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The objectives of this descriptive study were to (1) describe the pharmacokinetics of salicylic acid (SA) in the milk and plasma of postpartum dairy cattle following oral administration of acetylsalicylic acid (ASA; aspirin), (2) to estimate a recommended milk withdrawal period for dairy cattle treated with ASA, and (3) to determine the effect of ASA administration on plasma prostaglandin E

International audience; Objective: 25-hydroxyvitamin D (25OHD) deficiency has been associated with sleep disorders in adults. Only three cross-sectional studies were performed in children and showed an association between 25OHD deficiency and both obstructive sleep apnea syndrome and primary snoring. No longitudinal study has been performed in children from the general population. We analyzed the association between cord-blood vitamin D level at birth and night-sleep duration trajectories for children between 2 and 5-6 years old in a non-clinical cohort.Method: We included 264 children from the French EDEN mother-child birth-cohort with both cord-blood 25OHD level determined by radio-immunoassay at birth, and night-sleep trajectories for children between 2 and 5-6 years old obtained by the group-based trajectory modeling method. Associations between 25OHD and sleep trajectories were assessed by multinomial logistic regression adjusted for maternal and child characteristics.Results: The trajectories short sleep (

International audience; Objective. Sleep duration may vary inter-individually and intra-individually over time. We aimed at both identifying night-sleep duration (NSD) trajectories among preschoolers and studying associated factors. Methods. NSD were collected within the French birth-cohort study EDEN at ages 2, 3 and 5-6 years through parental questionnaires, and were used to model NSD trajectories among 1205 children. Familial socioeconomic factors, maternal sociodemographic, health and lifestyle characteristics as well as child health, lifestyle, and sleep characteristics at birth and/or at age 2 years were investigated in association with NSD using multinomial logistic regressions. Results. Five distinct NSD trajectories were identified: short (SS

The objective of this study was to identify the relative contribution of tenderness factors for three beef muscles with similar tenderness ratings. Longissimus lumborum (LL), tensor fascia latae (TF) and gastrocnemius (GC) were collected from 10 USDA low Choice beef carcasses and assigned to a 5 or 21 days aging period (n = 60). Sarcomere length, troponin-T degradation, collagen content, mature collagen crosslink density, intramuscular lipid content and trained panel analysis were measured. Correlation and multivariate regression analysis indicated each muscle has a specific tenderness factor that contributed to the overall tenderness evaluated by trained panelists. The equations indicated LL tenderness was driven by lipid content (P .05); TF tenderness was driven by collagen content (P .05). GC tenderness was driven by proteolysis (P .01), and only collagen content can be casually used as an overall tenderness predictor for all three cuts.

Objective The aim was to study, with a developmental approach, the longitudinal association between night-waking from age 2 to 5–6 years and behavior at age 5–6 years. Methods Within the French birth cohort study Etude sur les Determinants pre et post natals du developpement et de la sante de l'ENfant (EDEN), repeated measures of children's night-waking were collected at age 2, 3 and 5–6 through parental questionnaires and were used to model night-waking trajectories. Behavior was assessed with the “Strengths and Difficulties Questionnaire,” which provides five subscales measuring a child's conduct problems, emotional symptoms, peer relation problems, antisocial behavior, and hyperactivity/attention problems. The behavioral subscales were dichotomized at the tenth percentile. Multivariable logistic regressions, adjusted for parents' socio-economic factors, parental characteristics, and children's characteristics and sleep habits allowed us to study, in 1143 children, the association between night-waking trajectories from 2 to 5–6 years and behavior at age 5–6 years. Results The “2 to 5–6 rare night-waking” trajectory represented 78% of the included population (n = 896), and the “2 to 5–6 common night-waking” 22% (n = 247%). Children belonging to the “2 to 5–6 common night-waking trajectory” had, at age 5–6, increased risk of presenting emotional symptoms (odds ratio [OR] = 2.17, 95% CI = 1.27–3.70, p = 0.004), conduct problems (OR = 1.63, 95% CI = 1.00–2.65, p = 0.050), and hyperactivity/attention problems (OR = 1.61, 95% CI = 1.00–2.57, p = 0.049). After adjusting for baseline behavior at age two years, only the association with emotional symptoms remained significant (OR = 2.02, 95% CI = 1.15–3.55, p = 0.015). Results did not differ according to sex. Conclusion Results suggest that the persistence of night-waking difficulties in early years is positively associated with emotional symptoms, hyperactivity/inattention, and conduct problems.

