A striking parallel between cardiolipin fatty acid composition and phylogenetic belonging in marine bivalves: a possible adaptative evolution?

Thirty-five species of marine mollusk bivalves were analyzed for their fatty acid (FA) composition of cardiolipin (Ptd(2)Gro). All species showed a Ptd(2)Gro with strong selectivity for only a few polyunsaturated fatty acids, but three characteristic FA profiles emerged, with clear parallels to bivalve phylogeny. A first group of 12 species belonging to the Eupteriomorphia subgroup (Filibranchia) was characterized by a Ptd(2)Gro almost exclusively composed of 22:6n-3, whereas in the four Filibranchia Pteriomorph species analyzed, this FA was combined with substantial proportions of 18:2n-6 and 18:3n-3. Finally, a third group of 20 species, all belonging to the Heterodonta subclass, possessed Ptd(2)Gro containing predominantly both 22:6n-3 and 20:5n-3. Polyunsaturated FA moieties and arrangements in the Ptd(2)Gro of some marine species investigated in other classes of the mollusk phylum (Gastropoda, Polyplacophora) were found to be different. The present results suggest that the specific Ptd(2)Gro FA compositions in bivalves are likely to be controlled and conserved in species of the same phylogenetic group. Functional significances of the evolution of this mitochondrial lipid structure in bivalves are discussed.

[Functional urology: synopsis of the 101st Congress of the French Association of Urology]. / Résumé des communications d'urologie fonctionnelle présentées au 101e Congrès de l'Association française d'urologie.

Functional urology knows more and more a marked development. Regarding benign prostatic hyperplasia, combined treatments are used often and new molecules such as inhibitor of phosphodiesterase of type 5 are appearing. The gold standard treatment of urinary incontinence with sphincteric deficiency remains the artificial urinary sphincter, in men and in women, where the rate of success is nearly of 95 %. The use of botulinic toxin in neurogenic bladder and especially in overactive bladder is growing remarkably, notably in patients of whom quality of life is improve against a very low toxicity. However, the effect of the molecules becomes blurred within a few months. The CT diagnosis of urinary lithiasis is about to provide nowadays the main component of each calculi. Peyronie's disease remains scarce in which verapamil's injections are strongly suggested to amend pain but not the curve during erection.

[A case of uterine rupture discovered in the postpartum period]. / Un cas de rupture utérine découvert en post-partum.

Because of the increasing number of cicatricial uteruses, uterine ruptures are likely to become more frequent. However, few cases discovered in the postpartum period are described in literature. Our case report describes a uterine rupture, which occurred during a quick vaginal delivery, in a patient with previous cesarian section. The diagnosis has been made few days after delivery, the patient presenting pelvic pain and fever. We do not disagree with the principle to check uterine scar only when suspicion of rupture, but we should keep in mind that in case of endometritis in the postpartum period, with cicatricial uterus, it would be necessary to research uterine rupture by fitted imaging.

[A rare complication of vomiting in pregnancy: Wernicke's encephalopathy]. / Une complication rare des vomissements gravidiques: l'encéphalopathie de Gayet-Wernicke.

Gayet-Wernicke syndrome is a rare neurological pathology due to a deficit in vitamin B1. It occurs in alcoholics but several reports have been published of cases in a context of intractable vomiting. The frequency is probably under-estimated because there have been many cases described at autopsy. The diagnosis is clinical with the triad (found in 60% of cases) of mental confusion, oculomotor disorders and ataxia. MRI can confirm the diagnosis by hyper signal images most frequently in a peri-acqueductal location, the thalamus and mamillary bodies. We report 3 observations of Gayet-Wernicke encephalopathy discovered in a context of hyperemesis gravidarum. These 3 cases, which occurred within the past two years in the West of France, give us the opportunity to assess 3 different outcomes for this pathology. In a second section we review the main publications in the literature. Hyperemesis gravidarum is a frequent pathology and can be the cause of serious neurological complications. Early vitamin supplementation should be instituted in case of severe vomiting in order to ensure the pregnancy can continue together with the mother's well-being.

