Rectal tissue, plasma and urine concentrations of mesalazine after single and multiple administrations of 500 mg suppositories to healthy volunteers and ulcerative proctitis patients.

OBJECTIVE: Patients with ulcerative proctitis may have rectal mucosal properties different from healthy volunteers. This project compared the pharmacokinetics of rectally administered mesalazine in these two populations. METHODS: In two separate studies, nine patients with ulcerative proctitis and 16 healthy volunteers received a single 500 mg mesalazine suppository and then 500 mg every 8 h for 5 days. Blood samples were collected for 12 h in healthy volunteers and 30 h in patients, and urine for 24 h in healthy volunteers and 30 h in patients. Rectal biopsies were performed 8 h after the last dose. RESULTS: After a single dose to patients, mean mesalazine half-life (s.d.) was 5.0 (3.6) h. At steady-state, means (s.d.) were 89.1 (78.9) ng/mL for C(min), 361.1 (240.8) ng/mL for C(max), and 7.1 (7.3) h for half-life. Mean (range) rectal mesalazine concentrations were 167 (1.4-541.6) ng/mg tissue. After a single dose in healthy volunteers, mean (s.d.) half-life was 4.0 (4.7) h. At steady-state, means (s.d.) were 22.4 (61.6) ng/mL for C(min), 359.4 (166.3) ng/mL for C(max), and 0.9 (0.5) h for half-life. CONCLUSION: Mesalazine is released in the rectum of patients, with a bioavailability of about 40%. Tissue distribution is also appreciable. Both parameters appear higher than in healthy volunteers.

Appendicitis is a place for clinical judgement.

BACKGROUND: Acute appendicitis remains a clinical entity. Reports of negative appendectomies range from 9% to 40%. The goal of this study is to evaluate clinical performance and factors associated with complicated appendicitis. METHODS: Records of patients with a preoperative or postoperative diagnosis of appendicitis between January 1994 and December 1997 were reviewed. Demographic, clinical, and paraclinical data were collected. Multivariate analysis was carried out by logistical regression. RESULTS: Two hundred and thirty-seven consecutive cases were reviewed (male 132, female 105). The mean age was 31.4 +/- 16.8. Twenty-three cases had other surgical conditions. In the remaining cases (n = 214), 127 (59.4%) had noncomplicated appendicitis, 69 (32.2%) had complicated appendicitis, and 18 (8.4%) had negative exploration. Delays occurring before first medical consultation were significantly longer in patients with complicated appendicitis (3.30 days) and negative exploration (3.00 days) compared to patients with noncomplicated appendicitis (1.24 days) (P < 0.001). CONCLUSIONS: Acceptable rates of negative appendix and complicated appendicitis can be obtained from clinical data. The presence of complicated appendicitis is primarily associated with a longer delay before first medical consultation.

[Digital thermography for the evaluation of the effect of betamethasone in the treatment of acute sinusitis. Preliminary study]. / La thermographie numérisée pour l'évaluation de l'action de la bétaméthasone dans le traitement des sinusites aiguës. Etude préliminaire.

OBJECTIVES: Heat emitted during the process of inflammation can be visualized by means of dynamic telethermography (DDT). In the case of sinusitis, it is possible to verify the efficacy of an anti-inflammatory treatment such as betamethasone. PATIENTS AND METHODS: Ten adult ambulatory patients with sinusitis were treated with 2 tablets of betamethasone (Celestene) 2 mg daily for 10 days without concomitant medications. DDT images were obtained on day 0, day 2, day 3, day 5 and day 10. A color chart indicated differences in temperature according to the selected sensitivity. Computer analysis of the images was then obtained. Clinical assessment of symptoms and tolerance were recorded at the same time-points as the DDt images. RESULTS: The effect of treatment was beneficial in all patients since cure of sinusitis was achieved in 5, with marked improvement in 4 others and fair improvement in 1. Pain was significantly reduced on day 10 compared with day 0 (Friedman's test p < 0.0001). There was a simultaneous reduction of sinusitis associated signs: rhinorrhea, lacrimation, photophobia and cutaneous hyperesthesia as well as of general signs. On the DDT images, right-sinus to right-side and left-sinus to left-side ratios both showed a significant decrease between day 0 and day 10 from 41.00 +/- 14.07 to 7.90 +/- 7.22 (ANOVA p < 0.0001) and from 30.70 +/- 5.20 +/- 6.49 (ANOVA p < 0.0001) respectively. DISCUSSION: Whereas in animal pharmacology inflammation can be evaluated by any number of objective methods, only a very few are applicable to clinical situations. Powerful computer image analysis may prove useful in establishing nature and severity based inflammation reduction standards. CONCLUSION: These preliminary findings demonstrated that in most cases single agent therapy provides adequate and rapid control of clinical and thermographic signs of acute sinusitis. Computer analysis corraborates clinical findings and thermogram interpretations.

