C Caulin

Publications (80)353.19 Total impact

• Article: [What explains the increased rate of thromboses among the elderly? Pathophysiological data].

  I Mahé, C Caulin, J E Bergmann
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  ABSTRACT: The incidence of both arterial and venous thrombosis increases with age. The explanation is probably multifactorial, since elderly patients often have several risk factors. Aging per se appears to be an independent risk factor for thrombosis: age-related modifications of the vascular apparatus and blood components contribute to the development of a procoagulant state. Arterial and venous thromboses involve varying degrees of coagulation and platelet activation.
  La Presse Médicale 08/2005; 34(12):887-95. · 0.67 Impact Factor
• Article: [Age, an independent risk factor for thrombosis. Epidemiologic data].

  I Mahé, C Caulin, J F Bergmann
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  ABSTRACT: The incidence of thrombosis--arterial and venous--increases with age. This is the case for atheromatous diseases, atrial fibrillation and even venous thromboembolic disease. Ischemic heart disease is the most common cause of death in the elderly. Atrial fibrillation, an independent risk factor for cerebral vascular accidents, affects around 10% of persons older than 80 years. The incidence of venous thromboembolic disease increases with age, reaching 12.5 per 1000 people older than 75 years, compared with 5 per 1000 aged 60-75 and 2.5 per 1000 aged 40-59. Elderly persons often have two or more cardiovascular or venous thromboembolic risk factors and thus a still higher risk of thrombotic events. Their risk of thrombosis justifies the systematic search for acquired risk factors to assess the level of risk and take appropriate prevention measures.
  La Presse Médicale 08/2005; 34(12):878-86. · 0.67 Impact Factor
• Article: Lack of effect of a low-molecular-weight heparin (nadroparin) on mortality in bedridden medical in-patients: a prospective randomised double-blind study.

  I Mahé, J F Bergmann, P d'Azémar, J J Vaissie, C Caulin
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  ABSTRACT: Hospitalised medical patients are at significant risk of venous thromboembolic disease through fatal pulmonary embolism; low-molecular-weight heparins have been proved efficient in preventing deep venous thrombosis in surgical and medical patients, but their effect on mortality in bedridden medical patients remains unknown. In a multi-centre, randomised, double-blind, placebo-controlled study, 2,474 consecutive patients aged over 40 years admitted to internal medicine departments in the last 24 h and unable to move alone were randomised to receive 0.3 ml nadroparin (7,500 anti-Xa units) or placebo for up to 21 days. The primary end-point was overall mortality at day 21. There were no significant differences between the patients' characteristics. Overall mortality between the two groups was not statistically different [10.08% (124 of 1,230) versus 10.29% (128 of 1,244), respectively, in the nadroparin and in the placebo groups; relative risk reduction 0.02, CI (-0.27, +0.25), P=0.89]. An autopsy was performed in 123 of the 252 patients who died (49%). Pulmonary embolism was discovered at autopsy in 10 of 63 patients in the nadroparin group and in 17 of 60 in the placebo group [relative risk reduction 0.38, CI (-0.27, +0.70), P=0.13]. Nadroparin does not have a significant effect on mortality in bedridden medical patients, based on the study results. The study provides no data suggesting that low-molecular-weight heparins might reduce the incidence of thromboembolic in-patients hospitalised for an acute medical disease.
  European Journal of Clinical Pharmacology 08/2005; 61(5-6):347-51. · 2.85 Impact Factor
• Article: Paracetamol: a haemorrhagic risk factor in patients on warfarin.

