High prevalence of vertebral fractures in women with breast cancer starting aromatase inhibitor therapy.

BACKGROUND: The purpose of this study was to describe bone status in a large cohort of postmenopausal women with nonmetastatic breast cancer, at the initiation of aromatase inhibitor therapy. PATIENTS AND METHODS: A prospective, transversal and clinical study was conducted. Each woman had an extensive medical history, a biological evaluation, a bone mineral density (BMD) measurement and spinal X-rays. RESULTS: Four hundred and ninety-seven women aged 63.8 ± 9.6 years were included in this study. Eighty-five percent of these women had a 25-OH vitamin D concentration <75 nmol/l. One hundred and fifty-six women (31.4%) had a T-score < -2 at one of the three site measurements. Ninety-five women (19.1%) had a history of nonvertebral fracture with a total of 120 fractures. Spine X-rays evaluation revealed that 20% of the women had at least one vertebral fracture. The presence of vertebral fracture was associated with nonvertebral fracture history [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1-2.4] and with spine BMD (OR 1.4, 95% CI 1.1-1.7). The prevalence of vertebral fracture reached 62.9% in women with age above 70 years and femoral T-score < -2.5. CONCLUSION: Before starting aromatase inhibitor therapy for breast cancer, a large proportion of women had a vitamin D insufficiency and vertebral fractures.

Osteomalacia in a patient with Paget's bone disease treated with long-term etidronate.

A 93 year-old woman with Paget's disease of bone had been treated with etidronate without interruption during 20 years. The daily dose was usual (5mg/kg/day) but this prescription had never been stopped by her physicians. Two fractures had already occurred in pagetic (right tibia) and non pagetic bones (right fibula) within the last 2 years, and she presented rib fractures, another right tibia fracture and right femur fracture during hospitalization time. X-rays films showed major osteolysis of left ulna and right tibia. Blood samples and technetium bone scan brought no evidence for sarcoma or lytic evolution of the disease. A transiliac bone biopsy on non pagetic bone site confirmed the diagnosis of osteomalacia (increased osteoid parameters), with secondary hyperparathyroidism (hook resorption). In Paget's disease of bone, continuous treatment by etidronate may induce generalized osteomalacia, and increase the risk of fracture in both pagetic and non-pagetic bones. Whereas physicians and pharmaceutical industry try to improve the observance of those drugs, this striking observation also points out that a prescription always needs to be updated.

Kokumi taste perception is functional in a model carnivore, the domestic cat (Felis catus).

Kokumi taste is a well-accepted and characterised taste modality and is described as a sensation of enhancement of sweet, salty, and umami tastes. The Calcium Sensing Receptor (CaSR) has been designated as the putative kokumi taste receptor for humans, and a number of kokumi-active ligands of CaSR have been discovered recently with activity confirmed both in vivo and in vitro. Domestic cats (Felis catus) are obligate carnivores and accordingly, their diet is abundant in proteins, peptides, and amino acids. We hypothesised that CaSR is a key taste receptor for carnivores, due to its role in the detection of different peptides and amino acids in other species. Using in silico, in vitro and in vivo approaches, here we compare human CaSR to that of a model carnivore, the domestic cat. We found broad similarities in ligand specificity, but differences in taste sensitivity between the two species. Indeed our in vivo data shows that cats are sensitive to CaCl2 as a kokumi compound, but don't show this same activity with Glutathione, whereas for humans the reverse is true. Collectively, our data suggest that kokumi is an important taste modality for carnivores that drives the palatability of meat-derived compounds such as amino acids and peptides, and that there are differences in the perception of kokumi taste between carnivores and omnivores.

[Obstetrical and neonatal outcomes of gestational diabetes mellitus at Reunion Island (France)]. / Conséquences obstétricales et néonatales du diabète gestationnel dans la population du sud de l'île de la Réunion.

OBJECTIVE: To assess maternal and fetal outcomes in patients with gestational diabetes mellitus. PATIENTS AND METHODS: A retrospective study was conducted at the Sud-Reunion Hospital's maternity (French overseas department located in the Indian Ocean), during the period from January 1, 2001, through December 31, 2004. During this period, 1172 pregnant women presenting gestational diabetes mellitus were compared with 1172 non-diabetic controls matched on the basis of age, parity. Student t test, Pearson chi-square test and logistic regression model were used for statistical analysis. RESULTS: Gestational diabetes mellitus complicates about 7.5% of pregnancies in Reunion Island. Its occurrence was associated with a significantly increased prevalence of pre-pregnancy obesity (27 versus 9.4%) and chronic hypertension (5.3 versus 3.3%). The prevalence of preeclampsia and obstetrical vascular disorders were not different between the two groups, respectively 2.2 versus 2.7% (P=0.43) and 6.2 versus 4.4% (P=0.06). The rate of caesarean sections and inductions of labour was increased in the study group. The term of delivery was inferior in the study group, consecutive to increased rate of labour induction at 38 week-gestation. Macrosomia and large for gestational age (LGA) newborns rate were significantly higher in the study group, respectively 8.9 versus 4.2% and 22.5 versus 10.1% (P<0.001) but the rate of admission into neonatal unit was not significantly different. DISCUSSION AND CONCLUSION: Active management of gestational diabetes mellitus is associated with low maternal and perinatal morbidity. While age and parity are controlled by the study design, the prevalence of preeclampsia and gestational hypertension are not increased in women presenting gestational diabetes mellitus.

