Cytokines and anorexia nervosa.

OBJECTIVE: Recent studies have indicated that the inflammatory cytokines could be implicated in anorexia nervosa and in its complications. To determinate the potential role of interleukins (IL-1, IL-2, IL-4, IL-6, IL-10), interferon (IFN gamma), tumor necrosis factor (TNF-alpha), and transforming growth factor (TGF-beta2) in anorexia nervosa, serum concentrations of these cytokines were measured in patients suffering from anorexia nervosa in comparison to healthy subjects. METHOD: Twenty-nine anorexic women according to DSM-IV criteria participated in the study. The control group consisted of 20 healthy women without eating disorders, mood disorders, and immunological disorders. RESULTS: We find that serum IL-2 and TGF-beta2 concentrations were both significantly decreased in anorexic patients, although the other cytokines did not differ significantly between the two groups. CONCLUSION: Our results show that in patients with anorexia nervosa, there are lower levels of specific cytokines (especially IL-2 and TGF-beta2). These levels may reflect the combination of impaired nutrition and weight loss, therefore, the dysregulation of these cytokines may contribute in anorexia's complications. Follow-up studies should examine the effects of parameters such as starvation, psychopathologic factors, and psychoneuroendocrinological perturbation which could affect interplay between cytokines, neuropeptides, and neurotransmitters.

Palliative care with pregnant women.

When a pregnant woman has been declared dead because of brain death or cerebral death and a permanent vegetative state, the life and wellbeing of her fetus become a matter of crucial consideration. The possible options are an immediate caesarean section, continuation of efforts to maintain the organ functions of the woman to allow her fetus to mature, or discontinuation of the woman's somatic organ support. The decisions depend on the viability of the fetus, the probable health status of the fetus, any wish expressed by the mother and the commitment of her next of kin. Maintaining the pregnancy in order for the fetus to become more mature requires counselling of the woman's partner or family members. Immediate recourse of caesarean section should be withheld if the fetus is too immature or has a probable poor health status. Terminally ill pregnant women may require treatments which are potentially harmful to their fetus. Medical abortion early in pregnancy or premature delivery later in pregnancy are the usually recommended options. When the fetus is viable although extremely premature, delivery should not be imposed on a woman concerned with the risk of leaving a possibly handicapped child after her death.

[Pregnancy and drug abuse: current situation and therapeutic strategies]. / Grossesse et consommation de drogues psychoactives. Etat des lieux et stratégies thérapeutiques.

Drug abuse, a general public health problem, concerns a growing number of the pregnant women. Pregnancy in a drug addict is a high risk condition. The prevention of neonatal and pediatric complications involving both organic and psychological conditions, requires early individual medical, psychological and social support adapted to each pregnant addict. The risk for the mother and the fetus warrant prescription of substitution therapy during pregnancy. Published results concerning pregnancies in women on substitution therapy have been encouraging and clearly show a decrease in maternal and fetal complications. These studies are however difficult to conduct and carry a certain number of biases related to the social and economical context of the patients and also to the type of drug abuse (multiple drugs, drug combinations, psychostimulants, smoking, alcohol).

Localization of the Th2 cytokines IL-3, IL-4, IL-10 at the fetomaternal interface during human and murine pregnancy and lack of requirement for Fas/Fas ligand interaction for a successful allogeneic pregnancy.

PROBLEM: Th2 cytokines and Fas/Fas ligand interactions are proposed to be part of the placental barrier that contribute to the success of allogeneic pregnancy. To fully understand the role regulation of Th2 cytokines, we must isolate and identify the cells that produce them. We also need to assess the requirement for Fas/Fas ligand interaction in facilitating a successful allogeneic pregnancy. METHOD OF STUDY: To assess the site of production of Th2 cytokines, we used immunohistochemistry sections from placental and decidual tissue obtained at various stages of gestation in mice and humans. We used mice that are genetically deficient in Fas/Fas ligand interactions and raised specific anti-paternal CTLs by anti-paternal immunization of the mother before mating. RESULTS: The detailed results show that in both species the bulk of Th2 production may come from non-lymphoid tissues in the placenta and decidua, with a major role for trophoblasts. This raises questions about the mechanism(s) by which alloimmunization enhances local Th2 cytokine production. This issue is discussed. CONCLUSIONS: The success of allopregnancy in mice with circulating anti-paternal CTLs and deficient Fas/Fas ligand interactions rules out a mandatory role for such a mechanism in ensuring the success of allogeneic pregnancy.