  I Mahé, N Bertrand, L Drouet, G Simoneau, E Mazoyer, C Bal dit Sollier, C Caulin, J F Bergmann
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  ABSTRACT: To quantify the effect of paracetamol on the anticoagulant effect of warfarin under normal clinical conditions. In a prospective double-blind, cross-over, placebo-controlled study, 11 patients on stable warfarin therapy received in random order two 14-day regimens of paracetamol 4 g day(-1) or placebo, with a 14-day or more wash-out period in between, time necessary to fulfil the inclusion criteria. In patients on paracetamol, the mean maximum increase in the International Normalized Ratio (INR) observed was 1.04 +/- 0.55 vs. 0.20 +/- 0.32 in those on placebo (P = 0.003). The mean maximum INR observed was significantly higher with paracetamol than with placebo (3.47 vs. 2.61, P = 0.01). In patients receiving paracetamol, the mean observed INR was significantly increased after 4 days (+ 0.6 +/- 0.6, P < 0.001). Paracetamol at 4 g day(-1) induces a significant increase in INR in patients receiving a stable regimen of warfarin, increasing the risk of bleeding associated with warfarin.
  British Journal of Clinical Pharmacology 04/2005; 59(3):371-4. · 2.96 Impact Factor
• Article: [Clinical practice guideline: medical and nonmedical therapeutic strategies for smoking cessation. Bit of therapeutic practice: management and current practice in smoking cessation].

  G Lagrue, B Le Foll, P Melihan-Cheinin, G Rostoker, J Ades, R de Beaurepaire, Y Berlin, A Borgne, P Coninx, B Dautzenberg, [......], C Funk-Brentano, C Le Jeunne, F Meyer, M Petit, O Reveillaud, C Riche, C Thery, F Tremolieres, J-H Trouvin, O Wong
  Revue des Maladies Respiratoires 12/2003; 20(5 Pt 1):791-4. · 0.59 Impact Factor
• Article: [Which antithrombotic treatment should be used in the treatment of an elderly patient with chronic atrial fibrillation?].

  I Mahé, A S Grenard, C Caulin, J F Bergmann
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  ABSTRACT: FREQUENCY AND CONSEQUENCES: The incidence of atrial fibrillation (AF) increases regularly with age and affects nearly 10% of persons aged over 80. The risk of thromboembolism (notably stroke) associated is enhanced the older the patient and the more cardiovascular risk factors she/he exhibits. ADVANTAGES AND RISKS OF ANTICOAGULANTS: Treatment with anticoagulants is the only treatment that has demonstrated its efficacy in reducing the risks of thromboembolism, however there is a risk of haemorrhage. IN PRACTICE: A patient with AF exhibits both a risk of thromboembolism and a risk of haemorrhage. When confronted with such patients, the practitioner must choose an antithrombotic (anticoagulant or anti-arrhythmic agent) after careful objective and individual assessment of all the risks present in a given patient.
  La Presse Médicale 08/2003; 32(25):1170-4. · 0.67 Impact Factor
• Article: D-dimer: a characteristic of the coagulation state of each patient with chronic atrial fibrillation.

  I Mahé, L Drouet, O Chassany, E Mazoyer, G Simoneau, A L Knellwolf, C Caulin, J F Bergmann
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  ABSTRACT: It is accepted that patients with atrial fibrillation (AF) are characterised by increased levels of plasmatic D-dimers, with a wide inter-individual variability depending on the patients and therapeutic characteristics, but it has not been established if this level was predictive of the risk of arterial thromboembolic event. In order to answer such a question, it has to be established if the D-dimer level in a given patient is characteristic of such a patient (stable over time) if also fluctuating with time (and useless to characterise the patient). One hundred thirty clinically stable patients with chronic AF were recruited (anticoagulant: group 1, antiaggregant aspirin: group 2, no antithrombotic: group 3). During the follow-up of patients without clinical events (n=63), it is notable that in patients with D-dimer levels <500 ng/ml, these remained <1000 ng/ml, in patients with levels between 500 and 1000 ng/ml, these did not reach 1590 ng/ml, and in those with D-dimers >1000 ng/ml, the levels remained relatively stable. Mean age and D-dimer levels were lower in group 1 (74.4 years and 509.1 ng/ml, respectively) than in group 2 (82.4 years, p=0.0003 and 1015.7 ng/ml, p<0.0001, respectively) and in group 3 (79.3 years and 1289.3 ng/ml, p<0.0001, respectively). The effect of the antithrombotic therapy was independent of the age of patients (p=0.017). D-dimer levels in patients with chronic AF remain in the same range over time. They are lower on anticoagulant therapy than on antiaggregant or no antithrombotic therapy, irrespective of age. Thus, D-dimers appear to be a useful parameter for assessing the degree of hypercoagulability of patients whatever their age.
  Thrombosis Research 07/2002; 107(1-2):1-6. · 2.44 Impact Factor
• Article: [Fatal fulminant acute amebic colitis in metropolitan France].

