Contraception et obésité

Obesity prevalence in industrialized countries has been dramatically increasing for several decades. Obese women are sexually active but they use fewer contraceptive methods and are at high risk of unintended pregnancy. In addition, obesity is an important risk factor for venous thromboembolism events and arterial thrombosis (myocardial infarction and ischemic stroke). All these data are to be considered when choosing a contraceptive method for obese women. The purpose of this paper is to exhaustively review contraceptive methods available in France in 2017 and to evaluate the benefits–risks balance of each of them in obese women.     

Asthme et obésité

Introduction

Asthma is a chronic disease whose prevalence continues to increase. Obesity is a comorbidity makes it difficult to support and control of asthma.

Material and Methods

A retrospective study on 39 cases of obese asthmatics, whose body mass index (BMI) exceeds 30 kg/m², followed by allergy consultation service between January 2007 and August 2009.

Results

These 31 women and 8 men aged between 23 and 79 years (average age: 48.5 years). Diabetes is associated in 2 cases, hypertension in 5 cases and a sick syndrome in one case. The asthma was intermittent in 17 cases (43.5%), mild persistent in 7 cases (18%), moderate persistent in 11 cases (28.25%) and severe persistent in 4 cases (10.25%). The gastro-esophageal reflux was found in 25% of cases, an allergic rhinitis in 41% cases, conjunctivitis in 28% of cases, eczema in 7.6% cases, food allergy in 10% of cases especially Fish and drug in 0.7% cases mostly aspirin. A family atopy was noted in 10% of cases. The recommended treatment based on inhaled corticosteroids and béta2mimétiques long duration of action in 22 cases associated with xanthine in 4 cases, antihistamines and nasal corticosteroids in 16 cases and inhibitors of proton pump in 10 cases. Asthma is well controlled in 60% of cases, partially controlled in 30% of cases and uncontrolled in10% of cases. The flow volume curve done in all our patients had obstructive ventilatory disorder objectified in 89.7% and mixed in 10.3%. The obstructive ventilatory disorder wasmild in 60%of cases, moderate in 28.6% cases and severe in 11.4%.

Conclusion

According to this study the female and the difficulty of controlling asthma in the obese population.     

Phytothérapie et Internet

À lheure dune mise en question des politiques de santé publique et dun regain de faveur pour des thérapeutiques dites «alternatives», la phytothérapie suscite un intérêt croissant qui se mesure au nombre des sites Internet consacrés à la médecine par les plantes. Dans ce numéro, nous poursuivons la présentation des sites qui offrent le plus dintérêt pour nos lecteurs.

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At a time when the politics of public health are being challenged and when alternative therapeutics are being promoted, phytotherapy is arousing a growing interest that can be measured by the number of Internet sites devoted to plants based medicine. In this issue, we continue the presentation of the sites that provide the most interest for our readers.

     

Sucres, addiction et obésité

This review begins with an in-depth analysis of the medical concept of addiction and then describes recent research on food and sugar addiction and its role in obesity. Clinical research has established the existence of an addiction to food and refined sugars (ex. sucrose, fructose) whose prevalence is particularly high in some obese people. Food or sugar addiction is associated with functional changes in brain circuits involved in reinforcement learning, motivation and impulse control. These changes are similar to those seen in drug addiction (e.g., cocaine). Preclinical research on animals has shown that these brain changes can be caused by chronic overconsumption of high-sugar (or high-fat) foods. However, not all individuals (obese or not) go on to develop food and sugar addiction, suggesting the presence of an initial vulnerability whose origin remains to be understood.     

Phytothérapie et Internet

À lheure dune mise en question des politiques de santé publique et dun regain de faveur pour des thérapeutiques jugées plus naturelles, la phytothérapie suscite un intérêt croissant qui se mesure au nombre des sites Internet consacrés à la médecine par les plantes. Mais aujourdhui la masse dinformations disponibles et labsence totale de contrôle de la qualité de ces informations rendent de plus en plus difficiles les recherches documentaires sur les «autoroutes de linformation». Dans cette nouvelle rubrique Phytothérapie & Internet seront signalés les sites qui semblent présenter le plus dintérêt pour nos lecteurs.

