Coronary risk factors in school children in relation to their family history of coronary heart disease and hyperlipidemia

A school-based study was implemented to assess the family history of coronary heart disease (CHD) and hyperlipidemia (HL) in relation to serum lipoprotein and apolipoprotein levels. One hundred and twenty-five elementary school students (aged9–10 years) and 297 junior high school students (aged12–13 years) participated. Family history was evaluated by the following scoring method: positive family history in a parent. 2 points: in a grandparent. 1 point: and onset of CHD before age 60, 1 additional point. Family history of HL was positive in 8.2% of elementary school students, and 4.2% in junior high school students. Family history of CHD was positive in 11.5% of elementary students, and 11.0% in junior students. Family history score (FHS) for HL was related to serum total cholesterol (TC), low density lipoprotein cholesterol (LDLC), high density lipoprotein cholesterol, apolipoprotein A-T, apolipoprotein B (apoB) and lipoprotein (a) in elementary students, and to TC, LDLC, triglyceride and apoB in junior students. There was no relationship between FHS for CHD and serum lipoprotein or apolipoprotein levels in any student. The children with a positive FH of HL already demonstrated an atherogenic lipid profile while those with FH of CHD did not. which was probably because lipid profiles in children are more genetically mediated by a FH of HL than of CHD.     

Outpatient Management of Primary Spontaneous Pneumothorax in the Emergency Department of a Community Hospital Using a Small-bore Catheter and a Heimlich Valve

Objectives: The objective was to assess the effectiveness of a small-bore catheter (8F) connected to a one-way Heimlich valve in the emergency department (ED)-based outpatient management of primary spontaneous pneumothorax (PSP). Methods: The authors conducted a structured chart audit in a retrospective case series of patients with PSP who were treated with a small-bore (8F) catheter and a Heimlich valve who were seen in the ED of a community hospital between April 2000 and March 2005. To be eligible, patients had to be available for a telephone interview. Main outcomes were success of treatment (sustained, complete lung reexpansion), admission, and surgical intervention rates. Secondary outcomes included number of chest x-rays (CXRs), number of visits to the ED, treatment duration, complications, and recurrence rates. Results: The authors identified 62 discrete episodes of PSP in 50 patients, with a mean (±standard deviation [SD]) age of 25.5 ± 10.5 years (range = 14–53 years). In 50 of 62 episodes (81%, 95% confidence interval [CI] = 70.8% to 90.5%), patients were discharged directly from the ED. Patients were admitted to the hospital at some point for treatment in 27/62 episodes (43.5%, 95% CI = 31.2% to 55.9%). Surgery was performed for acute treatment failure in 17 episodes. Ultimately, 19 patients, who accounted for 21 of 62 episodes (33.9%, 95% CI = 22.1% to 45.6%), had surgery at some point in the study. Mean (±SD) time to admission for those patients initially discharged from the ED was 2.9 (±2.01) days (95% CI = 1.9 to 3.8 days). There were no serious complications from treatment; the minor complication rate (misplacement or dislodging of the chest tube) was 22.6% (95% CI = 12.2% to 33.0%). No association was found between the size of pneumothorax and treatment failure. Conclusions: This study suggests that the initial management of PSP with a small-bore catheter and Heimlich valve can easily be performed by emergency physicians in the community hospital setting and appears safe. A larger study systematically comparing this approach with alternative therapies is needed.     

Dénutrition chez un patient atteint de spondylarthrite ankylosante de cause particulière : l’ankylose des articulations temporomandibulaires

IntroductionAnkylosing spondylitis is a chronic inflammatory arthritis that predominantly affects axial structures. Although temporomandibular joints are commonly affected, the ankylosis is rare. Herein, we report the case of a patient suffering from undernutrition secondary to ankylosis of temporomandibular joints during ankylosing spondylitis.ObservationThe patient, 21 years old, had been followed since six years for juvenile idiopathic arthritis, identified three years ago as an ankylosing spondylitis. Since a year, the evolution had been marked by the occurrence of a limitation of mouth opening, impeding oral feeding, which became exclusively based on liquids. The patient was hospitalized in emergency for severe malnutrition with a weight loss of 15 kg in six months. The clinical exam showed a limitation of mouth opening, less than 10 mm, with impossibility of propulsive and lateral mandibular movements. Pelvic radiography showed a grade II sacroiliitis bilaterally and TDM a bilateral temporomandibular ankylosis. The patient had been previously treated with anti-inflammatory drugs and methotrexate, but the occurrence of diffuse cutaneous mycosis had required discontinuation of the latter. Osteolysis of the temporomandibular ankylosis was scheduled in the maxillofacial surgery service and treatment with biotherapy type infliximab considered after the fungal infection healing.ConclusionThe early treatment of patients with ankylosing spondylitis should reduce the risk of progression to ankylosis of the temporomandibular joints and so the occurrence of such cases of malnutrition.     

Dual suppression with oral contraceptives and gonadotrophin releasing- hormone agonists improves in-vitro fertilization outcome in high responder patients

Certain patients have a tendency for high response to gonadotrophin therapy which is often not ameliorated with prior gonadotrophin- releasing hormone agonist (GnRHa) suppression. As a result, these patients are frequently cancelled and often experience ovarian hyperstimulation syndrome (OHSS) episodes during in-vitro fertilization (IVF)-embryo transfer cycles. Patients with polycystic ovarian syndrome (PCOS) have been noted to be particularly sensitive to exogenous gonadotrophin therapy. We have developed a protocol which is effective in improving IVF outcome in high responder patients, including those with PCOS. Oral contraceptive pills (OCP) are taken for 25 days followed by s.c. leuprolide acetate, 1 mg/day, which is overlapped with the final 5 days of oral contraceptive administration. Low-dose gonadotrophin stimulation is then initiated on the third day of withdrawal bleeding in the form of either human menopausal gonadotrophins or purified urinary follicle-stimulating hormone at a dosage of 150 IU/day. Over a 5 year period, we reviewed our experience utilizing this dual method of suppression in 99 cycles obtained in 73 high responder patients. There were only 13 cancellations prior to embryo transfer (13.1%). The clinical and ongoing pregnancy rates per initiated cycle were 46.5 and 40.4% respectively. Only eight patients experienced mild-moderate OHSS following treatment. For those patients who had undergone previous IVF-embryo transfer cycles at our centre, significant improvements were noted in oocyte fertilization rates, embryo implantation rates and clinical/ongoing pregnancy rates with this protocol. Hormonal analyses revealed that the chief mechanism may be through an improved luteinizing hormone/follicle-stimulating hormone ratio following dual suppression. An additional feature of this dual method of suppression is significantly lower serum androgen concentrations, particularly dehydroepiandrosterone sulphate.