Search

Resume Introduction Le tabac et l’alcool sont les deux facteurs de risques principaux evitables de survenue de cancer et ont un impact non negligeable sur la mortalite, notamment chez les personnes atteintes de cancer du sein. Peu de recherches s’interessent aux usages de substances psychoactives des femmes traitees pour un cancer du sein. Cette etude decrit les frequences des consommations de tabac, d’alcool et leurs liens eventuels avec les variables sociodemographiques, medicales et psychologiques dans un echantillon de femmes traitees pour un cancer du sein en chirurgie oncologique. Methode D’octobre 2014 a aout 2015, des femmes en cours de traitement d’un cancer du sein etaient incluses dans le cadre d’un programme de reperage precoce et d’intervention breve concernant l’alcool et le tabac (RPIB) adapte au contexte oncologique. Le recueil de donnees concernant les consommations de tabac et d’alcool a ete realise avec des outils de reperage du statut tabagique (NIDA) et de l’usage d’alcool (AUDIT-C). Des questionnaires ont permis de documenter les donnees sociodemographiques et psychologiques (Thermometre de la detresse psychologique ; ESAS). Les donnees medicales ont ete rapportees par les participants et verifiees a partir des dossiers de soin. Resultats Au total, durant onze mois, 120 femmes atteintes d’un cancer du sein ont ete incluses dans l’echantillon. Une large majorite etait hospitalisee pour un premier cancer du sein (80,8 %), de type carcinome canalaire infiltrant (70,8 %), et beneficiait d’une chirurgie comme premier traitement (45 %). Sur l’echantillon total, 30,8 % sont fumeuses, et 38,4 % presentent une consommation d’alcool a risque. Aussi, 40,8 % manifestent une detresse psychologique. Les liens entre consommations et caracteristiques sociodemographiques, medicales et psychologiques sont en majorite non significatifs. Seul l’âge des patientes est negativement lie a la consommation de tabac. Discussion Le tabagisme et la consommation d’alcool a risque restent frequents au moment des traitements du cancer du sein. Une aide a la reduction des risques et des dommages lies aux comportements potentiellement addictifs devrait etre implantee tout au long du parcours de soins des patientes atteintes de cancer du sein.

International audience

CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.

Stickler syndrome is a group of rare genetic conditions (incidence, 1/7500 births) related to mutations in the collagen genes. Both the mutations and the clinical features vary widely across affected patients. The main manifestations are craniofacial birth defects, bone and joint symptoms, ocular abnormalities, and hearing loss. Stickler syndrome may be revealed at birth (25% of cases) by a combination of cleft palate, retrognathism, and micrognathism known as Pierre Robin sequence, which may cause neonatal respiratory problems. The ocular abnormalities include severe myopia, abnormalities of the vitreous, and a high risk of retinal detachment (60% of cases), which may cause blindness (4% of cases). Severe hearing loss with onset in early childhood may impair performance at school. Osteoarthritis (75% of patients) with onset before 30 years of age is a severe manifestation that causes chronic hip and low back pain and functional impairments. Joint replacement surgery is often required. The risk associated with multiple anesthesias is highest in patients with craniofacial defects. The bone status may deserve to be evaluated, as the combination of genetic abnormalities and physical impairments may promote bone loss. Clinicians should be cognizant of Stickler syndrome so that they can detect the disease in patients and their family members, prevent functional impairments, organize a multidisciplinary management strategy, and arrange for genetic counseling.

Resume Le syndrome de Stickler est une maladie genetique rare (incidence 1/7500 naissances) heterogene d’un point de vue genetique et clinique, liee a une mutation de genes du collagene. Ce syndrome associe des malformations crâniofaciales, des manifestations osteoarticulaires et sensorielles oculaires et auditives. Le syndrome de Pierre Robin, comportant une fente palatine, un retrognatisme et un micrognatisme peut reveler un syndrome de Stickler a la naissance (25 % des patients) et entrainer des difficultes respiratoires neonatales. L’atteinte ophtalmologique se manifeste par une forte myopie, des anomalies du vitre et un risque eleve de decollement de retine (60 % des patients) conduisant a une cecite (4 % des patients). Une surdite severe apparait tot dans l’enfance, conduisant a des retards d’acquisition scolaire. L’arthrose precoce (75 % des patients) survenant avant 30 ans est une complication majeure, responsable de douleurs chroniques de hanches, de lombalgies chroniques, d’un handicap fonctionnel et justifie frequemment des remplacements prothetiques. Les anesthesies iteratives sont d’autant plus a risque que les patients ont des malformations crâniofaciales. Le statut osseux des patients meriterait d’etre evalue, car l’influence genetique couplee au handicap physique favoriserait la fragilite osseuse. Le clinicien doit connaitre l’existence du syndrome de Stickler afin de depister les malades et leurs apparentes, de prevenir les complications fonctionnelles, d’organiser une prise en charge multidisciplinaire et le conseil genetique.

