Fracture incidence after 3 years of aromatase inhibitor therapy.

BACKGROUND: The purpose of this study was to describe the fracture incidence and bone mineral density (BMD) evolution in a large cohort of post-menopausal women with breast cancer after 3 years of aromatase inhibitor (AI) therapy. PATIENTS AND METHODS: A prospective, longitudinal study in real-life setting. Each woman had an extensive medical assessment, a biological evaluation, a BMD measurement, and systematic spinal X-rays at baseline and after 3 years of AI therapy. Women with osteoporosis at baseline (T-score < -2.5 and/or non-traumatic fracture history) were treated by oral weekly bisphosphonates. RESULTS: Among 497 women (mean age 63.8 ± 9.6 years) included in this study, 389 had a bone evaluation both at baseline and after 3 years of AI therapy: 267 women (mean age 61.2 ± 8.6) with no osteoporosis at baseline and 122 women (mean age 67.2 ± 9.1) with osteoporosis at baseline justifying a weekly oral bisphosphonate treatment. Women without bisphosphonates had a significant decrease in spine BMD (-3.5%, P < 0.01), neck BMD (-2.0%, P < 0.01), and total hip BMD (-2.1%, P < 0.01) over the 3 years but only 15 of them (5.6%) presented an incident vertebral or non-vertebral fracture. In osteoporotic women treated with bisphosphonates, spine and hip BMD were maintained at 3 years but 12 of them (9.8%) had an incident fracture. These fractured women were significantly older (74.1 ± 9.8 versus 66.5 ± 8.8) but also presented BMD loss during treatment suggesting poor adherence to bisphosphonate treatment. CONCLUSION: This real-life study confirmed that AIs induced moderate bone loss and low fracture incidence in post-menopausal women without initial osteoporosis. In women with baseline osteoporosis and AI therapy, oral bisphosphonates maintain BMD but were associated with a persistent fracture risk, particularly in older women.

[Thoraco-abdominal aortitis in ankylosing spondylitis: a case report and review of literature]. / Aortite thoraco-abdominale au cours d'une spondylarthrite ankylosante: un nouveau cas et revue de la littérature.

UNLABELLED: We report a case of aortitis in a patient with ankylosing spondylitis revealed by an unexplained persistent inflammation. CASE STUDY: The diagnosis of ankylosing spondylitis was retained in a 64-year-old woman suffering from inflammatory back and neck pain combined with buttock pain relieved by anti-inflammatory drugs (NSAIDs) since 2004 and more recent bilateral heel pain in the morning since 2006; sacroiliitis was grade 3 on the right and grade 2 on the left (modified New-York criteria). The patient had remained asymptomatic from April 2006 to 2007 with NSAID as needed. Nevertheless, biological inflammation persisted: erythrocyte sedimentation rate 44 to 55 mm/h, activated protein C 34 to 90 mg/L. Complementary examinations are negative: bilateral temporal artery biopsy, endoscopy with duodenal biopsy looking for Tropheryma whipplei. The thoraco-abdominal and pelvic CT scan revealed aortitis extending from the abdominal aorta to the iliac axis. Treatment with prednisone 0.5 mg/kg was started to decrease the inflammatory aortitis. DISCUSSION: The most "classical" cardiovascular damage observed in spondylitis is aortic insufficiency and conduction disturbances. The first cases of aortitis were reported in 1958. CONCLUSION: Inflammatory vascular disease should be evoked as a possible diagnosis in patients with ankylosing spondylitis the presenting an unexplained biological inflammation (ESR and CRP).

[Collective intoxication with "mad honey" on Reunion Island]. / Intoxication collective par "miel fou" a i'ile de la Réunion (océan Indien).

The authors report a collective intoxication with "mad honey" on Reunion Island, which occurred in 2008. Most patients presented with showed faintless, bradycardia, hypotension and dizziness, consistent with ingested food containing grayanotoxins. All patients fully recovered with a symptomatic treatment. A survey around the hives where the honey was collected, showed the presence of large quantities of Agauria salicifolia (Ericaceae family), an endemic plant in the south-western Indian Ocean and rich in grayanotoxins. A close relationship between these two events was strongly suspected. A monitoring system for the manufacture of honey should be implemented.

[Epidemiological surveillance of grippe and dengue. Réunion, 1996]. / Surveillance épidémiologique de la grippe et de la dengue. La Réunion, 1996.

The local Welfare and Health Authorities together with the country council of Reunion Island set up a medical supervision network for influenza and dengue fever in March 1996. Influenza of which the spreading over the island has never been well-researched is anticipated by a vaccination campaign organised in an empirical way after a model from the mother country (France). Dengue fever of which one of the vectors is omnipresent on the island ranged in an epidemic way in 1978. The aim of this network based on watching doctors, the laboratories of the island as well as the Pasteur Institute of Madagascar, is to adapt the prevention (Flu) and alert the Health Authorities in case of epidemic (Dengue). The article shows the results of 1996 observation and touches on the future of this type of supervision in a tropical environment.

[Paraduodenal hernia: 3 cases and revue of the literature (author's transl)]. / Les hernies paraduodénales. Revue de la littérature à propos de 3 cas.

Three cases of surgically treated para-duodenal hernia are presented. The literature is reviewed. Several modalities of this entity are described as well as the embryological hypotheses to explain their genesis. The diagnosis is usually made at the time of a laparotomy for bowel obstruction. The surgical manipulations to reduce the hernia content (one or several loops of small bowel) are discussed.

Fatal colonic explosion during colonoscopic polypectomy.

A patient is described who sustained the first reported colonic explosion during colonoscopic polypectomy. Mannitol solution was used for bowel preparation, and the colon was completely clean. During snare removal of a cecal polyp using high-frequency current a loud explosion occurred. In spite of emergency surgery with transfusion of 45 units of blood, uncontrollable hemorrhage persisted from multiple bleeding points, and the patient died. This occurrence seems to us to justify the routine use of carbon dioxide insufflation during polypectomy and the avoidance of mannitol for bowel preparation.