / Les localisations cardiaques des lymphomes. Revue de la littérature à propos d'une observation.

A case of malignant lymphoma with cardiovascular manifestations is reported. It is a febrile form with compression of the aortic ring provoking a murmur simulating aortic valve disease with an Osler's graft. An analysis of the various complications due to lymphomas reported in the published literature emphasizes the iatrogenic nature of some of them: cardiac toxicity of chemotherapy, post-radiotherapy pericarditis, and increased incidence of coronaritis after both cobalt and radiotherapy. The diagnosis of lymphomas in the cardiac area is difficult but should be evoked in case of febrile and chronic cardiopathy, no other etiology being detectable.

[An unusual cause of recurrent pericarditis: esophageal leiomyosarcoma (author's transl)]. / Une cause inhabituelle de péricardite récidivante: le léiomyosarcome de l'oesophage.

A supposed primary and cortico-sensitive pleuropericarditis in a 33-year-old woman with an apparent recovery of 9 months, revealed an esophageal leiomyosarcoma with a fatal issue following tumoral and purulent invasion of the mediastinum with an esophagobronchial fistula. Pericardis of tumoral origin may appear as a benign cryptogenetic affection sensitive to corticotherapy. Acquired esophagotracheobronchial fistulae are usually of neoplastic origin and the prognosis is extremely severe, survival being rarely more than three months. 69 cases of esophageal leiomyosarcoma have been reported in the published literature, but survival was prolonged in some patients treated surgically. Investigations for possible esophageal lesions should be conducted in all cases of pericarditis of unknown origin.

[Chronic neurobrucellosis with negative Wright's reaction. 2 cases (author's transl)]. / Neurobrucelloses chroniques avec sérodiagnostic de Wright négatif. 2 observations.

In two patients suffering from chronic neurobrucellosis with negative Wright's reaction the diagnosis could be made by other serological methods: complement fixation, demonstration of blocking antibodies by indirect immunofluorescence or Coombs'test. The therapeutic problems raised by chronic neurobrucellosis are discussed.

[Multiple spleens without obvious cardiac abnormalities. Results of highly selective arteriography in one case (author's transl)]. / Polysplénie sans anomalie cardiaque patente. Un cas étudié par antériographie supersélective.

Multiple spleens were first discovered accidentally during abdominal arteriography and were then investigated by selective and highly selective injections. The vascularization of the small spleens was by means of a branch of a main coeliomesenteric artery, which appears to be a constant feature in this syndrome, and possibly by an accessory artery arising directly from the aorta.