[Obesity, bariatric surgery and contraception]. / Obésité, chirurgie bariatrique et contraception.

The use of hormone therapy is an important therapeutic choice in woman's life, both for contraceptive purpose to avoid unwanted pregnancy, as well as for treatment of menstrual disorders, or climacteric symptoms. Medical care must therefore be dynamic, tailored to individual requirements as much as possible, reflecting personal and family background, potential risks related to treatment, and of course patient's wishes. We will first discuss the modalities of contraception in presence of obesity, then the need for potential adjustment following bariatric surgery.

Le choix d'une médication hormonale est un acte thérapeutique important dans la vie d'une femme, aussi bien dans un but contraceptif afin d'éviter une grossesse non désirée, que dans le cadre d'une prise en charge symptomatologique accompagnant le cycle menstruel ou entourant la ménopause. La prise en charge se doit donc d'être dynamique, individualisée au maximum, en tenant compte des antécédents personnels et familiaux, des facteurs de risque potentiels liés au traitement et, bien évidemment, des désirs de la patiente. Nous discuterons, dans un premier temps, de la contraception dans le cadre d'une obésité et, dans un second temps, de l'éventuelle adaptation après chirurgie bariatrique.

[Trisomy 18 in a bichorial-biamniotic twin pregnancy]. / Grossesse gémellaire bichoriale-biamniotique dont un des foetus est atteint de trisomie 18.

Screening for chromosomal abnormality such as trisomy 18 in a bichorial-biamniotic twin pregnancy is based on ultrasound and a non-invasive prenatal test (NIPT) from 12 weeks of gestation. An invasive examination such as amniocentesis is necessary for a diagnostic confirmation. The management of these complicated cases consists in performing a selective feticide in the first or third trimester of pregnancy. Trisomy 18 most often results from a chromosomal nondisjunction of maternal origin. Indeed, advanced maternal age is a major cause of chromosomal abnormality and a promoting factor of twin pregnancies. This is a severe condition with a very high stillbirth rate, even though there are certain cases where babies have managed to survive for several years.

Le dépistage d'une anomalie chromosomique de type trisomie 18 dans le cadre d'une grossesse gémellaire bichoriale-biamniotique repose sur l'échographie et sur la réalisation d'un test prénatal non invasif (NIPT) à partir de 12 semaines de gestation. Un examen invasif de type amniocentèse est nécessaire pour une confirmation diagnostique. La prise en charge de ces cas compliqués consiste à effectuer un foeticide sélectif au premier ou au troisième trimestre de la grossesse. La trisomie 18 résulte le plus souvent d'une non-disjonction chromosomique d'origine maternelle. En effet, l'âge maternel avancé est une cause majeure d'anomalie chromosomique et un facteur favorisant les grossesses gémellaires. Il s'agit d'une condition sévère avec un taux de mortinatalité très élevé bien qu'il existe certains cas où les enfants survivent plusieurs années.

Ulcer of Lipschutz, a rare and unknown cause of genital ulceration.

Acute genital ulcers are painful and distressing to women. Lipchutz Ulcer is an uncommon disease that typically occurs in sexually inactive young women. The main differential diagnosis are sexually-transmitted or non-infectious diseases which cause genital or oro-genital ulcerations. This article aims to review the diagnosis of acute genital ulcers and, through a rare case of acute genital ulcerations, to discuss diagnostic procedures.

A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia.

Complications of (pre)eclampsia may involve multiple systems and organs. Neurological symptoms may occur. Visual symptoms concern up to 25% the of patients with severe preeclampsia and 50% of the patients with eclampsia. An uncommon effect of severe preeclampsia is sudden blindness. Blindness may be part of a clinical and radiological presentation named Posterior Reversible Encephalopathy Syndrome (PRES). PRES may lead to permanent neurological deficit, recurrences or death. We report the case of a 24-year-old Caucasian patient, gravida 5 para 2 who developed preeclampsia and PRES complicated with blindness at 32 weeks of gestation. Optimal care allowed visual symptoms to resolve within 24 hours and a favourable maternal outcome and no long- term sequelae. We describe different causes and manifestations of PRES and highlight the need for immediate care in order to optimize the chance of symptoms reversibility.

[Sporadic Birt-Hogg-Dube syndrome]. / Syndrome de Birt-Hogg-Dubé sporadique.