  I Mahé, V Delahaye, C Caulin, J F Bergmann
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  ABSTRACT: Emergency care is required for patients presenting dysentery and fever. A 65-year old patient living in metropolitan France was hospitalized for watery diarrhea that had progressively worsened over the last month. Rectal bleeding was also noted. Serology tests at admission, together with parasitology examination of the fecal matter and colonoscopy led to the diagnosis of intestinal amebiasis a few hours before the patient's rapid death. Serology was positive for amebas and the diagnosis was confirmed by pathology examination of the colonoscopy biopsies. The diagnosis of amebiasis should be entertained even in Europe when there is no history of travel to endemic areas in patients who develop suggestive manifestations. Identification of amebas in the fecal matter and serology tests provide certain diagnosis. Clinicians should recall that rapidly fatal outcome is not uncommon in severe forms. Emergency care is mandatory.
  La Presse Médicale 10/2001; 30(26):1295-7. · 0.67 Impact Factor
• Article: Increased oral ganciclovir bioavailability in HIV-infected patients with chronic diarrhoea and wasting syndrome--a population pharmacokinetic study.

  S Mouly, G Aymard, J P Tillement, C Caulin, J F Bergmann, S Urien
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  ABSTRACT: Despite a lack of data, the antiviral agent ganciclovir is not indicated in AIDS patients with diarrhoea because of its presumed poor oral bioavailability. To assess the effect of diarrhoea on ganciclovir intestinal absorption, we conducted a pharmacokinetic study in 42 HIV-infected patients categorized into three groups: A, HIV stage A and B (n = 15); B, AIDS stage C (n = 13); C, AIDS with chronic diarrhoea and wasting syndrome (n = 14). Each patient was evaluated for nutritional (body mass index, albumin, transferrin serum levels), inflammatory (haptoglobin, orosomucoid), immunological (CD4 count, plasma viral load) and intestinal (D-xylose test, faecal fat and nitrogen output, intestinal permeability) status. Ganciclovir (1 g) was administered orally to fasted patients. Six blood samples were collected over 24 h. Serum was analysed for ganciclovir by h.p.l.c. Population pharmacokinetic analysis was performed using a nonlinear mixed effects modelling program, MP2. Mean intestinal permeability (lactulose/mannitol urinary ratio) was increased in group C (0.2) compared with group A (0.05) and B (0.1) patients. Drug concentration-time profiles were best described by a two-compartment model. Apparent oral clearance (CL/F) and central volume of distribution (V1/F) were influenced by clinical status (group). For groups A and B combined, final parameter estimates of CL/F and V1/F were 256 +/- 98 l h(-1) and 1320 +/- 470 l, respectively. Final parameter estimates for group C were 118 +/- 108 l h(-1) and 652 +/- 573 l for CL/F and V1/F, respectively. The 95% confidence intervals on differences between A and B combined and C were statistically significant ([ + 70, + 206] for CL/F, and [+ 314, + 1022] for V1/F). Compared with groups A and B, ganciclovir CL/F was significantly decreased in group C patients. AIDS patients with diarrhoea and severe disease may benefit from ganciclovir therapy, but a dose adjustment may be required according to their digestive and immunological status.
  British Journal of Clinical Pharmacology 07/2001; 51(6):557-65. · 2.96 Impact Factor
• Article: Endoscopic evaluation of the gastrotolerance of short-term antalgic treatment with low dose k-diclofenac: a comparison of ibuprofen and aspirin.

  I Mahé, S Mouly, E Mahé, M Diemer, A L Knellwolf, G Simoneau, C Caulin, J F Bergmann
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  ABSTRACT: In a short-term gastro-duodenal endoscopic study in 12 healthy volunteers, the gastrotoxicity was not different after intake of diclofenac-K 12.5 mg (0.33) or ibuprofen 200 mg (0.42, P=0.66) but significantly higher after aspirin 500 mg (2.67, P=0.002).
  Fundamental and Clinical Pharmacology 03/2001; 15(1):61-3. · 1.80 Impact Factor
• Article: Interaction between aspirin and ACE inhibitors in patients with heart failure.

