[Prevalence of psychiatric and substance use disorders among three generations of migrants: Results from French population cohort]. / Prévalence des troubles psychiatriques et addictologiques auprès de trois générations successives de migrants : résultats d'une étude menée en population générale.

INTRODUCTION: Mental health of migrant populations has become a major public health issue since these populations more often suffer from mental health problems than host populations. The influence of the migration process on the emergence of these disorders and its impact on future generations is uncertain. This study provides an estimate of the prevalence of mental disorders among three generations of migration. METHOD: The study was conducted in the general population by the French Collaborating Center of the World Health Organization, in France, on a sample of 37,063 people aged 18 and older. The subjects interviewed were selected by a quota sampling method and, thus, were representative of the general population in the 47 study sites in France. This method develops a sample of subjects with the same characteristics as the general population on predefined issues, such as age, sex, educational level and socioprofessional category. The designation of migrant status was based on the country of birth of the subject, the subject's parents and the subject's grandparents. We defined a migrant as first generation (a subject born abroad; n=1911), second generation (at least one parent born abroad; n=4147), or third generation (at least one grandparent born abroad; n=3763) of migrants. The diagnostic tool used was the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured diagnostic interview developed by psychiatrists for ICD-10 and DSM-IVTR psychiatric disorders in the general population. The comparisons by generation of migrants were performed by chi-square test for qualitative variables and by an analysis of variance for quantitative variables. The same tests were used to compare the presence of mental disorders according to the characteristics of the population. Factors with a P-value less than 0.2 were entered in a multivariable logistic regression to assess the relationship between the generation of migrants and the presence of mental disorders, adjusting for the confounding factors. RESULTS: Thirty-eight per cent of migrant subjects have psychological difficulties, versus 30 % in the host population. These results are observed on three successive generations of migrants. Migration status increases risk of depressive disorders (OR=1.555), bipolar disorder (OR=1.597, CI=1.146-2.227), post-traumatic stress disorder (OR=1.615), substance abuse (OR=2.522) and alcohol abuse (OR=1.524), and drug dependence (OR=2.116). This risk is maintained at the second and third generation. The migration process affects mental health of population regardless of socioeconomic status or geographic origin. CONCLUSION: The consideration of migration and generation of migration shows a specific psychopathological risk profile. This is related to the joint action of a migratory past and precarious socioeconomic situation.

[Mitochondrial Neuro-Gastro-Intestinal Encephalopathy (MNGIE): When and how to suspect it in front of an atypical anorexia nervosa?] / Encéphalopathie mitochondriale neuro-gastro-intestinale (MNGIE) : quand et comment l'évoquer devant une anorexie mentale atypique ?

INTRODUCTION: The Mitochondrial Neurogastrointestinal Encephalopathy (MNGIE) disease is an extremely underrated syndrome beginning around the age of eighteen years. Because of its severity, this diagnosis should be considered when a patient presents an atypical anorexia nervosa. MNGIE disease is inherited in an autosomal recessive manner and related to mutations of the TYMP gene (ch22q13.32-qter), encoding the thymidine phosphorylase. The MNGIE is often misdiagnosed and is associated with a time to diagnostic of about 12 years after first symptoms. Thus this critical review aims to help clinicians better identify symptoms and paraclinical markers of the MNGIE as a differential diagnosis of atypical anorexia nervosa. METHODS: A literature search was performed using PubMed and Google Scholar databases. RESULTS: The clinical diagnosis of the MNGIE disease should be based on the association of severe loss of weight and some additional symptoms: (1) severe gastrointestinal dysmotility (nausea, vomiting, intestinal pseudo-obstruction), (2) ptosis or external ophtalmoplegia and (3) peripheral sensorimotor neuropathy. When MNGIE disease is clinically suspected, paraclinical testing can help to validate the MNGIE diagnostic: (1) Arterial blood test reveals lactic acidemia (e.g. an increased serum concentration of lactate without pH modifications), and (2) Brain MRI indicates leukoencephalopathy, usually asymptomatic. Direct evidence of MNGIE disease is based on specific testing of: (1) the thymidine phopshorylase enzyme activity in leukocytes is less than 10% of the control, (2) the increase of plasmatic thymidine (>3µmol/L) and the increase of plamatic deoxyuridine (>5µmol/L), (3) the evidence of mutations of the TYMP gene by molecular genetic testing. CONCLUSION: The MNGIE disease is a severe trouble with multisystemic complications. The thymidine phopshorylase enzyme activity in leukocytes should be measured as soon as possible when a patient presents atypical anorexia nervosa.

