Révélations cardiaques atypiques rares du syndrome de Sheehan : à propos de trois cas

Sheehan syndrome is a potentially serious complication in the postpartum period corresponding to ischemic necrosis of the anterior pituitary related to postpartum haemorrhage. We report three original observations showing an unusual mode of revelation of this syndrome. The first observation is that of a 46-year-old patient admitted initially to resuscitation for a recovered cardiorespiratory arrest, severe hypoglycemia and profound hyponatremia. The second is that of a 45-year-old patient, admitted for recurrent cardiac tamponade after pericardial and pleural puncture and pericardial drainage; clinical survey found signs of slight panhypopituitarism. The latest case is that of a patient of 44 years, admitted to pericardial effusion average abundance revealed by dyspnea and tachypnea with hypotension. The interrogation of all patients revealed the concept of an old hemorrhagic syndrome, absence of lactation and secondary amenorrhea thereafter. Laboratory tests showed insufficient thyroid-stimulating, low cortisol, a hypogonadism hypogonadism. The pituitary magnetic resonance imaging showed an empty sella in the three cases. Patients were placed under replacement therapy with L-thyroxine and hydrocortisone with good clinical, biological and echocardiographic evolution. The three cases illustrate a rare heart atypical presentation for Sheehan's syndrome and underline the importance of early diagnosis and suitable replacement therapy of this syndrome to avoid this complication that can be life threatening.     

Neuromuscular Electrical Stimulation As a Possible Means to Prevent Muscle Tissue Wasting in Artificially Ventilated and Sedated Patients in the Intensive Care Unit: A Pilot Study

Objective: The aim of this study was to explore if electrical stimulation could prevent muscle atrophy. Material and Methods: Patients were hospitalized for postoperative coronary artery bypass graftin, chronic obstructive pulmonary disease, ventilatory failure, or acute cerebro‐vascular accident, and were divided into an intervention group or a control group. The intervention group underwent daily 30 minute training with an intermittent neuromuscular electrical stimulation applied to the right quadriceps muscle. Heart rate, respiration rate, systolic and diastolic blood pressure, and oxygen saturation were monitored before, during, and after electrical stimulation. Circumference of both thighs was measured. Results: The intervention resulted in a significant reduction of muscle atrophy in the stimulated as compared with the non‐stimulated limb (p < 0.05), without making any impact on cardiovascular, respiratory and, hemodynamic characteristics. Conclusions: Muscle atrophy is prevented by intermittent neuromuscular electrical stimulation while this intervention showed no obvious impact on the cardio‐respiratory conditions of the patients.     

健康教育和呼吸功能训练在心胸外科患者围术期综合应用的研究

目的探讨规范的呼吸系统健康教育和呼吸功能训练对心胸外科手术病人康复的影响。方法选择2006年6～11月开胸手术患者50例为对照组,2006年12月～2007年9月开胸手术患者为实验组,对照组按临床常规护理进行指导,实验组进行规范的呼吸系统健康教育和深慢呼吸、缩唇呼吸、咳嗽训练、吹气球训练等呼吸功能训练,观察比较两组患者术后并发症、胸管留置时间、住院天数,并进行统计学分折。结果实验组明显优于对照组,P<0.05。结论规范的呼吸系统健康教育和呼吸功能训练可减少开胸手术病人术后并发症、缩短胸管留置和患者住院时间,促进病人早日康复。     

Long‐term effects of rapid weight gain in children,adolescents and young adults with appropriate birth weight for gestational age: the kiel obesity prevention study

Aim: This study investigates the effect of rapid weight gain in term children, adolescents and young adults born appropriate for gestational age. Methods: In all, 173 girls and 178 boys aged 6.1–19.9 (12.5 ± 3.1)years participated. Rapid weight gain (group 1) was defined as a change in weight‐SDS (standard deviation score) from birth till two years >0.67, ‘no change’ as ≥?0.67 and ≤0.67 (group 2) vs ‘slow weight gain’ as 90th age‐/sex‐specific BMI‐percentile was defined as overweight. Parental BMI, socio‐economic status and lifestyle were assessed as confounders. Results: A total of 22.8% gained weight rapidly, and 15.7% was overweight. Group 1 compared with group 2 and 3 subjects was taller, heavier and had a higher prevalence of overweight (girls/boys: 26.2%/28.9% vs 11.6%/19.0% vs 2.8%/5.0%; p < 0.01/p < 0.05). Concomitantly, a higher WC, %FM and FFM were observed. Rapid weight gain was positively associated with REE (adjusted for FFM) in boys (r = 0.26; p < 0.01), but not with cardio‐metabolic risk factors. Conclusion: Rapid weight gain was related to increases in height, weight, a higher prevalence of overweight and central fat distribution. In addition, rapid weight gain was related to a higher REE in boys, but not to cardio‐metabolic risk factors.     