  I Mahé, C Meune, M Diemer, C Caulin, J F Bergmann
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  ABSTRACT: Both aspirin (acetylsalicylic acid) and ACE inhibitors are often used concomitantly, especially in patients with both heart failure and ischaemic heart disease, which is the most common underlying cause of heart failure. The safety of the association has been questioned because both drugs affect a related prostaglandin-mediated pathway. Thanks to their vasodilating properties, prostaglandins play an important role in heart failure where peripheral vasoconstriction occurs. Some of the beneficial effects of ACE inhibitors might be related to reduced degradation of bradykinin that enhances the synthesis of prostaglandins, while aspirin, through inhibiting the enzyme cyclo-oxygenase, inhibits the production of prostaglandins. To date no prospective study has been conducted to investigate the effect of long term aspirin treatment in the postinfarction period allowing the possible impact of the interaction between aspirin and ACE inhibitors upon survival to be confirmed or negated. However, the practitioner needs to know how to optimise the treatment of his or her patients. In order to stimulate arguments for and against the use of aspirin in patients with heart failure receiving ACE inhibitors, we searched MEDLINE from 1960 to 2000 using the key words heart failure, aspirin, and ACE inhibitors for English language articles and conducted a review of the available data. We report on the potential mechanisms of the interaction and the results of experimental studies on haemodynamic parameters. Results of retrospective clinical studies, subgroup analysis that were undertaken to evaluate the overall action upon haemodynamic parameters and survival of the association are summarised. Conflicting conclusions have been reported in the literature. Many explanations can be advanced to try to understand these conflicting conclusions: differences in study design (results of retrospective trials have to be interpreted with caution); differences in the choice of the evaluation parameter (problem of the clinical relevance of haemodynamic parameters); differences in the characteristics of the patient (different underlying cardiopathy, e.g. heart failure, hypertension or ischaemic cardiopathy); and differences in the type and the dosage of each treatment (especially ACE inhibitors and aspirin since an interaction might occur more often with dosage of aspirin greater than 250mg).
  Drug Safety 02/2001; 24(3):167-82. · 3.63 Impact Factor
• Article: Interaction between angiotensin-converting enzyme inhibitors and aspirin: a review.

  C Meune, I Mahe, J J Mourad, G Simoneau, A L Knellwolf, J F Bergmann, C Caulin
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  ABSTRACT: Aspirin and angiotensin-converting enzyme inhibitors (ACEIs) are often associated for the treatment of coronary disease and/or chronic heart failure, but conclusions of some prospective and retrospective studies show a possible negative interaction between aspirin and ACEIs. ACEIs inhibit the conversion of angiotensin I to angiotensin II and also the catabolism of bradykinin, which results in increased synthesis of vasodilatory agents [prostaglandins and nitric oxide (NO)], whereas aspirin inhibits prostaglandin synthesis. Thus, a potential interaction from the opposing effects of aspirin and ACEIs could affect the metabolism of bradykinin. We conducted an extensive Medline search, as well as a manual search, of published literature including pharmacodynamic studies and clinical trials concerning the impact of aspirin on the effect of ACEIs in hypertension, coronary disease and chronic heart failure. A review of this literature shows five studies in hypertension (all prospective and using blood pressure as the main criterion of assessment), five in coronary disease (three retrospective and two prospective trials, four of which use mortality as the criterion of assessment) and 13 in chronic heart failure (eight using haemodynamic measurements of which seven are prospective--one prospective study using pulmonary tests, four using clinical events including mortality as criterion of assessment of which two are prospective). The counteraction of ACEI efficacy by aspirin is demonstrated in one out of five studies in hypertension, one out of four of studies in coronary disease and nine out of thirteen in chronic heart failure. This counteraction is more often observed with high dosages of aspirin (greater than 250 mg/day, four out of six studies) and less often with lower dosages (less than or equal to 250 mg/day, three out of 11 studies). These studies are retrospective analyses or use haemodynamic end-points, so there is as yet no methodological argument strong enough to contraindicate the aspirin-ACEI association or to prove the clinical relevance of this interaction. In conclusion, prospective studies using mortality as a criterion of assessment are needed to offer the practitioner the answer to the question of ACEI-aspirin association.
  European Journal of Clinical Pharmacology 01/2001; 56(9-10):609-20. · 2.85 Impact Factor
• Article: [Survey of the negativation of bacteriologic tests in patients with active pulmonary tuberculosis: how long should the isolation be?].

