Mental health in medical, dental and pharmacist students: a cross-sectional study

Introduction

Health student’s mental health is considered a public health issue that dramatically increased with COVID 19’s pandemic. However, very few studies assessed the prevalence of mental health in medical, pharmacist, and dental students.

Objectives

Our goal was to assess mental health in health students from the same university one year after pandemic’s beginning and look at for associated factors.

Methods

An online survey was realized in Paris university which has the 3 specialties (medicine, pharmacy, and dental). We used the Hospitalization Anxiety and Depression scale, Composite International Diagnostic Interview - Short Form questionnaire, Maslach Burnout Inventory (with 2 versions (Student survey and Human Services Survey). We also asked for 12 months of suicidal ideation, humiliation, sexual harassment, and sexual aggression. We did multivariable logistic regression analyses to identify Major Depressive Episode (MDE) associated factors.

Results

We included 1925 students: 95 dental, 233 pharmacists, 541 medical preclinic, 587 medical clinic and 469 residents. Overall prevalence of 7- days anxiety symptoms, 7- days depressive symptoms, 12-month MDE, 12-month suicidal ideation, humiliation, sexual harassment and sexual aggression were 55%, 23%, 26%, 19%, 19%, 22% and 6% respectively. There were significative differences between groups for anxiety and depressive symptoms and MDE (p<0.001 for all). Associated factors to MDE in multivariable logistic regression were humiliation (OR=1.71, IC95[1.28-2.28]), sexual harassment (OR=1.60, IC95[1.19-2.16]), sexual abuse (OR=1.65, IC95[1.04-2.60])) and moderate (OR=1.49, IC95[1.17-1.90]) or important (OR=2.32, IC95[1.68-3.20]) subjective financial difficulties.

Conclusions

Health student’s prevalence of psychiatric symptoms is significant, but it seems possible to intervene on several risk factors.

Disclosure

No significant relationships.

[Validation of a French version of the 16-item Prodromal Questionnaire (fPQ16) in adolescents and young adults seeking help]

INTRODUCTION

The duration of untreated psychosis has been largely associated with poor outcomes in psychosis. Actual diagnostic tools may be used by very specialized teams and need sustained evaluation. We present a French version of a self-report questionnaire: the 16-item Prodromal Questionnaire (fPQ16). Our objective was to evaluate its predictive value for an ultra-high-risk state (UHR) or psychosis. The population enrolled was consulting in a young adults and adolescents center in Sainte-Anne hospital, Paris, France.

METHODS

PQ16 had first been translated into French and independently back translated and validated by the original authors. Between November 2016 and May 2018, every C'JAAD consulting patient was proposed to fill in the fPQ16. Each patient was next evaluated with the French version of the comprehensive assessment of at-risk mental state (CAARMS), which detects UHR or psychosis. Statistical analysis of fPQ16 concurrent validity was performed using ROC curves. fPQ16 acceptability was studied by four additional questions especially designed for that purpose.

RESULTS

One hundred participants were included. Mean age was 19.85years (SD 3.3 y). Fifty-eight percent of patients included were diagnosed with UHR (40%) or psychotic (18%) state after CAARMS evaluation. Mean score at fPQ16 was 5.7 (SD 3.8). Best cut-off score was 4 positive items, with excellent sensibility (91%) and correct specificity (60%). Positive predictive value of fPQ16 was 76%. Area under the curve was 0.85 (P<0.0001). fPQ16 showed good acceptability.

DISCUSSION

fPQ16 had good screening performances in our population. Cut-off score was lower than in previous studies, but performances were equal or better. As a well-accepted and short questionnaire, the fPQ16 could be a great screening tool in primary care. A version with 18-items, including two items focused on thought content and disorganization that are missing in PQ16, is under evaluation.

[Student's mental health: better measurement and considereration of the challenges]

