Are Cushing's disease patients curable?

Treatment of Cushing's disease remains a challenge. Whereas pituitary surgery can “cure” the patient and restore a completely normal pituitary adrenal axis, there are immediate failures and late recurrences which ultimately require alternate therapeutic approaches. These are numerous, but so are their drawbacks, and all appear to be “default options”. For the future, pituitary adenoma has to remain the “reasonable obsession” of efficient and optimistic therapists…     

Commotio cordis après impact précordial de Flashball

Less lethal weapons, like Flashball^®, are more and more used since 1995 in law enforcement, even by the local police to neutralize combative individuals and to disperse riot crowds. This gun fires large rubber bullets and has been incriminated many times in cases of face injuries with functional consequences. In this case report, we mention a case of sudden death from cardiac arrest due to low energy chest wall impact of a rubber bullet shot with the Flashball. Commotio cordis is potentialized by a lethal set of three including, a certain impact velocity, an exact location of the hit over the cardiac silhouette, and a precise timing 15 m/s prior to the peak of the T-wave. This case report highlights the fact that such impacts can cause significant injury to internal organs, in particular circonstances, implying the necessity of a raising awareness of the medical staff, in ordre to not underestimate the severity of such injuries.     

Le travail des centres maternels auprès de jeunes mères célibataires à haut risque

Single mothers represent about a quarter of French single-parent families. Within the population of single mothers, those who seek shelter in institutions such as maternity homes constitute a high-risk group. Grounded on two field studies with this population, and on our own clinical experience of joint psychotherapy of these mothers and their infant, this paper discusses the complex work realized by maternity homes. It emerges that maternity homes, as institutions, are brought to play, on the one hand, a maternal role that includes the holding, a “protective shield” role against excitation, and the safety of the mother to be and her infant. In this protected and stable environment, the mother will be able to develop her competencies to raise her infant and to build an affective bond with him. On the other hand, maternity homes should also act as a “father”, mediating the mother-infant relationship and, in doing that, they have to engage, as much as possible, the infant's father himself. In this “paternal role”, the institution should open the mother and her infant to the outside world, (re)integrating them in a social and affective network, and preventing them to relapse into the isolation or the multiple deprivations experienced by the preceding generations.     

Factors correlated with left ventricular mass in hypertensive patients

Left ventricular hypertrophy (LVH) is an independent risk factor in hypertensive patient. THE AIM: Of our study is to evaluate prospectively the relationship between left ventricular mass and clinical, echocardiographical and ambulatory blood pressure data in hypertensive subjects. METHODS: We studied 88 hypertensive patient who underwent clinical and laboratory investigation, echocardiography and 24 hours ambulatory blood pressure monitoring. Correlations were made between these data and left ventricular mass. RESULTS: Clinical data, which correlated well with left ventricular mass, were duration of hypertension, systolic arterial pressure and pulse arterial pressure. In echocardiography left atrial area and left ventricular dysfunction correlated significatively with left ventricular mass. Data from 24 hours blood pressure monitoring as daytime systolic pressure, nighttimes diastolic pressure, ambulatory systolic pressure and ambulatory pulse pressure. CONCLUSION: In hypertensive patient, left ventricular mass correlated well with left atrial dilation and diastolic left ventricular dysfunction. It also correlated with 24 hours ambulatory blood pressure monitoring data.