Bowel obstruction due to a right paraduodenal hernia with midgut malrotation.

Right paraduodenal internal hernia, which has an embryonic origin, can be a rare cause of bowel obstruction, generally in young adults. We report the case of a young man who sought emergency care for acute abdominal pain with obstruction.

Attitudes towards Alzheimer's disease as a risk factor for caregiver burden.

BACKGROUND: There is abundant literature on the determinants of caregiver burden in Alzheimer's disease (AD), but little is known about the possible implication of specific patterns of a caregiver's attitudes towards the disease that could increase their risk of--or protect them from--emotional distress and burden. The aim of this study was to test the hypothesis that negative attitudes towards AD are associated with an increased level of burden experienced by caregivers of AD patients. METHODS: Family caregivers of 51 patients with AD were asked to complete a questionnaire regarding their attitudes towards AD. In addition, we assessed the level of their quality of life, anxiety and depression as well as their perceived level of burden. In parallel, we documented the patients' characteristics: global cognitive efficiency (Mini-Mental State Examination), behavioral and affective symptoms (Neuropsychiatric Inventory) and functional level (Instrumental Activities of Daily Living). RESULTS: The score of caregiver burden was positively correlated with negative attitudes such as authoritarianism (r = 0.41, p < 0.01) and social restrictiveness (r = 0.49, p < 0.001) as well as emotional reactions of anxiety (r = 0.44, p < 0.01) and aggressiveness (r = 0.47, p < 0.001). In addition, scores of social restrictiveness, rejection and anxiety were significantly higher in women than in men. CONCLUSION: These results may have implications in terms of the prevention of caregiver burden. In particular, educational and support programs for caregivers should not be limited to developing their knowledge and skills but should also target attitudes towards the disease.

["Syndrome de glissement": clinical description, psychopathological models, and care management]. / Le syndrome de glissement : description clinique, modèles psychopathologiques, éléments de prise en charge.

"Syndrome de glissement", a French geriatric concept, is a serious state of physical and psychological destabilization, including anorexia, malnutrition, withdrawal and opposition. It can be compared to the American "failure to thrive syndrome" although it is a somewhat different and less extensive conception. It occurs after a free period following a disease being cured or a moving event. Considering that it has no known medical etiology and that it presents psychological symptoms, several theories can be considered. It differs from melancholia in several points: clinically, depressive thoughts are not as clear as in melancholia; biologically, there is no history of bipolar disorder and there is a poor response to antidepressants; according to a psychoanalytical model, there no longer appears to be any mental work, unlike in melancholia. Psychopathological mechanisms could be close to essential depression, involving disunion of instincts, and progressive disorganization, with a psychosomatic disorganization following a traumatism. The comparison with anaclitic depression of babies, also proposed for the American failure to thrive syndrome, leads us to question the link between "syndrome de glissement" and early traumatisms such as maternal deprivation. Moreover, it enhances the importance of environment and lack of anaclisis for the onset of a "syndrome de glissement" and its evolution. Relationship between the patient and his/her caretakers is frail and extremely necessary. When the syndrome occurs, relatives and caretakers are submitted to violent feelings, which can give rise to excessive reactions. This is the reason why a third party is required in order to support the caregiver-caregiven couple, which can be the institution. It is the only way caretakers can be supportive enough for the patient.