[Treatment of arterial hypertension and sexual dysfunctions. Is it a certain cause of poor treatment compliance?]. / Le traitement de l'HTA et les dysfonctions sexuelles. Une cause certaine de mauvaise observance du traitement?

The great interest risen by sildenafil (Viagra) resulted in talking again about erectif dysfunction and sexual disorders. Its commercial introduction has already renewed speech and social representation about sexuality. Each of the antihypertensive drug classes is know to generate sexual disorders. In reducing or normalising blood pressure, they decrease intracavernous perfusion pressure, already compromised by vascular disease of the hypertensive patient. This is due less to a side effect than to the logical consequence of treatment. Analysing last 15 years' medical publications shows little interest in searching for sexual side effects of hypertensive medication, in both sexes. In its every day practice, the physician can more easily have an opinion about their repercussions, than by reading studies, with mention of erectile dysfunction percentages often lower then the known prevalence in general population. However, if we want to improve therapeutic observance, whereas nearly half of the hypertensive patients are not compliant, we need to remedy. The solution would be improving patient-physician communication and relationship, and preventing potentially harmful effects of each antihypertensive agent by proceeding, if possible, to a sexually oriented history taking and physical examination before and during the treatment. This article reviews the works especially about sexual side effects of antihypertensive drug therapy.

[Osteopenia: a consequence of anorexia nervosa]. / L'ostéopénie: une conséquence de l'anorexie mentale.

The bone density in the spine and femoral neck was measured by dual-energy X-ray absorptiometry in 24 female with anorexia nervosa 14 to 34 y.o. (20.6 +/- 5.5 y.o.). Osteopenia or osteoporosis were always present. All the cases presented with hypogonadotrophic hypogonadism and secondary amenorrhea between 4 and 194 months (40.6 +/- 53.8 months) and with low levels of oestradiol and gonadotrophins. The anorectic patient cumulates hypogonadism and a low intake of calories, calcium and vitamin D, which causes a low body mass index. These factors are more important when present before peak bone mass is reached. The gonadotrophic deficit in the young anorectic male is less obvious clinically than in the young female with amenorrhea but can be however documented with hormonal data. The osteopenia of the anorectic girl can be at least partially corrected with the hormonal and nutritional treatment. In order to reach an adequate peak bone mass in late adolescence or early adulthood and to prevent the development of osteopenia, the male and female anorectic patients should receive a hormonal substitution and an adequate nutritional supply of calcium and vitamin D, as soon as the diagnosis has been made.

[Polyglandular autoimmune syndrome]. / Syndrome polyglandulaire auto-immun.

Polyglandular autoimmune syndrome (PGA's) are defined as the coexistence of one or several primary endocrine gland autoimmune insufficiencies, possibly associated with other immunological pathologies. We present the case of a female patient suffering from a primary thyroid failure associated with Biermer anemia and hypophysitis with secondary adrenal insufficiency. We then describe the PGA's, focusing on their interest to the pediatrician, internist, and primary case physician. The three types of polyglandular syndromes, types I and II with adrenal insufficiency, and type III without it, are discussed. (Classification of Neufeld et al.).

[Importance of infectious diseases and role of the infection specialist in a non-university hospital]. / Importance des maladies infectieuses et rôle de l'infectiologue dans un hôpital non universitaire.

More than 3000 infectious diseases treated in the past 10 years at the Department of Medicine of the Cadolles Hospital in Neuchâtel (Switzerland) have been gathered from a computer data base. The infectious disease specialist is directly involved in the diagnosis and treatment of the most severe or rare affections. However, he influences in a more general fashion the management of anti-infectious treatments by directing the treatment plan and helping to choose the proper antibiotics. He also is responsible for the prevention of nosocomial infections. The role and function of the infectious disease specialist as well as the importance of this specialty in a community hospital are discussed.

[10 years of medical-hospital data processing. Returns, answers, hazards or benefits of technology serving mankind]. / 10 ans d'informatique médico-hospitalière. Enjeux, défis, dangers ou bienfaits d'une technologie au service de l'homme.

