[Obesity and free inquiry]. / Obésité et libre examen.

The W.H.O. identifies obesity as one of the ten leading health risk factors. Obesity is a worldwide non-infectious pandemic with dramatic consequences, and its usual treatment comes generally to a failure. One may wonder if our therapeutic proposal is adequate, instead of speaking about the lack of willpower of our patients. The explanation of weight gain should not be reduced to a caloric balance. Obese people may have other physiological characteristics than lean ones. Examples are quoted.

[Experience of obesity's treatment by an interdisciplinary team]. / Expérience d'une prise en charge interdisciplinaire de l'obésité.

Owing to the multifactorial origin of obesity, we have created an interdisciplinary team devoted to a limited-in-time treatment, following three axles : nutritional education, body self-perception and emotions expression. The philosophy of this approach and some results are presented.

Usefulness of fluoxetine in obese non-insulin-dependent diabetics: a multicenter study.

Weight reduction is essential in the management of most non-insulin-dependent diabetics, but this therapeutical goal is difficult to obtain. In this double-blind parallel study, 82 non-insulin-dependent diabetics, moderately obese (BMI = 30 - 39 kg/m2), were given for an 8-week period either placebo (P) or fluoxetine (F), a specific serotonin reuptake inhibitor, in addition to their usual antidiabetic treatment. Thirty-nine of them received 60 mg fluoxetine a day and 43 were given the placebo. At admission, both groups had similar weight excess, metabolic control and serum lipid values. In comparison with the P-treated subjects, those treated with fluoxetine (F) lost more weight after 3 weeks (-1.9 vs. -0.7 kg, p < -0.0009) and after 8 weeks (-3.1 vs. -0.9 kg, p < 0.0007). Fasting blood glucose decreased in group F after 3 weeks (-1.5 vs -0.4 mmol/L, p < 0.003) and after 8 weeks (-1.7 vs. -0.02 mmol/L, p < 0.0004). HbAlc decreased from 8.5% to 7.7% in group F and from 8.6% to 8.3% in group P (p = 0.057). Mean triglyceride level was also reduced in group F after 8 weeks (p = 0.042). Fasting C-peptide did not change in either group, but fasting insulin values decreased in group F after 3 weeks (p < 0.02) and after 8 weeks (p < 0.05). The insulin/C-peptide molar ratio decreased significantly in group F after 3 weeks (p < 0.04) and after 8 weeks (p < 0.05) in comparison with group P. The drug was generally well tolerated and no major side effects were reported. In conclusion, the addition of fluoxetine to the usual oral hypoglycemic agent therapy might be beneficial in obese non-insulin-dependent diabetics, at least on a short-term basis.

A multicentre, double-blind, randomized study to compare the safety and efficacy of once-daily ORG 10172 and twice-daily low-dose heparin in preventing deep-vein thrombosis in patients with acute ischaemic stroke.

A multicentre, double-blind, randomized study was performed in 179 patients with acute ischaemic stroke resulting in limb paresis. The purpose was to compare the safety and efficacy of Org 10172 (1250 anti-Xa Units s.c. once daily) and heparin sodium (5000 IU s.c. twice daily) in preventing deep-vein thrombosis (DVT). Prophylaxis started within 72 hours of the onset of stroke and continued for at least 9 days. To detect DVT, patients underwent a daily 125I-fibrinogen leg scanning which, if found positive, was followed by venography. A first computed tomography scan of the brain was performed at screening to rule out cerebral haemorrhage and a second at cessation of treatment to detect any haemorrhagic transformations. At the 2-3-months' follow-up period the patients were examined for signs and symptoms of DVT or pulmonary embolism. On an intention-to-treat analysis, DVT occurred in 14.6% of patients receiving Org 10172 and in 19.8% of those receiving heparin during the treatment period (p = 0.392, NS). Pulmonary embolism was diagnosed in one patient in each group. Major conversion to a symptomatic haemorrhagic brain infarct was found in one patient in each group. Death occurred in 13.5% of patients treated with Org 10172 and in 6.7% of patients treated with heparin (p = 0.135, NS). Deaths were mainly related to pulmonary infection and cerebral oedema, thus considered to be due directly to the clinical status of the patients. 1250 anti-Xa Units of Org 10172 once daily is both safe and as effective as 5000 IU of heparin sodium twice daily given for DVT prophylaxis in patients with acute ischaemic stroke of recent onset.

