[Effects of glucocorticoids administration on memory. Cognitive impairment in Cushing's disease]. / Effets des glucocorticoïdes sur lá memoire. Troubles cognitifs dans la maladie de Cushing.

The case of a 85 years old woman is reported. She suffered from a partially reversible episodic memory dysfunction after i.m. injections of bethamethasone for acute lumbalgia. Cognitive impairments observed in Cushing's disease are reviewed as well as the deleterious effects of glucocorticoid treatments on episodic memory. They could be prevented by memantine.

[Neurosciences and the mind-brain connection: treatment of depression]. / Neurosciences et rapport pensée-cerveau: à propos des traitements de la dépression.

Neuroscientists claim that thoughts and intentions result only from brain activity. It is illustrated by the ability to control a robotic arm only by thought. However although they have a biological support, emotions, ideas and intentions are perceived at another level of reality than synapses and neurotransmitters. The reduction of mind to brain (called monism) represents a categorical error. Psychiatric praxis relies on a dualistic (complementary) position regarding e.g. depression treatment. Antidepressants and psychotherapy have distinct impacts on cerebral metabolism measured by fMRI and different ways to modify emotions. The combination of these two therapies is indicated in case of severe depression.

[Oxytocin: the hormone of love, trust and social bond. Clinical use in autism and social phobia]. / L'ocytocine: hormone de l'amour, de la confiance et du lien conjugal et social.

Oxytocin, an octapeptide synthesized in the hypothalamus, stimulates milk election and uterine contractions. In the brain this hormone acts as a neuropeptide. It could inhibit through the GABAergic system the activity of limbic amygdala, which is involved in the response to fear. Oxytocin could also induce the protective behaviour of the mother towards its offspring through the dopaminergic system. In mankind, oxytocin plays a role in trust, empathy, generosity, stress and sexuality. Clinical studies are testing potential benefits of oxytocin administration in autism, depression and social phobia. Results are still preliminary.

[Effects of folic acid on cerebrovascular and cancer risks]. / Effets de l'acide folique sur les risques cérébrovasculaires et oncologiques liés à l'homocystéine.

Homocysteine increase is associated with an elevated risk of cerebro-vascular (CV) disease as well as osteoporosis, dementia and depression. However, most secondary prevention trials did not show any CV benefit to decrease homocysteine levels through folate administration, with the possible exception of stroke. Reasons for these failures are analysed. Moreover, folate acid could decrease the risk of colon, breast and prostate cancers mainly in wine drinkers, whereas it increases the growth of preneoplasic cells of the latter cancers. In conclusion, folate acid does not benefit patients for secondary prevention of CV or malignant diseases but it still has to be proven that it could benefit patients for primary prevention.

[Scientific research in family medicine: practitioners' experience, barriers and needs]. / Recherche scientifique en médecine de famille: expériences, barrières et besoins des praticiens.

Scientific data from family medicine are relevant for the majority of the population. They are therefore essential from an ethical and public health perspective. We need to promote quality research in family medicine despite methodological, financial and logistic barriers. To highlight the strengths and weaknesses of research in family medicine in the French-speaking part of Switzerland we asked practitioners from this region to share their experience, critics and needs in relation to research. This article summarizes their contribution in light of the international literature.

[Estrogens and male sexuality: efficiency of antiestrogens in case of hypothalamic hypogonadism and late onset hypogonadism]. / Oestrogènes et sexualité masculine: effets des antioestrogènes en cas d'hypogonadisme hypothalamique.

Estrogen treatment in eugonadal men diminishes libido, whereas libido is preserved by estrogens in orchidectomized transsexuals as well as in cases of aromatase deficiency. Hypothalamic hypogonadism can be caused by stress, depression, anorexia or excessive exercise. It may result in erectile dysfunction and decreased libido. A 7 day trial of clomiphen (25 mg/day) can be used to test the responsiveness of the axis and may be continued for up to 6 months as a means to stimulation endogenous LH and testosterone secretion. Other antiestrogens such as raloxifen or anastrazol may have similar effects in obese men and in aging men with late onset hypogonadism (LOH).