Herpes zoster is a disease which occurs secondary to the reactivation of varicella-zoster virus. Motor involvement in acute herpes zoster is rare. We report a case of sciatica L5 due to herpes zoster infection with motor loss. Typical skin lesions occurred one week before the sciatica. Radiological finding did not explain the paresis. The diagnosis of zoster sciatica with motor involvement was suspected. Serological tests and cerebrospinal fluid examination established the diagnosis. The antiviral and physical treatment was conducted in order to improve functional outcome.

Resume Le sarcome d’Ewing extraosseux de l’adulte jeune est une tumeur rare, au pronostic malheureusement sombre. Nous en presentons un cas, situe dans la region diaphragmatique droite, extremement douloureux. Nous proposons dans un but pedagogique – qui n’a rien d’un corrige infaillible – de voir comment l’on peut analyser les composantes de la douleur physique et de la souffrance morale. Les choix therapeutiques sont alors argumentes, notamment la place de l’oxycodone, de la pregabaline et de l’accueil du patient.

International audience; Introduction. Osteoporotic fractures are a major public health problem because of the morbidity and mortality of fracture complications. The objective of this study was to examine predictive factors of mortality during the first year after an osteoporotic fracture. Methods. It is a retrospective case-control study using data of a group of 1081 patients aged over 50 years with severe osteoporotic fractures by the Rennes university hospital emergency department from August 2007 to September 2008. Patients (cases) who died during the year following the fracture were compared with others who had survived (controls) one year after the fracture, matched on age, sex and type of fracture. Pre-fracture comorbidities and complications after the fractures were studied. Results. Forty-two cases and 126 controls were analyzed without significant differences in age, sex or type of fracture. On univariate analysis, previous neoplasia, neurodegenerative disease, walking aids, thromboembolic complication, post fracture infection, post fracture heart failure, post fracture acute respiratory failure were associated with more mortality after osteoporotic fracture. After multivariate analysis, only previous neoplasia (OR = 4.63 [1.79 - 11.95]; p = 0.02) and acute respiratory failure after fracture (OR = 28.15 [5.75 - 137.9]; p

Resume Les auteurs rapportent une observation de cancer du sein chez un homme de 72 ans souffrant d’une spondylarthrite ankylosante traitee pendant quatre ans par anti-TNF-alpha (infliximab, etanercept), avec un antecedent familial de cancer du sein. La rarete et la gravite du cancer du sein chez l’homme, les facteurs genetiques et le role des anti-TNF sont discutes.

Background We investigated the possible role of antiphospholipid (APA) and anti-human β2-glycoprotein I (β2-GPI) antibodies (Ab) in thrombosis and atherosclerosis in human immunodeficiency (HIV)-positive patients, in whom they seem to be more frequent. Methods We measured APA and anti-β2-GPI Ab in 58 HIV-positive patients together with markers of disease progression, circulating β2-GPI, plasma lipids, biological markers of endothelial activation and integrity (plasma thrombomodulin, von Willebrand factor, vascular cell adhesion molecule 1) and with antimalonic dialdehyde antibodies (anti-MDA Ab). Results We found a 41% frequency of IgG APA in the HIV-positive patients. APA IgMs were rarely positive (7%), and anti-β2-GPI IgGs were positive in 3.4% patients. There was no correlation between APA or anti-β2-GPI Ab and the presence of opportunistic infections. Although plasma thrombomodulin, von Willebrand factor and vascular cell adhesion molecule 1 were significantly increased in the HIV-positive patients, APA was correlated only with vascular cell adhesion molecule 1, suggesting that APAs are correlated with endothelial activation but not with vascular endothelial lesions. A correlation between APA and anti-MDA IgG was demonstrated using multivariate analysis (r = 0.542, P

To investigate the effects of selenium or beta-carotene supplementation in human immunodeficiency virus (HIV)-infected patients, who are known to have deficiencies of selenium and vitamin A, we evaluated the blood enzymatic antioxidant system, including superoxide dismutase (SOD), selenodependent glutathione peroxidase (GPX), and catalase (Cat); glutathione (GSH) status; and plasma selenium concentration. The placebo group consisted of 18 HIV-infected patients with no supplementation, the selenium group was composed of 14 patients receiving oral selenium treatment, and the beta-carotene group comprised 13 patients receiving oral beta-carotene supplementation. All groups were studied for 1 y. At the beginning of the study, a significantly higher SOD activity (P < 0.001) was observed in all HIV-infected patients compared with uninfected control subjects, and GPX activity at baseline was higher in the placebo (P < 0.004) and selenium (P < 0.014) groups than in the control subjects. These higher enzyme activities could be related to an increased synthesis of these enzymes in erythrocyte precursors under oxidative stress. Moreover, we observed significantly lower GSH values in all HIV-infected patients than in control subjects at the beginning of the study (P < 0.001). After selenium or beta-carotene supplementation, no significant difference was observed for SOD activity compared with baseline. On the contrary, GPX activity increased significantly after selenium treatment (P < 0.04 between 3 and 6 mo), whereas a slight increase was found after beta-carotene treatment. Similarly, a significant increase in GSH values was observed at 12 mo compared with baseline both after selenium supplementation (P < 0.001) and beta-carotene supplementation (P < 0.01). Because GPX and GSH play an important role in the natural enzymatic defense system in detoxifying hydrogen peroxide in water, selenium supplementation could be of great interest in protecting cells against oxidative stress. The lower efficiency of beta-carotene could be attributed to the seriousness of the pathology at the time of recruitment into the beta-carotene group.