Mental health represents a high cost for society, estimated at 109 billion euros per year in France, 80 % of which are indirect costs. Mental diseases start before the age of 24 for 75 % of patients. Students, whose age is predominantly between 18 and 25, are a particularly high-risk population and for whom mental illness can have very serious consequences. The Observatoire de la vie Etudiante surveys from 2016 found a 12 month prevalence of depression of 15 % with suicidal thoughts in 8 % of the students higher than what is observed in the French general population, respectively 10 % and 5 %. The confinement itself and its consequences both economic (unemployment, difficulty for young people to find a job…) and social (isolation) could have a very bad effect on their mental health. The survey made by a governmental organization (Santé Publique France) revealed a significant increase in the prevalence of anxiety disorders at the start of confinement in the general population. This prevalence decreased during confinement but remained significantly higher than in 2017. Economic simulated data indicate that prevention in mental health could not only be effective but also profitable. In France, reimbursement by national health insurance of 12 sessions of psychologists for young people (between 11 to 21) is being tested in order to further and widely implement psychological prevention strategies rather than relying on already widely reimbursed pharmacological treatments. There are, however, several issues to discuss. First of all, is the need to define what psychopathology is considered to be. Then, it should be understood how measures of these concepts are created, how tools are constructed and how they operate in their environment. For depression, many different scales exist and even if the most used one are taken into account, they have very little content or symptoms in common. In addition, for the same scale, many different cut-offs exist to define whether a case should be considered as pathological or not, and so it is with the period of time studied being considered that may vary, both leading to consequences such as the differences observed in prevalence. Other biases should also be considered such as the age of the participants, the gender, the size of the sample, the response rate, the method of assessment and recruitment. Finally, it is necessary to question the assumptions and models used concerning the causes of psychic pathologies. Biological hypotheses on the origin of depression involve genetics and inflammation, but sociological and psychological factors must also be considered as well as the underlying complexity both in their nature and interactions at different structural levels of space and time. We should avoid drifting towards a biological or a sociological reductionism and move forward through complex systems approaches and models. With regard to student mental health in France, unfortunately, quality data are still lacking, and existing studies are difficult to compare as some may also have methodological issues. This article leads to the conclusion that there is a need for policies to assess student mental health at both local and national levels with a reflexional thinking on the tools and scales to use as measurements of these phenomena. This approach does not require being too assertive, but should have full transparency on the way the measures were designed and obtained. Measures are as much needed as are the needs for coordinated prevention and care in mental health.

SAT0634-HPR PATIENT-REPORTED OUTCOMES REGARDING TWO FORMS OF METHOTREXATE AUTOINJECTORS IN RHEUMATOID ARTHRITIS: AN INTERNATIONAL CROSS-OVER SURVEY

Background:

Several types of methotrexate (MTX) autoinjectors (AI) are currently marketed in rheumatoid arthritis (RA), yet comparative data are scarce.

Objectives:

Investigate respective perceptions of patients regarding two marketed forms of MTX AIviaa survey conducted by a global market research company.

Methods:

Patients with moderate to severe RA treated by one of the two forms of MTX AI were recruited. In each participating country (France, Ireland, United-Kingdom, Spain), the respective proportions of recruited patients were approximately aligned on local market shares. The two investigated devices were: A-AI/ The first MTX AI marketed in Europe: bigger size, with an activation button, without double injection sound-control, with a larger window; B-AI/ The second MTX AI commercialized in Europe: smaller and thinner size, without activation button, with double injection sound-control and a smaller window. Each patient was interviewed during 30 minutes on his or her satisfaction level with the currently used device. Then, they were presented the alternative AI and they could test it on skin-mimicking pads. After this step, the patients were interviewed on the alternative device.

Results:

100 patients were enrolled over one-month period (A-AI users, n=65; B-AI users, n=35). Overall, 61% of A-AI users reported that B-AI was “better” or “much better” whereas 43% of B-AI users judged A-AI as “better” or “much better”. When B-AI users were asked to evaluate convenience elements of A-AI, recognition of injection ending, general design and ease of use were the indicators that were the most poorly judged (60%, 54%, and 46% respectively). When A-AI users were cross-tested for B-AI, injection mode, general feeling, and ease of use were the three items providing the greatest satisfaction (80%, 77%, and 75%, respectively). When they were asked about the characteristics of their usual device, the button, the design of the device and discomfort associated with the injection were the most dissatisfactory elements (30%, 31%, 34% respectively). Also, 73% of A-AI users reported being interested in trying B-AI while 26% of B-AI users replied being so.

Last, 95% of B-AI users declared being “very satisfied” or “totally satisfied”, with ease of use and recognition of injection ending being the most attractive items (94% and 95% of high or full satisfaction respectively).

Conclusion:

In this international cross-over survey, the newest autoinjector on the market, B-AI has shown to exhibit better reported outcomes with respect to ease of use and recognition of the end of the injection and other tested indicators.

