Thrombose de l’aorte et infarctus spléniques révélateurs d’une thrombocytémie essentielle

Essential thrombocythemia is a myeloproliferative disorder responsible for both hemorrhagic and thrombotic complications mostly venous but also arterial, especially of the microcirculation. We report a 64-year-old female who presented with an aortic thrombus and splenic infarcts indicating essential thrombocythemia. Outcome was favourable with medical treatment combining low-molecular-weight heparin secondarily switched to warfarin, associated with aspirin and hydroxyurea.     

Kinderwunsch – Hyperprolaktinämie : Therapie mit Akupunktur ist laborchemisch messbar

A 2-years practice-based study with subsequent 1 year follow-up demonstrated for the first time direct laboratory-confirmed effect of a single acupuncture point on the skull in accordance with Yamamoto New Scalp Acupuncture. The study, including 30 women, showed that this kind of acupuncture treatment is no less effective than pharmaceutical therapy applying Bromocriptine, while producing no side effects.     

Evaluation of serum zonulin level in prediabetic patients

BackgroundThis study aimed to investigate the relationship between lipopolysaccharide (LPS) and zonulin levels and also to show the effect of acute hyperglycemic stress induced by oral glucose tolerance testing (OGTT) on zonulin levels in pre-diabetic patients.MethodsFour groups were constituted according to the criteria of the American Diabetes Association (ADA), based on OGTT results: control group (n:40); prediabetic group (n:56), divided into two subgroups: impaired fasting glucose group (IFG) (n:36), and impaired glucose tolerance (IGT) + IFG group (n:20) and type-2 diabetes mellitus (T2DM) group (n:45).ResultsZonulin and LPS did not significantly differ between the prediabetes and control groups, but were significantly higher in the T2DM group compared to both the prediabetic and the control group (P < 0.001). After OGTT, zonulin and LPS were significantly higher in the prediabetes group compared to the control group (P < 0.01 and P < 0.05, respectively), and significantly lower in the IFG and IFG + IGT groups compared to the T2DM group (P < 0.001, P < 0.001 and P < 0.001, P < 0.001, respectively). A positive correlation was detected between fasting zonulin and 2-hour zonulin (r = 0.727, P < 0.001) and between fasting LPS (r = 0.555, P < 0.001) and 2-hour LPS (r = 0.567, P < 0.001) in the prediabetic group. Increased zonulin and LPS levels and the positive correlation between these levels during the prediabetic period although non significant suggests onset of intestinal permeability.ConclusionsDuring acute hyperglycemia in prediabetic patients, up-regulation of zonulin and LPS may affect intestinal function. The intestines may play a key role in up-regulation of glucose and the pathogenesis of diabetes.     

Endocrinology of bone mineralization: An update

Throughout the world, millions of people suffer from fragilizing osteopathies such as osteomalacia and osteoporosis. Osteomalacia is a rare disorder, corresponding to mineralization abnormalities in adult bone, as opposed to rickets in children. Renal phosphate loss and hypophosphatasia are the main causes of vitamin-resistant osteomalacia. Diagnosis is based on clinical history, phosphocalcic metabolism assessment and, if necessary, molecular characterization, and must be rapid in order to initiate the most appropriate treatment and consider new treatments such as burosumab if necessary. Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fracture. Fracture-related burden is expected to increase over the coming decades linked to the aging of population and a treatment gap. In order to reduce this treatment gap, it is important to develop two strategies: improvement of screening and of treatment. Systematic screening using the FRAX® fracture risk assessment tool could be useful to increase anti-osteoporosis medical treatment and reduce fracture rates. The question of treatment sequencing in osteoporosis is another challenge, notably after denosumab cessation, complicated by a decrease in bone mineral density and increased risk of fracture. New treatments are also available, including romosozumab, a humanized monoclonal antibody, which promotes bone formation and inhibits bone resorption by inhibiting sclerostin. Romosozumab is approved in several countries, including France, for treating severe osteoporosis in postmenopausal women at high risk of fracture and free of cardiovascular comorbidity. Endocrinologists need to be aware of these fragilizing osteopathies in order to improve both diagnosis and treatment.     

Frühdiagnostik der funktionell relevanten koronaren Herzerkrankung

Zusammenfassung Die koronare Herzkrankheit (KHK) ist nach angiographischen Kriterien definiert als das Vorliegen von Lumeneinengungen der Koronarien >50%. Die mit einer solchen Lumenreduktion einhergehenden hämodynamischen Veränderungen stellen heute die Grenze für die Nachweisbarkeit der KHK mit den sensitivsten funktionellen Untersuchungsverfahren der Ischämiediagnostik dar. Bei Verdacht auf das Vorliegen einer KHK oder atypischer Beschwerdesymptomatik wird die Indikationsstellung zur Herzkatheterdiagnostik durch eine Ischämiediagnostik abgesichert. Diese kann entweder durch ergometrische Belastungstests oder durch bildgebende Verfahren in Kombination mit ergometrischer oder pharmakologischer Belastung erfolgen. Etabliert sind die Myokardszintigraphie und die Stressechokardiographie sowie in zunehmenden Maße auch die Stressmagnetresonanztomographie. Neben dem sensitiven Ischämienachweis hat der technische Fortschritt in der Computertomographie (CT) und der Magnetresonanztomographie (MRT) die Möglichkeit einer nichtinvasiven Darstellung der Koronargefäße und der Gefäßwandmorphologie eröffnet. Während die CT-Koronarangiographie mit ihrer hohen räumlichen Auflösung an der Schwelle zur klinischen Anwendung bei selektierten Patienten steht, hat die MRT das Potenzial, von der Wandbewegungsanalyse über die Perfusion und Koronarflussmessung bis hin zur Plaquecharakterisierung zukünftig eine kardiovaskuläre Rundumuntersuchung zu gewährleisten.