Anaemia and its risk factors and association with treatments in patients with diabetes: A cross-sectional study.

BACKGROUND: Anaemia is frequently seen in patients with diabetes and the main cause is renal failure. At all stages of renal failure, however, the prevalence of anaemia is higher in diabetes patients than expected for their glomerular filtration rate, suggesting that causes of anaemia other than renal failure are at work. The present cross-sectional study was conducted to investigate the possible iatrogenic causes of anaemia in patients with diabetes. SUBJECTS AND METHODS: This was a hospital-based cross-sectional study of all patients who had biological and clinical data covering a 2-year period. All had been in contact with the diabetes department either as outpatients or as inpatients mostly for educational purposes. Clinical factors, including type of diabetes, known diabetes complications, treatments received and biological data, were reviewed for their possible involvement in anaemia. RESULTS: A total of 4145 consecutive patients were included. Anaemia was observed in 1065 (25.7%) of them. Patients with anaemia were more frequently women and those with longer durations of diabetes. Haemoglobin concentrations were decreased, and prevalence of anaemia was increased at all stages of renal failure, already at stage 2, KDIGO classification. Anaemia patients were more frequently taking insulin, antiplatelet agents and renin-angiotensin system blockers (RASBs). After exclusion of patients with specific causes of anaemia, logistic regression analysis of all parameters correlated with anaemia on univariate analysis revealed that anaemia was associated with gender, antiplatelet agents and RASBs. CONCLUSION: This study has confirmed that anaemia is frequently seen in diabetes patients and strongly associated with renal failure (already at stage 2). Our observations highlight the adjuvant role of drugs, particularly RASBs, in the risk of anaemia in patients with diabetes.

Francisella tularensis aortitis.

Francisella tularensis, the agent of tularemia, is a Gram-negative coccobacillus primarily pathogen for animals and occasionally for humans. The clinical manifestations of tularemia include pneumonia, ulceroglandular, oropharyngeal, or typhoidal disease. Rare manifestations are also described, but to our knowledge, we describe here the first case of F. tularensis aortitis in a human. Diagnosis was confirmed by the presence of F. tularensis in blood culture, by the presence of F. tularensis DNA in the aortic biopsy and by specific IgG and IgM responses against the bacteria. The outcome was favorable after surgery and specific antimicrobial therapy.

Delayed hypersensitivity reaction after cervical disc replacement: a case report.

We report a case of allergic reaction after total cervical disc arthroplasty. A 52-year old woman was operated on for right C6 cervicobrachial neuralgia secondary to C5-C6 disc disease with foraminal stenosis. A cobalt-chromium-molybdenum total disc prosthesis had been implanted two years earlier. The patient was referred to our institution for recurrence of axial neck pain associated with abdominal patches of erythematous itching rash and swallowing disorder. Allergy tests confirmed type-4 allergic reaction to chromium. Symptoms decreased after removal of the prosthesis with secondary fusion. Delayed allergic reaction is uncommon in spine surgery, but should be considered in case of recurrence of initial symptomatology associated with non-spinal signs.

[Diagnosis and management of alcohol-use disorders]. / Diagnostic et prise en charge des troubles de l'usage d'alcool: données récentes.

With the publication of the DSM-5, the alcoholic disease becomes Alcohol-use disorders taking into account dependence and damages according to a gradient of severity. This conceptual evolution should improve the screening of people affected by this chronic and progressive disease associated with a heavy impact on morbidity and mortality. This identification is provided by the clinical interview and examination. Its sensitivity can be improved by questionnaires and biological markers. Damage and related pathologies have to be systematically revealed. In this context, the MoCA test allows the early detection of cognitive disorders. Care management aims for a change in consumption and consists in supporting the patient in his/her approach. Care management should be personalized, appropriated to the patient's informed choice and graded according to disorders' severity. This includes a psychosocial intervention which can be associated with drugs. Abstinence is no longer the only alternative: decreasing consumption with the aim of regulation has been shown interesting in the reduction of harmful consumption. When therapeutic withdrawal turns out to be necessary, use of a treatment should not be systematic. If necessary, benzodiazepines remain the first-line treatment with a limited duration of prescription. According to his/her profile, the patient can receive a long-term treatment to help to maintain abstinence, prevent relapse or reduce consumption. There is evidence that identifying and involving patients in their care significantly improve their health. Effective treatments are available for treating alcohol-use disorders. However, only a relatively small number of patients receive specific management appropriated to their needs and according to concrete goals.