Body distortions after massive weight loss: lack of updating of the body schema hypothesis.

Behavioural therapy and bariatric surgery often produce rapid, massive body weight loss that may impact a patient's ability to gauge his/her new body shape. Although the patient is aware of the weight loss, he/she continues to feel obese, as if there was a conflict between the previous body schema and the new one. Here, we report the case of a 40-year-old woman who developed major body distortions after massive weight loss. Psychometric and behavioural assessments revealed strong disturbances in several tasks involving body representation. In particular, we observed abnormal behaviour in a body-scaled action task. Our findings suggest that the rapidity of our patient's weight loss prevented her central nervous system from correctly updating the body schema.

A renin-like enzyme in rat luteal tissue: evidence of local synthesis and its regulation during pregnancy.

Changes in the concentration of a renin-like enzyme were studied in androgenized rats in which a single luteal phase was induced by the administration of chorionic gonadotrophin. A significant increase in the luteal renin-like enzyme (RLE) concentration was found between the youngest corpora lutea (48 h old) and the oldest one studied (6 days old). The luteal RLE content varied independently of changes in plasma renin concentration. These results suggest that this enzyme was produced locally. The lack of correlation between the luteal RLE and plasma prolactin supports our previous observation that the changes in luteal renin concentration appear not to be prolactin-dependent. Furthermore, the suckling-associated hormones appear not to be related with the regulation of luteal RLE concentration, since the values were not modified in androgenized maternal rats which were suckling when compared with the controls. Changes in luteal renin concentration were also studied during pregnancy. A significant increase was found a few hours after a fertile mating which reached a peak on day 1 of pregnancy, followed by a rapid decrease to low levels throughout the remainder of the pregnancy. Because the renin-angiotensin facilitates angiogenesis, luteal renin may act as an angiogenic factor, stimulating blood vessel growth in the corpora lutea. An alternative hypothesis is that the increase in RLE could be a trigger for calcium flux redistribution and steroid biosynthesis.

Cyclical changes in plasma renin during the oestrous cycle in the rat: synchronized effect of oestrogen and progesterone.

The aim of the present work was to study the relationship between sex hormones and plasma renin levels during the oestrous cycle in a Wistar-derived rat strain. Plasma renin activity (PRA) as well as a plasma renin concentration (PRC) were increased during the day of oestrus in rats with controlled 4-day oestrous cycles. This increase in PRA and PRC was not found when rats were ovariectomized on dioestrus day 2 and samples measured on the expected day of oestrus. The increase in PRA and PRC was not found when normal cyclic rats were treated with either tamoxifen or the progesterone receptor blocker RU 38486. Treatment with progesterone at pro-oestrus after ovariectomy on dioestrus day 2 partially increased the PRA and PRC when compared with the values found during the day of oestrus in control rats. The combined treatment of ovariectomized rats on dioestrus day 2 with oestrogen and progesterone restored the normal increase in PRA and PRC values on the expected day of oestrus. We therefore postulate that the sodium diuresis promoted by progesterone may be modulated by the previous peak of oestrogen. However, stimulation of extrarenal sources of renin cannot be excluded nor can an involvement of inactive precursors of renin in the fluctuations of active renin that occur during the oestrous cycle. No important change in plasma renin substrate (PRC) was observed during the oestrous cycle. PRA, PRC and PRS were determined every 4 h during the 4-day oestrous cycle. Our results clearly show a rhythmic variation in PRA and PRC which increases during the day of oestrus with a peak at 06.00 h.(ABSTRACT TRUNCATED AT 250 WORDS)

A renin-like enzyme in luteal tissue.

The aim of this study was to identify immunologically and biologically a renin-like enzyme (RLE) in rat corpora lutea (CL). The biological activity of partially purified extracts of CL was tested in vivo by injection into anesthetized pentolinium-treated rats, obtaining a pressor response similar to renal renin. The enzyme activity in vitro was inhibited to about 50% by pretreatment with a specific antibody against renal renin. When the extracts were incubated with angiotensinogen, the product was inhibited mainly by angiotensin I antibody. The fact that there was no change in RLE content in 24 or 48 h nephrectomized rats, suggested the idea of a local production rather than an active blood renin sequestration.

Antianginal efficacy over 24 hours and exercise hemodynamic effects of once daily sustained-release 300 mg diltiazem and 240 mg verapamil in stable angina pectoris.

