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Endoscopic snare resection prior to Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenoma. One hundred and thirty four patients were included in the study: 72 with surgical contraindications, 61 for whom surgical resection appeared to be too drastic and 1 who refused surgery. Treatment sessions were repeated every fifteen days until total tumour destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of seven patients. Eight patients were lost to follow up. Treatment results could be analysed in 119 patients. A successful treatment was achieved in 108 patients. Tumour destruction was complete in 85.4 percent of the cases with lesions of at least 4 cm in diameter and in 94.3 percent of the cases with smaller lesions. During the average 101 weeks follow up period, 15.7 percent of the patients with total tumour destruction had recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgical treatment. It would appear that endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method for the destruction of colorectal villous adenomas.

Between February and October 1991, 530 consecutive patients underwent myocardial revascularization or valvular surgery with warm continuous antegrade and retrograde cardioplegia (37 degrees C). Three hundred and thirty three patients had isolated myocardial revascularization, 159 valvular surgery alone and 25 had combined valvular and coronary bypass. The global mortality was 5.1%, 3.7% for coronary bypass, 7.5% for valvular surgery and 8% for combined valvular and coronary surgery. A multivariate analysis identified the "reperfusion time" as the only predictive factor of hospital mortality (p0.001). Intraortic balloon counterpulsation was required postoperatively in 3.2% of cases, 5.2% of coronary bypass and 0.8% of the valvular patients. Inotropic drugs were used to come off cardiopulmonary bypass in 16.5% of coronary and 37.5% of valvular patients. There were 0.9% perioperative infarctions: 1.2% in the coronary bypass cases and 0.6% in the valvular cases. Spontaneous return to sinus rythm was observed in 87.9% of cases. The average "reperfusion time" was 20.48 +/- 0.7 mn. Analysis of the influence of aortic cross clamp time on cardiac morbidity in two groups of coronary patients (Group I: short cross clamp time less than 60 mn; Group II: long cross clamp time, 60 to 33 mn) showed that the hospital mortality, the prevalence of the use of inotropic drugs and balloon counterpulsation the postoperative cardiac index, the rate of spontaneous de fibrillation and the reperfusion time did not depend on the aortic cross clamp time. Cardiac morbidity.

An integrated approach is described for the computerized management of a nephrology department. On a medical point of view, the system comprises a minimum medical record for every patient, different specialized records and knowledge bases presently covering hypertension, diabetes and chronic renal failure. From a technical point of view, the methodology used integrates data and knowledge management techniques. Various individual reports facilitate patient management. For hypertensive patients, an expert system is combined with the record system. The results of a preliminary evaluation are reported and future developments considered.

"ARTEMIS" is a standardized and computerized medical file which is intended for improving the follow-up of hypertensive patients, the efficacy of treatment and for realising national-wide surveys. The software "LIED" of data base for "ARTEMIS" is nowadays transposable on mini-computer. In Nephrology Unit of General Hospital from Colmar, the system has been working since September 1985 with MICRO-MEGA E 32 (Thomson). The administrative and medical data are directly acquired by the doctors and secretaries of the Unit on a conversational mode from six terminals. There is no writing collecting of data. An evaluation of the system was realized with the 113 first hypertensive patients. The results were compared to those obtained from patients of Paris area.

Taking over a chronic disease like diabetes in a hospital clinic raises multiple problems. Large numbers of diabetic patients and prolonged follow-up periods result in a mass of data that only computers can control. MELLITEE is a computerized system developed to facilitate the longterm management of patients and to help in maintaining a high standard of care. It includes a structured and standardized medical record. Physicians of three Parisian hospital clinics agreed on the minimum content of the record. MELLITEE is operated at the Saint-Louis Hospital on a 68,000 based mini-micro computer (Fortune/Thomson Micromega-32), running under the Unix operating system and with the Lied data base management system. Data are keyed directly into the computer by physicians, nurses and dietitians from throughout the department. On-line registration of information allows the suppression of the corresponding part of the usual paper record. The clinical data base obtained from administrative and medical information can be used to facilitate more effective patient follow-up and clinic management. The system is to be set up in the other collaborating centres in the near future, allowing pooling of data. It will also provide long-term information which can be used for evaluation of care and epidemiological research.

A survival analysis was performed in 1,453 patients treated by chronic haemodialysis and prospectively followed up in the computerised French Diaphane Dialysis Registry. Risk factors found for overall and cardiovascular mortality are age, male sex, high systolic of diastolic blood pressure, low body mass index and low predialysis values of cholesterol, triglycerides, haematocrit, urea, creatinine and potassium. These results confirm the importance of optimal blood pressure control. They indicate that the nutritional state may play a more vital role than certain cardio-vascular risk factors found in the general population.

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values less than 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather then three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index (less than 20 kg/m2), low cholesterol (less than 4.5 mmol/l) and low mean predialysis blood urea (less than 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.

Benefits of using bicarbonate (B) containing dialysates instead of acetate (A) dialysates is still controversial. A single blind study was therefore performed using patients as their own control. Thirteen males and 10 females (mean age 44 years), with a poor dialysis tolerance were included in the study. 14 patients were dialyzed one week with dialysate A (A 38 mmol/l, CO3H 0, Na 140, K 1.5, Ca 1.75, Mg 0.75, Cl 108.5) and then one week with dialysate B (A 9, CO3H 29, Na 140, K 1.5, Ca 1.75, Mg 0.75, Cl 108.5); 9 patients were dialyzed one week with B and then one week with A. Measured osmolarity was 302 mOsm/l for dialysate A and 291 for dialysate B. A Unimat dialysate generator from Bellco was used in both cases. Student paired t tests were used for comparisons. Predialysis mean values of body weight, systolic and diastolic blood pressures, serum Na, K, Ca, P, BUN, and creatinin did not differed significantly with A and B dialysates. Hypotensive episodes (19.6% vs 36.2% p less than 0.05), headaches (5.8% vs 14.5%, p less than 0.05), and vomiting (8.0% vs 18.5%, p less than 0.10) were less frequent with B than with A. Postdialysis blood CO3H, K and P were higher with B than with A (all p less than 0.05). Results confirm, in acute conditions, the better tolerance of bicarbonate dialysis comparatively to acetate dialysis.