Influence of lifelong soy isoflavones consumption on bone mass in the rat.

Soy isoflavones (IFs) have shown a bone-sparing effect through epidemiological studies in the Asian population. However, there is no evidence as to whether such protection would result from a lifelong exposure. We investigated the impact of an early exposure to IFs on bone status. Sixty female Wistar rats were fed either a standard diet (n=30) or the same food enriched with IFs (0.87 mg/g of diet) (n=30). After 1 month, they were allowed to mate, and were kept on the same regimen during the whole gestation and lactation periods. At weaning, female pups were each assigned to one of four nutritional groups; within each experimental group, animals were split into two groups, fed either the standard or the IF-rich diet. At 2, 3, 6, 12, 18, and 24 months after birth, 10 animals in each group were sacrificed. Femurs were collected for mechanical testing and bone mineral density (BMD) measurement. The rats perinatally or lifelong exposed to the IF-rich diet exhibited higher body weight and fat mass at 24 months of age. Peak bone mass was achieved between 6 and 12 months and did not differ between groups. In animals perinatally exposed to IF, BMD continued to increase. Thus, at 24 months, femoral total BMD (P<0.05), metaphyseal BMD (P<0.01), and failure load (P<0.05) were higher in the offspring born from mothers provided IF during pregnancy. Postnatal exposure alone did not improve bone parameters. This experiment provides evidence that perinatal exposure to phytoestrogens leads to a higher BMD later in life. It is suggested that these changes may have occurred as a consequence of programming effects, as has been shown for the endocrine and immune systems.

One-month exposure to soy isoflavones did not induce the ability to produce equol in postmenopausal women.

OBJECTIVE: As more and more postmenopausal women are taking soy isoflavone supplementation for relieving menopausal symptoms, we investigated the impact of chronic exposure on their bioavailability, with focus on achievable plasma concentrations and potential stimulation of the capacity to produce equol. SUBJECTS: A total of 12 Caucasian postmenopausal women. INTERVENTION: Volunteers ingested 100 mg isoflavones/day (aglycone equivalents, in cereal bars and yoghurts) for 1 month. Plasma concentrations of metabolites at 2, 4, 6, 8, 10, 12 and 24 h postdose, as well as urinary excretion in fractions over 36 h were compared between days 1 and 30. RESULTS: Similar plasma kinetic curves were obtained at day 1 and day 30 for genistein and daidzein. Maximum plasma concentrations were 1.68+/-0.68 micromol/l on day 1 compared to 2.27+/-0.76 micromol/l on day 30 for daidzein (P=0.056), and 3.88+/-1.50 micromol/l on day 1 compared to 5.30+/-2.38 micromol/l on day 30 for genistein (P=0.091). Urinary excretion of daidzein and genistein did not differ significantly between days 1 and 30. Maximum plasma concentration of equol increased significantly from 0.31+/-0.27 to 0.99+/-0.51 micromol/l for equol-producer volunteers (P=0.046). However, the seven volunteers who were classified as non-equol producers on day 1 did not acquire the ability to produce equol after 1-month exposure. CONCLUSIONS: Chronic exposure to isoflavones in postmenopausal women resulted in plasma concentrations as high as 2.5-5 micromol/l of each isoflavone, but did not induce the ability to produce equol.

Concentrations of isoflavones in plasma and urine of post-menopausal women chronically ingesting high quantities of soy isoflavones.

Soy food or food supplements based on soy containing isoflavones (Isos) are increasingly available in Western countries. However, the variability of Isos levels in urine and plasma in humans during chronic ingestion is poorly documented. Nevertheless, this is the way these compounds will most probably be used in the future, especially if the soy-based supplements market goes on increasing. Here, glycosilated Isos in an enriched extract of Prevastein equal to 100 mg of equivalent Isos aglycone was given daily to 27 post-menopausal women for 30 days and to 12 post-menopausal women for 60 days. Volunteers were given Prevastein in a cereal bar (25 mg Isos) and in a yoghurt (25 mg Isos) both at breakfast and dinner. Plasma samples were collected after overnight fasting. Urine samples were aliquots of a 24 h collection checked on volume and creatinin excretion levels. Genistein, daidzein and equol were measured at day 0 and every 15 days afterwards, using original specific ELISAs. Constant levels were reached from the 15th day. About 59.2% of the volunteers were significant equol producers in the first experiment and 58.3% in the second. A large variability in plasma and urine levels was observed among post-menopausal women consuming 100 mg Isos per day, although remaining relatively stable in each individual subject. This could partly account for the controversial effects of Isos recorded so far in clinical studies. So Isos plasma levels would have to be assayed during chronic exposures, and could help to better understand the large variability of the effects classically observed in clinical studies. ELISA techniques could be easily exported to analytical laboratories to help physicians and nutritionists with their prescriptions.

