Folate status during pregnancy: relationship with alcohol consumption, other maternal risk factors and pregnancy outcome.

This study was designed to identify the factors affecting folate status in pregnant women and to explore the relationship between folate status and alcohol consumption during pregnancy. For this purpose, 347 French women were recruited during 1985-1986 on their first visit to the antenatal clinic at Roubaix Hospital (northern France). Alcohol consumption was ascertained by a standardized interview. Folate status assessment was available for 246 pregnant women who were not given folate supplementation. Average folate levels during pregnancy were lower among young women and smokers. Serum folate values diminished with the educational level, and red cell folate values increased with high parity. Unexpectedly, high red cell folate values were strongly related with high alcohol consumption after adjustment for the maternal risk factors associated with alcohol consumption and folate status. This was probably because in the Roubaix region where the study was conducted women consume mostly beer, which contains folates. Pregnancy outcome was not related to folate levels; birthweight was negatively associated with alcohol consumption during the first trimester of pregnancy.     

A Role for Interferon- β in Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating neuropathy that is associated with long-lasting morbidity and a substantial risk of mortality. The 2 reference treatments, plasma exchange and intravenous immunoglobulins (IVIg), do not change the functional prognosis for the most severely ill patients. The pathogenesis of GBS involves humoral and cellular immune dysfunctions that have only recently been characterised. Antibodies to nerve antigens may participate in complement activation, antibody-dependent macrophage cytotoxicity and reversible conduction failure. The cellular immune reaction is associated with increases in pro-inflammatory cytokines [such as tumour necrosis factor-alpha (TNFalpha)] and matrix metalloproteinases (MMPs; e.g. MMP-9), and a decrease in anti-inflammatory cytokines [such as transforming growth factor-beta1 (TGFbeta1)]. All the changes favour adhesion to and transmigration across the endothelium of immune cells, a key phenomenon associated with GBS. Recovery from GBS is characterised by the normalisation of these changes. Experimental allergic neuritis (EAN), the experimental model of GBS, has strikingly similar immunological characteristics. The usual treatment options for patients with GBS (plasma exchange and IVIg) mainly target the humoral component of the immune response. Interferon-beta (IFNbeta) is a cellular immunomodulator that inhibits antigen presentation and TNFalpha production and binding, and modulates macrophage properties. IFNbeta increases anti-inflammatory T cell functions and the production of anti-inflammatory cytokines, such as TGFbeta1. IFNbeta has important effects on leukodiapedesis, caused by modulating the expression of cell adhesion molecules and the MMP-9 proteinases. It has been used with success in EAN, in some patients with acute exacerbation of chronic inflammatory demyelinating polyneuropathy, and in 1 patient with GBS. The pathophysiology of patients with GBS, an understanding of IFNbeta properties and results of experimental studies support the investigation of IFNbeta in trials of patients with GBS.     

The possible involvement of endogenous opioid peptides and catecholestrogens in provoking menstrual irregularities in women athletes

It is well known that women athletes engaged in strenuous physical exercise and endurance training may develop "athletic menstrual irregularities" (AMI). Although many studies have appeared dealing with the immediate endocrinological and physiological changes in these women, the underlying mechanisms have remained unknown to date. A number of hypotheses have been put forward, the most well-known among them, for example, defending the existence of a critical percent of body fat necessary to trigger or maintain normal menstruation. All these theories have, however, their own, sometimes numerous, methodological inaccuracies and a teleological way of investigation. Spectacular, and perhaps promising new developments concern the possible involvement of endogenous opioid peptides and catecholestrogens in these processes. In basal circumstances beta-endorphin, the most well-known endogenous substance with opiate-like activity, may decrease LH levels by suppressing hypothalamic GnRH. This phenomenon is, however, only observed during the estrogen-dominant late-follicular and mid-luteal phases. As for catecholestrogens, it appears essential to differentiate between, for example, the 2- and 4-hydroxy derivatives of both estrone and estradiol. While some of these catecholestrogens obviously seem to suppress LH levels, others seem to potentiate and induce the LH surge. In any case, similar to beta-endorphin, these activities of catecholestrogens appear to depend upon the essential presence of a sufficiently estrogenic environment. In addition, both endogenous opioid peptides and some of the catecholestrogens appear to be able to suppress prolactin release, probably by interfering with its inhibiting factor dopamine. Other effects of catecholestrogens may include the control of the luteolysis-potent prostaglandin F2 alpha. Although a number of studies have investigated the behaviour of beta-endorphin during and post-exercise, similar studies investigating catecholestrogens as to their relation to physical exercise are almost nonexistent. This, in association with the numerous methodological inaccuracies of various studies, makes it difficult to draw any firm conclusion. As to formulate new hypotheses, the only reasonable suggestion considers the possible existence of a complex feedback system including catecholestrogens and endogenous opioid peptides. Furthermore, recommendations made in this survey may be helpful in designing new, perhaps more firmly supported and appropriate future studies.     