Preoperative fasting does not affect haemodynamic status: a prospective, non-inferiority, echocardiography study.

BACKGROUND: The link between preoperative fasting and hypovolaemia remains unclear. We tested the hypothesis that preoperative fasting does not significantly increase the proportion of patients with hypovolaemia according to transthoracic echocardiography (TTE) criteria. METHODS: Patients of ASA status I-III and without bowel preparation were included in a non-inferiority, prospective, single-centre trial. Patients underwent passive leg raising (PLR) test and TTE at admission (Day 0) and after 8 h fasting (Day 1). The primary hypothesis was that an 8 h preoperative fasting does not increase the proportion (margin=5%) of patients with a positive PLR test ('functional approach'). The secondary hypothesis was that echocardiographic filling pressures or stroke volume (margin 10%) are not affected by preoperative fasting ('static approach'). RESULTS: One hundred patients were included and 98 analysed. After an 8 h fasting, the change in the proportion of responders to PLR was -6.1% [95% confidence interval (CI)=-16.0 to 3.8] of responders to PLR test on Day 0 when compared with Day 1. Because 95% CI was strictly inferior to 5%, there was no significant increase in the proportion of PLR responders on Day 1 when compared with Day 0. The 95% CI changes of static variables were always fewer than 10%, meaning that preoperative fasting induced significantly no relevant changes in static variables. CONCLUSION: Preoperative fasting did not alter TTE dynamic and static preload indices in ASA I-III adult patients. These results suggest that preoperative fasting does not induce significant hypovolaemia. Clinical trial registration NCT 01258361.

First report of the predominance of clonal complex 398 Staphylococcus aureus strains in osteomyelitis complicating diabetic foot ulcers: a national French study.

Staphylococcus aureus is the most common pathogen cultured from diabetic foot infection including diabetic foot osteomyelitis. This French multicentre study determined the genetic content of S. aureus isolated from 157 consecutive cases admitted to 12 diabetic foot centres between 2008 and 2011. We describe for the first time the emergence of the CC398 methicillin-susceptible S. aureus clone, the main clone in diabetic foot osteomyelitis, and its tropism for bone. This clone spreads to humans from an animal source through its intrinsic virulence. This adaptation of S. aureus isolates looks to be a worrisome problem and should be carefully monitored.

[Sugammadex and renal failure: a case report]. / Sugammadex et insuffisance rénale: à propos d'un cas.

We report a case of delayed rocuronium-induced deep block antagonization with sugammadex, thus requiring a total of three injections and a cumulative dose of 12 mg/kg over a 30 min period. The patient was an emergency case with full stomach that had required a rapid sequence induction. Because of hyperkaliemia due to an acute renal failure, rocuronium was preferred to succinylcholine. Use of sugammadex in the acute renal failure context is discussed.

Self-organized criticality in the intermediate phase of rigidity percolation.

Experimental results for covalent glasses have highlighted the existence of a self-organized phase due to the tendency of glass networks to minimize internal stress. Recently, we have shown that an equilibrated self-organized two-dimensional lattice-based model also possesses an intermediate phase in which a percolating rigid cluster exists with a probability between zero and one, depending on the average coordination of the network. In this paper, we study the properties of this intermediate phase in more detail. We find that microscopic perturbations, such as the addition or removal of a single bond, can affect the rigidity of macroscopic regions of the network, in particular, creating or destroying percolation. This, together with a power-law distribution of rigid cluster sizes, suggests that the system is maintained in a critical state on the rigid-floppy boundary throughout the intermediate phase, a behavior similar to self-organized criticality, but, remarkably, in a thermodynamically equilibrated state. The distinction between percolating and nonpercolating networks appears physically meaningless, even though the percolating cluster, when it exists, takes up a finite fraction of the network. We point out both similarities and differences between the intermediate phase and the critical point of ordinary percolation models without self-organization. Our results are consistent with an interpretation of recent experiments on the pressure dependence of Raman frequencies in chalcogenide glasses in terms of network homogeneity.

