[Bone density and biological markers in a population of 330 women]. / Densité osseuse et marqueurs biologiques dans une population de 330 femmes.

A population of 330 non-selected women underwent determination of bone density by means of Bi X absorptiometry of the lumbar spine and femur. The findings showed a negative correlation with the time since the menopause and a positive correlation with the duration of genitally active life and with substitutive hormonal treatment. The determination of the L1 density can replace that of the entire lumbar spine in cases in which osteoarthritis, atheroma or crushing make this determination unreliable. Conclusions cannot yet be based on measurements of the neck of femur. Changes in the biological markers in function of bone density values are difficult to interpret. The measurement of bone density and the assay of biological markers reflect two distinct phenomena, both of which must be taken into consideration in assessing osteoporotic risk.

[Future of premature infants of less than 33 weeks gestational age: results of an inquiry undertaken in 1985 in the Paris region]. / Devenir des prématurés de moins de 33 semaines d'âge gestationnel: résultats d'une enquête menée en 1985 dans la région parisienne.

Improvements in combining obstetrics and neonatology led to a trend to intervene earlier in premature babies born before the 33rd week of gestational age. The enquiry that was carried out in 1985 in the Paris geographical region had as its objective to assess on the one part how many premature deliveries occurred between the 25th and 33rd week of amenorrhea and on the other hand what happened in the short term to the infants born from these pregnancies, i.e., their mortality; and for those who survived, their quality of life. The study was carried out on a representative sample of the deliveries in 1985 in the four departments of the Paris region--Paris and the three departments of the Petite Couronne--where half of all deliveries were assessed. The enquiry covered 53,430 deliveries for which the overall prematurity rate was 4.5%, and those deliveries that occurred before 33 weeks of gestational age constituted 1.0% (539 babies). Twenty children were lost for follow-up after a year. This was 4.9% of the live births and 6.3% of the live children who left the neonatology centres. At 2 years of age, the numbers that were not followed up were eventually 24, which was 5.8% of live births and 7.6% of those that left the centres of neonatology. The results show a very high rate of antepartum mortality but also of mortality during and after labour. Only 379 infants out of the 539 (70%) were transferred into special care baby units. By 1 year of age, the survivors were 57% of the total number of deliveries and 75% of the live births and 82% of those transferred to the special units. As far as concerned those that were live born, the survival rate at the age of 1 year varied considerably according to the duration of the pregnancy. The number of those that survived a pregnancy of less than 27 weeks was low (31%). It was, at 28 weeks, 53%. This is the age where births have to be registered. It reached 87% of the live births that occurred at 32 weeks. One has to point out that there is no statistically significant difference between 27 and 28 weeks of gestation. Whereas there is a significant difference (p less than 0.05) with those delivered at 29 weeks (75%). 80% of those 291 infants that were examined at 1 year of age were considered to be normal as far as psychomotor and sensorial behaviour was concerned.(ABSTRACT TRUNCATED AT 400 WORDS)

Plasma renin activity in phaeochromocytoma: effects of beta-blockade and converting enzyme inhibition.

We measured plasma renin activity and plasma catecholamines in 26 untreated patients with phaeochromocytoma, 18 untreated patients with primary hypertension, and 10 normal control volunteers. Plasma renin activity measured in patients in the supine position, standing position and after walking for 1 h was higher in the subjects with phaeochromocytoma than in those with primary hypertension or in the volunteers (F = 9, P less than 0.001). In all three situations, renin activity was closely correlated with noradrenaline levels in the phaeochromocytoma patients (r = 0.545, r = 0.600, and r = 0.739; P less than 0.01) but not in the subjects with primary hypertension or in the volunteers. The cardioselective beta-blocker acebutolol reduced heart rate, mean blood pressure and renin activity by averages of 20, 12 and 89% respectively in the seven phaeochromocytoma patients given the drug. Captopril decreased mean blood pressure by 19% and raised renin activity by 293% in the nine phaeochromocytoma patients tested. These findings show that in phaeochromocytoma, hypertension is accompanied by high renin levels and that renin release is stimulated in response to noradrenaline overflow. The hypotension observed in response to beta-blockade and captopril provides indirect support for the possibility that renin-dependent mechanisms are involved in the hypertension of phaeochromocytoma.

