[Predictors of osteopenic syndrome in idiopathic pulmonary fibrosis].

AIM: To evaluate the functional state of bone tissue in patients with idiopathic pulmonary fibrosis (IPF), waiting for lung transplantation, and to determine possible predictors of lower bone mineral density (BMD) in this pathology in the pretransplantation period. SUBJECTS AND METHODS: Forty-nine IPF patients waiting for lung transplantation were examined. The patients' mean age was 53.4 +/- 6.4 years. BMD in the lumbar spine (L(II)-L(IV)) and femoral neck (FN) was estimated using dual-energy X-ray absorptiometry. All the patients underwent external respiratory function test, pulmonary diffusing capacity (DL(CO)), gasometry, and 6-minute walk test (6'WT). RESULTS: Osteopenia was recorded in 77% of the examinees, of them 28% had osteoporosis (OP). Normal BMD in both L(II)-L(IV) and FN was found only in 13% of the patients. The T score in L(II)-L(IV) was directly related to body mass index. There was a direct correlation between BMD in L(II)-L(IV) and FN, forced vital capacity (FVC), DL(CO), and arterial blood oxygen saturation (SaO2) and an inverse correlation with arterial carbon dioxide partial pressure (pCO2). No significant correlation was found between the distance covered in 6'WT, FEV1, pO2, and BMD in both L(II)-L(IV) and FN. Six (15%) subjects had atraumatic fractures at different sites. CONCLUSION: Osteopenia is a common systemic manifestation in patients with IPF in the pre-transplantation period. BMI, FVC, exercise desaturation, and DL(CO) may be considered as predictors for the development of OP initiated by IPF.

[Association between adipokines and the development of osteopenic syndrome in end-stage lung disease].

AIM: To study of an association between adipokines, nutritional status, and bone mineral density (BMD) in end-stage lung disease (ESLD). SUBJECTS AND METHODS: Forty-seven patients aged 26 to 62 years with ESLD were examined. BMD in the lumbar spine (L(II)-L(IV)) and left femoral neck (FN) was estimated using dual-energy X-ray absorptiometry (DXA). The serum levels of adipokines (leptin, adiponectin resistin, tumor necrosis factor-alpha (TNF-alpha), and its receptors sTNFR I, II) were determined. A control group consisted of 45 healthy volunteers matched for age and gender. RESULTS: Osteopenic syndrome (T-score < -1 SD) was recorded in 43 (91%) of the 47 examined patients with ESLD. In lung diseases, the concentrations of adiponectin, resistin, TNF-alpha, and its receptors were higher and the level of leptin was lower than in the control group. There was a positive correlation between the content of leptin (r = 0.64, p = 0.0002; r = 0.52, p = 0.009) and a negative correlation between adiponectin (r = -0.54, p = 0.009; r = -0.47, p = 0.003), TNF-alpha (r = -0.43, p = 0.03; r = -0.41, p = 0.04), and BMD in FN and FN L(II)-L(IV). Correlation analysis showed a positive correlation between the level of resistin (r = 0.57; p = 0.004), sTNFR I (r = 0.42; p = 0.03), sTNFR II (r = 0.44; p = 0.04), and BMD in L(II)-L(IV) only. The serum leptin level was positively correlated with body mass index (BMI) (r = 0.82; p < 0.0001) and total fat mass (TFM) (r = 0.84; p < 0.0001). On the contrary, the level of adiponectin was inversely correlated with BMI (r = -0.68; p < 0.001), serum resistin concentration (r = -0.57; p = 0.004), sTNFR I (r = -0.58; p = 0.007), and sTNFR II (r = -0.53; p = 0.006). It was stated that there was a strong inverse correction between the levels of leptin and adiponectin (r = -0.67; p = 0.0008). CONCLUSION: The found associations between adipokines and BMD may suggest that these markers are implicated in the pathogenesis of osteopenic syndrome in ESLD.

[Intracardiac hemodynamics in patients with isolated chronic obstructive pulmonary disease and coronary heart disease].

Analysis of intracardiac hemodynamics is presented in patients with isolated stage II, III and IV chronic obstructive pulmonary disease (COPD) in the period of exacerbation and in those having COPD with concomitant coronary heart disease (stable angina of functional class II). Retrospective evaluation included 100 medical histories. Color Doppler echoCG was performed and parameters of systolic and diastolic function of both ventricles measured. Results of correlation analysis of systolic and diastolic function of left and right ventricles are presented along with the data on blood pressure in the right chambers of the heart.

Impact of interferon-alpha treatment on liver fibrosis in patients with chronic hepatitis B: an overview of published trials.

