Distribution of adipose tissue: quantification and relationship with hepatic steatosis and vascular profiles of type 2 diabetic patients with metabolic syndrome.

AIM: As the distribution of fat is increasingly related to cardiovascular events, we examined whether or not abdominal-fat quantification using magnetic resonance imaging (MRI) software is reliable, and whether or not it is related to clinical markers of fat distribution as well as to metabolic and vascular status. METHODS: We recorded the anthropometric measurements of 34 obese type 2 diabetic patients with metabolic syndrome. The patients were enrolled to evaluate their abdominal (visceral and subcutaneous) adipose tissue by single-slice L3-L4 MRI. Manual and automated analyses were compared. The relationships between anthropometric measurements, biological markers and intima-media thickness of the common carotid artery were also assessed. RESULTS: We validated the automated software to quantify abdominal-fat deposition with MRI compared with manual measurements (r2=0.95). The waist-to-hip-circumference ratio (WHR) was the only clinical parameter that correlated with the proportion and quantity of visceral and subcutaneous abdominal-adipose tissue evaluated by MRI (r=0.60). In addition, fat repartition as evaluated by WHR was related to hepatic steatosis parameters (ferritin and ALAT) and to intima-media thickness, whereas simple waist circumference was not a determinant in these obese patients. We also showed that the adiponectin-to-leptin ratio was related to adipose tissue distribution. CONCLUSION: Distribution of abdominal fat, as evaluated by MRI, can be reflected by clinical determination of the WHR. Differences in regional accumulations of abdominal fat may be specifically related to variations in the risks of steatosis and vascular rigidity among obese type 2 diabetic patients.

[Use of tobacco cessation tools for pregnant women or couples attending pre-birth counseling sessions]. / Modalités de mise en oeuvre des outils de sevrage tabagique auprès des femmes enceintes ou des couples au cours des séances de préparation à la naissance.

Several tools have been helped to patients cease smoking. Many are poorly known and thus used little. In the context of pregnancy, midwives conducting pre-birth counseling sessions can help pregnant women and their partners stop smoking. The terms used during the sessions offer many occasions.

The fecal chymotrypsin photometric assay in the evaluation of exocrine pancreatic capacity. Comparison with other direct and indirect pancreatic function tests.

Fecal chymotrypsin (FCT) has been measured by a new photometric method (Monotest Chymotrypsin; Boehringer, Mannheim) in 78 patients: 44 with chronic pancreatitis and 34 not affected by any pancreatic disease. The results were compared with those from other tests of pancreatic secretory (secretin-cerulein test) and digestive [serum and urinary p-aminobenzoic acid (PABA) and pancreolauryl] capacity. When FCT values were severely reduced (below 6.7 U/g), from 90 to 100% of the patients also presented abnormal pancreatic secretory and digestive capacity. On the other hand, 87% of the patients with normal FCT (above 20 U/g) presented normal secretory and digestive capacity. Patients with intermediate FCT values (between 6.7 and 20 U/g) showed normal or abnormal pancreatic secretory and digestive capacity with the same probability. Therefore, FCT, carried out as a first test, seems to identify subjects that need no further pancreatic function tests (normal and severely impaired FCT) and patients who need other more complex functional investigations (intermediate FCT values).

[Comparison between the findings of x-ray computed tomography and thoracotomy in the evaluation of locoregional extensions of primary bronchial cancer. Apropos of 45 cases]. / Confrontation entre les données tomodensitométriques et la thoracotomie, dans le bilan d'extension loco-régional du cancer bronchique primitif.

This study concerns 45 patients operated on for a primary bronchial cancer and without local or regional extension on a standard pulmonary radiograph. All subjects had a computed tomographic examination (TDM) on average 28 days before thoracotomy. The comparison was established and the possibility of excising the tumour, joined to an anatomopathological study of the structures removed. The series included only those patients with the following minimal conditions: tumour volume of 4 cms, central tumour, or close to the chest wall. The degree of pleural extension was predicted with a sensibility of 92%, a specificity of 72% (accuracy of 78%). The parietal extension was predicted with a sensibility of 63%, a specificity of 100% (accuracy of 95%). Direct invasion of the mediastinum, present 16 times, was recognized by the scanner in 8 occasions (sensibility 50%) and excluded 23 times out of 25 (specificity 85%). Extension to mediastinal ganglions was detected by the scanner 10 times out of 15; the absence of invasion 27 times out of 30. Thus, if sometimes the TDM examination showed the certainty of local or regional tumour extension, in many cases it did not by itself allow this conclusion. This was true for tumours flush with the pleura or mediastinum because their resolution was insufficient to distinguish neoplastic tissue from normal or inflammatory tissue. The TDM always established a remarkable "map" of the mediastinal glands guiding the biopsy or the thoracotomy in case of enlarged glands. One of the limits includes the possibility of occult extension without glandular hypertrophy.

[Recurrent atelectasis disclosing a post-traumatic aneurysm of the thoracic aorta. Apropos of 2 cases]. / Atélectasies récidivantes révélatrices d'un anévrysme post-traumatique de l'aorte thoracique.

The authors report 2 cases, in which recurrent and reversible atelectasis of the left lung was the only manifestation leading to a diagnosis of post-traumatic aneurysm of the thoracic aorta at an early stage (D + 5). Other classically described signs were absent. These 2 cases demonstrate the need to seek an aortic aneurysm following any severe trauma. They emphasize the importance of bronchial endoscopy in this type of trauma. They confirm the value of CAT scan investigation.

Exocrine and endocrine functional reserve in the course of chronic pancreatitis as studied by maximal stimulation tests.

Thirty patients suffering from chronic alcoholic pancreatitis (18 calcified) were entered into a study of exocrine and endocrine pancreatic function based on two maximal stimulation tests, namely the secretin-cerulein test and the glucagon test with serum assays of C peptide. The glucagon test was also performed in 19 control subjects. In addition, 10 chronic pancreatitis patients and nine controls were subjected to an oral glucose tolerance test (OGTT) with serum insulin determinations. C peptide basal values were decreased only in patients with severe pancreatic exocrine insufficiency (P less than 0.001), while delta C peptide values were also reduced in patients with moderate exocrine insufficiency (P less than 0.001). Lipase output correlated very well with delta C peptide values (P less than 0.001). While serum insulin levels during OGTT and C peptide basal values showed no significant differences between the chronic pancreatitis and control groups, delta C peptide values were significantly reduced in chronic pancreatitis patients (P less than 0.02). Both endocrine and exocrine function are impaired in chronic pancreatitis, as demonstrated by maximal tests, even in early stages of the disease.