Obstetrical and neonatal outcomes in obese women.

OBJECTIVE: To compare the incidence of antenatal and intrapartum complications and neonatal outcomes among pre-pregnant obese women. METHODS: At the Sud-Reunion Hospital's maternity, Reunion Islands, France, over a 54-month period, each obese pregnant woman (BMI > or = 30 kg/m2) delivering a singleton after 22-weeks gestation was compared to the next age and parity-matched woman of normal pre-pregnancy weight (BMI 18.5-25 kg/m2), who delivered after the index case. The Students t test, Mann and Whitney test, Chi-square test and logistic regression model were used for statistical analysis. RESULTS: The study enrolled 2081 obese women and 2081 controls. The incidences of pre-eclampsia, chronic and pregnancy-induced hypertension, chronic and gestational diabetes mellitus were increased in the obese women group. Prenatal care in obese women required a high rate of hospitalizations as well as a high rate of insulin treatment. Obese women were more likely to be delivered by Caesarean section. The rate of in utero fetal death, neonatal and perinatal death was significantly higher in the obese women group. The high BMI in relation with both pre-eclampsia and in utero fetal death remained unchanged after adjustment of other risk factors. CONCLUSION: Obese women were more likely to present several obstetric complications and to be delivered by Caesarean section. Obstetricians who decide on a first Caesarean section in an obese woman should be aware of the cumulated obesity and uterine scar risks that could threaten any subsequent Caesarean section.

[Twin pregnancies in southern Reunion Island: a three-year cross-sectional study of risk factors and complications]. / Grossesses gémellaires dans le sud de l'île de la Réunion: étude transversale sur 3 ans des facteurs de risque et des complications.

OBJECTIVES: To describe characteristics of multiples pregnancies in southern Reunion Island. MATERIAL AND METHODS: A three-year [corrected] cross-sectional observational study aimed at describing risk factors, events and [corrcected] complications and associated with twin pregnancies from 22 weeks gestation onward, within a tertiary care hospital centre, the Groupe Hospitalier Sud-Réunion. RESULTS: The study included 241 multiple pregnancies out of 15 837 pregnant women. The regional incidence of multiple pregnancies was 1.5%. Indicators of eligible twin pregnancies (n=234) were mother age up or equal to 35 years (63% of women, OR 8.4; CI95% 6.3-11.1), infertility treatments (15%): ovarian stimulations (OR: 50.2; CI95% 24.7-102) and in vitro-fertilisations (OR: 44.3; CI95% 22.6-86.3). A low maternal corpulence before pregnancy (BMI<20) and celibacy were negatively associated with twin pregnancies. Prenatal cares for twin pregnancies were globally adequate. The need for hospitalisation was 50% (30% of whom for preterm delivery threats). Twin pregnancies increased risks for pre eclampsia (OR: 3.0; CI95% 1.6-5.7) and gestational diabetes (OR: 1.9; CI95% 1.2-2.8). Caesareans and instrumental delivery rates were 50% and 12% (vs 16% and 7%), respectively. Twin infants were preterm for 62% and very preterm for 18%. Last, they were more likely to die than singletons (perinatal mortality: 78 per thousand for monochorionic twins, 57 per thousand for bichorionic twins vs 17 per thousand, p<0.0001, respectively). CONCLUSION: In Reunion Island, the incidence of multiple pregnancies is similar to that seen in Europe, but seems less due to assisted reproduction techniques. In return, they are associated with higher morbidity and mortality rates.

[Congenital varicella: limits of prenatal diagnosis]. / La varicelle congénitale: les limites du diagnostic prénatal.