Preventive effect of Abelmoschus manihot (L.) Medik. on bone loss in the ovariectomised rats.

Because the biggest culprit in pathogenesis of osteoporosis is oestrogen deficiency, hormone replacement therapy remained the mainstay for prevention. However most of postmenopausal women are more inclined to use natural alternative. We thus investigated the ability of Abelmoschus manihot, a herbal medicine to prevent bone loss in ovariectomised rats. Female Wistar rats were sham operated (SH: 8) or ovariectomised (OVX: 24). On day 0, OVX rats were randomly assigned to groups as follows: eight received 10% Abelmoschus manihot leaves in their diet, eight were given 15% Abelmoschus manihot leaves and eight were untreated (OVX). Compounds were mixed with a soy protein-free diet and given orally for 3 months. At necropsy, bone mineral density (BMD) in the femur and in its metaphyseal zone was lower in OVX than SH (p<0.05). This osteopenia was prevented by consumption of the highest dose of Abelmoschus manihot leaves. Bone mineral content (BMC) in the total femur and its metaphyseal and diaphyseal subregions was improved, as well (p<0.05). This could be explained by a trend towards decreased bone resorption. The lowest dose did not elicit any significant effect. In conclusion, Abelmoschus manihot consumption, at the dose of 15% in the diet, provided bone-sparing effects by improving both BMD and BMC.

Postperfusion stenosis of the common left coronary artery.

Late stenosis is a rare but potentially lethal complication of coronary perfusion. In 3 patients, anginal pain appeared 2 to 6 months after aortic valve surgery. Coronary angiography was performed because of rapid evolution of symptoms. Severe stenosis of the common left coronary artery was shown in all 3 cases. Immediate aorto-coronary bypass was undertaken with good results. Graft patency was demonstrated in 2 cases, 6 and 7 months after the operations.

[Post-cannulation stenosis of the left coronary artery trunk. 5 operated cases]. / Sténose post-canulation du tronc de l'artère coronaire gauche. Cinq cas opérés

The authors report five cases of stenosis of the trunk of the left coronary artery following cannulation of the coronary artery, and discuss the types of lesion, and whether they exist as an entity. The morbidity of these lesions, and the threat of sudden death which they pose, indicates an aggressive treatment plan: - definite angina occurring 2 to 6 months after aortic surgery (under coronary artery perfusion) is an indication for urgent coronary arteriography; - this investigation must be followed by a revascularization procedure within a few days if it shows a tight stenosis of the coronary trunk. The constant finding of a good vascular bed distally would seem to presage good long-term results.

[Atheromatous stenosis of the left coronary trunk. 28 surgical cases]. / Sténoses athéromateuses du tronc de la coronaire gauche. Vingt-deux cas opérés

22 patients with atheromatous narrowing of the left coronary trunk underwent surgery between 1969 and 1974. Most of these patients had severe and incapacitating angina pectoris. The clinical features are readily explained by the size of the diffuse anatomical lesions, which are to be found on the left coronary trunk as well as on the three coronary vessels themselves. This series has not confirmed the serious risk of surgery in such cases, as there were no operative deaths. Secondary mortality was low (9%), and the 20 survivors (average length of follow-up: 26 months) were mostly (18/20) in an excellent condition functionally. These facts have lead us to advise surgery whenever possible.

[Anantomical aspects and surgical treatment of pulmonary stenoses and atresias with intact interventricular septum in the newborn and the infant under 6 months]. / Aspects anatomiques et traitement chirurgical des sténoses et atrésies pulmonaires á septum interventriculaire intact du nouveau-né et du nourrisson de moins de 6 mois

The series presented consists of 25 babies (18 of which were neonates), seen between 1972 and 1974. The anatomical and angiographic study revealed 5 anatomical types, according to whether the pulmonary orifice was patent or atretic, and according to the size of cavity of the right ventricle, which may be normal or reduced (perhaps almost totally). The diagnostic clinical features and findings on angiography are recalled. The operative procedure in all 25 cases was pulmonary valvotomy carried out with a brief normothermic period of cirulatory arrest. The technique is described briefly. The results, which vary widely with the anatomical type, were as follows: out of the 25 operated cases there were 12 deaths during or immediately after surgery. The figures are none-the-less encouraging, given the grave natural history of this condition in the baby. The best results were seen in cases in which there was a right ventricular cavity of normal or at least acceptable size. The maximum postoperative follow-up period was 3 years. Most of these children have a persistant pulmonary stenosis and hypertrophic right ventricle, and require a second operation in early infancy.