[Early diagnosis of silent atherosclerosis and detection of cardiovascular risk factors. A new strategy for the approach of cardiovascular prevention]. / Diagnostic précoce de l'athérosclérose silencieuse et dépistage des facteurs de risque cardiovasculaire. Nouvelle stratégie d'approche de la prévention cardiovasculaire. Groupe PCVMETRA.

The authors present a new strategy for cardiovascular disease prevention based on risk factor detection in occupational medicine and silent atherosclerosis detection in a specialized investigation centre. Employees from several firms in the Paris region were searched, in their working place, for cardiovascular risk factors, including blood cholesterol measurement. The subjects at risk thus selected underwent non-invasive explorations aimed at an early detection of silent atherosclerosis. Extracoronary plaques in the carotid, aorta and femoral arteries were detected by high-resolution ultrasonography, and coronary calcifications by ultrafast CT. The prevalence of arterial lesions and their relationship with risk factors were analysed in a subgroup of 208 untreated male subjects with high blood cholesterol level: 74 percent of these subjects had extracoronary plaques and 65 percent had coronary calcifications. This high prevalence of silent arterial lesions suggested that hypercholesterolaemia, even when moderate, has an early but inconsistent atherogenic effect. Moreover, extracoronary plaques and coronary calcifications were related to risk factors other than blood lipids, and among these factors age was predominant. The simultaneous detection of extracoronary and coronary lesions has demonstrated that extracoronary ultrasonography of several arteries is a good diagnostic test predicting the presence of coronary calcifications in the absence of coronary symptoms. Detection of silent atherosclerosis in subjects at risk therefore is an original and helpful complement to risk factor detection. It should better refine and individualize the diagnosis of risk and evaluate the effects of preventive cardiovascular treatments on atherosclerosis.

[Color coding in vascular Doppler echography aimed at improving lesion quantification]. / Le codage couleur en échographie Doppler vasculaire. Vers une amélioration de la quantification lésionnelle.

Color flow duplex scanning diffusion is now restricted by an expansive cost. Static or dynamic range of a faint endovascular image can better be assessed by mean velocities. Pathologic high velocities allows visualisation of the direction and the width of the jet. The Doppler cursor can be correctly aligned in the jet core and allows accurate measures, and the display of spectral analysis is better with faster computers. Recently, enhancement of low flow analysis is of particular interest in pre-occlusive or occlusive vascular pathology.

[Delayed clinical course of right ventricular infarction. Importance of changed diastolic function]. / Evolution clinique retardée d'un infarctus du ventricle droit. Importance des modifications de la fonction diastolique.

This observation illustrates once more the possibility of a delayed appearance of clinical manifestations of the infarction of the right ventricle. Morphological analysis during the catheterization provides a means for a detailed presentation of the adiastolic syndrome, stressing the importance of diastolic function of the right ventricle, especially the role of pericardium. The role of pericardial compliance seems to be brought into play by the acute dilatation of the right ventricle during its necrosis consecutive to the thrombosis of the right coronary artery at its genu superius.

Medical information management: improving the transfer of research results to presurgical evaluation.

We designed a medical information management (MIM) system to 1) identify high-risk patients (with cardiopulmonary dysfunction or undergoing major surgery), and 2) augment traditional mechanisms for referring high-risk patients to respiratory specialists. We define MIM as the combination of techniques that solicit, record, transfer, analyze, and distribute patient data according to designated protocols. A randomized trial compared 247 control subjects with 272 surgical patients assisted by information management. Data analysis focused on patients with cardiopulmonary impairment. The results showed that the MIM assisted patients received (1) more preoperative respiratory assessments (83.2 per cent vs. 9.2 per cent) than controls, 2) more preoperative respiratory therapy (37.9 per cent vs. 8.0 per cent) and 3) fewer postoperative respiratory complications (8.4 per cent vs. 16.1 per cent) than controls. These findings suggest that a MIM system can be an effective auxiliary mechanism for improving presurgical care.