Treatment of patients with RA should aim at the best care and must be based on a shared decision between the patient and the rheumatologist.1In this scope, the shared decision making is permitted when the patient agrees with the choice of treatment (medication, administration route, device, etc.). Patient’s involvement in decision making is assumed to lead to improvement in health outcomes such as a better adherence to the treatment.2

References:

[1]Smolen JS, Landewé R, Bijlsma J, et al EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update Annals of the Rheumatic Diseases 2017;76:960-977

[2]Nota,I.; Drossaert, C.H.; Taal,E.; Vonkeman, H.E.; van de Laar, M.A. Patient participation in decisions about disease modifying anti-rheumatic drugs: A cross-sectional survey. BMC Musculoskelet. Disord. 2014, 15, 333.

Disclosure of Interests:

None declared

[Early detection of mental health disorders at school: The Fil Harmonie pilot program]

OBJECTIVE

Most psychiatric disorders arise during adolescence, a period of life during which school takes an important place. School in France has an official mission of health education and prevention, and early detection of mental disorders is part of these goals. The aim of this study is to describe an innovative service operating in Paris that helps educational staff to deal with students having psychological or psychiatric symptoms. The Fil Harmonie program was launched in 2011. It consists of a telephone line available to all educational staff working for high schools in Paris.

METHODS

When in need of assistance, a member of the educational staff can call the dedicated hotline and expose the situation of their student to a trained psychologist. Over the course of the study, data concerning these phone calls were collected such as: socio-demographic characteristics of the student, the reason behind the call, the caller's professional role within the school, and care pathway information. All data collected during the phone calls were anonymized and computerized. We performed an observational descriptive study based on this data by using mixed methods: we integrated quantitative analysis and qualitative research in order to provide a better understanding of the Fil Harmonie program.

RESULTS

Between 18 September 2013 and 12 May 2014, the Fil Harmonie program handled 68 calls from educational staff. Students concerned by the calls were aged between 11 and 22 and the average age was 17.3 years. Over half (52.5%) of the pupils concerned had never seen a mental health professional before the call. In more than 70% of cases, the caller was a school nurse while other professionals such as teachers or headmasters represented only a minority of the callers. Approximately two thirds (67.2%) of students were described by the caller as socially isolated and 48.2% were described as sad or anhedonic. One out of four (26.7%) had repeated a school year at least once, and 55.9% of young people for whom a member of staff contacted Fil Harmonie had been missing class. In 56.7% of cases, there had been no contact with the student's family about the psychological situation. The qualitative analysis particularly highlighted the complexity of the collaboration between the family and the educational staff.

CONCLUSION

Schooling is an important opportunity to seize in mental health regarding early detection and access to care. By fostering collaboration between educational professionals and mental health services, Fil Harmonie meets a public health objective of prevention and should contribute to the reduction of care delays thus leading to better treatment outcome. Our study shows that such programs are feasible and answer a real need in our current health care system.

[Assessment of mental states at risk of psychotic transition: validation of the French version of the CAARMS]

This article aims to present the validation study of the French version of the Comprehensive Assessment of at risk mental states (CAARMS), an interview that seeks to determine whether young adults criteria for at-risk (AR) mental states, or psychosis. We assessed 40 young subjects, 15 were considered as "prodromal" (Prd) and 10 as experiencing a first episode of psychosis (PEP) by our expert clinician at the center - centre d'évaluation des jeunes adultes et adolescents, University Hospital Centre, Paris - and 15 were healthy controls matched for age and sex. When assessed with the CAARMS, 73 % (n=11) of the prodromal subjects reached the criteria for AR mental state, four subjects did not reach the criteria for AR, nor psychosis (P) and 100 % of the PEP reached the criteria for P. The three groups were significantly different on CAARMS total score (P<0.001) and subscores ; Prd subjects had intermediate scores between PEP (P<0.001) and controls (P<0.001) scores, PEP showing the highest scores. Post-hoc analysis showed that Prd significantly differed from Controls on each subscale (P<0.001) and that Prd differed from PEP on the "positive symptoms" subscale (P<0.001), as well as on "behavioural change" (P=0.021), owing to difference on the item "impaired role function". We used the brief psychiatric rating scale 24 items with anchor (BPRS24-EA) in addition to with the CAARMS, the AR group showed intermediate scores between controls and P subjects. Total scores of both scales were correlated (r=0.408 ; P=0.043) and the BPRS24-EA "positive symptoms" score was correlated with CAARMS' scores on the "Positive symptoms" subscale (r=0.456, P=0.022), "emotional disturbance" (r=0.506, P=0.01), and "behavioural change" (r=0.666 P=0.001). We found no correlation between BPRS negative and depression subscales and any of the CAARMS' subscales. When looking at its reliability, reliability coefficients (Cronbach's alpha) showed excellent reliability for "positive symptoms", "emotional disturbance", "behavioural change" and "general psychopathology" (respectively r=0.82, 0.75, 0.78, 0.84, 0.83) and moderate reliability for "cognitive change", "negative symptoms" and "motor/physical change" (respectively r=0.39, 0.59, 0.43). Overall, analysis of the results of construct validity, concurrent validity and reliability of the CAARMS indicates that the French version is valid and reliable. It is now available to develop and implement early detection programs in French speaking countries.