Novel approach of human epidermal growth factor receptor 2 detection in noninvasive and invasive transitional cell carcinoma of the bladder.

PURPOSE: In recent years over expression of HER2 has been identified in malignant tumors of organs other than breast. Studies of bladder carcinoma that analyzed HER2 protein expression and gene amplification with a variety of nonstandardized methods have shown heterogeneous results. The results reported vary from 2% to 74% of protein over expression, to 4% to 59% of gene amplification of HER2, possibly due to differences in study design, material selection or laboratory methodology. MATERIALS AND METHODS: In the present study archival tissue from 87 patients with noninvasive papillary (25) and invasive (62) TCC was analyzed for amplification of the HER2 gene and over expression of its encoded protein. HER2 protein expression was detected by immunohistochemistry using the HercepTest. Routinely processed paraffin embedded tissue was investigated for HER2 gene amplification using CISH and FISH. RESULTS: Of the invasive 37 (58%) and of the noninvasive 19 (76%) transitional cell carcinomas investigated showed over expression of the HER2 protein (3+ and 2+) using a standardized immunohistochemical method. HER2 gene amplification assays performed on positive cases evaluated by immunohistochemistry were obtained in 81% and 43% of 3+ and 2+ HER2 protein over expressing invasive, respectively, and in 21% of noninvasive papillary bladder tumors. HER2 gene amplification detection results using CISH and FISH showed a concordance of 100%. The occurrence of aneusomy of chromosome 17 in association with HER2 gene amplification was investigated. CONCLUSIONS: Validation of the HER2 oncogene in bladder cancer may allow for the potential use of Herceptin(R) antibody therapy. Therefore, the appropriate treatment approach has to be based on reliable and standardized analysis. Our results indicate that CISH could provide an accurate and practical alternative to FISH for the clinical diagnosis of HER2 oncogene amplification in bladder cancer.

[Breastfeeding and vegan diet]. / Allaitement maternel et végétalisme.

Vegan diet in lactating women can induce vitamin B12 deficiency for their children with risk of an impaired neurological development. A 9.5-month-old girl presented with impaired growth and severe hypotonia. She had a macrocytic anemia secondary to vitamin B12 deficiency. MRI showed cerebral atrophy. She was exclusively breastfed. Her mother was also vitamin B12 deficient, secondary to a vegan diet. She had a macrocytic anemia when discharged from the maternity. Vegan diet is a totally inadequate regimen for pregnant and lactating women, especially for their children. Prevention is based on screening, information and vitamin supplementation.

[Assessment of a general practitioner training campaign for early detection of cutaneous melanoma in the Haut-Rhin department of France]. / Evaluation d'une campagne de formation des médecins généralistes et des médecins du travail au dépistage du mélanome dans le Haut-Rhin.