[Mid-term fate of Beall's prosthesis in the mitral or mitro-tricuspid position. Apropos of 100 cases]. / Devenir à moyen terme des prothèses de beall en position mitrale ou mitro-tricuspidienne

Aiming at investigation, a Beall's valve was implanted in mitral or in mitral-tricuspid positions only on 100 patients, between November 1969 and February 1972. The details of the initial valve lesions, the clinical condition of the patients, and the modalities of prosthetic replacement are described. The causes of death within the first month were analysed. None could be related with the prosthesis itself. At distance, 17 patients were lost of sight, 18 died and 51 were studied from 12-42 months after operation. It results from this investigation: -- that 84% of the patients reexamined were improved. Most of them were included in a better functional class; -- that the incidence of thrombo-embolic accidents amounted to 12% for the whole group of patients, a percentage similar to that observed with other types of prostheses; -- that in contraat, haemolysis is an obvious disadvantage of Beall's prosthesis (20 of 51 cases); -- that abnormal wears in two valves resulted in valve dysfunction compelled to re-operation. These latter two incidents have lead to abandoning this type of prosthesis.

[Closure of ventricular septal defects. Comparison of 2 technics]. / La fermeture des défauts septaux interventriculaires.Comparaison de deux techniques

To be correctly done, closure of a ventricular septal defect must be sound, and must also avoid damage to the conducting tissue. These two essentials are somewhat contradictory, since in order to avoid the bundle of His in its position along the postero-inferior edge of the ventricular septal defect (VSD) in the membranous septum, the sutures inserted into this region must be superficial, and therefore weak. It is for this reason that the published series continue to show evidence of a significant number of post-operative shunts and atrio-ventricular blocks, as much in the closure of isolated VSDs as in the treatment of Fallot's tetralogy. This paper compares two techniques of suturing the prosthetic material which is used to close the VSD: the classical technique, in which it is intended to avoid the bundle of His by working below it, on the right side of the interventricular septum, and a different technique in which the sutures are applied directly to the free edge of the interventricular communication.

[Palliative surgery of transposition of great vessels associated with pulmonary stenosis]. / La chirurgie palliative de la transposition des gros vaisseaux associée à sténose pulmonaire

Palliative treatment for transposition of the great vessels with pulmonary stenosis (combined or not with ventricular septal defect) was studied in relation with 24 patients operated upon at Laennec's Hospital in Professor Mathey's section between January 70 and January 74. Three therapeutic attitudes are possible according to whether or not an atrial septal defect is created (Blalock-Hanlon's operation) in combination with the systemic-pulmonary artery anastomosis, and according to whether the operations are performed in one or many steps. It seems that for the badly-tolerated forms of the new-born, combination of both operations seems to be the best attitude, the curative treatment being impossible at this age.

[Pacemakers in children]. / Les pacemakers chez l'enfant.

This is a study of pacemakers in 32 children with permanent pacemakers, 7 of them for congenital block, and 25 for post-operative block, representing a total of 69 pacemaker implantations. After a brief survey of the results, there is a discussion of the problems of the indications, relative for the congenital blocks, and absolute for the surgical blocks after a short period of observation. The choice of type of pacemaker rests upon three essential features: minimum inconvenience, a good length of active life, and the facility of an increased rate. Recent technical progress has allowed these features to be combined. The pacemakers currently available are shown on a table. The results are to a large extent determined by extreme care being taken over the implantation; meticulous asepsis, a low threshold on the electrode test, a pacemaker which is "comfortable" in its site, all these are essential if the serious complications are to be avoided, namely infection and pacemaker failure. The best route for the child, as for the adult, is by way of an epigastric approach with an abdominal pocket. In the very small infant, it seems better to implant by left thoracotomy, and to site the pacemaker intrapleurally.

[Treatment of acute colectasia not due to cryptogenic colitis. 4 cases]. / Traitement des colectasies aiguës non dues à une colite cryptogénétique. 4 observations.

Four patients with acute colonic pseudo-obstruction were treated by colonoscopic aspiration. This treatment proved sufficient in 1 case due to Salmonella colitis and 1 case of parkinsonian dysautonomia. It has made it possible to diagnose a pyocholecyst masked by the colonic dilatation it had provoked, and facilitated its surgical treatment. A transient result was obtained in a case of otherwise asymptomatic choleperitoneum. Colonoscopy was relatively easy, perfectly well tolerated and always useful. It is therefore recommended for the treatment of acute colonic pseudo-obstruction except in cryptogenic colitis where its effectiveness and safety have not been demonstrated.