[Detection, diagnosis and localization of pheochromocytoma. 77 cases in a population of 21,420 hypertensive patients]. / Recherche, diagnostic et localisation du phéochromocytome. 77 cas dans une population de 21,420 hypertendus.

Phaeochromocytoma was diagnosed in 77 (0.36%) of 21,420 hypertensive patients examined in the hypertension units of the Broussais and Saint-Joseph hospitals, Paris, between 1976 and 1986. Our diagnostic strategy is to reserve biochemical examinations to cases with suspected phaeochromocytoma and to explore only those patients who have positive laboratory results. Patients suspected of harbouring a phaeochromocytoma are those who complain of headaches, palpitations and sweating (these 3 symptoms together having a 90.9% sensitivity and a 99.9% exclusion value), those who have a family history of phaeochromocytoma or who present with medullary thyroid carcinoma or phakomatosis, or those who do not respond to anti-hypertensive treatments. Altogether, these patients account for less than 10% of all cases of hypertension. The most sensitive test in this group is measurement of urinary metanephrines. Among 30 patients with phaeochromocytoma in whom urinary metanephrines and plasma noradrenaline were measured on the same day, none had urinary metanephrine values lower than 3.69 mumol/24 h (0.7 mg/24 h) while 6, who had normal blood pressure at the time of sampling, had noradrenaline levels below 3.53 nmol/l (600 pg/ml). Prior to surgery, the tumour was correctly located by urography (69% of 58 n = tumours), ultrasounds (74%, n = 38), arteriography (83%, n = 23), radioisotope scanning (91%, n = 32), computed tomography (95%, n = 40) and nuclear magnetic resonance imaging (12/12). In 28 patients who had both radioisotope scanning and computed tomography the sensitivities of these examinations were 90% and 100% respectively. A stage by stage approach to the diagnosis of phaeochromocytoma, using detection criteria followed by biochemistry then location methods, is an economical strategy with the best yield from diagnostic and imaging techniques.

[Plasma renin and catecholamine activity in pheochromocytoma]. / Activité rénine et catécholamines plasmatiques au cours du phéochromocytome.

We have studied the renin aldosterone system and plasma catecholamines in 26 untreated patients with phaeochromocytoma, 21 untreated patients with primary hypertension, and in 10 normal volunteers. Blood pressure (mmHg), plasma renin activity (radioimmunoassay of angiotensin I, ng/ml/h), plasma concentrations of aldosterone (direct radioimmuno-assay, pg/ml), adrenaline and noradrenaline (radioenzymatic assay with catechol-O-methyl transferase, pg/ml) were measured after 1 h of supine rest, 5 mn upright and after walking 1 h. Seven patients with phaeochromocytoma were subsequently given 400 mg acebutolol bid for 3 days, and five were given 1 mg/kg captopril. Supine renin activity was higher in phaeochromocytoma than in primary hypertension and in volunteers (average 2.54, 1.03 and 0.85, F = 7.1, p less than .01) and rose higher after walking (mean increase 3.84, 1.19 and 0.68 respectively, F = 6.3, p less than .01). Aldosterone was higher after walking in phaeochromocytoma than in primary hypertension (534 vs 275 pg/ml, p = .03). Differences in renin and aldosterone could not be explained by age, natriuresis or plasma volume. Catecholamines were as expected much higher in phaeochromocytoma than in the other two groups (p less than .01). At variance with primary hypertensive and normal volunteers, renin was tightly correlated with noradrenaline in patients with phaeochromocytoma (r' = .54, r' = .60, and r' = .74 in supine position, after standing and after walking 1 h, p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)