INTRODUCTION: Primary varicella infection during pregnancy is uncommon. Fetal varicella syndrome is unusual when varicella occurs after 20 weeks of gestation. CASE REPORT: A mother contracted chicken pox at 21 weeks and 3 days of gestation. Monthly monitoring was assured by the center for prenatal diagnosis, starting from 23 weeks. At 36 weeks, foetal echography detected liver calcifications, without other lesions. At 38 weeks, the patient went into spontaneous labour and delivered a male baby. The baby presented cicatricial skin lesions all over the body and scalp. The cerebral scan detected calcifications and a bilateral chorioretinitis was noticed. At 12 months, the infant had delayed psychomotor acquisitions, a cerebral cortical atrophy and blindness. CONCLUSION: The presence of fetal liver calcifications after chicken pox in the mother is a seldom reported sign. In our observation, liver calcifications were the single sign of a severe fetal damage.

Chronic consumption of short-chain fructooligosaccharides by healthy subjects decreased basal hepatic glucose production but had no effect on insulin-stimulated glucose metabolism.

We aimed to study the effects of chronic ingestion of short-chain fructooligosaccharides (FOS), an indigestible carbohydrate, on hepatic glucose production, insulin-mediated glucose metabolism, erythrocyte insulin binding, and blood lipids in healthy subjects. Twelve healthy volunteers received either 20 g FOS/d or sucrose for 4 wk in a double-blind crossover design. FOS did not modify fasting plasma glucose and insulin concentrations. Mean (+/- SEM) basal hepatic glucose production was lower after FOS than after sucrose consumption (2.18 +/- 0.10 compared with 2.32 +/- 0.09 mg.kg-1, min-1, respectively; P < 0.02, paired Student's t test). However, neither insulin suppression of hepatic glucose production nor insulin stimulation of glucose uptake measured by hyperinsulinemic clamp was significantly different between the two dietary periods. Erythrocyte insulin binding was also comparable. Serum triacylglycerols, total and high-density- lipoprotein cholesterol, apolipoproteins A-I and B, and lipoprotein(a) were not modified by FOS. To try to understand why FOS did not increase serum lipids, the in vitro production of short-chain fatty acids from FOS was evaluated by using human fecal inoculum and compared with that from lactulose, which was found to increase serum lipids. FOS produced an acetate-propionate ratio two times lower than that of lactulose. We conclude that 4 wk of 20 g FOS/d decreased basal hepatic glucose production but had no detectable effect on insulin-stimulated glucose metabolism in healthy subjects. The colonic fermentation pattern of undigestible carbohydrates may be relevant to predicting their metabolic effects.

[Uremic polyneuropathy: a study of vibratory perception threshold in 19 patients]. / Polineuropatia uremica: estudo do limiar de percepção vibratória em 19 pacientes.

A vibratory perception threshold study was done in 19 patients with uremic polyneuropathy, using a palesthesiometer. Three patients were maintained in conservative treatment (controls), 7 patients maintained with hemodialysis and 9 patients with peritoneal dialysis, during a period of 4 to 72 months. Abnormal vibratory perception threshold was found in 94.73% when the first toe was studied, 36.84% with the fifth finger and 52.63% with the second finger. The statistical analysis between the hemodialysis, peritoneal dialysis and control group was non significant. It was not found any correlation between the severity and duration of neuropathy with the low perception threshold. The authors conclude that this is a simple method, easy to be done and very useful in the quantification of the vibratory perception threshold in the uremic patient, but lack specificity regarding severity of the illness.

[Severe cytomegalic inclusions disease in the fetus of a woman immunized before pregnancy]. / Maladie des inclusions cytomégaliques sévères chez le foetus d'une femme immunisée avant la grossesse.

After detection of a fetal microcephaly at 24 weeks gestation, we performed an amniocentesis at 29 weeks with chromosomal and polymerase chain reaction (PCR) search for viral contamination. Cytomegalovirus (CMV) infection was confirmed by PCR although the mother had previously been tested as immunized for CMV prior to conception. Abortion was induced; the fetus presented clinical CMV injuries confirmed by positive tissue culture (liver, brain and lungs). Recent publications have reported similar observations with variable viral strains. These findings point out the importance attentive search for ultrasonographic signs suggestive of fetal CMV infection.

[Post mortem brain MRI: an alternative for pathology examination in Bourneville tuberous sclerosis of the fetus?]. / IRM cérébrale post mortem: une substitution à l'examen anatomo-pathologique dans la sclérose tubéreuse de Bourneville du foetus?

Antenatal discovery of cardiac rhabdomyomes evokes the diagnosis of Bourneville's disease. Antenatal brain exploration with ultrasonography and magnetic resonance imaging (MRI) can highlight cerebral localizations. In the event of termination of pregnancy, confirmation of the cerebral lesions can be achieved with post mortem MRI as well as pathology examination. MRI can be usefully employed in the event pathology examination is not feasible.

[Parametrial pregnancy. Report of a case of "paracervical" pregnancy treated by medico-surgical management]. / Grossesse paramétriale. A propos d'un cas de grossesse "paracervicale" traitée par association médico-chirurgicale.

