Qualité de l'évaluation de l'état nutritionnel et évaluation de l'observance des compléments nutritionnels oraux chez des patients hospitalisés au CHU de Dijon.

International audienc

Delivery of oral nutrition supplement in hospital: Evaluation of professional practices in evaluation of nutritional status and representations of ONS by the caregivers and patients

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Uptake in the pancreatic uncinate process on the 111In-octreotide scintigraphy

International audienceBACKGROUND: The aim of this study was to assess the relevance of physiological In-octreotide uptake in the head of pancreas and to establish its imaging features in comparison with pathological uptake in patients with neuroendocrine tumors (NET).PATIENTS AND METHODS: We retrospectively reviewed all patients that underwent In-octreotide single-photon emission tomography (SPECT) scintigraphy in our institution. Only patients with an isolated uptake in the head of the pancreas were included. In-octreotidescintigraphy consisted in planar whole-body and abdominal SPECT/computed tomography (CT) images acquired at 6 and 30 h' postinjection. Different imaging features of the pancreatic focalized uptake were assessed: its precise location on the pancreas head, shape, intensity [visually and quantitatively by calculating the pancreatic to hepatic uptake ratio (L/H ratio)] and intensity changes.RESULTS: Thirteen patients out of 230 were included. Among them, a pancreatic NET was confirmed in five patients. On In-octreotide SPECT/CT, two of these had uptake located in the uncinate process, and three had uptake focused in the right lateral borders or in the whole head. SPECT images demonstrated high uptake (L/H ratio >2) in four patients out of five. In the eight remaining patients, pancreatic NET was ruled out. For all of these physiological cases, SPECT/CT acquisitions revealed that the uptake was both located in the uncinate process and with an L/H ratio below 2.CONCLUSION: The simple criteria of localization and uptake quantification can help to discriminate between a possible physiological uptake in the uncinate process of the pancreatic head and a pathological uptake induced by a NET

A Case of Violent Suicide Attempt in a Context of Myxedema Psychosis following Radioiodine Treatment in a Patient with Graves’ Disease

Introduction. Hypothyroidism has been associated with mood disorders but some cases of acute psychosis have also been reported. However, less attention has been paid to suicidal behavior in these patients. Case Report. We report a case of suicide attempt by self-stabbing in a 43-year-old woman without past psychiatric history, four months after radioiodine therapy for Graves’ disease. On clinical examination remarkable signs of myxedema were found and blood investigations showed hypothyroidism with an extremely high thyroid stimulating hormone (TSH) level (152 mUI/L; reference range 0.20-5.10). The patient presented delirium symptoms at the time of self-stabbing, which was associated with persecutory delusions and auditory harm command hallucinations. A rapid physical and psychiatric improvement was observed after the initiation of an oral thyroid replacement therapy without relapse after early discontinuation of the antipsychotic treatment. Discussion. The most distinctive feature of our case is that the violent suicide attempt could be attributed to the myxedema psychosis. Suicide may result from several factors, including psychosocial stressors, psychiatric symptoms, and hormonal disturbance. This unique presentation should remind clinicians to systematically consider ordering additional tests in patients with atypical psychiatric presentation, even when serious behavioral disorders (such as violent suicide attempts) are present and may result in premature transfer to psychiatric units

Impact of Oral Immunonutrition on Postoperative Morbidity in Digestive Oncologic Surgery

International audienceObjective: The objective of the present study was to assess the effect of preoperative immunonutrition on a nationwide scale.Background: According to international guidelines, immunonutrition should be prescribed before major oncologic digestive surgery to decrease postoperative morbidity. Nevertheless, this practice remains controversial.Methods: We used a prospective national health database named “Echantillon généraliste des Bénéficiaires.” Patients were selected with ICD10 codes of cancer and digestive surgery procedures from 2012 to 2016. Two groups were identified: with reimbursement of immunonutrition 45 days before surgery (IN-group) or not (no-IN-group). Primary outcome was 90-day severe morbidity. Secondary outcomes were postoperative length of stay (LOS) and overall survival. Logistic regression and survival analysis adjusted with IPW method were performed.Results: One thousand seven hundred seventy-one patients were included. The proportion of different cancers was as follows: 72% patients were included in the colorectal group, 14% in the hepato-pancreato-biliary group, and 12% in the upper gastrointestinal group. Patients from the IN-group (n = 606, 34%) were younger (67.1 ± 11.8 vs 69.2 ± 12.2 years, P < 0.001), with increased use of other oral nutritional supplements (49.5% vs 31.8%, P < 0.001) and had more digestive anastomoses (89.4% vs 83.0%, P < 0.001). There was no significant difference between the 2 groups for 90-day severe morbidity [odds ratio (OR): 0.91, 95% confidence interval (95% CI): 0.73–1.14] or in survival (hazard ratio: 0.89, 95% CI: 0.73–1.08). LOS were shorter in the IN-group [−1.26 days, 95% CI: −2.40 to −0.10)].Conclusion: The preoperative use of immunonutrition before major oncologic digestive surgery was not associated with any significant difference in morbidity or mortality. However, the LOS was significantly shorter in the IN-group

Change in Birth Rate Before and After Bariatric Surgery in France

International audienc