Le but de cette etude est d’evaluer la place de la pudeur de la femme en salle de naissance, de comparer son ressenti a celui des personnes accompagnantes et du personnel medical. Il s’agit d’une enquete prospective a partir de questionnaires distribues aux femmes (n = 254), aux personnes accompagnantes (n = 225) et au personnel medical (n = 68) presents en salle de naissance au centre hospitalier universitaire (CHU) de Poitiers entre le 14 mai et le 1er juillet 2007. Les femmes sont 75,7 % a etre satisfaites du respect de leur pudeur en salle de naissance. Cependant, il existe un ressenti significativement plus negatif lorsqu’elles ont recu une education religieuse (62,5 %, p = 0,01) ou lorsque l’accouchement a necessite d’une extraction instrumentale (57,5 %, p = 0,0075). La perception de la pudeur des trois principaux acteurs de la naissance s’avere differente. Pour 75,7 %des femmes et 73,2 %des personnes accompagnantes, la pudeur est globalement bien respectee, alors que seulement 58,2 % du personnel medical emet cette opinion. Cette etude fait ressortir l’importance de gestes simples, realisables par tous, dans toutes situations pour respecter au mieux la pudeur, pour favoriser le bon vecu de l’accouchement et valoriser ainsi les interactions precoces avec l’enfant.

The internist has a role to play in the practical approach of HELLP syndrome, a disease which can differ according to its symptoms, course and causes. Any recent epigastric pain during the end of pregnancy must be considered as a symptom of HELLP syndrome. Liver disease together with thrombocytopenia may be present even without any renovascular involvement. The disease can be threatening for the mother and lead to the foetal death. It can be sometimes difficult to be distinguished from thrombotic microangiopathy. Treatment consists mainly in rapid discontinuation of pregnancy. Steroid therapy could allow to simplify anaesthesia procedures and to avoid blood transfusion. Early-onset HELLP syndrome could be a marker a chronic nephropathy or a thrombophilic disorder. The HELLP syndrome is a very demonstrative example of the help the internist can afford to the obstetrician in the management of pregnancy-associated disorders.

Resume Propos. – Les principaux symptomes du syndrome d'apnee du sommeil (SAS) ronflement et troubles de la vigilance ont deja fait l'objet de plusieurs publications concernant la grossesse, notamment compliquee de preeclampsie. Leur frequence est elevee et semble correlee a la pathologie vasculaire. L'objectif de ce travail etait d'evaluer la frequence des principaux symptomes du SAS pendant la grossesse et de rechercher secondairement un lien avec l'hypertension arterielle gravidique (HTAG) et le retard de croissance intra-uterin (RCIU). Methodes. – Quatre cent trente-huit autoquestionnaires ont fait l'objet d'une analyse apres avoir ete remplis par les accouchees d'une maternite de niveau III, a l'exclusion des grossesses multiples. Ce questionnaire comportait des donnees demographiques et obstetricales, une analyse du sommeil au dernier trimestre ainsi qu'un depistage du ronflement et des troubles de la vigilance avec score d'Epworth. Resultats. – Quarante-cinq pour cent des patientes interrogees ronflaient en cours de grossesse, parmi lesquelles 85 % ne ronflaient pas avant la grossesse. La somnolence diurne concernait 84,5 % des femmes avec un score d'Epworth significativement augmente par rapport a la population non ronfleuse ( p Conclusions. – Les symptomes du SAS sont frequents durant la grossesse. L'association ronflement–aggravation des troubles de la vigilance parait etre correlee a l'HTAG. Les donnees polysomnographiques sont encore insuffisantes pour en expliquer le mecanisme physiopathologique et avancer des criteres diagnostiques utilisables en cours de grossesse.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 7-C1 - p. 711-715

Resume La thrombopenie est une anomalie de l’hemostase se caracterisant par une numeration plaquettaire anormalement basse (inferieure a 150 × 10 3 /mm 3 ). Cette affection particulierement frequente chez la jeune femme peut etre rencontree lors d’une grossesse. Le Purpura Thrombopenique Idiopathique (PTI) doit etre evoque chez toute femme enceinte presentant une thrombopenie isolee, mais reste un diagnostic d’exclusion de toutes les autres causes de thrombopenie gravidique. La decouverte d’un PTI necessite la prise en charge de la femme, mais aussi du fœtus, puis du nouveau ne. De ce fait, elle fait appel a une equipe pluridisciplinaire comprenant obstetriciens, sages-femmes, internistes ou hematologistes, et pediatres. La surveillance et les decisions therapeutiques seront adaptees au cas par cas, en fonction de la cinetique des numerations plaquettaires.

