Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients.

INTRODUCTION: Hypopituitarism is associated with higher prevalence of cardiovascular risk factors and premature death. Furthermore, some clinical and therapeutic features of hypopituitarism have been associated with a worse prognosis. OBJECTIVE: We reviewed, retrospectively, a large series of adult patients with hypopituitarism using stringent epidemiological criteria. Prevalence, association with cardiovascular risk factors, mortality and survival have been analysed. DESIGN AND METHODS: Two hundred and nine adult hypopituitary patients (56·9% females) from a population of 405 218 inhabitants, followed for 10 years. RESULTS: Prevalence of hypopituitarism at the end of the study was 37·5 cases/100 000 inhabitants. Incidence of hypopituitarism was 2·07 cases/100 000 inhabitants and year. Thirty-two patients died during the period of the study. Standardized mortality rate (SMR) was 8·05, higher in males (8·92 vs 7·34) and in younger patients (84·93 vs 5·26). Diagnosis of acromegaly (P = 0·033), previous radiotherapy (P = 0·02), higher BMI (P = 0·04), diabetes mellitus (P = 0·03) and cancer (P < 0·0001) were associated with mortality. A lower survival was associated with older age at diagnosis, nontumoural causes, previous radiotherapy, diabetes mellitus with poor metabolic control and malignant disease. CONCLUSIONS: Prevalence of hypopituitarism was 37·5 cases/100 000 inhabitants, and annual incidence was 2·07 cases/100 000 inhabitants. SMR was 8 times higher in hypopituitarism than in general population and was also higher in males and younger patients. Reduced survival was significantly related to cancer, nontumoural causes of hypopituitarism, older age at diagnosis, previous radiotherapy and diabetes mellitus with poor metabolic control.

[A definition of work-related asthma and its social and occupational consequences in adults and teenagers]. / Définition de l'asthme en relation avec le travail et ses conséquences sociales et professionnelles chez l'adulte et l'adolescent.

Work-related asthma (WRA) accounts for 10-25% of all adult asthma. It therefore seems important to raise questions regarding an asthmatic's approach to occupational or job training activities. WRA takes on two forms: work-exacerbated asthma (WEA) and occupational asthma (OA), which encompasses different subtypes of heterogeneous mechanisms. It currently represents a major challenge for occupational medicine in terms of detailed diagnosis, social care, the economic repercussions for workers and employers and, last but not least, social insurance. This review aims to sensitize health care practitioners to the peculiarities of WRA management in routine practice. More specifically, prognosis depends on early diagnosis, medical care and work adjustment measures. WEA and OA are explained in detail in view of identifying causative agents and at-risk occupations and defining adapted medical strategy. Relevant lines of questioning and complementary exams are presented. In addition, the key role of the occupational physician, especially as regards recognition and identification of occupational disease, is underlined, the objective being to facilitate optimal professional and social management. In future studies, the key role of counseling and orientation mechanisms should be highlighted as means of preventing WRA occurrence.

[Acute and subacute chemical pneumonitis]. / Pathologies respiratoires aiguës et subaiguës d'origine toxique.

Acute or subacute chemical-induced lung injury is rarely compound specific and is most often caused by an accidental occupational, domestic or environmental exposure to an inhaled chemical agent. The industrial disaster that happened in Bhopal in 1984, accidental poisoning with chlorine and petroleum hydrocarbons and also vesicant gases used during conflicts, are specific examples. Rarely, a chemical agent can cause lung damage by being ingested and reaching the lung through the systemic circulation (for example accidental or deliberate paraquat ingestion). Household accidents should not be underestimated. An important cause of household accidents is chlorine inhalation resulting from mixing bleach with acids such as the scale removers used to clean toilets. Chemical agents can provoke direct and/or indirect damage to the respiratory tract. The acute or subacute clinical manifestations resulting from inhalation of chemical agents are very varied and include inhalation fevers, acute non-cardiogenic pulmonary oedema, adult respiratory distress syndrome, reactive airways dysfunction syndrome and acute or subacute pneumonitis. The site and the severity of chemical-induced respiratory damage caused by inhaled chemical agents depend mainly on the nature and the amount of the agent inhaled. The immediate and long-term prognosis and possible sequelae are also variable. This review excludes infectious or immunologically induced acute respiratory diseases.

