Lower-limb neurologic deficit after vaginal delivery: a prospective observational study.

BACKGROUND: Lower limb neurologic deficit after vaginal delivery remains poorly understood. The objective of this study was to describe the incidence, characteristics and prognosis associated with nerve injury occurring to women during vaginal delivery. METHODS: A single-center observational study of women who complained about a lower limb neurologic deficit that appeared immediately after vaginal delivery. The follow-up period was up to four years. RESULTS: Among the 10 569 women with a singleton vaginal delivery during the 30-month study period, 31 (0.3%) reported a neurologic deficit. Most women were nulliparous (71%) and the mean duration of the second stage of labor was 94 min [range 13-224 min]. In two-thirds of cases, delivery required instrumental assistance. Most neurologic deficits were sensory (67.7%) and primarily involved femoral nerve territory (83.9%). Most women recovered within six weeks (69.2%). In one case (a sensory deficit of the entire right leg), recovery only occurred after 3.5 years. CONCLUSION: Neurologic deficit was identified in 0.3% of our vaginal delivery population. Recovery from neurologic deficit may take many weeks and may occasionally be disabling.

Methotrexate efficacy and tolerance in plaque psoriasis. A prospective real-life multicentre study in France.

BACKGROUND: Methotrexate (MTX) is a major systemic treatment for moderate to severe plaque psoriasis. A randomized trial has recently been published evaluating a single weekly dosage (17.5mg), but few prospective real-life data are available. The main objective of this study was to prospectively evaluate the efficacy of MTX in real-life. The secondary objectives were to evaluate predictive parameters for treatment efficacy and the frequency of adverse events. PATIENTS AND METHODS: A prospective cohort involving consecutive at in 25 centres belonging to GEM RESOPSO included all adults with plaque psoriasis in whom MTX treatment was initiated. The efficacy criterion was achievement of PASI 75 at week (W) 12/16. The impact of demographic data, psoriasis characteristics (duration, topography, rheumatism), dosage (W12/16 dosage, cumulative dose after 4 weeks), and mode of administration (subcutaneous vs. oral, concomitant use of folic acid) on efficacy was evaluated. Intention-to-treat (ITT),per protocol (PP), and multivariate analyses were performed. RESULTS: Two hundred and fifty-six patients (F/M: 105/151; mean age: 45.0 years; rheumatism: 12.6%) with plaque psoriasis were included. 99 patients were not analysed at W12/16 (16 because of inefficacy, 16 because of intolerance, 56 were lost to follow-up or had data missing). PASI 75 was achieved in 98 patients, with efficacy of 38.3% in the ITT analysis and 58.3% in the PP analysis. In the ITT analysis, absence of previous use of cyclosporine (P=0.01) and a cumulative dose of MTX>60mg after 4 weeks (P<0.0001) were associated with higher PASI 75 rates. In the PP analysis, only absence of previous use of cyclosporine (P=0.0009) was associated with a better PASI 75 results. There was no association between PASI 75 and patient characteristics (including body mass index), clinical aspects of psoriasis, route of administration, combination with folic acid, or W12/16 dose. Adverse events were reported by 34.8% of patients. These consisted mainly of digestive disorders (nausea, abdominal pain), asthenia and moderate hepatic cytolysis. The frequency of adverse events was correlated with methotrexate dosage. DISCUSSION: The efficacy of MTX in plaque psoriasis in this real-life study of 256 patients is consistent with the data in the literature, including the recently published randomized trial (41% PASI 75). This rate was unaffected by patient weight, route of administration and combined use of folic acid. Absence of previous use of cyclosporine appears to be associated with better efficacy although there is no clear explanation for this. The initial dosage (high dose in the first month) appears to be associated with superior efficacy for W12/W16.

[Oncogenic osteomalacia: increased production of fibroblast growth factor 23 is not the unique actor]. / Ostéomalacie oncogénique : le FGF 23 ne fait pas tout.

The importance of fibroblast growth factor 23 (FGF 23) has been highlighted in the mechanism of urinary leakage of phosphate in the oncogenic osteomalacia (OO). It is now a component of diagnosis of this disease. We report a 58-year-old man who presented with osteomalacia and hypophosphatemia secondary to urinary leakage of phosphorus. Although serum FGF 23 was normal, the diagnosis of OO was obtained after another cause of acquired prolonged hypophosphatemia has been excluded (hyperparathyroidism and Fanconi syndrome in particular). The search for a deep tumor was performed, allowing the detection of a 12 mm hemangiopericytoma in the upper thigh. Its removal allowed the rapid resolution of clinical symptoms and laboratory abnormalities. The importance of functional sequelae in OO depends on prompt diagnosis. Tumorectomy remains the optimal treatment. Thus, the search for a secreting tumor is essential even in the absence of elevated serum FGF 23.

Effect of a fat-reduced dish in a meal on 24-h energy and macronutrient intake.

A covertly fat-reduced and low-calorie dish was provided at lunchtime once a week to normal-weight human subjects. A normal-calorie version of the dish was served for the first 3 weeks, the low-calorie version for the following 4 weeks and the normal-calorie version again for the last 3 weeks. Participants did not compensate for the 840-kJ (201 kcal) fat reduction of their main dish during the lunchtime meal. This lack of compensation persisted after four successive weekly presentations. When the normal-caloric version was offered again, energy intake at lunch immediately recovered. There was 80% adjustment in 24-h energy intake from the first to the last test day on the low-calorie dish, and a return to the baseline level when the normal energy content of the dish was restored. No compensation specific to fat occurred after the consumption of the low-fat dish and so the proportion of energy intake derived from fat decreased from 39.6% in the period on the normal-caloric dish to 36.1% in the 4 weeks on the low-calorie dish. Thus, fat-reduced dishes seem a good means to improve the composition of the diet.

Effect of the physical state of a food on subsequent intake in human subjects.

The effect of the physical state of food on further intake was studied. Human subjects were served two experimental foods at lunchtime 1 week apart. In a first experiment, the two-food meals had the same caloric content, weight, volume, composition and temperature but differed only in their physical form (solid or liquid). As compared to the solid meal, the 24-h total caloric intake following the liquid food was higher. This difference could be attributed to cognitive cues from the form of food or to the lack of masticatory movements while ingesting the liquid meal. The last hypothesis was tested in a second experiment. "In which the test-meals appeared absolutely identical to the senses and were composed of a liquid and a solid item; however, the major part of calories was either in the liquid or in the solid part. When most of the calories had to be drunk, the total subsequent caloric intake was higher than when the most of the calories had to be eaten. It seems that calories ingested in a liquid form are not well taken in account and could induce a subsequent overconsumption, at least until satiety was conditioned to the fluid.

Learned caloric adjustment of human intake.

The time course of caloric compensation of food intake was studied in human subjects presented with a new calorically dilute snack food under naturalistic conditions. In a preliminary test, two versions of the snack food, normal in calories (NC) or low in calories (LC), were found equally palatable by the subjects (15 to 17-year-old boys). In the first part of the experiment two groups were presented with a 125g serving of either NC or LC version as an afternoon snack. Intakes during the subsequent dinner (1 h later) were measured. In the second part of the experiment, the same subjects were allowed to habituate to NC or LC, i.e. on five consecutive days, subjects were served NC or LC food ad libitum at afternoon snack-time; servings and left-overs were weighed. On the sixth day, the snack was a 125 g serving of the habitual food and dinner intakes were measured. It was shown that in these adolescent males a 200 kcal difference in the afternoon snack was not immediately compensated for by dinner intake. However, precise caloric adjustment occurred after habituation. This casts in question the value for weight control of such a use of food products having lower caloric content than conventional products.