To compare the efficacy and safety of atosiban and salbutamol in the treatment of preterm labor.A multicenter, double-blind, double-placebo, randomized, controlled trial. Women (n=241) diagnosed with preterm labor at 23-33 gestational weeks were enrolled and received either atosiban (n=119) or salbutamol (n=122). At randomization, women were stratified by gestational age (or =28 weeks and28 weeks). Atosiban (i.v. bolus dose of 6.75 mg, then 300 microg/min for 3h and 100 microg/min for up to 48h) and salbutamol (2.5-45 microg/min) were administered by i.v. infusion for up to 48h. Retreatment with study drug or an alternative tocolytic agent was allowed. Main outcome measures included tocolytic effectiveness which was assessed in terms of the number of women undelivered after 48h and 7 days. Tocolytic efficacy and tolerability were assessed in terms of the proportion of women undelivered and who did not require alternative tocolytic therapy at 48h and 7 days of starting treatment. Safety was assessed in terms of maternal side effects and neonatal morbidity.Tocolytic effectiveness at 48h was 93.3 versus 95.0% (P=0.67) and after 7 days was 89.9 versus 90.1% (P=0.93) in the atosiban and salbutamol groups, respectively. Tocolytic efficacy and tolerability within 48h was 79.8 versus 75.2% (P=0.15), and after 7 days was 58.8 versus 46.3% (P=0.021) in the atosiban and salbutamol groups, respectively. Maternal adverse events, including serious events, occurred more frequently in the salbutamol group. Neonatal outcomes were comparable between the study groups.The oxytocin antagonist atosiban was found to be better tolerated by both mother and fetus than salbutamol, with a comparable neonatal and infant safety profile, and atosiban was as effective as salbutamol in delaying threatened preterm birth. This study supports the clinical use of atosiban in the treatment of preterm labor.

Thermal degradation of polystyrene and polyvinylchloride was studied by thermomanometric analysis. A design of experiments was used to quantify the influence of 8 physico-chemical parameters on the responses of the analyser and on the different types of degradation compounds.

Previous work has shown that organochlorine compounds, including chlordane, lindane and polychlorinated biphenyls, and heavy metals, including lead, mercury and cadmium, are readily detected in the shed skins of snakes dosed with these toxicants. This suggested the shed skins may have broad utility as a non-lethal biomarker tissue for environmental contamination. In the present study, two polycyclic aromatic hydrocarbons (PAHs), benzo[a]pyrene (B[a]P) and 3-methylcholanthrene (3-MC), were similarly studied, as representatives of a third major pollutant category of environmental concern. Both compounds were again readily detected in shed snake skins. These collective results suggest considerable environmental contamination information might be obtained from the evaluation of field-collected shed skins. An advantage of such evaluation is that capture, handling or sacrifice of the live animals is not required.

Objective: To determine if external cephalic version (ECV) is a reasonable alternative to repeat cesarean section in case of breech presentation. Study design: Retrospective study of 38 women with one previous cesarean section and a breech presentation after 36 weeks of gestational age who have had at least one experience of ECV. Statistics used the Fisher's test with significance when P

Objective: To show that intrapartum prophylactic amnioinfusion (AI) in case of oligohydramnios or particulate meconiumstained amniotic fluid could be beneficial. Study design: From the first March 1993 until the 30th June 1995, 4031 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (71 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2) (64 patients) were included. Each group was compared to an historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2)), age, parity, gestational age and duration of labor. Statistical analysis was performed using the Student's t-test and the Fisher's exact test when appropriate with a level of significance of P less than 0.05. Results: The mean infused volume was 893 ml in G1 and 734 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (11.3 vs. 24.5%; P < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (12.5 vs. 23.43%; P < 0.05). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also could not find any significant difference between G2 and CG2 (1.6 vs. 9.4%; P = 0.05). No neonatal or maternal adverse effect happened in this short study. Comment: AI is easy to perform during labour in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic AI performed in case of oligohydramnios and abnormal fetal heart rate.