Fluoxetine therapy in obese diabetic and glucose intolerant patients.

A double-blind placebo-controlled trial was conducted, involving 97 obese diabetic and glucose intolerant patients receiving either 60 mg fluoxetine daily (47 patients) or a placebo (50 patients); a similar calorie-restricted diet was prescribed to all patients. Weight loss was significantly higher in the fluoxetine-treated patients, whose diabetic status improved. Drop-out rate was not significantly different for both groups of patients.

Triflusal versus acetylsalicylic acid: a double-blind study for the prophylaxis of deep vein thrombosis after hip surgery.

The authors report the results of a randomised double-blind study comparing the antithrombotic activity of a new anti-platelet drug (Triflusal) with that of acetylsalicylic acid (ASA). 99 patients who underwent hip surgery were included in the study (total hip replacement, osteosynthesis of a pertrochanter fracture or Moore's prosthesis for intracapsular fracture of the femoral neck). Of the 48 patients having received Triflusal, 7 (14.5%) developed deep vein thrombosis as indicated by 125I-fibrinogen isotopic scanning and confirmed by phlebography. Of the 51 patients treated with ASA, 11 (21.6%) presented the same complication as diagnosed by the same techniques. This difference is not statistically significant, considering the number of cases studied. Nevertheless, Triflusal appears to provide prevention of thromboembolic risk to patients who have undergone hip surgery, particularly total hip replacement.

Left atrial myxoma associated with systemic AA amyloidosis.

A 76-year-old woman presenting with generalized amyloidosis of the AA-type protein was found to have a left atrial myxoma. Retrospective estimation of the concentration of SAA protein, a serum precursor of AA amyloid, before and after surgical removal of the myxoma, showed that the SAA protein had disappeared after the operation. A common manifestation of myxoma is the development of a severe inflammatory syndrome that sometimes simulates rheumatic fever or bacterial endocarditis. However, to our knowledge, it has never been described in association with amyloidosis. We suggest that atrial myxoma should be added the list of neoplastic and inflammatory diseases predisposing to AA amyloidosis.

Thyroid status in elderly sick patients.

Thyroid investigations were performed on 55 euthyroid patients hospitalized for chronic disease or recovering from acute illness. Three age groups were considered. Abnormalities were found only in patients over 75 years: 1) in the TRH test the maximum increase in serum TSH (delta TSHmax) was less marked and frequently delayed to 60 min, whereas the increase in T3 in 120 min (delta T3) was maintained; basal TSH was normal; 2) in 15 out of 28 cases, the pattern of circulating thyronines was abnormal showing an increase in reverse T3 a normal or decreased T3, and a rise in free T4 index beyond the normal range in 3 cases. In all cases but one, the combination of delta TSHmax, and delta T3 differentiated these patients from hyperthyroids.

Prevention of postoperative deep-vein thrombosis by low-dose heparin in open prostatectomy.

A double-blind trial was designed to investigate the efficacy of low-dose heparin in preventing deep-vein thrombosis (DVT) after open prostatectomy... The diagnosis of DVT was established by the 125I-fibrinogen test. The incidence of DVT was 39.4% in the control group (33 patients) and 9.7% in the heparin group (31 patients) (p less than 0.01). These results suggest that low-dose heparin effectively prevents DVT after open prostatectomy

Osteogenesis imperfecta associated with multiple myeloma.

In a case of osteogenesis imperfecta with multiple fractures already from childhood, myelomatosis was diagnosed at the age of 52 years because of a serum M-component (IgG, lambda), Bence Jones proteinuria, myeloma cells in the bone marrow, and osteolytic skeletal lesions. She died 10 months later. A partial postmortem examination of a larger bone lesion confirmed the diagnosis.

[Bone histology and 25-OH vitamin D plasma levels in alcoholics without cirrhosis (author's transl)]. / Etude histologique de la minéralisation osseuse et taux de 25-hydroxycholecalciférol dans l'éthylisme chronique.

Bone mineralization is impaired in alcoholic non cirrhotics admitted to hospital for withdrawal. The defect is more marked in women than in men. Low 25-OH vitamin D plasma values may be observed in these patients and seem to be related to malnutrition. The degree of bone demineralization is not statistically correlated to 25-OH vitamin D plasma level.