INTRODUCTION: Dermatologists frequently provide training for general practitioners, but such training is not systematic and evaluation is rare. MATERIALS AND METHODS: A training campaign for general practitioners and occupational physicians in melanoma screening was carried out in the Haut-Rhin Department of France in 2004. The 630 general practitioners and 120 occupational physicians in this geographic department received repeated mail together with materials (posters and booklets) for their waiting rooms, and they were invited to attend medical training sessions. The sessions consisted of 10 photographs for initial evaluation, provision of epidemiological information, training in identification of subjects at risk and diagnosis of pigmented lesions, with a further 10 photographs for evaluation at the end. The 20 evaluation photographs were randomly selected for each session from 40 photographs comprising 18 cases of melanomas, 14 of nevi, 4 of basal cell carcinomas and 4 of seborrheic keratoses. At the end of each session, the physicians returned 2 anonymous questionnaires containing their overall assessment of the campaign (Q1) and their answers concerning the 20 evaluation photographs (proposed diagnosis and management strategy) (Q2). The questionnaires were then analyzed. The 40 evaluation photographs were also tested on 47 dermatologists. RESULTS: Three hundred and fifty physicians - 278/630 general practitioners (44%) and 72/120 occupational physicians (60%) - attended 18 medical training sessions. Response levels for questionnaires Q1 and Q2 were 88% and 90% respectively. Almost all of the physicians involved considered the campaign to be warranted. At the end of the training sessions, 96% felt they were better equipped to identify subjects at risk for melanoma and 53% (58% of general practitioners and 39% of occupational physicians, p=0.03) felt they had greatly improved their ability to diagnose pigmented lesions. The median number of correct replies concerning the evaluation photographs increased from 6/10 to 7/10 between the initial evaluation photographs and the final evaluation photographs (p<0.0001), with no difference being seen between the general practitioners and occupational physicians. The median number of correct replies from the 47 dermatologists was 35/40 (8.75/10). The most striking improvement noted during the campaign concerned the ability to identify melanomas. The figure rose from an initial 59% at the start of the session (initial evaluation photographs) (versus 86% for the dermatologists) to 84% by the end of the session (final evaluation photographs) (p<0.0001). The management strategy proposed for photographs of melanoma (irrespective of the proposed diagnosis) was judged "appropriate" in 86% of cases at the start of the session versus 94% at the end of the session (p<0.001). Seborrheic keratosis was correctly identified in 43% of cases by the general practitioners/occupational physicians versus 75% by the dermatologists, and was confused with melanoma in 22% of cases by the general practitioners/occupational physicians versus 5% by the dermatologists. No improvement was seen during the training session in terms of the ability of the general practitioners/occupational physicians to correctly identify seborrheic keratosis. The majority of participants indicated their willingness to participate in the screening program and asked to receive information on melanoma on a regular basis. DISCUSSION: This initial study shows the immediate impact of medical training sessions on general practitioners/occupational physicians to be important in terms of sensitization and moderate but significant in terms of improved diagnosis of pigmented lesions. The longer term impact, as well as the impact of the campaign on physicians not taking part in the medical training sessions, remains unknown. This study militates in favor of the involvement of general practitioners and occupational physicians in mass screening for melanoma in collaboration with dermatologists. The 2004 campaign in the Haut-Rhin Department also included information for the general public. The primary evaluation criterion of the campaign will be change in incidence of thick melanomas recorded by the departmental cancer registry.

[PSA and benign prostatic hyperplasia]. / PSA et hypertrophie bénigne de la prostate.

In the opinion of many urologists, prostate-specific antigen (PSA), which is not specific of any disease, is not considered in the diagnosis and follow-up of benign prostatic hyperplasia (BPH). Nonetheless, prostate cancer diagnosis is based on PSA screening. PSA value is thus available for a majority of men above 50. Recent data suggest that there is a link between PSA value and BPH natural history, turning PSA into a tool for BPH management and prevention of complications such as retention. It hasn't got into practice so far, as recommended criteria for PSA screening in BPH have not been issued. The debate over this topic is only at its beginning.

[Problems raised by the gynaecologic management of women with BRCA 1 & 2 mutations]. / Problèmes posés par la prise en charge gynécologique des femmes porteuses d'une mutation germinale des gènes BRCA 1 & 2.

Breast and ovarian cancer occur more frequently in young women with BRCA 1 &2 mutations (respective cumulative risks from 37 to 85% and 10 to 20%), and raise specific gynaecologic problems as prophylactic surgery and hormonal treatments. Two medical files from 2 sisters with BRCA 1 mutation (exon 11) are presented and the authors discuss the therapeutic options chosen. BRCA 1 & 2 tumour suppressor genes seem to play a major role in the repair of cellular damages inducing by the estrogenic proliferative signal. The prophylactic mastectomy is effective for the breast cancer prevention but its acceptance is low. The oophorectomydecreases the ovarian risk (knowing the occurrence of peritoneal carcinomatosis in 1.8% of cases) and currently the breast cancer risk (RR = 0.47) by the hormonal privation: the hormone replacement therapy does not seem to increase the breast cancer risk in the small series published. The HRT is possible in women with BRCA mutation under medical supervision and if the doses of hormones are light. The first results concerning the chemoprevention by Tamoxifen are encouraging (RR = 0.38) in these patients, but more studies are needed. The oral contraception exerts an uncertain effect against ovarian cancer, but possibly enhances the breast cancer risk in this group of women (RR = 3.3). The management of women with BRCA mutation is varying according to their own priorities, which can change during their life.