Cycloheximide Reduces the Effects of Anoxic Insult In Vivo and In Vitro

In vivo and in vitro techniques were utilized to examine the influence of a protein synthesis blocker, cycloheximide (CHX), on the damaging effects of anoxia in the rat. CHX administered 1 h before transient (30 min) forebrain ischaemia increased the survival of animals, decreased body weight loss and reduced the occurrence of delayed degeneration in the CA1 pyramidal region. The same dose of CHX injected 1 h after ischaemia induced status epilepticus, a decrease in survival rate, and did not reduce weight loss or CA1 damage in any of the surviving rats. Electrophysiological techniques were then used to determine the effects of various periods of anoxia and aglycaemia (AA) on CA1 field excitatory postsynaptic potentials (EPSPs) in hippocampal slices incubated in the presence or absence of CHX. In CHX-treated slices, recuperation of EPSP amplitude (45±16%) was significantly greater than in control slices (9±9%) following an AA episode of 3 min 45 s. No difference was seen in the percent recuperation of EPSPs in the control and CHX-treated slices after shorter or longer episodes of AA. From these studies, it appears that CHX protects against the damaging effect of ischaemia in vivo or AA in vitro.     

Burch laparoscopic colposuspension. Results of 30-month follow-up

Burch colpo-suspension, which is the present gold standard for treatment of stress urinary incontinence, may be performed laparoscopically. STUDY AIM: The aim of this retrospective study was to report the results of laparoscopic Burch colpo-suspension with a 30-month follow-up and to assess the reason for the unsuccessful results. PATIENTS AND METHOD: From 1990 to 1999, 118 patients (mean age: 46 years) were operated on for stress urinary incontinence with laparoscopic colpo-suspension. Urinary incontinence was classified grade 1 (6%), 2 (67%) and 3 (27%). The Burch colpo-suspension was performed through extraperitoneal approach in 51% and transperitoneal in 49%. A genital prolapse was associated in 31% of the patients and treated with sacropexy. A subtotal hysterectomy was performed in 25% of the patients and a vaginal hysterectomy in 46%. RESULTS: Global morbidity rate was 19%, including four cases of bladder injury. With a 30-month follow-up, 76/118 (64.4%) had no more urinary incontinence. Parity, age, previous pelvic surgery, detrusor instability and low urethral closure pressure were not predictive of recurrent stress urinary incontinence after treatment. Associated sacropexy was only correlated with a high risk of failure (P = 0.04). Patients with hysterectomy had significantly better results (72% vs 41.9%) (P = 0.05). Trans- and extraperitoneal techniques had similar results (P = 0.7). CONCLUSION: With a 30-month follow-up, 64.4% of the patients had satisfactory results with strictly no more stress urinary incontinence. There was no significant difference between the trans- and the extraperitoneal approach. Sacropexy was only associated with a higher rate of failure.     

Hysterectomy for benign lesions: peroperative and early postoperative complications

OBJECTIVE: Although hysterectomy for benign disorders is a routine and usually well-tolerated procedure, complications do occur, and the resulting morbidity rates are not negligible. The aim of this prospective study was to report perioperative and early postoperative complications observed after hysterectomy, regardless of the route or the operator. PATIENTS AND METHODS: Between March 31, 1991 and December 14, 1998, 1,604 patients (mean age: 46.5 +/- 8.1 years) underwent an hysterectomy for benign disorders. Perioperative and early postoperative complications, in the 1,248 vaginal hysterectomies (77.9%), 190 laparoscopically-assisted vaginal hysterectomies (11.9%) and 166 abdominal hysterectomies (10.2%) were noticed in each group and compared. RESULTS: None of the patients died in this series. Lesions on the urinary tract included 15 bladder injuries (0.9%) and 1 ureter injury (0.06%) without significant difference between routes. There were 9 (0.6%) intestinal injuries, with a significant increase when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 mL: and vaginal hysterectomy caused significantly fewer cases of heavy bleeding (2%, p < 0.001) than either laparotomy (6.7%) or laparoscopy (5.3%). The overall reoperating rate was 0.8% and this does not differ with the type of the procedure. CONCLUSION: Peri- and early postoperative complications after hysterectomy for benign disorders are not a rare event. In order to control complications and decrease the morbidity, a high-risk population should be defined based on the patients' history of pelvic surgery and endometriosis, on their parity and the size of their uterus. For these patients, the most appropriate route should be preferred and complications should be assessed using different tests and subsequently treated during the same procedure.     

Probabilistic exposure assessment to food chemicals based on extreme value theory. Application to heavy metals from fish and sea products.

This paper presents new statistical methods in the field of exposure assessment. We focus on the estimation of the probability for the exposure to exceed a fixed safe level such as the provisional tolerable weekly intake (PTWI), when both consumption data and contamination data are independently available. Various calculations of exposure are proposed and compared. For many contaminants, PTWI belongs to the exposure tail distribution, which suggests the use of extreme value theory (EVT) to evaluate the risk. Our approach consists in modelling the exposure tail by a Pareto type distribution characterized by a Pareto index which may be seen as a measure of the risk of exceeding the PTWI. Using propositions by EVT specialists, we correct the bias of the usual Hill estimator to accurately estimate this risk index. We compare the results with an empirical plug-in method and show that the Pareto adjustment is relevant and efficient when exposure is low compared to the PTWI while the plug-in method should be used when exposure is higher. To illustrate our approach, we present some exposure assessment for heavy metals (lead, cadmium, mercury) via sea product consumption.