[Obesity, bariatric surgery and contraception]. / Obésité, chirurgie bariatrique et contraception.

The use of hormone therapy is an important therapeutic choice in woman's life, both for contraceptive purpose to avoid unwanted pregnancy, as well as for treatment of menstrual disorders, or climacteric symptoms. Medical care must therefore be dynamic, tailored to individual requirements as much as possible, reflecting personal and family background, potential risks related to treatment, and of course patient's wishes. We will first discuss the modalities of contraception in presence of obesity, then the need for potential adjustment following bariatric surgery.

Le choix d'une médication hormonale est un acte thérapeutique important dans la vie d'une femme, aussi bien dans un but contraceptif afin d'éviter une grossesse non désirée, que dans le cadre d'une prise en charge symptomatologique accompagnant le cycle menstruel ou entourant la ménopause. La prise en charge se doit donc d'être dynamique, individualisée au maximum, en tenant compte des antécédents personnels et familiaux, des facteurs de risque potentiels liés au traitement et, bien évidemment, des désirs de la patiente. Nous discuterons, dans un premier temps, de la contraception dans le cadre d'une obésité et, dans un second temps, de l'éventuelle adaptation après chirurgie bariatrique.

[Trisomy 18 in a bichorial-biamniotic twin pregnancy]. / Grossesse gémellaire bichoriale-biamniotique dont un des foetus est atteint de trisomie 18.

Screening for chromosomal abnormality such as trisomy 18 in a bichorial-biamniotic twin pregnancy is based on ultrasound and a non-invasive prenatal test (NIPT) from 12 weeks of gestation. An invasive examination such as amniocentesis is necessary for a diagnostic confirmation. The management of these complicated cases consists in performing a selective feticide in the first or third trimester of pregnancy. Trisomy 18 most often results from a chromosomal nondisjunction of maternal origin. Indeed, advanced maternal age is a major cause of chromosomal abnormality and a promoting factor of twin pregnancies. This is a severe condition with a very high stillbirth rate, even though there are certain cases where babies have managed to survive for several years.

Le dépistage d'une anomalie chromosomique de type trisomie 18 dans le cadre d'une grossesse gémellaire bichoriale-biamniotique repose sur l'échographie et sur la réalisation d'un test prénatal non invasif (NIPT) à partir de 12 semaines de gestation. Un examen invasif de type amniocentèse est nécessaire pour une confirmation diagnostique. La prise en charge de ces cas compliqués consiste à effectuer un foeticide sélectif au premier ou au troisième trimestre de la grossesse. La trisomie 18 résulte le plus souvent d'une non-disjonction chromosomique d'origine maternelle. En effet, l'âge maternel avancé est une cause majeure d'anomalie chromosomique et un facteur favorisant les grossesses gémellaires. Il s'agit d'une condition sévère avec un taux de mortinatalité très élevé bien qu'il existe certains cas où les enfants survivent plusieurs années.

[Sporadic Birt-Hogg-Dube syndrome]. / Syndrome de Birt-Hogg-Dubé sporadique.

Birt-Hogg-Dube is a rare syndrome which is sporadic or hereditary with a dominant autosomal transmission. Various organs, in particular the skin, can be affected. In the presently reported case, skin was covered by hundreds of small molluscoid papules corresponding to trichodiscomas, fibrofolliculomas and skin tags.

[Case of the month. Acute generalized exanthematous pustulosis due to an iodinated contrast radiodiagnostic agent]. / Le cas clinique de mois. Pustulose exanthématique aiguë généralisée due a un agent de contraste iodé pour radiodiagnostic.

Iodinated contrast agents are frequently involved in delayed polymorphic adverse skin reactions. Acute generalized exanthematous pustulosis following administration of iodinated contrast agents is a rare but severe form of such reactions. The disease is characterized by the sudden occurrence of an erosive and pustular erythroderma with fever, leukocytosis and sometimes peripheral adenopathies and liver involvement. This condition is considered as an immunologic reaction, primarily involving T lymphocytes. The overall mortality reaches about 1%. Elucidating the differential diagnosis with other acute paroxysmal drug eruptions (toxic epidermal necrolysis, Steven-Johnson syndrome and drug hypersensitivity syndrome) is of paramount importance for establishing the adequate treatment of PEAG.

