[The use of postnatal corticosteroid therapy in premature infants to prevent or treat bronchopulmonary dysplasia: current situation and recommendations]. / Utilisation de la corticothérapie postnatale chez le nouveau-né prématuré dans la prévention et le traitement de la dysplasie bronchopulmonaire : état des lieux et conduite à tenir.

In the last few years, several studies related to the benefit/risk balance of postnatal corticosteroids administered to premature neonates for prevention or treatment of bronchopulmonary dysplasia (BPD) have been published. These data encourage caution, given the risk of long-term adverse neurodevelopmental outcomes. In the meantime, the clinical profile of BPD has been altered based on the progress made in the pre- and postnatal care of premature infants. In 2006, a survey conducted in France in neonatal centers showed that corticosteroids were still frequently used (57% of the centers) following various protocols in very preterm-born infants for respiratory impairment. To promote safer practices and rational use of corticosteroids in the prevention and treatment of BPD in preterm-born neonates, we reviewed the available data in order to establish recommendations. Systemic administration of corticosteroids for prevention or treatment of BPD: (i) should not be used during the first 4 days of life; (ii) is not indicated in the first 3 weeks of life nor (iii) in extubated infants (nasal ventilation or oxygen therapy). The systemic administration of steroids can only be considered after the first 3 weeks of life in very preterm-born ventilator-dependent infants to facilitate extubation (or prevent reintubation related to the severity of BPD). Postnatal dexamethasone administration studied in several randomized clinical trials was shown to have an unfavorable benefit/risk profile, mainly because of the long-term adverse neurocognitive outcomes. Very few studies have been conducted with betamethasone in the postnatal period. According to sparse data, this drug might be as efficacious as dexamethasone, but its long-term risk profile is unknown. It should be noted that following prenatal administration, the benefit/risk profile of betamethasone is better than that of dexamethasone, especially with regard to neurocognitive development. Intravenous hydrocortisone administered at an early stage for the prevention of BPD is being evaluated and should not be administered in this indication, except within clinical trials approved by the ethics committee. No other corticosteroids have been evaluated in the postnatal period in respiratory indications. In conclusion, in the situations described above for which systemic corticosteroids could be justified, the use of betamethasone (or hydrocortisone) appears to be better. As usual, the lowest possible dose of corticosteroids should be administered for the shortest possible duration. The betamethasone-equivalent dose of 0.125 mg/kg/day for 3 days is deemed adequate. If inhaled, corticosteroid therapy may facilitate extubation. Neither its efficacy in respiratory diseases nor its long-term risk profile has been so far established.

Healing response to anorganic bone implantation in periodontal intrabony defects in dogs. Part I. Bone regeneration. A microradiographic study.

The purpose of the present study was to explore the regenerative potential of anorganic bone plus collagen (AB-C) in experimental intrabony defects. Eight healthy female beagle dogs, 3 to 4 years old and weighing 15 to 16 kilos, were used. After extraction of the mandibular third premolars (P3), surgical defects were created and inflammation induced by placement of cotton and steel braids. Eight weeks later, the braids were removed. The experimental lesions thus obtained were either treated by plain flap curettage (group 1: control) or were, in addition, implanted with AB-C (group 2: experimental). Blocks of AB-C alone were observed by scanning electron microscopy (SEM). The results show that the surface of the particles have the characteristics of a bone tissue. These particles are gathered together with a fibrillar network. Six, 18, and 36 weeks postoperative (PO), non-decalcified specimens from both groups were examined histologically by contact microradiography. In group 1, no significant bone regeneration was observed at 6, 18, or 36 weeks PO. In group 2, trabeculae undergoing mineralization and circumscribing dense particles above the reference notch were seen at 6 weeks PO; 18 and 36 week specimens showed significant bone regeneration with more or less dense remaining particles. The periodontal ligament space was always clear and the only signs of ankylosis noticed were deep in the notch on one 18 week group 2 specimen and on one 36 week group 1 specimen.

[New attachment formation with guided tissue regeneration. Review of the literature]. / Formation d'une nouvelle attache par régénération tissulaire guidée. Revue de littérature.

Restoring gum epithelial-conjunctive attachment on calcified tooth surfaces is the main objective of every treatment program of periodontal lesions. Research works are resulting today in a better understanding of biological mechanisms involved in tissue healing or rebuilding processes. These scientific studies allow to control such new therapeutics that can create a biocompatible environment essential to the metabolism of regenerating cells.

[Increase of blood lead in alcoholism. Relation with blood pressure]. / Elévation de la plombémie au cours de l'alcoolisme. Relation avec la pression artérielle.

Blood lead levels and blood pressure were measured on admission in 161 chronic alcoholic patients (121 men and 40 women) hospitalized for detoxification. The mean lead level was 280 micrograms/l and the highest value, in one patient, was 725 micrograms/l. These figures were as high as those of subjects under occupational exposure to lead. Blood lead level was correlated with blood pressure, and the statistical correlation appeared to be independent. Blood lead level was also correlated with serum gamma-glutamyl-transferase concentration and with the mean corpuscular volume. Wine drinkers had higher blood lead level than beer and/or liquor drinkers (mean: 298 micrograms/l versus 225 micrograms/l respectively), which fits with the higher lead content of wine.

[Arsenous anhydride poisoning. Peripheral neuropathy and changes in cognitive functions]. / Intoxication par l'anhydride arsénieux. Neuropathie périphérique et altération des fonctions cognitives.

The authors report the evolution over an 11 months period of a case of subacute intoxication with arsenic in a 30 years old woman. In addition to the classical peripheral neuropathy, we observed impairment of the superior neurological functions which improved together with the neuropathy. These malfunctions are rarely described in the literature although arsenic seems to cross the blood-brain barrier easily. There is no other explanation, and we believe arsenic to be responsible for these disturbances. We suggest systematic testing of the superior neurological functions in cases of arsenic intoxication.