[Is there an indication for dehydroepiandrosterone (DHEA) treatment in elderly women with Addison disease? Beneficial and adverse effects of DHEA]. / Y a-t-il une indication au traitement par la déhydroépiandrostérone (DHEA) chez les femmes âgées et les Addisoniens? Effets bénéfiques et indésirables de la DHEA.

DHEA is a cetosteroid secreted by the adrenal gland. Serum levels of DHEA decline by an average of 10% per decade whereas cortisol levels remain stable. The relative lack of DHEA secretion in elderly people has been called adrenopause. The daily administration of 50 mg of DHEA to women over 60 years old results in a two-fold increase in serum level of testosterone and androstenedione and in a 10% increase of estradiol in men. A 10 to 20% increase of IGF-1 is observed in both sexes. In women over 70 years old treated by 50 mg/day of DHEA for 6 months an improvement of bone turnover and of skin status was observed as well as an increase of overall well-being and of libido. These beneficial psychological effects have also been observed in younger men and women with adrenal insufficiency. In men 50 to 65 years old, 100 mg/day of DHEA for 6 months could slightly increase the lean body mass and the muscle strength. Moreover DHEA could increase immune function and NK cell activity. As there are no actual data about cardio-vascular and oncological risks of a prolonged treatment with DHEA, the administration of this steroid must still be considered experimental. Previous or present cancer of the breast or of the prostate is an absolute contraindication to DHEA treatment.

[The benefits of aging. I. Patience and cure: spontaneous beneficial course of certain diseases]. / Les bienfaits du vieillissement. I. Patienter pour guérir: évolution spontanément favorable de certaines maladies.

Some chronic diseases have a favourable course and are cured spontaneously. Allergic diseases such as eczema, hay fever and asthma have a good outcome in more than 75% of cases within 7 to 25 years, depending on the kind of allergy. Migraines have also a good evolution in children and after menopause. Many symptoms due to menstruation such as dysmenorrhea, premenstrual syndrome or anemia, disappear after menopause as well as diseases due to estrogens such as uterine leiomyoma, endometriosis and prolactinoma. The risk of epilepsy relapse after a first seizure is about 40% after 2 years. The risk is lower in children. Attention deficit disorder affects 3 to 5% of children but is present in only 30% of them in adult age. The prevalence of depression decreases in women between 30 and 60 years of age. Functional somatic syndromes such as fibromyalgia, irritable bowel syndrome or dyspepsia decrease in 2/3 of cases within 5 to 10 years if there is no history of anxio-depressive symptoms. However, prognosis is reserved when initial symptoms are severe or if they are connected to sexual abuse, domestic violence or depression. Other diseases have a spontaneous favourable course such as myopia, idiopathic infertility, polycystic ovary disease or ventricular arrhythmia. The knowledge of a good prognosis enables to avoid unnecessary treatments and to reassure many patients.

[The benefits of aging. II. Aging and dying in our time: reasons for optimism?]. / Les bienfaits du vieillissement. II. Vieillir et mourir de nos jours: des raisons d'être optimiste?

The increase of life expectancy is due to the successful treatments of infectious diseases and to the prevention of cardio-vascular (C-V) diseases. People are afraid that an increase of life expectancy would go together with an extension of years of chronic illness and disability. However the compression-of-morbidity hypothesis predicts that persons with better health habits and with a low level of C-V risk factors survive longer without a parallel increase of the period of disability. Depression decreases life quality of elderly people and increases sucidial risk as well as C-V mortality. The prevalence of depression varies between 10 and 20% in different european cities. Emotional well-being and vitality characterized by optimism and sociability seem to protect old people from adverse health outcome. There is a marked increase in epithelial carcinoma in old people. Some cancers (breast, colon) have a reduced aggressiveness in elderly patients. A better access to palliative care and a better control of terminal pain and suffering should restrain patients to ask help for assisted suicide. People who had near death experience recall they felt light and peace. These coping mechanisms seem to ease the passage towards death. Elderly people should be surrounded by a social and affective network in order to help them to cope with illness, dependance and loneliness and to keep their humour and optimism.