中国15省份18~59岁成年人心血管代谢危险因素现状及人口经济因素的影响

目的 分析我国成年人心血管代谢性危险因素的流行特征及聚集性。方法 利用2015年“中国居民营养状况变迁的队列研究”中有完整体格测量、血样检测及人口经济特征数据的5 456名18～59岁成年人作为研究对象。采用国际糖尿病联盟（IDF）于2005年发布的标准判定心血管代谢性危险因素，包括中心性肥胖、血压升高、血糖升高、TG升高和HDL-C降低。同时存在≥2个危险因素定义为危险因素聚集。采用多因素logistic回归模型分析人口经济因素与各代谢性危险因素之间的关联性。结果 2015年我国15省份约有80.8%的成年人有≥1种心血管代谢性危险因素，约有54.0%的成年人存在危险因素聚集。性别、年龄、文化程度和地区分布与主要代谢性危险因素存在显著关联。在调整了其他因素后，成年女性中心性肥胖和HDL-C降低的危险性高于成年男性，而血压升高、血糖升高和TG升高的危险性低于男性。45～59岁成年人除HDL-C降低外的4项危险因素的危险性均高于18～44岁组。东部地区成年人中心性肥胖、血压升高、血糖升高的危险性明显高于中、西部地区。结论 仅有<20%的18～59岁成年人不存在心血管代谢性危险因素，一半以上的成年人有≥2种的危险因素。性别、年龄和地区分布是主要影响因素。建议在高危人群中优先采取针对性干预措施，及早预防心血管疾病的发生。     

社区老年人心脑疾病的健康教育

目的贯彻预防为主，实现健康老龄化。方法开展社区健康教育活动，进行老年人心脑疾病知识宣传教育。结果通过近三年的健康教育后，宣教社区60岁以上老年人心脑疾病的发病率和病死率明显下降。结论社区健康教育对防治老年心脑疾病有积极作用。     

Cardiovascular health behavior and blood pressure in adolescents: A longitudinal analysis

BackgroundThe ideal cardiovascular health behaviors (ICHB) have been associated with a subsequent positive health status in adults. However, evidence regarding blood pressure (BP) and ICHB in adolescents is scarce. The aim of this prospective cohort was to evaluate the impact of accumulation of ICHB on BP values in adolescents over two years.MethodsThis is a longitudinal analysis with 445 adolescents (232 girls) aged 12–18 years old. Resting blood pressure was measured at baseline and 2 years later, and ICHBs at baseline according to standard procedures. Based on the American Heart Association definition, the ICHB index was defined as a sum of meeting the ICHBs (from 0 to 4, where 4 would be the healthiest profile of all ICHBs) for a healthy diet, physical activity, smoking status and body mass index.ResultsAdjusted means values (ANCOVA) of BP parameters through achievement of a greater number of (between 1-4) the ICHBs (adjusting for potential confounders, age, sex, pubertal stage and socioeconomic status) showed that, as increase the number of ICHB accumulated as a lower the BP levels [ICHB and SBP (F_3.435) = 4.501, p = 0.004), DBP (F_(3.435) = 2.725, p = 0.044), pulse pressure (F_(3.435) = 4.004, p = 0.008), and rate pressure product (F_(3.435) = 2.866, p = 0.036)] over two years.ConclusionA lower number of ICHB (smoking status, body mass index, physical activity, and diet) during adolescence play a key role on blood pressure over two years. A higher number of ICHB is seen to be associated with a lower risk of short-term, hypertension.     

Whole-Body Magnetic Resonance Angiography (WBMRA) as a tool for driving efficiency in the cost and treatment of Claudication Co-morbities

The Whole-Body Magnetic Resonance Angiography (WBMRA) consists of a contrast-enhanced Magnetic Resonance Angiogram (MRA) scan of the entire body in a single step. In the diagnosis of cardiovascular co-morbidities in Peripheral Arterial Disease (PAD), the utilization of WBMRA can streamline the diagnostic process by minimizing the usage of MRA, CT, and Angiograms. In this work, the potential cost savings to the hospital by using WBMRA in PAD are modeled based on collected data that accounts for all interventions in the radiological department of a set of 50 patients with Claudication in the period 2008–2012 at Ninewells Hospital (NHS Tayside). As the application of WBMRA is only marginally more expensive than lower-limb MRA, a large gain in efficiency is possible by eliminating unneeded MRA by 25% and Angiograms by 30% as well as several steps of consultations. We estimate that this can save up to £1.2M in NHS Tayside and Fife, £7.5M in Scotland and £90M in UK per annum. In addition, WBMRA can save £20M per year in the UK in the treatment of Diabetes.