BACKGROUND: The impact of interferon treatment in patients with hepatitis B virus (HBV) infection on fibrosis progression in comparison with its natural history has yet to be assessed in any large-scale randomized studies. The present report is a review of the evidence-based data published so far. METHODS: Studies were included if they had at least two repeated estimates of liver fibrosis per patient treated with interferon-alpha (whether pegylated or not). Meta-analysis was performed using a random-effects model. RESULTS: Altogether, 13 studies were included in the review, involving a total of 707 HBV patients treated with interferon-alpha-2a or -2b for 12-83 months. Only one study included pegylated interferon as monotherapy. A total of 787 untreated patients were also followed. Only one study used a non-invasive biomarker. There was a significant reduction in the fibrosis progression rate, with a risk reduction of 0.49 (95% CI: -0.64--0.34; chi(2)=119; degrees of freedom [DF]=6; P<0.0001), and significant heterogeneity (Cochran Q=81; P<0.0001). This significant impact was similar for both randomized (reduction of risk: -0.45; 95% CI: -0.64--0.26; P<0.0001) and not-randomized (controlled) studies (reduction of risk: -0.53; 95% CI: -0.79--0.28; P<0.0001). CONCLUSION: According to these findings, the benefit of interferon treatment on fibrosis progression is clinically significant in patients with advanced fibrosis by the reduction of fibrosis progression to cirrhosis. Pegylated interferon now needs to be compared, in terms of benefit-risk factors, with the new generation of HBV treatments (such as entecavir and tenofovir), using non-invasive biomarkers.

[Treatment of chronic hepatitis B in HIV co-infected patients]. / Traitement de l'hépatite chronique B chez les patients co-infectés par le VIH.

Because of complex interactions between HIV, hepatitis B virus (HBV), immune system and antiretrovirals, treatment of HBV infection in HIV population should consider both viruses. In co-infected patients with no indication of antiretrovirals, drugs with dual activity against HBV and HIV are not recommended to avoid development of HIV resistance (lamivudine, emtricitabine, entecavir, tenofovir disoproxil fumarate). Adefovir dipivoxil or pegylated interferon may be used. Telbivudine may have a role in combination with adefovir dipivoxil in this situation. In patients with an indication of antiretroviral therapy, regimens should include tenofovir in association with lamivudine or emtricitabine. In patients who had developed HBV lamivudine (or emtricitabine) resistance addition of tenofovir to antiretroviral regimen including maintenance of lamivudine or emtricitabine is the preferred choice.

Methodological aspects of the interpretation of non-invasive biomarkers of liver fibrosis: a 2008 update.

This review summarizes the methodological aspects of the interpretation of non-invasive biomarkers in liver fibrosis. A scoring system has been updated to better compare the quality of fibrosis biomarkers. Several methodological issues are related to the classical methodology using biopsy, as this is considered the gold standard. However, from evidence-based data, it appears that the methodology needs to change to prevent flawed conclusions among key opinion leaders as well as in obsolete guidelines. As waiting for the perfect biomarker for the diagnosis of advanced fibrosis to come along is probably a waste of time, in the meantime, methods can be improved. The main proposals for improving the methodology are, to take into account the spectrum bias, to assess accuracy between adjacent stages, to compare biomarkers in the same patient, to assess the cause of failure among discordant cases and to use specific statistical methods adapted for imperfect gold standards.

Continuous infusion of high-dose omeprazole is more effective than standard-dose omeprazole in patients with high-risk peptic ulcer bleeding: a retrospective study.

UNLABELLED: High-dose omeprazole reduces the rate of recurrent bleeding after endoscopic treatment of peptic ulcer bleeding. However, the effectiveness of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding has never been shown. AIM: To compare the benefits of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding. METHODS: We reviewed the medical files of patients admitted between 1997 and 2004 for high-risk peptic ulcer bleeding who had undergone successful endoscopic treatment. We distinguished 2 periods: before 2001, standard-dose omeprazole (40 mg/day intravenously until alimentation was possible, then 40 mg/day orally for 1 week); after 2001, high-dose omeprazole (80 mg bolus injection, then 8 mg/h continuous infusion for 72 h, then 40 mg/day orally for 1 week). During both periods, patients subsequently received omeprazole, 20 mg/day, orally for 3 weeks. RESULTS: We enrolled 114 patients (period 1, n = 45, period 2, n = 69). Therapy with high-dose omeprazole significantly decreased the occurrence of poor outcome (27 vs. 12%, P = 0.04), rebleeding (24 vs. 7%, P = 0.01), mortality due to haemorrhagic shock (11 vs. 0%, P < 0.001) and need for surgery (9 vs. 1%, P = 0.05). CONCLUSIONS: In this retrospective study, high-dose omeprazole reduced the occurrence of rebleeding, need for surgery and mortality due to hemorrhagic shock in patients with high-risk peptic ulcer bleeding, as compared with standard-dose omeprazole.

Doctoring by go-between: aspects of health care for Malay children.