  V Denis, J Salord, L Raskine, M Sanson-Le Pors, M Diemer, C Caulin, J Bergmann
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  ABSTRACT: The risk of contamination by contact with patients with tuberculosis is reduced by isolation of patients until negativation of direct sputum analysis for the research of tuberculosis bacilli. To evaluate the efficacy of this isolation, we compared, in 32 patients with active tuberculosis, the results of direct examination and culture of the sputum and the clinical outcome. Thirty-two successive patients hospitalized in the same internal medicine unit, received antituberculosis drugs and had 3 sputum examinations per week with direct analysis and culture until negativation of the 3 direct examinations. Then, isolation ended. At the time of direct-negativation, 14 of the 32 patients kept positive cultures. In the 18 remaining subjects, the cultures became negative, about seven days before direct-negativation. Patients with negative cultures had more frequently weight increase (83% versus 71%), were more rapidly without fever (11 days versus 19 days), had less cough and had less severe radiologic disease (50% versus 75%) compared to patients with positive cultures but these differences were not statistically significant due to the small sample size. In tuberculosis patients, 3 successive negative direct sputum examinations do not eliminate the risk of tuberculosis transmission, specially to hospitalized or immunocompromised patients. The risk of contamination in these cases, although unknown, may be weak. Terminating isolation should not be based on sputum examination alone, but also on other factors such as the clinical course (resolution of cough and fever, weight), the initial number of bacilli, and the severity of the radiological lesions.
  Annales de medecine interne 01/2001; 151(8):618-23.
• Article: Oral ganciclovir systemic exposure is enhanced in HIV-infected patients with diarrhea and weight loss.

  S Mouly, G Aymard, B Diquet, C Caulin, J F Bergmann
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  ABSTRACT: To determine whether diarrhea and intestinal malabsorption during HIV infection alter oral ganciclovir systemic exposure. We studied the oral disposition of ganciclovir in 42 HIV-infected patients stratified into three groups: A (n = 15), HIV (stage A and B); B (n = 13), AIDS (stage C); and C (n = 14), AIDS with chronic diarrhea and wasting syndrome (10% or more weight loss). Each patient was evaluated for nutritional (body mass index, serum albumin and transferrin), immunologic (CD4 count, plasma viral load) and intestinal status (D-xylose test, fecal fat and nitrogen excretion, and intestinal permeability). Following an overnight fast, 1 g oral ganciclovir was given to patients. Six blood samples were collected over 24 hours. Serum was analyzed for ganciclovir by high performance liquid chromatography. Drug disposition was characterized using a population pharmacokinetic approach. Mean intestinal permeability increased as HIV disease progressed (0. 05, 0.1, and 0.2 for groups A, B, and C, respectively). Average weight-adjusted maximum concentration (Cmax) in group C was twofold more than that in group A and B patients (12.5 versus 6 and 6.4 ng/ml/kg), and average area under the curve (AUC0-infinity) was threefold greater in group C patients (193 versus 59 and 65 ng. hour/ml/kg in groups A and B, respectively). Mean oral clearance was threefold lower in group C (96 versus 258 and 212 L/hour in groups A and B, respectively). Because systemic exposure of oral ganciclovir is enhanced in AIDS patients with diarrhea and wasting syndrome, oral ganciclovir therapy may benefit these patients.
  JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2000; 24(4):344-51. · 4.43 Impact Factor
• Article: PEP trial. Pulmonary Embolism Prevention.