[Skin and its main neurocristopathies]. / La peau et ses principales neurocristopathies.

The neurocristopathies encompass genetic disorders targeting some structures originating from the neural crest development. Hence, skin is affected by some clinical manifestations of these disorders. This review covers the main aspects found in neurofibromatosis, tuberous sclerosis, incontinentia pigmenti, neurocutaneous melanoblastosis, basal cell naevomatosis and the epidermal naevus syndrome.

[How I explore...A patient with palmar erythema]. / Comment j'explore...Un patient avec un érythème palmaire.

Palmar erythema occurs in a series of physiological and pathological conditions. The first group encompasses hereditary and idiopathic conditions, as well as the time of pregnancy and ageing. The pathological states include some dermatoses as well as hepatic, autoimmune, infectious and paraneoplastic conditions. Medications may also be responsible for palmar erythema, in particular some chemotherapy agents.

Ulcer of Lipschutz, a rare and unknown cause of genital ulceration.

Acute genital ulcers are painful and distressing to women. Lipchutz Ulcer is an uncommon disease that typically occurs in sexually inactive young women. The main differential diagnosis are sexually-transmitted or non-infectious diseases which cause genital or oro-genital ulcerations. This article aims to review the diagnosis of acute genital ulcers and, through a rare case of acute genital ulcerations, to discuss diagnostic procedures.

Enlarged cell-associated proteoglycans abolish E-cadherin functionality in invasive tumor cells.

Mouse and dog epithelial cell lines, expressing high levels of the Ca(2+)-dependent cell-cell adhesion molecule E-cadherin in vitro, generated invasive and metastatic tumors in athymic mice. From these tumors, neoplastic cell lines were isolated. All ex vivo isolates retained high expression levels of E-cadherin at their surface. Nevertheless, some showed a fusiform morphotype, were defective in Ca(2+)-dependent cell aggregation, and were invasive in vitro, indicating that E-cadherin was not functional. Cell-associated proteoglycans were found to be enlarged in these variants as compared to their counterparts with functional E-cadherin. Treatment of the cells with the drug 4-methylumbelliferyl beta-D-xyloside specifically reduced the amount and size of cell-associated proteoglycans. This same drug induced an epithelial morphotype, increased Ca(2+)- and E-cadherin-dependent cell aggregation, and abrogated invasiveness without influencing E-cadherin expression levels. Our results indicate that enlarged proteoglycans can prevent the homophilic binding of E-cadherin, probably by steric hindrance. This is one more mechanism by which carcinomas may counteract invasion-suppressor genes and acquire malignancy.

A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia.

Complications of (pre)eclampsia may involve multiple systems and organs. Neurological symptoms may occur. Visual symptoms concern up to 25% the of patients with severe preeclampsia and 50% of the patients with eclampsia. An uncommon effect of severe preeclampsia is sudden blindness. Blindness may be part of a clinical and radiological presentation named Posterior Reversible Encephalopathy Syndrome (PRES). PRES may lead to permanent neurological deficit, recurrences or death. We report the case of a 24-year-old Caucasian patient, gravida 5 para 2 who developed preeclampsia and PRES complicated with blindness at 32 weeks of gestation. Optimal care allowed visual symptoms to resolve within 24 hours and a favourable maternal outcome and no long- term sequelae. We describe different causes and manifestations of PRES and highlight the need for immediate care in order to optimize the chance of symptoms reversibility.

Intracellular survival and multiplication of virulent and less virulent strains of Streptococcus bovis in pigeon macrophages.