Birt-Hogg-Dube is a rare syndrome which is sporadic or hereditary with a dominant autosomal transmission. Various organs, in particular the skin, can be affected. In the presently reported case, skin was covered by hundreds of small molluscoid papules corresponding to trichodiscomas, fibrofolliculomas and skin tags.

[Case of the month. Acute generalized exanthematous pustulosis due to an iodinated contrast radiodiagnostic agent]. / Le cas clinique de mois. Pustulose exanthématique aiguë généralisée due a un agent de contraste iodé pour radiodiagnostic.

Iodinated contrast agents are frequently involved in delayed polymorphic adverse skin reactions. Acute generalized exanthematous pustulosis following administration of iodinated contrast agents is a rare but severe form of such reactions. The disease is characterized by the sudden occurrence of an erosive and pustular erythroderma with fever, leukocytosis and sometimes peripheral adenopathies and liver involvement. This condition is considered as an immunologic reaction, primarily involving T lymphocytes. The overall mortality reaches about 1%. Elucidating the differential diagnosis with other acute paroxysmal drug eruptions (toxic epidermal necrolysis, Steven-Johnson syndrome and drug hypersensitivity syndrome) is of paramount importance for establishing the adequate treatment of PEAG.

[Skin and its main neurocristopathies]. / La peau et ses principales neurocristopathies.

The neurocristopathies encompass genetic disorders targeting some structures originating from the neural crest development. Hence, skin is affected by some clinical manifestations of these disorders. This review covers the main aspects found in neurofibromatosis, tuberous sclerosis, incontinentia pigmenti, neurocutaneous melanoblastosis, basal cell naevomatosis and the epidermal naevus syndrome.

[How I explore...A patient with palmar erythema]. / Comment j'explore...Un patient avec un érythème palmaire.

Palmar erythema occurs in a series of physiological and pathological conditions. The first group encompasses hereditary and idiopathic conditions, as well as the time of pregnancy and ageing. The pathological states include some dermatoses as well as hepatic, autoimmune, infectious and paraneoplastic conditions. Medications may also be responsible for palmar erythema, in particular some chemotherapy agents.

Near-infrared (NIR) monitoring of H2O2 vapor concentration during vapor hydrogen peroxide (VHP) sterilisation.

PURPOSE: There is an increasing use in the pharmaceutical industry of barrier systems such as transfer isolators, sterilisation tunnels and work station isolators. As Vapor Hydrogen Peroxide (VHP) sterilisation of isolators and lyophilizers becomes an important sterilisation method, there is an acute need for a VHP monitoring system to be used for in-process control and validation. In this study, near infrared (NIR) spectrofotometry was evaluated as a potential technique to monitor hydrogen peroxide. Additionally the H2O2 vapor permeability of different packaging materials, commonly used in steam and ethylene oxide sterilisation, was evaluated. METHODS: NIR spectrofotometry, using a gas cell connected with optic fibres, was evaluated as a potential technique to monitor hydrogen peroxide vapor and water vapor during VHP sterilisation of an isolator. A NIR spectrum was taken every 30 s during VHP sterilisation of an isolator. The influence of injection rate, air flow rate, working temperature and gas distribution was investigated. The H2O2 vapor permeability of different packaging materials was determined by placing the gas cell in the sterilisation bags and sealing the bags hermetically. The sterilisation bag was then subjected to VHP sterilisation. RESULTS: The NIR spectra taken at steady state sterilization conditions showed 4 absorption peaks: at 1364, 1378 and 1400 nm attributed to water and at 1420 nm attributed to H2O2 vapor. By measuring the absorbance level at these wavelengths, the actual concentration of H2O and H2O2 vapor in the isolator was calculated. The water vapor permeation of the sterilisation bags, measured with NIR, appeared to be equal for all materials tested. Whereas Tyvek was the most permeable material for hydrogen peroxide vapor (82.7% of the reference concentration outside the bag), only 30% was found in bags made of medical paper. Sterilisation bags consisting of laminate films and PVC sealed to medical paper showed intermediate permeability. CONCLUSIONS: Near-infrared (NIR) spectroscopy using a gas cell with optic fibres is a useful technique to monitor VHP sterilisation cycles. There was a difference in H2O2 vapor permeability of different packaging materials, commonly used in steam and ethylene oxide sterilisation.

Sucrose laurate gels as a percutaneous delivery system for oestradiol in rabbits.