[Student's use of illicit drugs: a survey in a preventive health service]

INTRODUCTION

The use of illicit drugs by students and the possible psychological repercussions in this population of young adults is an important public health issue. While some data in the literature suggest a relationship between cannabis and the occurrence of mental health disorders, and in particular psychotic illnesses, epidemiologic surveys have shown that cannabis is the most consumed illicit drug in France.

AIM OF THE STUDY

To carry out a quantitative and qualitative epidemiological investigation of substance use within a student population seen during their mandatory preventive health visit at the University medical facility.

METHOD

Students were asked to take part in an investigation of their substance consumption and their individual experiences with cannabis in particular. Personality autoquestionnaires were performed and the psychotomimetic effects of cannabis were investigated with substance use within a student population seen during their mandatory preventive health visit at the University medical facility.

RESULTS

A total of 3,807 students took part in the survey with a response rate of approximately 50%. Preliminary results relating to a subsample of this study are presented here (n = 880, mean age 20 years, 65% women). 44% of the students consumed cannabis at least once in their life. The prevalence of regular consumption in students (at least once a week) was of 18%, 11% had periods of daily or close to daily consumptions, and 13% used cannabis in the last month. For each of the drugs cocaine, ecstasy (MDMA), and mushrooms (psilocybin) the prevalence of experimentation (at least once) was 5% for cocaine, 4% for ecstasy and mushrooms, and for LSD the rate was 1,5%. Other evaluated substances had a prevalence of consumption lower than 1%. For the first cannabis consumptions, a majority of students state to felt "pleasant" effects: relaxation (71%) and euphoria (53%). 13% state to have felt effects of anxiety or sadness. 25% admit having had difficulties of expression, 24% memory deficits, 35% trouble with coordination or balance and 39% difficulties of concentration. Approximately 16% had impressions of depersonalization and derealization. Lastly, some experienced "psychotic-like" effects such as visual (10%) and auditory (6%) hallucinations, as well as referential ideas (16%), mistrust or feelings of persecution (11%). 26% of the student sample had felt at least one of these last four "psychotic-like" effects.

DISCUSSION

The results are consistent with the idea that the impact of cannabis consumption is highly variable among different consumers. Implications for prevention strategies are discussed such as educational interventions based on recognition and motivation for change.

[National information campaigns on depression. A biopsychosocial anthropology?]

INTRODUCTION

Information and prevention campaigns are privileged tools for public health institutions in their risk reduction policies concerning heath disorders and their consequences. Mental health in general, and depression in particular, have been the focus of several public campaigns in different countries for 20 years.

AIM OF THE STUDY

The aim of this paper is to analyse depression campaign messages, to highlight their underlying logics and to show some of their effects, in particular in relation to contextual conflicts between professionals that possibly emerge because of these campaigns.

MATERIAL

Previous depression campaign materials were analysed, and the recent French campaign launched in November 2007 was the subject of specific attention.

RESULTS

Common messages of the campaigns are centred on the prevention of emergence, recurrence, worsening and individual, social and economic consequences of depressive disorders. Depression is always presented as "a disease"; a position which differs from international classifications describing depression as "a disorder", a much less affirmative statement. This choice, which has important "performance" values is based upon several factors including the difficulty to "popularise" psychological technology, a consensus resulting from a political struggle between professionals, a reaction to the current norms of autonomy implying a new set of rights and responsibilities from and towards the people who are "sick", and the importance given to the reduction of stigmatisation from which the "mentally ill" suffer. From all of these aspects appears a logic of "dementalisation" corresponding to a "deficit" model, in which depression is presented as something external to the individual, and where treatment is supposed to "fix" the deficit.