[Respiratory effects of manufactured nanoparticles]. / Effets respiratoires des nanoparticules manufacturées.

Nanotechnology, defined as techniques aimed to design, characterize and produce materials on a nanometer scale, is a fast-growing field today. Nanomaterials are made of nanoobjects (nanoparticles, nanofibers, nanotubes...). The nanoscale confers on these materials their novel, hitherto unknown, chemical and physical properties by the laws of quantum physics which are essentially expressed on this scale. Nanotechnology applications are numerous (e.g., cosmetics, industry and medicine) and they keep growing. We can safely predict that the production and utilization of nanomaterials will increase greatly in the years to come. Nonetheless, the same properties that make these nanomaterials very attractive are a source of concern: there are questions about their potential toxicity, their long-term side effects, and their biodegradability. These questions are based on knowledge of the toxic effects of micrometric particles in air pollution and the fear that these effects will be amplified because of the nanometric size of the new materials. We present in this article a global but not exhaustive summary of current knowledge. We begin by defining lung penetration, deposition, translocation and elimination of nanoparticles. Finally, we consider the respiratory effects of metallic nanoparticles, titanium dioxide nanoparticles in particular, and carbon nanotubes. In vivo and in vitro experimental studies currently available highlight the existence of biological effects of nanoparticles on the respiratory system with generation of oxidative stress, pro-inflammatory and pro-thrombotic effects and the possible development of fibrosis and pulmonary emphysema or DNA damage. A better understanding of the potential biological effects of nanoparticles is required to implement appropriate preventive measures in the workplace and/or in the general population, if this should be necessary.

[Etiology, epidemiology, biology. Occupational respiratory cancers]. / Cancers respiratoires professionnels.

Lung cancer and pleural mesothelioma are the most common occupational cancers. Recent epidemiological studies have estimated that the fraction attributable to occupational factors varies from 13 to 29% for lung cancer in men and is about 85% for pleural mesothelioma in men. Previous occupational exposure to asbestos is the most common occupational exposure in these cancers. Mesothelioma immediately leads the clinician to look for past asbestos exposure. In contrast, the search for an occupational exposure that should be routine in all cases of lung cancer, is generally more difficult because of the number of occupational aetiological factors and the absence of criteria that allow distinction of an occupational cancer from a tobacco related one. Therefore attention should be paid to the identification of occupational exposure in order to set up primary prevention programmes to prevent exposure still present in the working environment and, on the other hand, to identify the subjects entitled to the acknowledgement of occupational disease and/or to obtain the compensation available to asbestos victims.

[Occupational respiratory cancers]. / Cancers respiratoires professionnels.

Lung cancer and pleural mesothelioma are the most common occupational cancers. Recent epidemiological studies have estimated that the fraction attributable to occupational factors varies from 13 to 29% for lung cancer in men and is about 85% for pleural mesothelioma in men. Previous occupational exposure to asbestos is the most common occupational exposure in these cancers. Mesothelioma immediately leads the clinician to look for past asbestos exposure. In contrast, the search for an occupational exposure that should be routine in all cases of lung cancer, is generally more difficult because of the number of occupational aetiological factors and the absence of criteria that allow distinction of an occupational cancer from a tobacco related one. Therefore attention should be paid to the identification of occupational exposure in order to set up primary prevention programmes to prevent exposure still present in the working environment and, on the other hand, to identify the subjects entitled to the acknowledgement of occupational disease and/or to obtain the compensation available to asbestos victims.

Effects of frequency of static stretching on straight-leg raise in elementary school children.

AIM: The aim of this study was to evaluate the efficacy of different frequencies of a stretching exercise program on lower extremity range of motion (ROM) in prepubertal schoolchildren. METHODS: A total of 62 children were divided into 3 groups (experimental groups: A, B; control group: C). Experimental group A performed hamstring stretches for 5 min during the Physical Education classes over a full school term (9 months), 2 sessions per week (31 weeks, 62 sessions of Physical Education). Experimental group B performed hamstring stretches for 5 min during the Physical Education classes and during a specific extracurricular physical activity, over a full school term (9 months), 4 sessions per week (31 weeks, 62 sessions of Physical Education and 62 sessions of after-school physical activities). Control group followed the standard class program of Physical Education classes. Hamstring flexibility was measured using the straight leg raise test before and after the program. RESULTS: No significant differences were revealed in ROM before and after the Physical Education classes for the control group. However, significant improvements in ROM were shown in the two experimental groups (P<0.001). Four days per week produced a greater rate of gains in ROM (16.9 degrees) than 2 days per week (9.3 degrees). For all groups, the initial and the final ROM between the right and left sides were similar. CONCLUSION: This study indicates that a full school term (9 months) incorporating static stretching as part of the Physical Education classes and the extracurricular physical activities significantly increases the ROM of the hamstrings in prepubertal schoolchildren. The study also suggests that the increase of the frequency of stretching is effective for increasing ROM.