The medical data processing has been introduced 10 years ago in the city hospital of Neuchâtel. The application includes a problem oriented electronic medical record, software assistance for diagnoses coding, diagnostic and therapeutic files, access to Medline, specific applications for intensive care and neonatology, and also a medical server meant for exchanging data with general practitioners and other hospitals. The reliability, the security and the usefulness of the application are discussed, as well as the orientation of the new application, being developed at present, is described. The physicians, i.e. today users, must prepare themselves the applications for the coming years. The treatment of the medical data must be optimal and also make the personal relationship between the physician and his patient easier.

[Impotence: viewpoint of the internist]. / L'impuissance: point de vue de l'interniste.

Male sexual inadequacy due to erection dysfunction is often the result of cumulative organic (vascular, neurologic, endocrinologic) and psychogenic factors. Diagnosis and therapy must take into account all these various causative factors, and treatment failures are often due to unilateral appraisal of the patient. Sex counseling is necessary in all cases, even when organic causes have been documented. However, vasodilating drugs, androgens, and arterial or venous surgery also have a definite place in the treatment of erection failure.

Determination of fertility interval with ovulation time estimation using differential skin surface temperature (DST) measurement.

Temperature distributions over the breasts of five healthy, young female volunteers using non-pharmaceutical contraceptives were studied over a menstrual cycle to identify "dynamic" temperature points related to E2-induced vascularity and "static" temperature points reflecting the body's core temperature. Corresponding thermometric measurements were analyzed. It was shown during a preliminary study that the DST between a "dynamic" and "static" point, so located, provides advance information on ovulation timing independent of physiologic disturbances and circadian and ambient temperature changes.

PIP: The basal body temperature (BBT) method of ovulation detection has received much attention in the past among natural birth control practitioners and infertility clinics, but it is not capable of determining the ovulation time in advance to estimate the onset of the fertile interval. Thus, the method can be used neither to improve the probability of conception for couples desiring children nor to minimize the abstinence period for natural birth control (NBC) practitioners. In a few studios made on breast temperature changes during the menstrual cycle of a woman, high temperature spots on the skin surface related to vascular activity have been observed around the breasts in the preovulatory peroid, but these could not be correlated with ovulation time in out of laboratory conditions, since the skin temperature is a function of ambient temperature. To overcome this problem, the measurement of "differential skin surface temperature (DST'" between 2 different points of the body is proposed. A study was undertaken on 5 healthy, regularly menstruating, young men volunteers, 25-35 years of age, using only nonpharmaceutical contraceptives (e.g. NBC, diapragms, IUDs). Infrared thermography (IRT) was used to scan the breast and study temperature distributions related to the vascular variations during a menstrual cycle. Based on visual inspection of IRT images, dynamic temperature point B on a warm area just outside the areola and static temperature point C just below the breast (avascular area) were chosen for monitoring. All volunteers recorded their BBT every morning using a commercial mercury fertility thermometer. They also noted the time, drugs consumed, or journey taken, so that proper BBT analysis of the cycle could be subsequently made. As a 2nd phase, 2 oral contraceptive (OC) users underwent the IRT scanning and DST measurement over 1 menstrual cycle for control purposes. The degree of rise in DST was related to the level of plasma estradiol (E2) in the individual patients, and the correlation between them was significant. The changes in DST were statistically significant, compared with the BBT variations. The BBT change due to fever was not reflected in the DST curve of the same volunteer, indicating that in at least 1 case DST was not affected by transient physiologic changes. This could prove to be a significant advantage of the DST as compared with the BBT. The temperature distribution changes were observed (by IRT) to be almost symmetric on the 2 breasts. The study with 2 women using OCs confirmed the high degree of basal vascularization already reported and showed no significant variations in DST. In sum, the DST between a "dynamic" and "static" point, so located, provides advance information on ovulation timing independent of physiologic disturbances and circadian and ambient temperature changes.

Diagnostic strategy in hyperandrogenic syndrome.

Plasma testosterone (T), androstenedione (A), follicle-stimulating hormone, (FSH), luteinizing hormone (LH), prolactin (PRL), and urinary 17-ketosteroids (17-CS) have been measured in 152 women complaining of acne and/or hirsutism. Mean plasma levels of T, A, LH, PRL, and urinary 17-CS were significantly increased as compared to controls. T and/or A were increased in 59% of the cases. T was higher in women with PRL greater than 16 micrograms/l as compared to women with PRL less than 13 micrograms/l. Hirsutism had markedly decreased in 64% and acne in 84% of patients treated with cyproterone acetate.