In this study sucrose laurate was formulated in hydrogels and investigated as a suitable transdermal penetration enhancer for oestradiol. Using rabbits as an animal model, the absolute bioavailability and the skin irritation were evaluated after single and multiple application. Three hydrogels containing 60 mg% oestradiol were evaluated: Oestrogel, and two hypromellose gels containing 5 and 15% sucrose laurate (w/w), respectively. No stability problem of the sucrose laurate was detected during a storage period of four months at 7 +/- 2 degrees C. After single application no significant difference (P < 0.05) was observed between the bioavailability parameters of Oestrogel and the 5% sucrose laurate gel. The values obtained for the 15% sucrose laurate gel were significantly higher than for the other gels. When applied on day 7 after a 6-day treatment, twice daily with the respective placebo gel, no significant difference was seen amongst the three formulations for any of the parameters evaluated. When the results after multiple application were compared with those after single application, a significant increase in oestradiol bioavailability was seen for the gel containing 30% ethanol and a significant decrease in oestradiol bioavailability was seen for the 5 and 15% sucrose laurate gels. Histological evaluation of the untreated and treated skin biopsies, showed a significantly higher incidence of infiltrate for all treated skin biopsies in comparison with the untreated ones. A significant increase in skinfold thickness was seen for the skin biopsies treated with gel containing 15% sucrose laurate. It can be concluded that sucrose laurate shows a potential as an absorption enhancer for percutaneous drug delivery.

Evaluation of the nebulisation of sodium ceftiofur in the treatment of experimental Pasteurella haemolytica bronchopneumonia in calves.

Severe acute bronchopneumonia was induced in 24 conventional Friesian Holstein calves by inoculating them intratracheally with Pasteurella haemolytica type A1. Twelve of the calves were treated intramuscularly with sodium ceftiofur and 12 were treated with an aerosol of sodium ceftiofur. The mortality rate in the group of calves treated with the aerosol was significantly lower, and their clinical and haematological parameters returned to normal significantly faster than in the calves treated intramuscularly.

Intracellular survival and multiplication of virulent and less virulent strains of Streptococcus bovis in pigeon macrophages.

The intracellular fate of pigeon S. bovis strains ingested by macrophages was studied in vivo and in vitro. During in vivo experiments, histological and electron microscopical examinations demonstrated numerous cocci, which appeared to be actively multiplying, within splenic macrophages of pigeons experimentally inoculated with a highly virulent S. bovis serotype 1 strain. In pigeons inoculated with a low virulence serotype 3 strain, intracellular cocci were only occasionally observed. For in vitro experiments, pigeon peritoneal macrophages were inoculated with a S. bovis serotype 1 or serotype 3 strain and incubated. Following an initial decrease, an increase in the number of intracellular bacteria was observed in tests performed with the S. bovis serotype 1 strain, demonstrating intracellular multiplication. Macrophages in these experiments had all died after 7 h of incubation, possibly indicating that the intracellular replication of S. bovis resulted in the release of substances toxic for macrophages. In experiments performed with the S. bovis serotype 3 strain, the number of intracellular bacteria continuously decreased, reflecting killing of organisms. Significant changes in the number of adhering macrophages in S. bovis serotype 3 inoculated cultures were not observed. These results indicate S. bovis in pigeons is a facultative intracellular bacterium and intracellular multiplication may be involved in virulence.

Effect of adjuvant administration on weight gain, infectious diseases, and mortality of veal calves.

Young weaned calves are susceptible to viral and bacterial infections. In two studies 279 and 500 weaned calves were injected at random with an adjuvant, with saline or were left untreated in order to evaluate their weight gain or illness and mortality during the first 10 weeks of fattening on a fat-stock farm. However, in contrast to studies reported in the literature, no significantly higher increase in weight gain and no significant improvement of illness and mortality were found with adjuvant treatment.

Effect of drug formulation and feeding on the pharmacokinetics of orally administered quinidine in the horse.

