Homocysteine threshold value based on cystathionine beta synthase and paraoxonase 1 activities in mice.

BACKGROUND: Hyperhomocysteinaemia is a metabolic disorder associated with the development of premature atherosclerosis. Among the determinants which predispose to premature thromboembolic and atherothrombotic events, serum activity of paraoxonase 1, mainly synthesized in the liver, has been shown to be a predictor of cardiovascular disease and to be negatively correlated with serum homocysteine levels in human. Even though treatments of hyperhomocysteinaemic patients ongoing cardiovascular complications are commonly used, it still remains unclear above which homocysteine level a preventive therapy should be started. MATERIALS AND METHODS: In order to establish a threshold of plasma homocysteine concentration we have analyzed the hepatic cystathionine beta synthase and paraoxonase 1 activities in a moderate to intermediate murine model of hyperhomocysteinaemia. Using wild type and heterozygous cystathionine beta synthase deficient mice fed a methionine enriched diet or a control diet, we first studied the link between cystathionine beta synthase and paraoxonase 1 activities and plasma homocysteine concentration. RESULTS: Among the animals used in this study, we observed a negative correlation between plasma homocysteine level and cystathionine beta synthase activity (rho=-0.52, P=0.0008) or paraoxonase 1 activity (rho=-0.49, P=0.002). Starting from these results, a homocysteine cut-off value of 15 microm has been found for both cystathionine beta synthase (P=0.0003) and paraoxonase 1 (P=0.0007) activities. CONCLUSIONS: Our results suggest that both cystathionine beta synthase and paraoxonase 1 activities are significantly decreased in mice with a plasma homocysteine value greater than 15 microm. In an attempt to set up preventive treatment for cardiovascular disease our results indicate that treatments should be started from 15 microm of plasma homocysteine.

[An observational, retrospective two-year cost study in primary open-angle glaucoma and ocular hypertension in newly diagnosed patients]. / Etude observationnelle rétrospective de coûts des deux premières années de traitement dans le glaucome primitif à angle ouvert et l'hypertension oculaire en France.

PURPOSE: To investigate the different treatment strategies in France and the direct costs for patients with newly diagnosed primary open-angle glaucoma or ocular hypertension who have started treatment with beta-blockers, and to estimate the total direct cost for two years of treat. MATERIAL: and methods: We analyzed 225 medical charts retrospective in eleven academically and office-based centers in France over the first two years after diagnosis. Standard costs for each resource in current medical practice were determined from the French Social Security perspective. RESULTS: The vast majority of patients (90%) had a diagnosis of primary, open-angle glaucoma or ocular hypertension in both eyes. In 60% of the patients we found a moderate or severe defect in their visual field or optic nerve. Intraocular pressure before treatment was 23.9+4.7mmHg and 17.5+4.2mmHg after two years of treatment. Over the first two years, 25% of visits led to a change in therapy (medical or surgical), involving 64% of the patients. Two-thirds of the changes occurred during the first year of treatment and in around 80% of cases for low intraocular pressure at check-up. Laser surgery or surgical intervention was performed in 25% of the patients. Total direct costs for two years were 5698F.F. The intraocular pressure before treatment was positively correlated (p<0.01) with treatment costs, while the initial intraocular pressure-lowering effects of treatment were negatively correlated with two-year costs. CONCLUSION: After two years of treatment, the mean intraocular pressure decreased from 24 to 17.5mmHg. The higher the basal intraocular pressures is, the more intensive the treatment and the higher the costs. The more efficient the treatment to decrease baseline intraocular pressure is, the earlier the costs will be reduced.

[Gouty encephalopathy: myth or reality?]. / L/encéphalopathie goutteuse: mythe ou réalité?

Case report is a 75-year old woman who presented an unexplained febrile encephalopathy with diffuse myoclonic jerks and a gout's polyarthritis. None of these etiologies was found: infectious, toxic, vascular, metabolic, hormonal, immunologic. The spectacular effect on neurologic symptoms of a treatment by colchicine alone lead us to consider that gout encephalopathy probably exists.

[Travelers' diarrhea]. / Diarrhées du voyageur.

Up to fifty per cent of travellers going from temperate countries to tropical or subtropical countries present a diarrhoea. Enterotoxigenic Escherichia coli remain the most frequent bacterial cause, being identified in 40 to 70% of cases. Laboratory investigations are reserved to grave or protracted cases or those which resist to empirical therapy. Careful selection of food and beverage can limit its incidence. In adults at high risk of complications (sick or aged people) or who cannot suffer an interruption of their activity, one can prefer to a chemoprophylaxis with possible occurrence of adverse effects the early administration of a fluoroquinolone, which besides is a first-choice treatment of serious cases.

[Inflammatory rheumatism and celiac disease in adults. Coincidence or pathogenic relationship?]. / Rhumatisme inflammatoire et maladie coeliaque de l'adulte. Coïncidence ou lien pathogénique?

Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.

[Acute myocarditis in non-typhoid Salmonella infection]. / Myocardite aiguë au cours d'une salmonellose non typhique.

The authors report a case of myocarditis secondary to a Salmonella Virchow infection in a 20 year old non-immunodeficient man without a previous medical history. The outcome was favourable after treatment with fluoroquinolone. The features of this rare complication of non-typhic salmonella infection are discussed with respect to this and four other recently published cases.