Resume Ce travail rapporte une observation de pheochromocytome dont la presentation clinique immediate simulait un infarctus du myocarde en phase aigue complique d'un etat de choc. La gravite du tableau initial conduit a une coronarographie a la phase aigue ; l'absence de lesions coronariennes et d'elevation des enzymes cardiaques ont permis d'ecarter le diagnostic d'infarctus du myocarde. Il n'y a pas d'arguments pour une myocardite d'origine infectieuse ou toxique, l'alteration severe de la fonction systolique ventriculaire gauche sera rattachee a une myocardite cathecholergique devant l'existence d'une vasoconstriction peripherique intense. Ce diagnostic sera confirme par l'echographie abdominale et les dosages urinaires de derives methoxyles. Le diagnostic de pheochromocytome est habituellement evoque devant une hypertension permanente avec des paroxysmes. Mais le pheochromocytome peut etre responsable d'une symptomatologie adrenergique variable, et l'equilibre hemodynamique peut etre menace par une liberation massive spontanee ou provoquee des amines pressives. La diversite et la gravite de ces tableaux cliniques doivent donc le faire suspecter systematiquement devant toute cardiomyopathie sans etiologie evidente en particulier chez les patients hypertendus. La seule therapeutique est l'exerese chirurgicale de la tumeur. Le diagnostic repose, en urgence, en dehors de l'anamnese, sur l'echographie et/ou la tomodensitometrie abdominale et les dosages des cathecholamines urinaires. Ces examens peuvent etre realises en quelques heures.

La chimiotherapie neo-adjuvante a initialement ete developpee pour la prise en charge des cancers du sein inflammatoires ou non operables d’emblee. Depuis une vingtaine d’annees, les indications de la chimiotherapie neo-adjuvante se sont elargies aux patientes presentant un cancer du sein operable d’emblee mais au prix d’une mastectomie.

The effects of oral micronized progesterone on the endometrium and bleeding pattern have been assessed in a multicenter study of 101 postmenopausal patients. During a minimum of 6 cycles, the participants received either percutaneous 17 beta-estradiol (1.5 mg/day) associated with micronized progesterone (100 mg/day), given at bedtime for 21/28 days or 25 days/calendar month (n = 98) [1], or E2 (3 mg/day) for 25 days associated with progesterone (300 mg/day), from day 16 to day 25 (n = 3) [2], according to their willingness to induce, or not, cyclic withdrawal bleeding. Each endometrial biopsy performed at 6-month minimum was assessed by two independent pathologists: results showed 61% quiescent without mitosis, 23% mildly active with very rare mitoses and 8% partial secretory endometrium. The remaining biopsies showed inadequate tissue (4%) or a sub-atrophy (4%). No hyperplasia was found by any pathologist. In the case of inadequate material, the mean thickness of endometrial mucosa measured by ultrasonography was 3.9 mm. Amenorrhea incidence was 93.3 and 91.6% at the 3rd and 6th month of therapy, respectively. No bleeding occurred in more than 80% of women. The results show that a low dose of oral progesterone (100 mg/day), given during 25 days, efficiently protects the endometrium by fully inhibiting mitoses and induces amenorrhea in the majority of postmenopausal women, allowing better compliance to long-term therapy.

The accessory spleen is often a incidental discovery. The accessory post-accidental spleen are unusual. The torsion of a movable spleen is possible and represent about 0.2 to 0.3% of splenectomy. But the torsion of an accessory spleen is exceptional. A case of acute torsion of an accessory spleen is reported. In a 26-year-old women was admitted with acute abdominal pain. The abdominal ultrasound and the abdominal X-Ray are no specific. In the face of the acute pain, a laparoscopy was necessary. At laparoscopy, the patient was found to have torsion and infarction of an accessory spleen in the pelvis. The treatment was a splenectomy and the evolution was favorable.

In patients with androgen insensitivity syndrome (AIS), RFLP study of the androgen receptor gene made it possible to analyze whether deletions or mutations could be responsible for abnormalities in androgen responsiveness. We studied RFLPs of DNA from 25 46,XY patients with partial AIS (PAIS), defined as a concentration of androgen receptor in genital-skin fibroblasts less than 340 fmol/mg DNA, and DNA from 27 46,XY patients with complete AIS (CAIS) with no detectable androgen receptor site. DNA samples were digested with BamHI, EcoRI, HindIII and TaqI restriction enzymes and hybridized with three cDNA probes covering the three domains of the androgen receptor. When we had the maternal and an unaffected brother's DNA, we analyzed the two androgen receptor gene polymorphisms described, the HindIII and the exon 1 CAG repeat polymorphisms, in order to distinguish the two maternal X chromosomes, and to detect carriers of AIS. We did not find any large deletion among the 52 patients. We observed a heterozygous mother in 3 of 14 families studied with the HindIII polymorphism, and in 12 of 25 families using the exon 1 CAG repeat polymorphism. This study suggests that in AIS, abnormalities in androgen receptor response could be related to point mutations or microdeletions rather than to gross structural alterations of the androgen receptor gene. Furthermore, unless the point mutation has been described, exon 1 and HindIII polymorphism studies would enable the identification of carriers in 50% of families, and the prenatal diagnosis of AIS.