Self-organization with equilibration: a model for the intermediate phase in rigidity percolation.

Recent experimental results for covalent glasses suggest the existence of an intermediate phase attributed to the self-organization of the glass network resulting from the tendency to minimize its internal stress. However, the exact nature of this experimentally measured phase remains unclear. We modified a previously proposed model of self-organization by generating a uniform sampling of stress-free networks. In our model, studied on a diluted triangular lattice, an unusual intermediate phase appears, in which both rigid and floppy networks have a chance to occur, a result also observed in a related model on a Bethe lattice by Barré et al[Phys. Rev. Lett. 94, 208701 (2005)]. Our results for the bond-configurational entropy of self-organized networks, which turns out to be only about 2% lower than that of random networks, suggest that a self-organized intermediate phase could be common in systems near the rigidity percolation threshold.

[Analysis of hematopoietic growth factor prescriptions in 19 french cancer centers]. / Analyse de la prescription de facteurs de croissance hématopoïétique dans 19 centres anticancéreux français. Groupe de pharmaciens de la Fédération nationale des centres de lutte contre le cancer.

Medical prescription of hematopoietic growth factors (HGF) was analysed in 19 anticancer french centers during 2 months. About 4% of anticancer chemotherapeutic cycles prescribed during this period were supported by HGF prescription. The mean duration of treatment was 8 days. Among the 755 collected prescriptions, two tumor localizations represented about 50% of the prescriptions: malignant non Hodgkin lymphomas and breast cancer. The other main localizations concerned adult or pediatric soft tissue sarcomas (18%), testicular cancer (7%) and gynecologic tumors (6%). The prescription for primary prophylaxis for febrile neutropenia remains the main use of HGF (44%). The respect of the guidelines established by the F|d|ration nationale des centres de lutte contre le cancer was analyzed. Overall, 66% of the prescriptions were in adequation with these guidelines. Whereas the consommation of HGF decreased in the 19 considered institutions, it did not reach a plateau and could decrease in institutions which are awaked to the international and national recommendations.

[Therapeutic approach to post-radiation xerostomia. A reservoir prosthesis and an artificial salivary gland]. / Approche thérapeutique de la xérostomie post-radique. Prothèse réservoir et "glande salivaire artificielle".

Radiation-induced xerostomia is an incapacitating sequela of salivary gland irradiation in patients receiving tumoricidal X-ray therapeutical doses for cancer of the upper respiratory and gastrointestinal tracts. All stimulant type therapeutics available are powerless to bring back wetness into the mouth of patients with asialia. Replacement therapy constitutes the only alternative for symptomatic treatment. Artificial salivary gland sprays have a proven unsustained, short-lasting efficacy. The administration of an oral mucine-containing salivary emollient solution drip, presented either in the form of an oral or external container, constitutes an original symptomatic treatment regimen, the efficacy of which has been established. The authors here review the concept and methodology of their palliative treatment protocol against chronic asialia.

[An artificial salivary gland. Indications. Technical note concerning installation]. / La glande salivaire artificielle. Indications.--Note technique de mise en place.

