A case of severe paraneoplastic itch resistant to antihistamines and responding to serotonin reuptake inhibitors

This article covers an interesting topic. Paraneoplastic pruritus is rare but can be severe. It can sometimes be resistant to usual treatments. In our case, it was resistant to antihistamines but was relieved by inhibitors of serotonin scrapping.     

Maternal and Neonatal Circulating Markers of Metabolic and Cardiovascular Risk in the Metformin in Gestational Diabetes (MiG) Trial: Responses to maternal metformin versus insulin treatment

OBJECTIVE

This study was designed to compare glucose, lipids, and C-reactive protein (CRP) in women with gestational diabetes mellitus treated with metformin or insulin and in cord plasma of their offspring and to examine how these markers relate to infant size at birth.

RESEARCH DESIGN AND METHODS

Women with gestational diabetes mellitus were randomly assigned to metformin or insulin in the Metformin in Gestational Diabetes trial. Fasting maternal plasma glucose, lipids, and CRP were measured at randomization, 36 weeks’ gestation, and 6–8 weeks postpartum as well as in cord plasma. Women with available cord blood samples (metformin n = 236, insulin n = 242) were included.

RESULTS

Maternal plasma triglycerides increased more from randomization to 36 weeks’ gestation in women treated with metformin (21.93%) versus insulin (9.69%, P < 0.001). Maternal and cord plasma lipids, CRP, and neonatal anthropometry did not differ between treatments. In logistic regression analyses adjusted for confounders, the strongest associations with birth weight >90th centile were maternal triglycerides and measures of glucose control at 36 weeks.

CONCLUSIONS

There were few differences in circulating maternal and neonatal markers of metabolic status and no differences in measures of anthropometry between the offspring of women treated with metformin and the offspring of women treated with insulin. There may be subtle effects of metformin on maternal lipid function, but the findings suggest that treating gestational diabetes mellitus with metformin does not adversely affect lipids or CRP in cord plasma or neonatal anthropometric measures.Gestational diabetes mellitus is carbohydrate intolerance first diagnosed during pregnancy (1) and affects up to 18% of pregnancies. The prevalence varies depending on maternal demographics and diagnostic criteria (2). The prevalence of gestational diabetes mellitus is increasing, which is likely driven by the rising population prevalence of overweight and obesity and increasing maternal age at pregnancy (3). Gestational diabetes mellitus increases maternal and infant morbidity and mortality during pregnancy (4). Women with a history of gestational diabetes mellitus are at risk for metabolic syndrome, type 2 diabetes (5), and cardiovascular disease in later life (6). Children born to women with gestational diabetes mellitus have higher rates of type 2 diabetes and obesity (7).Treating gestational diabetes mellitus improves pregnancy outcomes for both mother and infant (8). Current therapies include modification of diet, increased physical activity, and drug therapy with insulin and oral hypoglycemic agents, including metformin. In addition to improving insulin sensitivity and hyperglycemia, metformin therapy in the setting of type 2 diabetes reduces triglycerides (9), total cholesterol, LDL cholesterol (10), and VLDL cholesterol; increases HDL cholesterol (9); and reduces markers of inflammation and thrombosis (11). Metformin therapy in gestational diabetes mellitus achieves maternal glucose control and pregnancy outcomes similar to insulin therapy (12,13).In contrast to insulin, metformin crosses the placenta (14) and, therefore, could directly influence fetal metabolism. Our recent follow-up studies in 2-year-old offspring of women enrolled in the Metformin in Gestational Diabetes (MiG) trial showed increased subcutaneous fat measurements with no increase in abdominal adiposity or total fat (15). Further assessments are required to determine whether metformin actually reduces visceral/ectopic fat. Therefore, we hypothesized that metformin would be more effective than insulin in improving markers of insulin sensitivity and cardiovascular risk during pregnancy and postpartum in women with gestational diabetes mellitus and in their newborns.     

Smoking versus infection as the aetiology of bronchial mucous gland hypertrophy in chronic bronchitis

The smoking habits of 50 proved cases of chronic bronchitis were studied. Bronchoscopy was done and a bronchial biopsy was taken for histological examination. Bronchial lavage was obtained under sterile conditions for bacteriological studies. The degree of bronchial mucous gland hypertrophy was determined, and the presence or absence of infection, as shown by the presence of potential pathogens in the bronchial lavage, was noted. We think that tobacco smoking and its resulting irritation to the bronchi is the most important underlying cause of bronchial mucous gland hypertrophy because there is: (1) a significantly higher incidence of mucous gland hypertrophy in smokers than in non-smokers among the 50 chronic bronchitics studied; (2) a significantly higher accumulated lifetime tobacco consumption in patients exhibiting mucous gland hypertrophy than in those without hypertrophy of the bronchial mucous glands; (3) a significant association and correlation between the degree of mucous gland hypertrophy and the intensity of smoking; and (4) no difference in the comparative frequency of occurrence of bronchial mucous gland hypertrophy in subjects with and without demonstrable infection, as shown by the presence of potential pathogens in the bronchial lavage. We could not deny that infection might be having an initiating or potentiating effect.     

Hemangiopericytoma of the lumbar spine

Hemangiocytoma are rare malignant vascular tumor. Vertebral location is uncommun. They occur preferentially at the lumbo-sacrul spine with paravertebral extension. The features include spinal pains, para vertebral tumefaction and paresthesia. The CT and MRI scans can help to diagnosis which is histological. The treatment is surgical combined or no with radiotherapy. The pronostic is marqued by the recidive risk and metastases. We report a new case of vertebral hemangiopericytoma of the thoraco-lumbar spine with litteratur review.     

Dental pulp stem cells, niches, and notch signaling in tooth injury

Stem cells guarantee tissue repair and regeneration throughout life. The decision between cell self-renewal and differentiation is influenced by a specialized microenvironment called the 'stem cell niche'. In the tooth, stem cell niches are formed at specific anatomic locations of the dental pulp. The microenvironment of these niches regulates how dental pulp stem cell populations participate in tissue maintenance, repair, and regeneration. Signaling molecules such as Notch proteins are important regulators of stem cell function, with various capacities to induce proliferation or differentiation. Dental injuries often lead to odontoblast apoptosis, which triggers activation of dental pulp stem cells followed by their proliferation, migration, and differentiation into odontoblast-like cells, which elaborate a reparative dentin. Better knowledge of the regulation of dental pulp stem cells within their niches in pathological conditions will aid in the development of novel treatments for dental tissue repair and regeneration.