Short- and long-term results of total vs subtotal thyroidectomies in the surgical treatment of Graves' disease.

OBJECTIVE: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. METHODS: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue--mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. RESULTS: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT--with follow-ups averaging two years (0.5-8)--are receiving thyroxin substitution. CONCLUSIONS: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

[Ten questions on the causes and consequences of obesity: stress hormones]. / Dix questions sur les causes et les conséquences de l'obésité: des hormones aux stress.

In Switzerland, 6% of men and 5% of women are obese (BMI > 30); 33% of men and 17% of women are overweight (BMI 25-30). Both genetic and environmental factors are responsible for obesity. There is an increased risk of C-V disease, diabetes and steato-hepatitis in abdominal obesity (abdominal circumference > 102 cm for men and > 88 cm for women). There is also an increased level of cortisol, which could be due to a difficulty to cope with psycho-social stress. Leptine and different hormones play a role in fat storage. Menopause and pregnancy are moderate risk factors for obesity. Weight gain may also result from different drugs, smoking cessation and stress. Eating disorders such as boulimia and binge eating must be diagnosed and treated. Beneficial health effect of weight loss is analysed.

[Ten questions on the treatment of obesity: from dieting to surgery]. / Dix questions sur les traitements de l'obésité: des régimes à la chirurgie.

Advantages and risk of weight reduction achieved by combining diets or unbalanced diets with restriction of carbohydrates or fat are discussed. Nutriments differ according to their density, their flavour, their satiating, and their thermogenic effect. Food is also a source of pleasure and a remedy to frustration. One of the problems of dieting is that most patients regain the weight they have lost due to a hypometabolism secondary to caloric restriction. Only physical exercise together with behavior therapy are able to slow down this weight regain. The indication of drug treatment with orlistat, sibutramine and fluoxetin and the indication to bariatric surgery are presented. The importance of the prevention of obesity by nutrition teaching in schools as well as the necessity of a long term treatment as in type II diabetes are underlined.

[What's new in hormone replacement therapy for postmenopausal women? I. Advantages of hormone replacement therapy (HRT)]. / Quoi de neuf dans le traitement hormonal substitutif de la ménopause? I. Avantages du traitement hormonal substitutif (THS).

Different cohort studies have shown that HRT decreases the risk of cardio-vascular (C-V) disease and the risk of bone fracture by 30 to 50%. The only controlled study (HERS study) did not show any benefit of HRT with estradiol and medroxyprogesterone (MPG) in secondary prevention. The beneficial effect of estrogens on coronary dilatation and on HDL cholesterol could be attenuated by some progestogens such as MPG but not by nomegestrol acetate. In this framework, the comparative metabolic effects of different progestogens and tibolone are described in this article. The effects of estrogens on mood and of androgens on libido are discussed. The preventive effect of estrogens on osteoporosis and on Alzheimer disease is compared to other nonhormonal treatments.

[What's new in hormone replacement therapy of postmenopausal women? II. Risks of hormone replacement therapy (HRT)]. / Quoi de neuf dans le traitement hormonal substitutif de la ménopause? II. Risques du traitement hormonal substitutif (THS).

A 50 year old woman has a 10% lifetime risk of developing a breast cancer. Depending on the duration of the treatment, HRT can increase this risk by 30 to 45%. The risk of endometrial cancer, which affects 2.3% of women, is increased even if sequential progestogens are given together with estrogens. The risk of venous thrombosis is increased 3 times. The occurrence of ictus is not modified by HRT. On the other hand estrogens may prevent the abdominal deposit of fat. The cancer risks associated with HRT must be balanced against their protective effects on cardio-vascular (C-V)diseases. In untreated women, mortality due to C-V disease is 39% whereas mortality due to breast cancer is 3% and only 0.3% for endometrial cancer. This article discusses also the possibility of HRT and of non hormonal treatments in patients with previous breast cancer.