The paper is a preliminary account of the way Malay adults handle sickness episodes when they occur among their children. We first show how children are conceived of as different from adults, then give some of the reasons for their vulnerability: their 'vital principle' is weak and unstable, they react more violently to humoral variations, they are related to and attracted by the supernatural world. The second section gives a sample of common indigenous illness categories as applied to children, then summarizes a typical aetiological model including factors that are children-specific. Such factors often point to either parent as initiating the episode by disrupting the animal, symbolic or social world, or by placing the child out of harmony with the outside world. The third section provides an account of therapeutic alternatives, some of which are coherent with the aetiology, others--aiming at restoring the whole person's balance--are not specific of a particular sickness. Both types can be provided by native curers, whereas only the former is expected from urban based general practitioners; we show how Malay parents in fact partly relate to medical doctors as if they were traditional healers. To sum up, we emphasize the mediating role of adults towards sick children: not only do they provide identification and treatment but they often hold themselves responsible for the disorder. We also show the socializing, hence integrating, function of sickness for children: they are gradually taught about the world order, and introduced to the value system of the culture in which they are growing up. We also note that both aetiologies and therapies can be children-specific.(ABSTRACT TRUNCATED AT 250 WORDS)

Drainage after thyroidectomy: a randomized clinical trial.

A randomized clinical trial of surgical drainage in thyroid surgery was performed on 97 patients. Morbidity was not significantly different between both groups. The length of hospital stay was shorter in the undrained group. However, this RCT is not an indication of the value of drainage after thyroid surgery because the series is too small. Using a meta-analysis of the RCTs reported it is possible to show that to drain is not useful.

[Prophylactic drainage after thyroidectomy: a randomized trial]. / Drainage prophylactique après thyroïdectomie: un essai randomisé.

A randomized clinical trial of surgical drainage in thyroid surgery was performed with 97 patients. Using equivalence testing it is reported that morbidity was not significantly different between the two groups and the length of hospital stay was shorter in the undrained group. It is possible to perform thyroidectomy without drainage in a selected population.

[Acute water intoxication after prolonged infusion of oxytocin]. / Intoxication aiguë par l'eau après perfusion prolongée d'ocytocine.

The authors report a case of acute water intoxication with severe neurological features which complicated prolonged administration of oxytocin for post-partum hemorrhage. The patient was a 35-year-old woman with a tight mitral stenosis. The patient recovered consciousness after the hydro-electrolytic state had been put right. The precautions that have to be undertaken and the monitoring that is necessary to avoid hyponatraemia with water retention are reviewed. It is important to know the risk factors which are connected with this treatment and how certain abnormal conditions of the heart can play a role in causing this syndrome.

[Science and medicine in 18th Century Luxembourg]. / Wissenschaft und Medizin im 18. Jahrhundert in Luxemburg.

During the 18th century science and medicine are poorly developed in Luxembourg (present part of the former duchy). Leprosy is vanishing and black death belongs to the past, whereas dysentery, typhoid fever and other epidemical diseases are thriving. In some specific diseases people claim help from protective saints such as St. Hubert (rabies) and St. Willibrord or the Blessed Virgin Mary. Besides these aspects the paper gives a concise outline of the situation in Luxembourg during the 18th century concerning hospitals, physicians, pharmacists and popular medicine.

[Breakdown of the anastomosis after colectomy. The causes and prevention (author's transl)]. / Les désunions anastomotiques après colectomie. Leurs causes. Leur prévention.

Over a period of 3 years the authors have carried out 184 colectomies with immediate restoration of continuity. In 25 of these operated patients the sutures broke down, i.e. 13.5% and 8 died, i.e. one patient out of 3. In the light of this series, the authors studied factors favouring breakdown, whether relative to the patient (age, sex, pathology, nature of the lesion) or the technic followed, i.e. in fact the surgeon (extent of the colonic resection, type and mode of anastomosis, modes of suture and drainage). Were studied also, in prevention, the first or contemporaneous construction of a colostomy, which according to the authors totally prevents breakdown of the subjacent anastomosis, but has its own complications.

Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?

BACKGROUND: Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients. AIM: To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis. METHODS: We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients. RESULTS: A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87). CONCLUSIONS: Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.

CYP2C9*3 Loss-of-Function Allele Is Associated With Acute Upper Gastrointestinal Bleeding Related to the Use of NSAIDs Other Than Aspirin.

Nonsteroidal anti-inflammatory drugs (NSAIDs), other than aspirin, are to some extent metabolized by cytochrome P450 2C9 (CYP2C9). The CYP2C9 359Leu (CYP2C9*3) loss-of-function allele could be a risk factor for acute upper gastrointestinal bleeding (AUGIB) related to the use of NSAIDs other than aspirin. To test this hypothesis, we performed a prospective, multicenter, case-case study in patients hospitalized for AUGIB related to the use of NSAIDs. A total of 131 patients had been treated with aspirin and 57 patients had been treated with an NSAID other than aspirin (non-ASP). In the aspirin group, 12 patients (9.2%) had the CYP2C9 359Leu allele as compared with 19 (33.3%) in the non-ASP group (odds ratio (OR) = 5.0; 95% confidence interval 2.2-11.1, P < 0.0001). In a multivariate analysis, CYP2C9 359Leu remained associated with the non-ASP group (OR = 7.2 (2.6-20.3), P = 0.0002) even though 40% of these patients were under treatment with antiulcer drugs at the time of admission. Therefore the results of the study support the hypothesis that the CYP2C9 359Leu allele is a robust risk factor for AUGIB related to the use of NSAIDs other than aspirin.