  I Mahé, J F Bergmann, E Mahé, C Caulin
  The Lancet 08/2000; 356(9225):248; author reply 250-1. · 38.28 Impact Factor
• Article: Interaction between angiotensin-converting enzyme inhibitors and aspirin: a review

  C. Meune, I. Mahe, J.J. Mourad, G. Simoneau, A.L. Knellwolf, J.F. Bergmann, C. Caulin
  [show abstract] [hide abstract]
  ABSTRACT: Aspirin and angiotensin-converting enzyme inhibitors (ACEIs) are often associated for the treatment of coronary disease and/or chronic heart failure, but conclusions of some prospective and retrospective studies show a possible negative interaction between aspirin and ACEIs. ACEIs inhibit the conversion of angiotensin I to angiotensin II and also the catabolism of bradykinin, which results in increased synthesis of vasodilatory agents [prostaglandins and nitric oxide (NO)], whereas aspirin inhibits prostaglandin synthesis. Thus, a potential interaction from the opposing effects of aspirin and ACEIs could affect the metabolism of bradykinin. We conducted an extensive Medline search, as well as a manual search, of published literature including pharmacodynamic studies and clinical trials concerning the impact of aspirin on the effect of ACEIs in hypertension, coronary disease and chronic heart failure. A review of this literature shows five studies in hypertension (all prospective and using blood pressure as the main criterion of assessment), five in coronary disease (three retrospective and two prospective trials, four of which use mortality as the criterion of assessment) and 13 in chronic heart failure (eight using haemodynamic measurements of which seven are prospective - one prospective study using pulmonary tests, four using clinical events including mortality as criterion of assessment of which two are prospective). The counteraction of ACEI efficacy by aspirin is demonstrated in one out of five studies in hypertension, one out of four of studies in coronary disease and nine out of thirteen in chronic heart failure. This counteraction is more often observed with high dosages of aspirin (greater than 250 mg/day, four out of six studies) and less often with lower dosages (less than or equal to 250 mg/day, three out of 11 studies). These studies are retrospective analyses or use haemodynamic end-points, so there is as yet no methodological argument strong enough to contraindicate the aspirin-ACEI association or to prove the clinical relevance of this interaction. In conclusion, prospective studies using mortality as a criterion of assessment are needed to offer the practitioner the answer to the question of ACEI-aspirin association.
  European Journal of Clinical Pharmacology 01/2000; 56(9):609-620. · 2.85 Impact Factor
• Article: Impact of guidelines to alter antitetanus prophylaxis practices and reduce costs in the emergency department.

  D Elkharrat, A Boyer Chammard, L Raskine, I Durand-Zaleski, A Zerbani, C Caulin, C Chastang
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  ABSTRACT: The objective of this study was to assess the impact of an intervention to modify antitetanus prophylaxis of open wounds. This prospective, before-and-after study was conducted in an emergency department of a large metropolitan hospital. Consecutive patients with open wounds were managed according to the World Health Organization (WHO) guidelines before an intervention, then according to new guidelines afterwards. Locally developed guidelines were introduced and backed up by a teaching program, with emphasis on reducing unwarranted human tetanus immunoglobulins and costs. Serum tetanus antitoxins level was measured in postintervention patients mainly to verify the soundness of the intervention, eventually to complete patients' protection during follow-up, and to derive more reliable recommendations for the future. Main outcome measures included the number of treatments conforming to each set of guidelines, the rate of tetanus immunoglobulin prescriptions, and the cost of each strategy. Two groups of 389 and 459 patients were included. Treatment conforming to guidelines increased from 60% to 79%, undertreatment decreased from 31% to 19%, and overtreatment decreased from 9% to 2% (P < 0.001). Tetanus immunoglobulin prescriptions decreased from 23% to 1% (P < 0.001). On the basis of antitoxins level, 60% of 367 postintervention patients were correctly treated, 29% were overtreated, and 11% were undertreated. Nevertheless, with the WHO guidelines, only 49% would have been correctly treated, 39% would have been overtreated (29% with immunoglobulins), and 12% would have been undertreated (P < 0.001). Costs decreased from $32 to $24 per patient. New guidelines resulted in improved tetanus prophylaxis at reduced costs in an emergency department. Because they rely on immunization history, however, guidelines currently in use are misleading. More reliable recommendations, including a test for tetanus antibody status in some cases, are needed.
  American Journal of Therapeutics 07/1999; 6(4):203-9. · 1.49 Impact Factor
• Article: Reporting on quality of life in RCTs. Authors are creating database of quality of life questionnaires.