Idiopathic or iatrogenic aptyalism is responsible for disabling odontostomatological symptoms and constitutes a predisposing factor for bucco-dental complications. Drug treatment designed to stimulate the salivary parenchyma is doomed to failure in cases of severe, irreversible alteration of the glandular acini. The only available treatment is palliative consisting of buccal artificial salivation. Two modalities of endobuccal administration of artificial saliva have been developed: prosthesis-reservoir and "artificial salivary gland". The "artificial salivary gland" consists of a system connecting an external reservoir to the buccal cavity via a catheter implanted over part of its path. The artificial saliva stored in the reservoir is advanced mechanically as far as the mouth where it is released according to an adjustable flow rate. The insertion of a medical silicone catheter is an outpatient procedure with a simple postoperative course. Under normal conditions, one millilitre of saliva solution per hour is sufficient to ensure satisfactory humidification of the buccal mucosa. Dysfunction of the system is generally due to a mechanical problem and any consequent alterations are treated as required. The indications for "artificial salivary gland" must be reserved to semi-urgent cases with severe aptyalism and as a therapeutic relay in the context of global management of the aptyalic patient. This new modality of administration could be extended to other diseases requiring endobuccal drip treatment.

Immunohistochemistry of a component protein of the breast cystic disease fluid with mol. wt 15,000.

A specific protein from the liquid of a mammary cyst with a molecular weight of 15,000 (GCDFP 15) was studied in normal and pathological mammary tissue using an immunohistochemical method (peroxidase-anti-peroxidase complex). An immunoreactivity of the GCDFP type was found in normal idrosadenoid glands having an apocrine secretion. Histologically normal mammary tissue was not immunoreactive. In benign breast tissue the GCDFP was found particularly in epithelium undergoing apocrine metaplasia (55/55) and in atypical lobular epithelial hyperplasia (8/10). Of the adenocarcinomas of the breast 136/161 (84%) were immunoreactive, especially lobular carcinoma (13/13). The proportion of tumors with a high percentage of immunoreactive cells (76-100%) was greater for Bloom's grade I (1/29: 34%) than for grade III (10/66: 15%). A significant correlation was found between the percentage of immunoreactive cells and the cytosolic concentration of progesterone receptors. The morphological intracellular identification of GCDFP (due to its greater sensitivity) and its correlation with progesterone receptors allowed a more precise evaluation of the functional state and the hormonal dependency of the breast cells by underlining the heterogeneity of the tumoral cell population.

Immunohistochemical detection of alphalactalbumin in breast lesions.

Alphalactalbumin was investigated in breast cells using the immunoperoxidase technique with a specific anti-alphalactalbumin serum. In 50 benign tumors alphalactalbumin immunoreactivity was demonstrated in the epithelium of fibroadenomas and in fibrocystic disease showing apocrine metaplasia. Alphalactalbumin immunoreactivity, investigated in 124 breast cancers, was present in all cells of lobular tumors but in only 76% of other cancers where the pattern was heterogeneous. Perineoplastic mammary tissue of normal appearance was not labeled with the anti-alphalactalbumin antiserum except where lobular hyperplasia was present. The presence of alphalactalbumin-type immunoreactivity was not correlated with the histopathological staging of Bloom and Richardson, nor with menopausal status. The incidence of positivity was 90% when estrogen and progesterone receptors were present in the tumor. The demonstration of alphalactalbumin using immunoperoxidase could be used to complement the histological classification of breast cancers.

[Treatment of hypercalcemia in osteolytic metastases with oral amino-hydroxypropylidene-diphosphonate]. / Traitement des hypercalcémies des métastases ostéolytiques par l'amino-hydroxypropylidène-diphosphonate par voie orale.

Twelve patients with malignant hypercalcemia were treated with amino-hydroxypropylidene-diphosphonate (APD), a potent inhibitor of osteoclast-mediated bone resorption. The mean serum calcium levels fell from 3,48 +/- 0,27 mmol/l before treatment to 2,66 +/- 0,31 after 10 days of oral APD (10 to 15 mg/kg/d) as the sole agent (p less than 0,001). The molar calcium/creatine ratio in the 24-h urine was significantly reduced from 2,11 +/- 0,73 to 0,70 +/- 0,52 after ten days of treatment (p less than 0,001). Serum phosphorus and urine hydroxyproline did not change significantly. Tolerance was good except for two patients with hiatal hernia who developed oesophagitis. Ours results confirm that oral APD is an effective and simple treatment of malignant hypercalcemia.