DISCUSSION

The French campaign shares many of those fundamental characteristics: prevalence, seriousness of the disease's consequences, low level of services use, preference for biological monoaminergic theories, and environmental risk factors to explain the disease (an aetiology which is more bioenvironmental than really biopsychosocial), presentation of the main chemotherapeutics and psychological treatments, referring first to a general practitioner, importance of reducing stigmatisation, and presentation of depression as a disease. However, the French campaign differs from other campaigns in its use of an organising concept for the symptoms (slowing down) and a more precise description of the frontiers between normal and pathological functioning. Furthermore, beyond the usual biological and environmental elements, greater importance is given to the psychological mechanisms and to phenomena that are not only in the "real world", such as symbolic losses. Nevertheless, it does not explicitly recommend any psychotherapy "brand".

CONCLUSION

This "specificity" reflects the compromise found between the different French professional positions and the opposing paradigms that govern them. The campaign led by the French Institut national de prévention et d'éducation à la Santé (Inpes) on depression is a first step of prevention and heath promotion of mental health in France. The analyses presented in this paper highlight the present orientations in this domain, its underlying tensions and the importance of respecting and preserving the multiple aspects of this domain, which are many different ways to explore the complex object that is mental health. This paper also replaces those campaigns in the complexity of their logic and their context, in an attempt to provide elements for a dispassionate reflection for all of the actors concerned by these questions.

[Use of services and treatment adequacy of major depressive episodes in France]

INTRODUCTION

Though depressive disorders are major problems of public health, general population data about use of services and treatment adequacy are scarce in France. The literature suggests that the percentage of people suffering from mental disorders who are adequately treated is low.

AIM OF THE STUDY

The objective of this study was to estimate the 12-month use of services in the French general population suffering from major depressive episodes (MDE) and levels of treatment adequacy.

METHOD

This analysis was conducted on data from the Health barometer 2005, an epidemiological survey concerning several health topics. Thirty thousand five hundred and fourteen individuals from 12 to 75 years old were interviewed by telephone from October 2004 to February 2005. Depressive disorders were assessed by a standardized tool, the CIDI-SF, according to DSM-IV classification.

RESULTS

The mental health questions were answered by 16,883 individuals; i.e. by 60% of individuals aged 15 or older. One year prevalence of MDE was 7.8%. In this group, 58.2% used services in a 12-month period, though only 21% of the service users received adequate treatment. Amongst those who used services, 2/3 consulted health care professionals (i.e. 1/3 of people presenting a MDE). The remaining percentage - 21.4% - of people presenting a MDE used psychotropic drugs without mentioning any use of services for mental health problems. The vast majority of individuals with MDE who used services (34.6% of those with MDE) consulted a professional trained to treat depression (general practitioner, psychiatrist, psychologist and psychotherapist). Only a small proportion (19.9%) of those consulting a professional went to a non-specialist professional as well; and even less (6%) consulted only a non-specialist professional. Amongst trained professionals, most consultations (61%, or 21.1% of the MDE group) concern general practitioners; another 38.4% (13.3% of the MDE group) involved psychiatrists; and 27.8% (9.6% of the MDE group) went to psychologists or psychotherapists. Amongst the psychologists and psychotherapists, most consultations were with psychologists (74.1%). The proportion with adequate treatment differed according to the type of professional. Consulting a general practitioner is associated with the lowest levels of adequate treatment (37.2%, and for general practitioners only, 21.5%). Consulting a psychiatrist is associated with higher proportions of adequate treatment (65.1%, and for consulting a psychiatrist only, 60.7%). Consulting both a general practitioner and a psychiatrist is associated with the highest levels of adequate treatment (79.7%). Antidepressants (ATD) are used far more frequently than psychotherapy (PT): 33.4% of individuals with MDE used ATD, and among the latter, 58.4% had also used anxiolytic drugs (AXL). Finally, 26.9% of the MDE group used AXL, 7.5% without any use of ATD. For PT, 10.8% used PT, and 8.1% used PT and ATD.

DISCUSSION

Improving use of professionals and treatment adequacy are two primary objectives from a public health perspective. Since most adequately treated people used an antidepressant therapy (90%), and only 30% a PT, use of psychotherapeutic approaches might be improved. Moreover, levels of treatment adequacy are very low in people presenting an MDE who did not consult for "mental health reasons". Improving the recognition of symptoms of depression might contribute to better treatment adequacy.