  O Chassany, J F Bergmann, C Caulin
  BMJ 05/1999; 318(7191):1142. · 14.09 Impact Factor
• Article: Validation of a specific quality of life questionnaire for functional digestive disorders.

  O Chassany, P Marquis, B Scherrer, N W Read, T Finger, J F Bergmann, B Fraitag, J Geneve, C Caulin
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  ABSTRACT: Dyspepsia and irritable bowel syndrome are suitable conditions for assessment of quality of life. Their similarities justify the elaboration of a single specific questionnaire for the two conditions. To examine the process leading to the validation of the psychometric properties of the functional digestive disorders quality of life questionnaire (FDDQL). Initially, the questionnaire was given to 154 patients, to assess its acceptability and reproducibility, analyse its content, and reduce the number of items. Its responsiveness was tested during two therapeutic trials which included 428 patients. The questionnaire has been translated into French, English, and German. The psychometric validation study was conducted in France, United Kingdom, and Germany by 187 practitioners. A total of 401 patients with dyspepsia or irritable bowel syndrome, defined by the Rome criteria, filled in the FDDQL and generic SF-36 questionnaires. The structure of the FDDQL scales was checked by factorial analysis. Its reliability was expressed by a Cronbach's alpha coefficient of 0.94. Assessment of its discriminant validity showed that the more severe the functional digestive disorders, the more impaired the quality of life (p<0.05). Concurrent validity was supported by the correlation found between the FDDQL and SF-36 questionnaire scales. The final version of the questionnaire contains 43 items belonging to eight domains. The properties of the FDDQL questionnaire, available in French, English, and German, make it appropriate for use in clinical trials designed to evaluate its responsiveness to treatment among patients with dyspepsia and irritable bowel syndrome.
  Gut 05/1999; 44(4):527-33. · 10.11 Impact Factor
• Article: Relevance in the emergency department of a decisional algorithm for outpatient care of women with acute pyelonephritis.

  D Elkharrat, C Chastang, M Boudiaf, A Le Corre, L Raskine, C Caulin
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  ABSTRACT: The outcome of three types of management for patients with acute pyelonephritis, in an emergency department is assessed. This was carried out by a prospective enrolment of patients with acute pyelonephritis. Through a decisional algorithm, doctors were encouraged to discharge female patients under 60 years with acute uncomplicated pyelonephritis, either directly from the emergency ward or after a short stay in the observation unit. All received a single intravenous dose of pefloxacin, after urine and blood cultures were obtained; before discharge a normal ultrasonography of the abdomen and the pelvis was required. Conversely, hospitalization was advised for patients who did not fit the criteria of uncomplicated pyelonephritis. Only females with positive urine cultures qualified. Of 83 patients enrolled, 70 were females with positive urine cultures, 60 of whom had uncomplicated pyelonephritis. At 3 weeks, two of 70 patients were lost to follow-up. In the remaining 68, favourable outcome was observed in 98% of 48 patients discharged from the observation unit (95% CI: [94%; 100%]), 90% of 10 discharged from the emergency ward (95% CI: [73%; 100%]) and 70% of 10 hospitalized (95% CI: [50%; 93%]). A decisional algorithm was useful in determining that over 85% of women who present to our emergency department with pyelonephritis have an uncomplicated form and may be safely treated as outpatients, if necessary after a brief stay in the observation unit. Prospective controlled trials are needed to determine duration of antimicrobial therapy, length of follow-up and finally, to compare tolerance and cost-effectiveness of outpatient vs. inpatient care of acute uncomplicated pyelonephritis.
  European Journal of Emergency Medicine 04/1999; 6(1):15-20. · 0.90 Impact Factor