The antianginal efficacy of 240 mg sustained release verapamil once daily doses and 300 mg diltiazem was studied in 20 normotensive patients with chronic stable angina pectoris, using a randomized, double-blind crossover design. Patients received a blinded therapy of verapamil placebo and diltiazem placebo for six weeks than only sustained-release diltiazem (SRD) for a long-term phase of three weeks, after a two-week placebo baseline period. Symptom-limited bicycle exercise was longer with the verapamil (510+/-129.9 s) and diltiazem (540+/-124.6 s) than with placebo at baseline (396+/-152.2 s, P<0.005). Verapamil and diltiazem reduced the weekly rate of anginal attacks from 5.1+/-8.6 during placebo to 4.4+/-4.1 with verapamil and 1.9+/-3.2 with diltiazem (P<0.05). The antianginal effects of the two agents are probably mediated by reduction of myocardial oxygen demand at submaximal exercise. In addition, diltiazem appears to provide more symptomatic relief and reduces the weekly number of anginal attacks significantly more than verapamil. Therefore its once-daily administration simplifies the treatment schedule and should improve patients' compliance.

Activation of renal renin by a protein plasma fraction: a novel enzymatic mechanism.

A 3-fold increase in active renin was found after a kidney cortex extract was incubated with plasma from either normal or nephrectomized rats (0.34 +/- 0.04 to 1.34 +/- 0.08 and 1.60 +/- 0.06 micrograms Angiotensin I/mg tissue/hr, respectively). A plasma protein that activates renal renin was purified 900-fold. Purification of the protein was achieved by a combination of ammonium sulfate fractionation, molecular filtration on Sephacryl S-200 HR and ion-exchange chromatography on Mono Q HR 5/5 associated to an fast performance liquid chromatography (FPLC) system. The protein shows a molecular weight of approximately 54,000 Da. Renin activation was not inhibited by serine protease inhibitors, such as phenylmethyl sulfonylfluoride, aprotinin, soybean trypsin inhibitor and N-tosyl-L-phenylalanine chloromethyl ketone or by the cystein protease inhibitors N-ethylmaleimide and leupeptin. By using enzyme inhibitors, it was found that the activation process is not mediated by kallikrein, plasmin, tonin, cathepsin B or trypsin-like enzymes. From these results, we conclude that there is in circulating plasma a previously unidentified enzyme capable of activating inactive kidney renin. However, the possibility that this protein acts by activating the renin-substrate reaction cannot be dismissed.

Spontaneous inhibition or inactivation of renin in rat plasma.

Renin appears to be rapidly inactivated in vitro. The present study was undertaken to clarify this observation and to establish the existence of substances involved in renin inactivation. The disappearance rate of renin (including pure renin) was measured in plasma incubated at 37 degrees C and in circulating blood. Pure renin added to plasmas disappears in vitro at the same rate (t1/2 approximately or equal to 40 min) that renin in plasma from normal rats and from rats submitted to a hemorrhage. This process appears not to be mediated by proteases. The disappearance rate of endogenous renin in the normal group (n = 18) was 39.7 min with rapid phase (R) of t1/2 = 14.2 min and a slow phase (S) of t1/2 = 94.3 min), whereas it was 32.1 min (t1/2 R = 13.1 min and t1/2 S = 69.1 min) in rats submitted to an hemorrhage (n = 6). The t1/2 of pure renin was 31.4 min (t1/2 R = 13.3 min and t1/2 S = 69.2 min). Incubation of plasma reveals that renin is inactivated or inhibited in vitro at a similar rate than in circulating plasma. These results suggest that inactivation and sequestration of renin could be two independent mechanisms in the maintenance of plasma renin activity.

Evisceración vaginal tras tratamiento con radioterapia e histerectomía abdominal / Vaginal evisceration after treatment with radiotherapy and abdominal hysterectomy

La evisceración vaginal es una complicación muy rara. Es más frecuente en mujeres posmenopáusicas y con antecedente de cirugía vaginal, fundamentalmente histerectomía. También puede darse en mujeres premenopáusicas, vinculándose en estos casos a traumatismos, iatrogenia o introducción de cuerpos extraños. El íleon distal es el órgano más frecuentemente eviscerado, aunque el prolapso de epiplón, trompas de Falopio y apéndice también se han descrito. Presentamos el caso de una mujer de 43 años con evisceración transvaginal de epiplón a los seis meses de realizarse una histerectomía abdominal por recidiva de un cáncer escamoso de cérvix.