Objectives : We studied whether the Soccer World Cup Tournament in 1998 had an impact on the number of distress calls received by an emergency service. Methods: Time series analysis was used retrospectively to study the relative frequency of telephone calls to a French emergency dispatching center during the period of the World Cup. Results: Between 1 May 1997 and 15 August 1998 a total of 109,139 calls were recorded. During the period of the World Cup (10 June–12 July 1998) there was an overall decrease in rescue requests, distress calls, treatments in a mobile intensive care unit, and ambulance runs. There was no significant decrease during the French team matches except that between France and Italy. Discussion: Rescue requests vary with the occurrence of public events. The decline which we discovered affected not the period of specific matches but the duration of the entire tournament. These results raise the question of the specificity of distress calls to an emergency dispatching center that receives not only medical requests but also general questions concerning illnesses.

A 72-year-old male with a 4-year history of TNFα antagonist therapy (infliximab and etanercept) for ankylosing spondylitis was diagnosed with breast cancer. He had a family history of breast cancer. The low incidence and considerable severity of breast cancer in males, genetic risk factors, and potential role for TNFα antagonist therapy are discussed.

We report the case of a woman who, at the age of 27, developed a cerebral arterial occlusion. The laboratory investigations showed an anti-human beta2-glycoprotein I antibody, but no other biological sign of antiphospholipid antibody syndrome or autoimmune disorders. The patient otherwise presented with diabetes and moderate obesity. The species specificity of anti-beta2-glycoprotein I antibodies probably explains the discrepancy between false negative results for antiphospholipid antibodies assayed by clotting and ELISA studies and positivity for anti-human beta2-glycoprotein I. Further studies will be important to evaluate the frequency of such antibodies, as well as their value as a risk factor for venous and arterial thrombosis, and their signification within the antiphospholipid antibody syndrome.

OBJECTIVE To evaluate erythrocyte lipid peroxidation (LPO) before and after an adaptive short-term insulin therapy in NIDDM patients who were chronically hyperglycemic. RESEARCH DESIGN AND METHODS Twenty-six patients with NIDDM (mean HbA1c, 11.28%) aged 53.04 ± 2.03 years were submitted for 3 days to constant intravenous glucose and continuous insulin perfusion at an adaptable rate to maintain glycemia within the normal range. An evaluation of LPO at baseline and after euglycemic insulin therapy was determined by erythrocyte free and total malondialdehyde (MDA) levels, polyunsaturated fatty acid (PUFA) percentage, vitamin E and glutathione content, and the following antioxidant enzymatic activity determinations: glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT). Fasting serum glucose, HbA1c, triglycerides, cholesterol, and HDL cholesterol levels were also determined at these time points. RESULTS At baseline, erythrocyte free and total MDA were significantly higher in NIDDM patients than in control subjects (11.14 ± 0.80 vs. 1.74 ± 0.11 nmol/g Hb [P < 0.0001] for free MDA; 18.04 ± 1.79 vs. 7.85 ± 0.55 nmol/g Hb [P < 0.0001] for total MDA). PUFAs, particularly C20:4 and C22:5, were increased (14.69 ± 0.34 vs. 12.03 ± 0.31 and 2.31 ± 0.04 vs. 1.71 ± 0.03% of total fatty acids, respectively). Vitamin E and glutathione were reduced significantly (6.16 ± 0.61 vs. 14.84 ± 0.64 nmol/g Hb and 0.42 ± 0.04 vs. 0.97 ± 0.06 mmol/l, respectively). No difference was observed for the enzymatic activities. After euglycemic insulin therapy, triglycerides significantly decreased compared with baseline concentrations (1.55 ± 0.13 vs. 2.42 ± 0.22 mmol/l; P < 0.001), whereas other lipidic parameters were unchanged. Free MDA significantly decreased (8.60 ± 0.76 vs. 11.14 ± 0.80 nmol/g Hb [P < 0.01]), while vitamin E increased (7.93 ± 0.73 vs. 6.16 ± 0.61 nmol/g Hb [P < 0.05]). No difference was observed for PUFAs, glutathione, or total MDA. CONCLUSIONS The observed erythrocyte LPO in NIDDM decreased after a short-term adaptive insulin therapy. This decrease could be principally attributed to the normalized glycemia that reduces reactive oxygen species (ROS) production, which in turn may explain the increase in erythrocyte membrane vitamin E and the decrease in MDA. This study shows the value of a euglycemic environment in NIDDM to reduce LPO and, at long range, to minimize clinical diabetes complications.