The intracellular fate of pigeon S. bovis strains ingested by macrophages was studied in vivo and in vitro. During in vivo experiments, histological and electron microscopical examinations demonstrated numerous cocci, which appeared to be actively multiplying, within splenic macrophages of pigeons experimentally inoculated with a highly virulent S. bovis serotype 1 strain. In pigeons inoculated with a low virulence serotype 3 strain, intracellular cocci were only occasionally observed. For in vitro experiments, pigeon peritoneal macrophages were inoculated with a S. bovis serotype 1 or serotype 3 strain and incubated. Following an initial decrease, an increase in the number of intracellular bacteria was observed in tests performed with the S. bovis serotype 1 strain, demonstrating intracellular multiplication. Macrophages in these experiments had all died after 7 h of incubation, possibly indicating that the intracellular replication of S. bovis resulted in the release of substances toxic for macrophages. In experiments performed with the S. bovis serotype 3 strain, the number of intracellular bacteria continuously decreased, reflecting killing of organisms. Significant changes in the number of adhering macrophages in S. bovis serotype 3 inoculated cultures were not observed. These results indicate S. bovis in pigeons is a facultative intracellular bacterium and intracellular multiplication may be involved in virulence.

Performance of a modified starch hydrophilic matrix for the sustained release of theophylline in healthy volunteers.

Two experimental formulations of theophylline with a hydrophilic starch matrix were evaluated for their sustained-release characteristics after single administration in healthy human volunteers. Theo-dur was chosen as a reference sustained-release formulation. In a first study, the extent of absorption was similar for a syrup, for Theo-dur, and for the experimental formulation of theophylline with 70% drum-dried corn starch as the sustained-release agent (DDCS-70). The maximal plasma concentration (Cmax) was significantly lower, and the time to reach Cmax as well as the time span during which the plasma concentration was at least 75% of the Cmax were significantly higher for Theo-dur than for the DDCS-70 formulation. A sustained-release profile, as for Theo-dur, was not reached for DDCS-70. In a second study the influence of the starch:drug ratio on the bioavailability was investigated. The decrease in starch content from 70 to 50% of the formulation did not improve the plasma concentration-time profile towards a sustained-release profile.

Influence of the sterilization process on alginate dispersions.

The influence of different sterilization procedures on alginate dispersions was studied by measuring viscosity and molecular weight changes. Autoclaving caused a 64% decrease in viscosity. Heating at a low temperature over several cycles was less efficient in sterilizing alginates and there was a progressive breakdown of the alginate chain over the succeeding cycles. Heating during ethylene oxide sterilization also resulted in reduced viscosity and breakdown. Membrane filtration yielded a sterile product with no significant reduction in viscosity or mol. wt.

Sorption of isosorbide dinitrate to central venous catheters.

As several studies demonstrated the sorption of isosorbide dinitrate (ISDN) to intravenous delivery systems, a study on the sorption of ISDN to several central venous catheters was performed. Fourteen different catheters were perfused during a 2 h period, under simulated infusion conditions, with ISDN (250 micrograms mL-1) in 0.9% (w/v) sodium chloride. The drug loss to a polyethylene and a silicone catheter was 0.2 and 6.1%, respectively. The sorption to a polyvinylchloride heparin-coated thermodilution catheter was 1-6.9% depending on the length of the catheter. The drug loss to polyurethane catheters of different composition varied between 3.8 and 28.9%. For polyurethane catheters composed of cycloaliphatic polyurethanes an inverse relation was shown between Shore A hardness and sorption.

Light stability of molsidomine in infusion fluids.

The influence of artificial light, daylight or stimulated sunlight on the stability of molsidomine was investigated. In static experiments an 80 micrograms mL-1 solution of molsidomine in saline was stored in an unprotected infusion bag. During dynamic experiments the molsidomine solution (80 micrograms mL-1) was dropped at 12.5 mL h-1 from an unprotected infusion bag, from an infusion bag covered with aluminium-foil, or from an infusion bag protected with a UV-cover. Either unprotected infusion tubing or infusion tubing with a UV-filter were connected to the infusion bags. Static as well as dynamic experiments showed a half-life of about 20 min for the unprotected molsidomine solutions, when placed behind a window during a sunny day. Protection from light of the infusion bag but not of the infusion tubing had only a minor influence on the drug half-life. Protection of the infusion bag and the infusion tubing with a UV-filter increased the half-life to several days. These results confirm that both the infusion bag and the infusion tubing need adequate light protection during molsidomine administration.

A fluorescence method for the determination of the molecular weight cut-off of alginate-polylysine microcapsules.