Vaginal evisceration is a very rare complication. It is more often in postmenopausal women with a history of vaginal surgery, mainly hysterectomy. It can also occur in premenopausal women, linking these cases to trauma, iatrogenic or foreign bodies. The distal ileum is most often gutted organ prolapse, although omentum, fallopian tubes and appendix are also described. We report a 43-year old transvaginal omental evisceration after six months of an abdominal hysterectomy for recurrent squamous cervical cancer.

Incorporación del estudio de ADN fetal en sangre materna al cribado de cromosomopatías / Incorporation of the study of fetal DNA in maternal blood to the screening of chromosomal diseases

OBJETIVO: Evaluar la efectividad del cribado combinado de primer trimestre para la detección prenatal de aneuploidías tras 6 años de implantación en nuestro servicio y su repercusión en la disminución de pruebas diagnósticas invasivas. Se propone establecer un protocolo para incorporar el estudio de ADN fetal en sangre materna a partir de las revisiones bibliográficas publicadas. MÉTODO: Se evaluó el riesgo de anomalía cromosómica fetal en 3177 gestaciones mediante cribado combinado de primer trimestre entre enero de 2011 y diciembre de 2014. Se revisaron las amniocentesis realizadas desde que se instauró el cribado combinado en 2008 comparándolas con las de los 5 años anteriores. RESULTADOS: La tasa de detección del cribado para trisomía 21 fue del 94,4% y la tasa de falsos positivos de 6,4%. En el año 2005 estábamos realizando 194 amniocentesis, tras 6 años de implantación del cribado, en el año 2013 se realizaron 35 amniocentesis lo que implica una disminución del 70%. CONCLUSIONES: El cribado combinado de primer trimestre ha demostrado una mayor tasa de detección para trisomía 21 que el cribado de segundo trimestre y/o la edad materna, además de que ha llevado a una importante reducción en el número de pruebas invasivas. En los próximos años la incorporación del estudio de ADN fetal mejorará la detección de aneuploidías, con una drástica disminución de las pruebas invasivas por lo que se hace necesario la implantación de nuevos protocolos.

AIMS: To evaluate the effectiveness of first trimester combined screening in the prenatal detection of aneuploidy after 6 years of implantation in our service and its impact in reducing invasive diagnostic tests. It is proposed to establish a protocol to incorporate the study of fetal DNA in maternal blood from published literature reviews. METHODS: The risk of fetal chromosomal anomalies was assessed in 3177 pregnancies with first trimester combined screening between January 2009 and December 2014. The amniocenteses performed were checked against those of the previous 5 years. RESULTS: The detection rate of screening for trisomy 21 was 94.4% and the false-positive rate was 6.4%. In 2005 there were 194 amniocenteses. In 2013, 5 years after the introduction of screening, 68 amniocenteses were performed, representing a 70% reduction in invasive procedures. CONCLUSIONS: First trimester combined screening has shown a higher detection rate for trisomy 21 that the second trimester screening and/or maternal age, and has substantially reduced the use of invasive prenatal diagnostics procedures. In the coming years, the incorporation of the study of fetal DNA improve the detection of aneuploidys with a drastic reduction of invasive tests so that, the implementation of new protocols is necessary.

Linfoma de Hodgkin y no Hodgkin durante la gestación: a propósito de dos casos / Hodgkin's and non-Hodgkin during pregnancy: report of two cases

Las neoplasias hematológicas en el embarazo conllevan un gran riesgo para la madre y el feto. El linfoma, Hodgkin (LH) y no Hodgkin (LNH), es la cuarta causa más frecuente de cáncer diagnosticado en el embarazo. El tipo más frecuente es el LH, mientras que la incidencia de LNH es muy baja. Presentamos dos casos de gestantes de 29 y 25 años, diagnosticadas en el segundo trimestre de la gestación de LNH mediastínico de células B y LH tipo esclerosis nodular respectivamente. Ambas fueron tratadas con quimioterapia desde el diagnóstico hasta dos semanas antes del parto, con buen resultado perinatal.

Haematological cancer in pregnancy poses a substantial risk to both, mother and fetus. Lymphoma, including Hodgkin's lymphoma (HL) and Non-Hodgkin's lymphoma (NHL), is the fourth most frequent malignancy diagnosed during pregnancy. The most common type of lymphoma in this setting is HL, and the incidence of pregnancy associated NHL is very low. In this report we describe two cases of a 29-year-old woman and a 25-year-old woman both in the second trimester of pregnancy, diagnosed with mediastinal B-cell NHL and nodular-sclerosis HL respectively. They were managed with chemotherapy since the diagnosis as far as two weeks before the delivery, both with a successful fetal outcome.