[Occupational chronic obstructive pulmonary diseases. Legal aspects and practical management]. / Bronchopneumopathies chroniques obstructives professionnelles. Aspects médicolégaux, conduite à tenir en pratique.

The existence of occupational chronic obstructive pulmonary diseases (COPD) is now well established. Since 1989, several regulations have been progressively introduced, allowing compensation for some cases of occupational COPD. Following a brief review of the main occupational causes of COPD, the authors describe the present context for compensation in France and the procedures to be followed to ensure that patient's interests are supported.

[Occupational risk factors for lung cancer]. / Facteurs de risque professionnels du cancer bronchopulmonaire.

OBJECTIVE: We aimed to review the literature regarding the dose-response relationship between occupational exposure to chemicals classified by the International Agency for Research on Cancer (IARC) as carcinogenic agents and the risk of some lung cancers and on any combined effect with tobacco exposure on lung cancer risk. METHODS: A literature search was performed in three databases as well as in the IARC monographs between January 1990 and April 2015. RESULTS: The literature is abundant for some carcinogens such as asbestos, crystalline silica and diesel exhaust fumes but is more sparse for many carcinogens and particularly any interaction with tobacco on lung cancer risk. CONCLUSION: Few data exist for most lung occupational carcinogens including their interaction with tobacco exposure. In the case of exposure to occupational carcinogens and co-exposure to tobacco smoke, there is a dual primary prevention objective: the elimination of both occupational risk factors and tobacco smoke.

Overexpression and promoter mutation of the TERT gene in malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is a very aggressive tumor with no known curative treatment. Better knowledge of the molecular mechanisms of mesothelial carcinogenesis is required to develop new therapeutic strategies. MPM, like all cancer cells, needs to maintain telomere length to prevent senescence. Previous studies suggested that the telomere lengthening mechanism in MPM is based mainly on telomerase activity. For this reason, we focused on the key catalytic enzyme, TERT (telomerase reverse transcriptase), by analyzing its gene expression in MPM and by studying the mechanism underlying its upregulation. We used our large collection of MPM composed of 61 MPM in culture and 71 frozen MPM tumor samples. Evaluation of TERT mRNA expression by quantitative RT-PCR showed overexpression in MPM in culture compared with normal mesothelial cells, and in MPM tumor samples compared with normal pleura. We identified a 'hot spot' of mutations in the TERT gene core promoter in both MPM in culture and in MPM tumor samples with an overall frequency of 15%. Furthermore, data clearly identified mutation in the TERT promoter as a mechanism of TERT mRNA upregulation in MPM. In contrast, gene copy number amplification was not associated with TERT overexpression. Then, we analyzed the clinicopathological, etiological and genetic characteristics of MPM with mutations in the TERT promoter. TERT promoter mutations were more frequent in MPM with sarcomatoid histologic subtype (P<0.01), and they were frequently associated with CDKN2A gene inactivation (P=0.03). In conclusion, a subgroup of MPM presents TERT promoter mutations, which lead to TERT mRNA upregulation. This is the first recurrent gain-of-function oncogenic mutations identified in MPM.

[Mercury poisoning]. / Intoxication par le mercure.