[Factors associated with the choice of breast or bottle-feeding for hospitalized newborns]. / Facteurs associés au choix du mode d'alimentation pour un nouveau-né hospitalisé.

UNLABELLED: This study was carried out in Rennes's maternity hospitals (France), to determine the breastfeeding rate for newborns hospitalized after birth, as well as the factors associated with the choice to breastfeed or not in these conditions. METHODS: Three hundred and twenty mothers delivered in Rennes Teaching Hospital, whose neonates were transferred in neonatal care unit, were questioned about their choice for neonate feeding. RESULTS: Three hundred and eight of the 320 mothers concerned by the study answered our interview. Fifty one percent of them chose to breast feed, which is near the breastfeeding rate of the general population of Rennes' maternity hospitals (52%). A high sociocultural level, a mother previously breastfed herself, and a previous breast feeding (RR = 5.2; P < 10(-8)) were associated with the choice of breastfeeding. Factors concerning the information of the mothers were also associated with the choice of breastfeeding information during the preparation to birth sessions (RR = 1.7; P < 10(-5)), individual information on the breastfeeding of an ill newborn (RR = 1.5; P < 0.01), and the simple advice to breastfeed given by a health care professional (RR = 2; P < 10(-8)). Of the four qualities named, the more breast-milk qualities a mother knew, the higher breastfeeding rate was (10% for none, 27% for one, 54% for two, and 76% for three or four). Concerning the postnatal factors, gestational age below 31 weeks multiplied breast feeding by 1.5 (P < 0.05), and an early contact mother-child (first day) by 1.3 (P < 0.05). CONCLUSION: This study pointed out the populations at risk of no breastfeeding. Informations on the properties of breastfeeding given to mothers by health care professionals may influence them in their choice of breast feeding or not their ill newborn.

Breast feeding after reduction mammaplasty performed during adolescence.

UNLABELLED: Reduction mammaplasty (RM) can be performed during adolescence if the functional capacity of the breast is preserved. Future breast feeding must be carefully considered in the therapeutic decision making process. PURPOSE OF THE STUDY: Breast feeding after reduction mammaplasty performed during adolescence was assessed to determine surgical factors influencing outcome and patient reception of information concerning breast feeding. METHODS: A questionnaire was sent to 109 women who had undergone reduction mammaplasty between 1981 and 1997 when they were 15-17 years old to ascertain their reasons for having surgery, their satisfaction, and their attitude towards breast feeding. RESULTS: Sixty-five questionnaires (60%) could be analyzed. Mean delay since surgery was 8.1 years. Seventeen women (26%) had delivered 25 infants (mean 1.5). Mean delay after surgery to first delivery was 7.68 years. Five women (29%) nursed their first infant for a mean 11.3 days. None of the women interrupted breast feeding for a reason related to a nipple anomaly or difficult sucking. Twelve women (71%) did not nurse their first infant, because of the prior breast surgery for six of them. Among the 48 nulliparous women, 24 (50%) stated they would nurse their future infant. Although information on breast feeding was systematically delivered, 41 women (63%) stated they had not been informed. There was no statistical relationship between breast feeding and degree of satisfaction, patient-assessed scar quality, or nipple disorders. CONCLUSION: Adolescents who undergo reduction mammaplasty can nurse their future infants with a complication rate similar to that in the general population. Special attention must be given to delivery of information on breast feeding.

[Role of biotic interactions on the growth of pre-recruitment and development of Pecten maximus (L.) in the Bay of Breast]. / Rôle des interactions biotiques sur le devenir du pré-recrutement et la croissance de Pecten maximus (L.) en rade de Brest.