Quinidine is the drug of choice for the treatment of cardiac arrhythmias in horses. The plasma concentrations vs. time profiles following oral administration of two formulations of quinidine sulphate, an oral solution and an oral suspension paste, were evaluated in nine horses. They received multiple administrations of the oral solution under fed and non-fed conditions and of the paste under non-fed conditions. A loading dose of 20 mg.kg-1 and a maintenance dose of 10 mg.kg-1 quinidine with dosing interval of 6 h were used. The relative bioavailability of the oral solution under fed conditions in comparison to the solution under non-fed conditions was 75.0 +/- 10.2% for the loading dose and 97.18 +/- 31.66% after the fourth dose. For the paste formulation the relative bioavailability values are not reported, as steady-state levels were not reached. There was a large variation in plasma quinidine levels when the paste formulation was administered. Feeding conditions had a significant influence on the Cmax values after administration of the loading dose. The Tmax values were not affected by food intake. It was concluded that an oral solution has to be preferred because of the variable drug bioavailability from the paste formulation and the poor acceptability of the paste by the horse.

Micro-encapsulation of MDCK-ras-e cells prevents loss of E-cadherin invasion-suppressor function in vivo.

The invasion-suppressor molecule E-cadherin mediates Ca(2+)-dependent cell aggregation and prevents invasion. E-cadherin-positive Madin-Darby canine kidney (MDCK) cells that were non-invasive in vitro formed, upon i.p. injection, tumors that were invasive. Differentiated tubular tumor areas showed an intense immuno-signal for E-cadherin at intercellular contacts, whereas undifferentiated structures did not. Cell lines derived from such tumors turned out to be invasive in vitro and showed decreased Ca(2+)-dependent cell aggregation but no change in E-cadherin immunopositivity. This combination of phenotypes indicated a loss of the E-cadherin invasion-suppressor function. Micro-encapsulation of i.p.-injected cells prevented the loss of the E-cadherin invasion-suppressor function. We concluded that this loss in vivo was dependent upon immediate contacts between tumor cells and host cells or upon host factors that could not cross the capsule membrane.

Enlarged cell-associated proteoglycans abolish E-cadherin functionality in invasive tumor cells.

Mouse and dog epithelial cell lines, expressing high levels of the Ca(2+)-dependent cell-cell adhesion molecule E-cadherin in vitro, generated invasive and metastatic tumors in athymic mice. From these tumors, neoplastic cell lines were isolated. All ex vivo isolates retained high expression levels of E-cadherin at their surface. Nevertheless, some showed a fusiform morphotype, were defective in Ca(2+)-dependent cell aggregation, and were invasive in vitro, indicating that E-cadherin was not functional. Cell-associated proteoglycans were found to be enlarged in these variants as compared to their counterparts with functional E-cadherin. Treatment of the cells with the drug 4-methylumbelliferyl beta-D-xyloside specifically reduced the amount and size of cell-associated proteoglycans. This same drug induced an epithelial morphotype, increased Ca(2+)- and E-cadherin-dependent cell aggregation, and abrogated invasiveness without influencing E-cadherin expression levels. Our results indicate that enlarged proteoglycans can prevent the homophilic binding of E-cadherin, probably by steric hindrance. This is one more mechanism by which carcinomas may counteract invasion-suppressor genes and acquire malignancy.

The molecular weight cut-off of microcapsules is determined by the reaction between alginate and polylysine.

Mammalian cells encapsulated in alginate-polylysine microcapsules are used as artificial organs in cancer research and in biotechnology. These applications require microcapsules with a reproducible mol. wt. cut-off. The high cost of the polycation, polylysine, requires an efficient preparation procedure. This article shows that the overall reported contact time of 5 minutes at ambient conditions should be increased several times in order to reach a maximal binding between the calcium alginate beads and 0.1% (w/v) polylysine solutions. An increase of the polylysine concentration from 0.0125% to 0.8% (w/v) resulted in a faster maximal binding, but the amount of polylysine bound increased also. Immersion of calcium alginate beads with a diameter of 750 mum, prepared from 1 mL alginate, in 30 mL of a 0.8% (w/v) polylysine solution, resulted in a polylysine spill of more than 89%. The time required to reach a maximal binding was related to the reaction temperature. The interaction zone between calcium alginate beads and fluorescein isothiocyanate-labeled polylysine solutions was visualized with a confocal laser scanning microscope as a function of time. Microcapsules, prepared at 40 degrees C with 0.1% (w/v) polylysine solutions with mol. wts. between 12 and 249.2 kD, were permeable for fluorescein isothiocyanate-labeled dextran, mol. wt. 4.7, but not for 40.5 kD. Higher polylysine concentrations resulted in a membrane with a mol. wt. cut-off lower than 4.7 kD.