Mercury is a widespread heavy metal with potential severe impacts on human health. Exposure conditions to mercury and profile of toxicity among humans depend on the chemical forms of the mercury: elemental or metallic mercury, inorganic or organic mercury compounds. This article aims to reviewing and synthesizing the main knowledge of the mercury toxicity and its organic compounds that clinicians should know. Acute inhalation of metallic or inorganic mercury vapours mainly induces pulmonary diseases, whereas chronic inhalation rather induces neurological or renal disorders (encephalopathy and interstitial or glomerular nephritis). Methylmercury poisonings from intoxicated food occurred among some populations resulting in neurological disorders and developmental troubles for children exposed in utero. Treatment using chelating agents is recommended in case of symptomatic acute mercury intoxication; sometimes it improves the clinical effects of chronic mercury poisoning. Although it is currently rare to encounter situations of severe intoxication, efforts remain necessary to decrease the mercury concentration in the environment and to reduce risk on human health due to low level exposure (dental amalgam, fish contamination by organic mercury compounds…). In case of occupational exposure to mercury and its compounds, some disorders could be compensated in France. Clinicians should work with toxicologists for the diagnosis and treatment of mercury intoxication.

Respiratory effects of manufactured nanoparticles.

Nanotechnology is the set of techniques used to engineer, characterize, and produce materials that have at least one dimension within the nanoscale. These nanomaterials, or nanoobjects, include nanoparticles and nanotubes. As dictated by the laws of quantum physics, a size within the nanoscale results in unique physicochemical properties and distinctive behaviors. Nanotechnology has a host of applications in fields ranging from cosmetology to the industry and medicine. The production and use of nanomaterials are expanding at a brisk pace. However, concerns are emerging about the potential health effects of nanoparticles in the short and long terms. These concerns are rooted in data on the harmful health effects of micrometric airborne particulate matter. Conceivably, these adverse effects might be amplified when the particles are within the nanoscale. This article is a nonexhaustive overview of current data on the penetration, deposition, translocation, and elimination of inhaled nanoparticles and on the respiratory effects of metallic nanoparticles (with special attention to titanium dioxide) and carbon nanotubes. Both in vivo and in vitro studies consistently found biological effects of nanoparticles on the respiratory system, including oxidative stress generation, proinflammatory and prothrombotic effects, pulmonary fibrosis and emphysema, and DNA damage. Improved knowledge of the potential biological effects of nanoparticles is needed to guide preventive strategies for the workplace and/or general population if needed.

[Exposure to asbestos and the indoor environment]. / Situations d'exposition à l'amiante et environnement intérieur.

A link between the inhalation of asbestos fibres and the outcome of benign and malignant respiratory diseases has been established from numerous epidemiological data in occupational settings. Occupational exposure limit values have been established with a gradual lowering of these over time. Conversely, there are few epidemiological data dealing with exposure in the indoor environment. However, numerous materials and products containing asbestos (MPCA) are present in the indoor environment, due to their widespread use in the construction sector in the years between 1960 and 1990. The regulations were changed from the late 1990s, leading to a systematic inventory of the presence of asbestos-containing materials in buildings. The aim of this manuscript is to clarify the different types of MPCA encountered in the indoor environment, to describe the techniques used to highlight asbestos depending on the nature of the materials, the regulatory requirements relating to asbestos in non-occupational situations, and to update on the state of knowledge on asbestos-related diseases in the indoor environment.

[Acute and chronic cadmium poisoning]. / Intoxication aiguë et chronique au cadmium.

Cadmium is a metallic impurity in various minerals. The two main cadmium exposure sources in general population are food and tobacco smoking. Its industrial exploitation has grown in the early twentieth century. Cadmium is used in accumulators or alkaline batteries (80%) and in pigments for paints or plastics (10%), in electrolytic process by deposit or by cadmium plating on metals or to reduce melting points (welding rods...). Cadmium is a cumulative toxic substance whose half-time for elimination is about 20 to 40 years and it is mainly stored in the liver and kidneys. Inhalation of cadmium oxide fumes may cause inhalation fevers or chemical pneumonitis. Cadmium chronic poisoning causes mainly renal tubulopathy and could be the cause of osteomalacia and diffuse osteoporosis. Cadmium is classified as certain carcinogen agent for humans by International Agency for Research on Cancer (IARC). The most relevant biological index exposure is the urinary cadmium. According to literature, no chelating agent can be still used in human cadmium poisonings. In France, some diseases caused by occupational exposure to cadmium may be compensated.

Intoxication caused by ingestion of rape oil denatured with aniline.