Biotic interactions within benthic megafauna were studied from quantitative dredge samples to investigate their role in the persistence of low scallop, Pecten maximus, stocks in the Bay of Brest. The distributions of 148 species of the megafauna and of four age classes of Pecten maximus were sampled. Suspension feeders dominate all megabenthic assemblages within the bay. This domination can be related to Crepidula fornicata spreading in the bay; however, no direct competition for food between scallops and the slipper limpet (introduced species) has been observed. On the other hand, Crepidula spreading leads to major changes in sediment type (silting) in the bay owing to biodeposit production, and silting would be a major factor inducing the decrease in Pecten maximus distribution. Predation would not be limiting. Within 10 years, one may predict a strong decrease in the area colonized by scallops in the bay.

Uterine rupture during pregnancy following myomectomy via coelioscopy.

A 33-year-old woman underwent a myomectomy via coelioscopy and then showed 5 years later a uterine rupture at the 32nd week of amenorrhea. The rupture was diagnosed after the echography, while there was no peritoneal maternal patency nor foetal consequence. After a cesarean and an uterine repair, the recovery of the mother was satisfactory but the newborn was to die at the 6th week of life. This obstetrical complication raises the problem of myomectomy via coelioscopy in young women, whose indications are being discussed.

[Gestational diabetes: the Rennes Study of joint obstetrical and endocrinological management]. / Le diabète gestationnel : étude rennaise prise en charge conjointe obstétricale et endocrinienne.

OBJECTIVE: To assess the efficacy of a co-program of care in gestational diabetes conducted by the obstetrical and endocrinological units of the Rennes South Hospital (Hopital Sud) and the possibility of adapting obstetrical care to existing risk factors. PATIENTS AND METHODS: A retrospective analysis was made of 200 cases of gestational diabetes diagnosed between January 1993 and December 1996 in the obstetrical units. RESULTS: Instrumental extraction and cesarean section were required for 13.5% and 20.5% of the deliveries respectively. Shoulder dystocia occurred in 2%. 19.9% of the infants had macrosomia and 5. 3% were small for gestational age. Neonatal morbidity required transfer to the pediatric intensive care unit for only 2.9% of the infants. Frequency of cesarean section and macrosomia correlated with poor blood glucose control and excess maternal weight for gravidic hypertension. At 3 months post-partum, glucose intolerance and non-insulin-dependent diabetes were diagnosed in 13% and 2% respectively. CONCLUSION: Systemic screening and obstetrical and endocrinological care allowed patients to prevent maternal and fetal complications in gestational diabetes and to initiate hygiene and dietary habits for the prevention of post-partum non-insulin-dependent diabetes. Obstetrical care can be adapted to risk factors such as overweight, late screening or poor blood glucose control.

Polyamine profiles in tumor, normal tissue of the homologous breast, blood, and urine of breast cancer sufferers.

Polyamines are involved in the development of breast cancer. We assayed polyamines in erythrocytes, urines, and breast tissues (tumor tissue and histologically normal breast tissue close to the tumor) of patients with invasive breast cancer (n = 174) and benign breast disease (n = 71, used as controls). Polyamine levels in red blood cells and urine were similar to the polyamine concentrations found in healthy subjects, and thus cannot be used as diagnostic markers of breast cancer. In cancer tissue, polyamines were significantly increased in comparison with the polyamine concentrations in controls, and were correlated to the tumor aggressiveness as evaluated by histological grade and Ki-67 proliferative index. On the other hand, correlation was found between polyamine levels in the tumor and the status of the hormone receptors. In the mammary tissue close to the cancer, polyamines dramatically decreased in comparison with the polyamine levels of tissue samples removed around the histologically proven benign tumors. The changes of the polyamine concentrations in the histologically normal breast tissue in the vicinity of the cancer could play a role in the cancer development and need further studies, especially if polyamines are considered as a potential therapeutic target in breast cancer.

Benefits of complete polyamine deprivation in hormone responsive and hormone resistant MCF-7 human breast adenocarcinoma in vivo.