We report an exceptional case of para-cervical pregnancy. Ultrasonography enabled accurate diagnosis after explorative laparoscopy. Treatment was conservative involving methotrexate and surgical ablation of the pregnancy by vaginal approach with a successful outcome.

[Pregnancy beyond age 40 in 382 women: a retrospective study in Reunion Island]. / Grossesse chez 382 femmes de plus de 40 ans: étude rétrospective dans la population de l'île de la Réunion.

OBJECTIVE: To examine obstetrical and neonatal outcomes among women age 40 years and older. MATERIAL AND METHODS: There was a retrospective study including 382 pregnant women at least 40 years of age and 7786 controls aged 20-34, stratified according to parity. Associations between maternal age and pregnancy outcomes were assessed using Pearson's chi(2) test, Fischer exact test, Student test or Mann and Whitney test, as appropriate. RESULTS: Maternal age 40 and over was associated with an increased risk for gestational diabetes (multiparas: OR 3.2, 95%CI 2.2-4.8; grandmultiparas: 2.8, 1.6-5.0), chronic diabetes (multiparas: 3.5, 1.04-10.6), chronic hypertension (multiparas: 3.1, 1.5-6.1; grandmultiparas: 12.1, 3.3-53.2), pregnancy-induced hypertension (nulliparas: 4.6, 1.01-17.3; multiparas: 2.6, 1.3-5.4) and preclampsia (multiparas: 2.9, 1.1-7.2). The risk for cesarean section was 2-fold higher in older multiparas and grandmultiparas. The same was true for the rate of operative vaginal delivery. The rate of fetal chromosomal abnormalities was 7-fold higher in older gravidas. Rates of fetal death were significantly increased in the cohort of older pregnant women (nulliparas: 11.2, 2.9-44.0; multiparas: 3.9, 1.4-10.9). CONCLUSION: Pregnancy at age 40 and over is associated with high rates of obstetrical complications, cesarean sections and operative vaginal deliveries, emphasizing the importance of rigorous antenatal care.

[Intraerythrocytic potassium and diuretic therapy]. / Potássio intra-eritrocitário e diureticoterapia.

Diuretic-induced hypokalemia is one of the most common and important disturbances during antihypertensive therapy. However, it has been suggested that determination of serum potassium levels may not reflect significant changes of its intracellular concentration. This study was performed to evaluate whether there is any change of red cell potassium concentration as compared to serum potassium levels, in ten patients receiving chlorthalidone, 25 mg/day, during 4 weeks. Significant antihypertensive effect was achieved and despite serum potassium levels less than 3.5 mEq/1 occurred in four patients, no significant change in intracellular concentration of potassium was observed in this population with essential hypertension.

[Modes of deliveries of twins as a function of their presentation. A study of 371 pregnancies]. / Présentations et modes d'accouchements de 371 grossesses gémellaires.

OBJECTIVE: In France, global rate of caesarian section in twin pregnancies has been 50.2% in 2003. Modes of delivery according to different twin presentations remain controversial in the literature. The purpose of our study is to analyze our practice of twin deliveries in a 5-year period, with neonatal outcomes. PATIENTS AND METHODS: Among 22,243 women having delivered in our maternity (22 weeks and over) during the study period, the study population consisted of 371 twin pregnancies, of which 305 after 33 weeks gestation. RESULTS: Different presentations were relatively identical whatever the gestational age of pregnancies: the "cephalic-cephalic" presentation represented 60 to 70% of the total, the "cephalic-breech" presentation approximately 10% while the "breech-cephalic" or "breech-breech" presentations approximately 8% each. Mean terms of pregnancies were 35.2 ± 2.8 weeks, mean birthweight being 2243 ± 561 g. C-section rate was 53.5%. When the first twin was in cephalic presentation, C-section rate was 40% while it was almost 100% when the first twin was in breech or "other" presentations. CONCLUSION: There were no significant differences in neonatal outcomes (mean birthweights, Apgar scores, transfers in neonatology, perinatal deaths) according to different mode of deliveries (vaginal or C-sections). Our policy of planned cesarean section may need to be revised.

[Macroglobulinosis cutis revealing Waldenström macroglobulinemia]. / Une maladie de Waldenström révélée par une macroglobulinemia cutis.

Waldenström macroglobulinemia is defined by a bone marrow lymphoplasmacytic infiltration associated with serum IgM monoclonal gammopathy. Specific properties of the IgM gammopathy induce the main clinical manifestations revealing the disease: hyperviscosity syndrome, autoimmune peripheral neuropathy, cryoglobulinemia or hemolysis, and exceptional skin deposit such as macroglobulinosis cutis that we here report. Physicians should be aware of these clinical manifestations to avoid diagnostic delay.