One hundred seventy children, 16 months to 14 years of age, were intoxicated by the ingestion of rape oil denatured with aniline. The most frequent findings were fever, itch, adenopathy, hepatomegaly, and varied exanthems. A few weeks after the onset of the disease, more than a third of the patients experienced a syndrome similar to scleroderma. After more than nine months, three patients were found to be seriously impaired. Two girls died of measles contracted during the course of the intoxication. Prednisone caused dramatic and rapid symptomatic relief.

[Hyperinsulinism probably caused by diffuse pancreatic hyperplasia]. / Hiperinsulinismo por probable hiperplasia difusa pancreática.

A case history of a two years seven months old boy with hyperinsulinism and marked psychomotor retardation is presented. In this patient, biochemical analysis revealed persistent hypoglycemia. Basal insulin levels (RIA) were consistently superior to 10 mU/ml. and were higher than would be expected from the child's glycemias. Angiographic study of the celiac trunk revealed diffuse pancreatic enlargement. Therapy was initiated with oral diazoxide normalizing and stabilizing the patient's glycemia. The importance of an early diagnosis of this condition and the necessary biochemical analyses involved are discussed as well as the use of diazoxide in the medical treatment of hypoglycemia.

[Hypogonadotrophic hypogonadism and anosmia (Maestre San Juan-Kallman's syndrome) (author's transl)]. / Síndrome de Maestre de San Juan-Kallman (hipogonadismo hipogonadotrófico y anosmia).

Authors present a case of Maestre de San Juan-Kallman syndrome in a male 14 year old, with hypogonadotrophic hypogonadism and anosmia, and with other associated malformations (cryptorchism, epilepsy, hypoacusia and chromosomal anomalies). Standard values of FSH and LH are undetectable. After stimulation with LH-RH, a continued release of gonadotropins is produced. With the clomiphene stimulation there is a negative response.

Molecular epidemiology of caliciviruses causing outbreaks and sporadic cases of acute gastroenteritis in Spain.

The molecular epidemiology of human caliciviruses (HuCVs) causing sporadic cases and outbreaks of acute gastroenteritis around eastern Spain (Catalonia and the Valencian Community) was studied by reverse transcription-PCR (RT-PCR) and by sequencing part of the RNA polymerase gene in open reading frame 1. HuCVs were detected in 44 of 310 stool specimens (14.19%) negative for other enteric pathogens obtained from children with acute gastroenteritis. Norwalk-like viruses (NLVs) were the most common cause of the gastroenteritis outbreaks investigated here. They were detected in 14 out of 25 (56%) outbreaks with an identified pathogen. Genotypes producing both sporadic cases and outbreaks were diverse, with a predominance of GGII strains related to genotypes Melksham and Lordsdale. Five strains clustered with a "new variant" designated GGIIb, which was detected circulating throughout quite a few European countries in the years 2000 and 2001. The emergence mechanism of these strains might be the occurrence of intertypic recombinations between different viruses. The nucleotide sequence of part of the capsid gene (ORF2) from three of these strains demonstrated their relationship with Mexico virus.

Herniorrafia inguinal ambulatoria bajo anestesia local versus herniorrafia en admisión bajo anestesia regional / Ambulatory inguinal herniorraphy under local anesthesia versus hernorraphy with admission under regional anesthesia

Se tomaron 200 pacientes con hernias inguinales del Hospital Dr. Luis Eduardo Aybar, cien de estos pacientes fueron herniorrafias hechas previamente bajo anestesia regional en admisión y los comparamos con cien pacientes cuyas herniorrafias fueron hechas con anestesia local en forma ambulatoria. Encontramos una marcada diferencia en la estadía en el hospital en los casos operados con anestesia regional (1080 días, 10.8 días por paciente), y los operados con anestesia local (11 días, 0.1 día por paciente), resultando así el costo de la estadía de los pacientes con anestesia regional de $99, 975.00 y bajo anestesia local de $967.30 y a la vez una importante diferencia en cuanto al costo en material gastable por herniorrafia con anestesia local ($460.00) y herniorrafia con anestesia regional ($537.00). La herniorrafia con anestesia local ambulatoria es un procedimiento bien tolerado por el paciente, especialmente los menores de 25 años. Mujeres con ernias pequeñas, hernias indirectas pequeñas, y pacientes con hernias deslizadas, hernias recidivantes y hernias con hidrocele, no toleran bien la herniorrafia con anestesia local