There is no consensus concerning thromboembolic prophylaxis in high-risk pregnant women with a previous his tory of heparin-induced thrombocytopenia. An alternative an ticoagulant therapy is danaparoïd, whereas unfractioned and low-molecular-weight heparin therapy is contraindicated. We report a case of successful thrombosis prophylaxis using dan aparoid in a high-thrombosis-risk pregnant woman with a his tory of heparin-induced thrombocytopenia during a previous pregnancy and Widal's disease.

The internist has a role to play in the practical approach of HELLP syndrome, a disease which can differ according to its symptoms, course and causes. Any recent epigastric pain during the end of pregnancy must be considered as a symptom of HELLP syndrome. Liver disease together with thrombocytopenia may be present even without any renovascular involvement. The disease can be threatening for the mother and lead to the foetal death. It can be sometimes difficult to be distinguished from thrombotic microangiopathy. Treatment consists mainly in rapid discontinuation of pregnancy. Steroid therapy could allow to simplify anaesthesia procedures and to avoid blood transfusion. Early-onset HELLP syndrome could be a marker a chronic nephropathy or a thrombophilic disorder. The HELLP syndrome is a very demonstrative example of the help the internist can afford to the obstetrician in the management of pregnancy-associated disorders.

We report two cases of maternal diaphragmatic hernia during pregnancy. Diaphragmatic hernia is an unusual and severe disease. Maternal and fetal prognosis are threatened. Diagnosis is uncertain when confronted to respiratory and digestive symptoms without any specificity. The chest X ray is the first exam to perform. The objective of this work is to discuss the management of such a pathology in terms of ways of delivery and surgical cure of hernia.

To investigate the frequency of main symptoms of Obstructive Sleep Apnea Syndrom (OSAS) and their relationship with Pregnancy Induced-Hypertension (PIH) as well as Intrauterine Growth Retardation (IGR) as suggested by recent studies.Four hundred (and) thirty-eight enquiry forms completed during post-partum period were analysed, after exclusion of multiple pregnancies. Collected data were demographic characteristics, obstetrical events, sleep disorders during last trimester, screening of snoring and vigilance troubles with an Epworth score.Forty-five percentages of the patients reported to have habitual snoring during pregnancy. Among these, 85% were non-snorers before pregnancy. Daytime somnolence concerned 84,5% of the population with an Epworth score significatively increased (P0,0001). The prevalence of PIH was found to be 4,5%, with two apparently independent risk factors: the body mass index (OR=1,1) and an association between snoring and increased vigilance trouble (OR=2,6). No statistical difference was found concerning IGR.SAS symptoms are frequent during pregnancy and snoring appears to be linked with PIH. However, polysomnographic data are not yet sufficient to explain pathophysiological mechanisms and find relevant diagnostic markers during pregnancy.

The SLA (sandblasted with large grit and acid etched) surface is a textured surface that has been documented to lead to a rapid and strong implant fixation. The purpose of the present study was to determine the contribution of sandblasting in addition to etching to implant anchorage. It was also aimed to determine if the pits carved during etching alone have a bone-interlocking capacity that leads to microanchorage between the implant and bone. SLA implants and machined-and-acid-etched (MA) implants were placed in the maxilla of Land Race pigs. After 10 weeks of healing, they were reverse torqued. The reverse torque of the SLA and MA implants was 157.29 ± 38.04 N cm and 105.33 ± 25.12 N cm, respectively. Sandblasting increased bone anchorage by 49.3%; the difference was statistically significant (p = .028). Bone was found attached to both surfaces; bone ingrowth was found in the pits of both surfaces. It is suggested that the two surfaces are able to generate bone interlocking and mechanical coupling at the interface. When finite-element modeling is performed with these surfaces, it is suggested that the bound mode be used instead of the slip mode. © 2003 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 68B: 149–159, 2004

The authors use a circuit model for GREC's pulse charge to explain in a simple way the prepulse's origins. Based on this modeling and some computations, they have modified the Marx bank's discharge circuit to reduce the prepulse. This approach has more than halved the prepulse, from 1.5 MV to 0.6 MV.