Perivalvular abscesses associated with endocarditis; clinical features and prognostic factors of overall survival in a series of 233 cases. Perivalvular Abscesses French Multicentre Study

AIMS

The purposes of this study were to determine the clinical features and to identify prognostic factors of abscesses associated with infective endocarditis.

METHODS AND RESULTS

During a 5-year period from January 1989, 233 patients with perivalvular abscesses associated with infective endocarditis were enrolled in a retrospective multicentre study. Of the patients, 213 received medical surgical therapy and 20 medical therapy alone. No causative microorganism could be identified in 31% of cases. Sensitivity for the detection of abscesses was 36 and 80%, respectively using transthoracic and transoesophageal echocardiography. Surgical treatment consisted of primary suture of the abscess (38%), insertion of a felt aortic or mitral ring using Teflon or pericardium (42%), or debridment of the abscess cavity (20%). The 1 month operative mortality was 16%. Actuarial rates for overall survival at 3 and 27 months in operated patients were 75 +/- 10% and 59 +/- 11%, respectively. Increasing patient age, staphylococcal infection, and fistulization of the abscess were found to be independent risk factors in both 1 month and overall operative mortality. Renal failure was a risk factor predictive of operative mortality at 1 month, whereas uncontrolled infection and circumferential abscess were regarded as risk factors predictive of overall operative mortality.

CONCLUSION

The data determined prognostic factors of abscesses associated with infective endocarditis.

[Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology]

The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.

Hypertriglyceridaemia and Lewis (A-B-) phenotype in non-insulin-dependent diabetic patients

A relationship between Lewis (a-b-) phenotype and the metabolic syndrome X has been suggested. We studied the frequency of Lewis (a-b-) phenotype in subjects with non-insulin-dependent diabetes mellitus (NIDDM) as well as the relationship between Lewis phenotype and lipid concentration in NIDDM patients. Lewis red blood cell phenotyping was done in 207 NIDDM subjects and 345 non-diabetic control subjects by immuno-agglutination with anti-Lewis a and b monoclonal antibodies. Among NIDDM patients, the proportion with the Lewis (a-b-) phenotype was significantly increased (23.6% vs 14.3%, p = 0.01), and this phenotype was associated with higher levels of triglycerides (2.40 +/- 2.58 vs 1.97 +/- 1.25, p = 0.03). This study shows a relationship between NIDDM and Lewis (a-b-) phenotype. Hypertriglyceridaemia in Lewis-negative NIDDM could suggest an increased risk of ischaemic heart disease for these subjects.

[Stenoses of the supra-aortic trunks associated with aortic supravalvular stenosis in a 3-year-old girl. Long-term surgical result]

Supravalvular aortic stenosis may be associated with arterial lesions. This condition is rare and its natural history is not well known. The authors report the case of a child operated in 1981 for supravalvular aortic stenosis and stenoses of the supraaortic vessels. The operation consisted of enlarging the ascending aorta with a patch and resection-reimplantation of both carotids without interposition of prosthetic material. Twelve years later, the haemodynamic result was the same as that of the postoperative control. This case tends to prove the low evolutive potential of this condition and the long term benefits of this surgical technique.

[Valvuloplasty of a tricuspid bioprosthesis by the Inoue's technique]

The authors report the case of a patient who had undergone tricuspid valve replacement with a bioprosthesis in 1985 after infectious endocarditis complicated by paradoxical embolism. The appearance of signs of right heart failure eight years later led to the diagnosis of stenotic degeneration of the bioprosthesis. Inoue balloon valvuloplasty was performed with no complications leading to significant improvement in the patient's condition.

[Value of the methylergometrin maleate test in recurrent cardio-circulatory arrests]

A 56-year-old man, with no particular past history, sustained two cardio-circulatory arrests preceded by constrictive chest pain. Coronary arteriography was normal during etiological investigations. The methylergometrine maleate (Méthergin (tm)) test enabled the diagnosis of severe spastic angina and guided appropriate management of this patient.

[Right cardiac insufficiency disclosing systemic mastocytosis]

The authors report the case of a 54-year old woman presenting with right cardiac failure in whom the diagnosis of contemporaneous cutaneous-systemic mast cell disease was made. The cardiac symptoms regressed concomitantly with the vasomotor manifestations of the mast cell disease. Following a review of the principal mast cell mediators, the cardiovascular manifestations of the disease are studied and pathogenetic hypotheses are being put forward.