[Cardiac decompensation after an adenectomy for primary hyperparathyroidism: hypocalcemic cardiopathy or cascade effect?]. / Décompensation cardiaque après adénectomie pour hyperparathyroïdie primaire: cardiopathie hypocalcémique ou effet de cascade?

A 42 year old woman presented with an auricular tachyarrhythmia as well as a congestive cardiac failure ascribed to a viral myocarditis, two months after an adenectomy for primary hyperparathyroidism. Serum calcium was low whereas parathormone serum was increased suggesting a "hungry bone syndrome". The left ventricular dysfunction persisted for a long period even after normalization of the serum calcium. The contributory role of hypocalcemia in unexplained or refractory heart failure is reviewed. The eventuality of a cascade effect is evoked.

[Do viagra and fertilization in vitro announce the end of etiologic treatments in andrology?]. / Le Viagra et la fécondation in vitro ont-ils sonné le glas des traitements étiologiques en andrologie ?

Viagra and in vitro fertilization (IVF) with intraovocyte injection of spermatozoa (ICSI) have revolutionized the treatments of impotence and male sterility. They are able to treat successfully most of the cases whatever is the cause of the problem. The andrologist is tempted to renounce to look for an etiological factor and to treat directly his patient. The risk is to miss a diagnosis such as genital tract obstruction, testicular cancer, gonadotropin deficiency, sperm autoimmunity, coital disorders, or reversible toxin exposures, which could benefit from a specific treatment. Moreover IVF can endanger the woman's health and genetic consequences must not be overlooked if ICSI is performed. Concerning impotence a diagnosis of prolactinoma, diabetes or ischemic cardiopathy must not be missed because Viagra can also have cardio-vascular side-effects. This article reviews some etiological factors responsible for male infertility or impotence. The importance of a global appraisal of the patient is underlined in order not to limit his role to the one of a sperm producer.

[Etiology and treatment of sterility due to azoospermia]. / Etiologie et traitement de la stérilité due à une azoospermie.

Azoospermia can be classified according to the serum level of FSH into obstructive (OA) or non-obstructive (NOA) azoospermia. It can also be due to a lack of gonadotrophins. In the latter case the administration of FSH and HCG can normalize the sperm production. In the other cases ICSI must be performed. In OA sperm can be retrieved using percutaneous epididymal aspiration or testicular fine needle aspiration in case of failure of vasovasostomy or epididymovasostomy. In NOA or spermatogenic arrest, focal spermatogenesis can be observed in 40 to 50% of cases using repeated testis biopsies, allowing to perform ICSI. Although the risk of malformation in children born after ICSI is not increased there is an increased risk to transmit genetic abnormalities in case of NOA (such as the rate of sex chromosome, or microdeletions of the Y chromosome) and in case of congenital OA (mutations of the cystic fibrosis gene).

[Growth and collagen synthesis disorders in asthmatic children treated with inhaled steroids]. / Troubles de la croissance et de la synthèse du collagène chez des enfants asthmatiques traités par des stéroïdes en inhalation.

We report the case of an atopic patient aged 16 with a perannual asthma. He has been treated since the age of 4 with inhaled corticosteroïds. His growth was regular until he was 14 when beclomethasone was replaced by fluticasone (both administered by pressurized inhaler) due to adrenal suppression. Growth inhibiting effects of different inhaled corticosteroids are discussed focusing mainly on their effect on collagen synthesis.

[Attempted suicide with 400 thyroxine pills: what happened to the physician-patient relationship?]. / Tentamen avec 400 comprimés de thyroxine: que s'est-il passé dans la relation médecin-malade?

Patient aged 49 who developed hypothyroidism after receiving 1131 for relapsing Graves' disease after treatment with propylthiouracil followed by homeopathy. Substitution with thyroxine (0.05 mg/day) was prescribed. Depressed by the perspective of a life long treatment, the patient swallowed 400 pills (20 mg). The evolution was uncomplicated after betablockers administration at hospital. One year later she became euthyroid without further medication. The occurrence of transient hypothyroidism after curitherapy is discussed. The importance of mutual participation in the patient/physician relationship is underlined in the framework of divergent conceptions of medicine.