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At a time when the politics of public health are being challenged and natural treatments are witnessing a popularity revival, phytotherapy is arousing a growing interest that can be measured by the number of Internet sites devoted to plants based medicine.However, the large amount of available information and the total absence of quality controls concerning the information these sites give, make documentary research increasingly difficult on these information motorways. In this new section, Phytotherapy & Internet, the sites that present the most interest for our readers are mentioned.

     

Chirurgie bariatrique et fertilité

Obesity is associated with various health consequences including infertility. In women, anovulation is most often linked to polycystic ovary syndrome or can be secondary to hypogonadotrophic hypogonadism. Hypogonadotrophic hypogonadism has also been described in men in several publications. More recent data suggest that obesity can induce direct spermatogenesis alteration. Bariatric surgery has become very popular in France in the last fifteen years. It is the most effective therapy in severe obesity and is associated with a significant and long-lasting weight loss and a significant decrease in obesity-related morbidity and mortality. More than 50,000 procedures are performed every year. Bariatric surgery has positive effects on menstrual cycles in women and on hypogonadism in men. But its effects on sperm parameters seem controversial. Furthermore, few data are available concerning the impact of bariatric surgery on assisted reproductive techniques (ART) outcomes.     

Fibrinolyse et fibrinogénolyse en réanimation

Fibrinolysis is normally regulated by many activators and inhibitors, in a step-wise sequence. This regulation limits the fibrinolytic process on the blood clot and prevents its systemic dissemination.Specific clinical situations may be followed by an overwhelming primary fibrinolytic process: amniotic fluid embolism, anaphylactic shock and snake bites. In these cases, defibrination is caused by direct proteolysis of plasma fibrinogen. In the most frequent cases, exaggerated fibrinolysis is due to an early activation of plasma and endothelial coagulation. The fibrinolytic process may induce a severe haemorrhagic syndrome in the early post-partum period and in severe liver failure. In these cases, treament with antifibrinolytics must use aprotinin or tranexamic acid to counteract plasmin generation and effects.     

Sténoses et complications trachéales postintubation

Granuloma, tracheomalacia, tracheo-œsophageal fistula and glottis œdema are well-known post-intubation complications. Post-intubation tracheal stenosis and tracheal ruptures are described in this article.Main points – Clinical signs of tracheal stenosis and tracheal ruptures are not always typical and diagnosis is often made at a late stage. Treatment of post-intubation tracheal stenosis can be difficult because of the poor health status at the time of the diagnosis. Obstructive fibrinous tracheal pseudomembrane is a recently described and potentially fatal complication of endotracheal intubation. Immediate mechanical ablation of the membrane is curative.Prospects – Management of post-intubation tracheal stenosis should be multidisciplinary. Initial bronchoscopic conservative treatment appears to be applicable to almost all patients and allows secondary surgery to be performed in good conditions. Conservative treatment of tracheal ruptures must be considered, when the rupture is well tolerated or in the opposite case when surgery is contraindicated because of poor general conditions.     

Antiépileptiques et canaux ioniques

Résumé  Les antiépileptiques sont utilisés de manière empirique dans le traitement des douleurs neuropathiques. Si certains d’entre eux affectent la neurotransmission glutamatergique (acide valpro?que, felbamate) ou GABAergique (benzodiazépines, vigabatrin), leurs cibles principales sont les canaux sodium (phényto?ne, carbamazépine, lamotrigine, acide valpro?que, felbamate) et calcium (gabapentin) sensibles au potentiel. Chez l’animal, les effets antihyperalgésiques des antiépileptiques peuvent être mis en évidence dans des modèles de douleurs non seulement neuropathiques mais aussi inflamamtoires. Les modifications marquées de l’expression et/ou des propriétés des cibles des antiépileptiques observées dans ces modèles altèrent les propriétés élecriques des membranes des neurones, ce qui pourrait contribuer à la genèse des douleurs. C’est le cas plus particulièrement des changements des caractéristiques des canaux sodium sensibles au potentiel, dont certains sont experimés de manière préférentielle, voire speércifique, dans les fibres afférentes primaires qui transmettent les messages nociceptifs. On peut penser que des composés synthétisés pour moduler sélectivement les canaux ioniques propres aux fibres afférentes primaires auront une efficacié thérapeutique supérieure à celle des antiépileptiques actuellement disponibles, tout en étant dépourvus de leurs efets indśirables.