Metástasis ováricas de carcinoma de células pequeñas de pulmón / Ovarian metastases of small cell carcinoma oat-cell type of lung

La incidencia de cáncer de pulmón sigue aumentando, sobre todo en las mujeres y, aunque las metástasis en ovario son raras, hay que tenerla en cuenta en el estudio de extensión y seguimiento del mismo, porque en la mayoría de los casos en el momento del diagnóstico se verifica diseminación a distancia. Presentamos el caso de una paciente de 29 años en la que se planteó duda diagnóstica inicialmente entre tumor ovárico maligno con metástasis pulmonares versus linfoma, llegándose al diagnóstico final de carcinoma de células pequeñas tipo oat-cell de pulmón con metástasis ováricas.

The incidence of lung cancer is increasing, especially in women, and although metastasis in the ovary is uncommon it should be taken into account in the extension study and monitoring of the same because distant spread is verified in most cases at the time of diagnosis. We report the case of a 29-year-old patient which diagnostic doubt arose initially from malignant ovarian tumor with lung metastases or lymphoma, and she came to the final diagnosis of small cell carcinoma oat-cell type of lung with ovarian metastases.

Changes during lactation in the renin-like enzyme concentration in rat luteal tissue.

The activity of a renin-like enzyme (RLE) previously found in rat copora lutea was studied during lactation. Luteal RLE concentration significantly increased after delivery and reached a maximum on day 5 of lactation. Plasmatic levels of PRL and progesterone also increased through lactation. Treatment with 2 bromo-alpha-ergocryptine, which diminished plasma PRL and progesterone levels, enhanced luteal RLE activity. Therefore, the increase in luteal RLE during lactation seems to be independent of PRL and progesterone levels, but dopamine could be involved in its regulation. The increase in luteal RLE is not related to the intensity of the suckling stimulus, since RLE values were not modified in mothers suckling 2 to 10 pups. In conclusion, RLE activity in rat corpora lutea changes during lactation with a pattern similar to that of plasmatic PRL and progesterone, but seems not to be regulated by these hormones, nor by the intensity of suckling. On the contrary, luteal RLE may be regulated by dopamine.

The novel serine protease PreR-Co promotes endothelium-independent vasorelaxation in rabbit aortic rings.

The effect of a novel enzyme (PreR-Co) that activates renal prorenin was studied on rabbit aortas with and without endothelium. It was tested 1) in the basal tone of nonstimulated or ANG II-sensitized rings or rings precontracted with norepinephrine (NE), PGF(2alpha), high KCl concentration, and 2) in rings pretreated with enalaprilat, losartan, PD-123319, N(omega)-nitro-l-arginine methyl ester, HOE-140, indomethacin, or serine protease inhibitors (PMSF, aprotinin, or soybean trypsin inhibitor); kallilkrein and bradykinin were also tested in ANG II-sensitized rings. PreR-Co produced a vasorelaxant effect in the basal tone and in the precontracted rabbit aorta. The effect was endothelium independent, potentiated by endothelium removal or nitric oxide (NO) synthase inhibition, and abolished by boiling the enzyme. In addition, the effect improved when basal tone was increased in ANG II-sensitized aortic rings or in precontracted vessels. No activation of the ANG II, bradykinin, prostaglandin, or NO pathway mediating the PreR-Co response could be obtained, suggesting a direct action of the enzyme. This action seems to be dependent on esterasic activity because serine protease inhibitors like PMSF and aprotinin were able to block the vasorelaxant effect of PreR-Co.

Reversal of left ventricular hypertrophy following once daily administration of felodipine for two years to elderly subjects with isolated systolic hypertension.

Left ventricular mass sometimes decreases during the treatment of hypertension. In a two-year open study, we investigated the ability of extended release (ER) felodipine (5 or 10 mg), plus chlorthalidone (25 mg), given once daily, to reduce left ventricular mass in 84 elderly patients with isolated systolic hypertension. Drug dosage was determined in an initial stepped-care titration phase lasting six weeks. Mean systolic blood pressure decreased after two years of treatment with 5 or 10 mg of felodipine (p < 0. 001) and the left ventricular mass index decreased too (p < 0.0001). One or two weeks after withdrawal of therapies, blood pressure returned to pretreatment values. We concluded that left ventricular mass can be reduced in elderly patients with isolated systolic hypertension and ventricular hypertrophy who receive felodipine 5-10 mg once daily. This treatment was generally well tolerated.