Polyamines are ubiquitous cellular compounds which are required for estradiol induced proliferation in breast cancer. Complete polyamine deprivation, using 2 alpha-difluoromethyl-ornithine (DFMO, Eflornithine), a specific inactivator of ornithine decarboxylase (key-enzyme of the polyamine biosynthesis) combined with inhibition of the bacterial production of gastrointestinal polyamine and a polyamine free regimen, was demonstrated to exhibit a cytostatic effect and a decrease of the three tumoral polyamine concentrations in a MCF-7 tumor model. In this experiment, complete polyamine deprivation has been tested on a standard MCF-7 tumor and on a variant MCF-7 tumor (i.e. with a tamoxifen acquired resistance). Polyamine deprivation was effective on the tumor growth, both on standard and variant sub-types. The polyamine contents of two types of tumor were similar, and identically, polyamine deprivation has caused a decrease of putrescine, spermidine and also spermine tumoral concentrations measured by the HPLC method in standard and variant MCF-7 tumors. Acquired tamoxifen resistance is common in patients undergoing hormonal therapy for advanced breast cancer. It has been hypothesized that the direct stimulation of polyamine pathway without estradiol involvement could be one of the mechanisms responsible for the tamoxifen resistance. The ability of polyamine deprivation to inhibit the growth of tumors becoming tamoxifen resistant could offer a therapeutic advantage in case of tumor with acquired tamoxifen resistance and could be tested to prevent or delay the hormonal responsiveness to breast cancer.

[Hysterectomy for benign lesions in Brittany: analysis of medical practices]. / Hystérectomies pour pathologie bénigne en région Bretagne: analyse des pratiques.

OBJECTIVES: By who, why and how are done hysterectomies for benign lesions. MATERIAL: and methods. The 413 medical files of all the patients who underwent an hysterectomy for benign lesion during the last trimester of 1997 were recorded by the Medical Information Departments of the 53 health establishments of the Brittany Region. Surgical procedures, medical indications, pathological findings were analyzed according to the guidelines encountered in the medical literature. RESULTS: Hysterectomies were done by many surgeons (112). Inaugural signs noted in the medical files were classical, but various and often associated without a main indication of hysterectomy. Histological diagnose were identical with those found usually in the literature. The abdominal route was mainly used, particularly when the operation was done by a generalist surgeon and in case of uterus weight superior to 250 g. The post operative outcome has revealed the same nature and frequency of complications as usually described. CONCLUSION: In this study, it appears that efforts remain necessary to clarify the indications for hysterectomy in the medical files (in order to promote the alternative procedures to the hysterectomy), and that the proportion of hysterectomies performed by the abdominal route should be reduced in aid of the others surgical routes.

Polyamines in human breast cancer and its relations to classical prognostic features: clinical implications.

Experimental evidence suggest an important role of polyamines in breast cancer development. Polyamines have been determined in tissue and erythrocyte samples from 100 patients with primary invasive breast cancer and 30 patients with fibroadenomas. Statistical analysis was performed in order to determine the prognostic value of the polyamine patterns of tumor tissues and erythrocytes in comparison with clinical and histological prognostic factors. In malignant tissues, polyamine levels were significantly higher than in benign tissues. They correlated with markers of tumor aggressivity (axillary node involvement and especially with markers of high mitotic rate as Ki-67 staining, histological grade). No correlation was found between estrogen and progesterone status, tumor size and polyamine concentrations. Erythrocyte polyamines levels were identical between cancer patients and controls. The knowledge of the polyamine pattern in breast cancer could become useful in clinical practice particularly if polyamine metabolism is targeted as a therapeutic approach.

[Teaching resources of a hospital Gynecology-Obstetrics service. Review of the literature and practical applications]. / Les ressources pédagogiques d'un service hospitalier de Gynécologie-Obstétrique. Revue de la littérature et applications pratiques.

OBJECTIVES: To summarize the methods encountered in a gynecological department for teaching medical students. STUDY: Review of the Medline literature underlying the benefits and disadvantages of each method using the issues of the modern theories of teaching. RESULTS: All the methods are helpful for learning, with different and complementary objectives. Students can constitute a set of skills using a teaching program containing clear objectives and evaluation on which the future medical practice will be based. CONCLUSION: Students have immediate benefits from an active clinical learning involving them and are prepared to the Continued Medical Education.