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Summary  Anticonvulsant drugs are empirically used for alleviating neuropathic pain. Although some of them affect glutamatergic (valproic acid, felbamate) and GABAergic (benzodiazepines, vigabatrin) neurotransmission, their main targets are voltage-dependent sodium (phenytoin, carbamazepne, lamotrigine, valproic acid, felbamate) and calcium (gabapentin) channels. Anticonvulsant drugs exhibit antihyperalgesic effects in animal models of both neuropathic and inflammatory pain. Marked alterations of the expression and/or the properties of anticonvulsants’ targets in these animal models change the electrical properties of the neurone membranes, and might contribute to the generation and maintenance of pain. This applies particularly to the modifications of the characteristics of the voltage-dependent sodium channels, some of which are preferentially, and even specifically, expressed in primary afferent fibres that convey nociceptive messages.Compounds developed to selectively modulate the ionic channels proper to the primary afferent fibres can be expected to have higher therapeutic efficacy than anticonvulsant drugs presently available, and to be devoid of their undesirable effects.

Texte présenté d’un cours de perfectionnement, intitulé ?Douleur et Canaux loniques?qui s’est tenu dans le cadre de la 22^e réunion annuelle de la SFD, le 19 novembre 1998 à Versailles.     

Analgésiques opiacés et hyperalgésie implications thérapeutiques

Résumé  Il est bien admis que certaines lésions tissulaires peuvent induire de longues hyperalgésies, allodynies voire des douleurs spontanées. Bien que les substances opiacées soient de puissants analgésiques, nous avons pu observer qu’ils peuvent également activer des systèmes facilitateurs de la nociception (systèmes pronociceptifs) qui s’opposent dès la première administration aux effets analgésiques des substances opiacées et peuvent conduire à des hyperalgésies de longue durée. Les antagonistes des récepteurs NMDA, tels que le MK-801 ou la kétamine, peuvent prévenir totalement ces phénomènes et amplifier l’effet analgésique opiacé. Nous avons pu également observer que l’administration répétée d’une substance opiacée entra?ne une augmentation de la sensibilité à la douleur qui masque de plus en plus un effet analgésique qui appara?t invariant donnant l’impression d’une tolérance aux effets analgésiques. Ce phénomène de sensibilisation à la douleur peut également être prévenu par les antagonistes NMDA. La capacité de la naloxone à induire une hyperalgésie chez les animaux qui ont retrouvé progressivement un seuil nociceptif normal après sevrage suggère que les animaux préalablement traités par la substance opiacée ne sont pas revenus à leur état initial mais sont dans un nouvel état correspondant à un nouvel équilibre à haut niveau entre systèmes analgésiques opio?de-dépendants et des systèmes pronociceptifs NMDA-dépendants. L’ensemble de ces données suggère que tolérance et sensibilisation à la douleur relèvent d’un même continuum adaptatif dans lequel les systèmes glutamatergiques NMDA-dépendants pourraient jouer un r?le majeur. Le r?le possible d’un tel processus dans le phénomène de chronicisation de la douleur est discuté.      

Déformation des membres et lésions cutanées

Orthopaedic deformities of the upper or lower limbs are commonly observed as a consequence of degenerative, post-traumatic, vascular neurological diseases. Regardless of their aetiology, they can result in cutaneous lesions due to maceration, abnormal bone contours or changes to pressure points when lying in bed or sitting in a chair. Treating these cutaneous lesions is complicated and must always be proceeded by a diagnosis of the deformities, identification of their causes and their subsequent correction. The aim of this study is to review the various orthopaedic deformities that may be found in neurological patients, put forward a diagnosis strategy and develop treatments appropriate for the specific requirements of these patients. Early treatment of these orthopaedic deformities is recommended in order to avoid secondary infection of the cutaneous lesions that increases the irritation from these deformities, in turn making them more difficult to treat and thus creating a vicious circle.