Several applications of microcapsules for the encapsulation of living cells or macromolecules require well defined pore sizes. The molecular weight cut-off of alginate-polylysine microcapsules has been determined using a range of fluorescent labelled dextran molecules. The diffusion of the fluorescein isothiocyanate labelled (FITC)-dextrans into the microcapsules was followed by fluorescence and confocal laser scanning microscopy. The permeability of microcapsules for FITC-dextrans with a molecular weight of 4,700 daltons and the impermeability for FITC-dextrans with a molecular weight of 40,500 daltons was confirmed with both techniques. Determination of the molecular weight cut-off, using confocal laser scanning microscopy was more reliable and required a smaller sample than fluorescence measurements.

Sucrose laurate gels as a percutaneous delivery system for oestradiol in rabbits.

In this study sucrose laurate was formulated in hydrogels and investigated as a suitable transdermal penetration enhancer for oestradiol. Using rabbits as an animal model, the absolute bioavailability and the skin irritation were evaluated after single and multiple application. Three hydrogels containing 60 mg% oestradiol were evaluated: Oestrogel, and two hypromellose gels containing 5 and 15% sucrose laurate (w/w), respectively. No stability problem of the sucrose laurate was detected during a storage period of four months at 7 +/- 2 degrees C. After single application no significant difference (P < 0.05) was observed between the bioavailability parameters of Oestrogel and the 5% sucrose laurate gel. The values obtained for the 15% sucrose laurate gel were significantly higher than for the other gels. When applied on day 7 after a 6-day treatment, twice daily with the respective placebo gel, no significant difference was seen amongst the three formulations for any of the parameters evaluated. When the results after multiple application were compared with those after single application, a significant increase in oestradiol bioavailability was seen for the gel containing 30% ethanol and a significant decrease in oestradiol bioavailability was seen for the 5 and 15% sucrose laurate gels. Histological evaluation of the untreated and treated skin biopsies, showed a significantly higher incidence of infiltrate for all treated skin biopsies in comparison with the untreated ones. A significant increase in skinfold thickness was seen for the skin biopsies treated with gel containing 15% sucrose laurate. It can be concluded that sucrose laurate shows a potential as an absorption enhancer for percutaneous drug delivery.

Host reaction against empty alginate-polylysine microcapsules. Influence of preparation procedure.

Microcapsules, prepared with alginate and polylysine, were injected intraperitoneally into mice and the number of peritoneal leucocytes as well as the cells sticking to the capsule wall were counted after 4-28 days. A significant increase in host reaction was observed when the microcapsules contained an outer layer of polylysine as compared with calcium alginate beads without polylysine or microcapsules coated with an outer layer of alginate. The alginate sources influenced the host reaction significantly. After an intraperitoneal residence of 4 days, the microcapsules were mainly surrounded by macrophages. After 28 days, several cell layers surrounded the microcapsules; macrophages, multinucleate giant cells, fibroblasts and mesothelial cells.

Host reaction against alginate-polylysine microcapsules containing living cells.

Syngeneic and nude mice were injected intraperitoneally with saline, empty microcapsules, aggregates of tumourogenic MO4 cells, encapsulated non-tumourogenic MO cells and encapsulated MO4 cells. The host reaction 4 days after injection, was evaluated by counting the leucocytes in the peritoneal cavity and the cells sticking to recovered microcapsules. A significantly lower number of peritoneal leucocytes was found in mice injected with empty microcapsules or encapsulated MO cells as compared with encapsulated MO4 cells. Histological evaluation showed a significantly higher number of cells sticking to microcapsules containing cells as compared with empty microcapsules. These observations showed that the cellular host reaction against intraperitoneal implants can be evaluated by counting the leucocytes in the peritoneal lavage and histology of recovered capsules.

Evaluation of the nebulisation of sodium ceftiofur in the treatment of experimental Pasteurella haemolytica bronchopneumonia in calves.

Severe acute bronchopneumonia was induced in 24 conventional Friesian Holstein calves by inoculating them intratracheally with Pasteurella haemolytica type A1. Twelve of the calves were treated intramuscularly with sodium ceftiofur and 12 were treated with an aerosol of sodium ceftiofur. The mortality rate in the group of calves treated with the aerosol was significantly lower, and their clinical and haematological parameters returned to normal significantly faster than in the calves treated intramuscularly.