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Biomedical subjects

J Bringer

Publications and source records attributed to J Bringer.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Long term follow up of medical treatment of differentiated thyroid cancer].

106 patients, 114 W, 27 M, were thyroidectomized for differentiated thyroid cancer (follicular 29.3%-papillary 54.3%) with different stages of gravity (NO: 48.2% - N1: 32.8% - N2: 19%). Neck dissection was used in cases of involved nodes. One or several doses of 131 I were given to 126 subjects, 106 patients were treated with LT4 (mean daily dose: 2.5 micrograms/kg BW). 23 patients presenting intolerance to LT4 with non suppressed TSH for 13 of them were treated by an association of TRIAC + LT4. The follow up included a yearly check up involving clinical examination, plasma Tg and TSH assessment, neck ultrasonography and X-ray of the chest. Therapy was stopped for 4 weeks in cases with Tg above its detectable value and a total body scan performed with Tg and TSH controls. The mean duration of follow up was 94.5 +/- 67.7 months and extended to more than 5 years for 61% of the patients. We observed 22 relapses of the tumor with 4 deaths. Age less then 45 years, appears as the best factor of prognosis. 2 groups of patients were compared to evaluate the incidence of TSH suppression on the relapse free survival (group 1 n = 30 with a TSH < or = 0.10 mU/l and group 2 n = 15 with a TSH always > 1 mU/l during the follow up). The relapse free survival was shorter in group 2 (p = 0.01). Association of TRIAC with LT4 leads to a reduction of the daily dose of LT4 (m = 25 micrograms/day) with a significant improvement of TSH suppression and clinical tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Weight excess before pregnancy: complications and cost.

OBJECTIVE: To investigate the incidence of pregnancy complications and the cost of prenatal care in patients with pregravid overweight. DESIGN: Retrospective study of patients dispatched into four groups: normal weight, moderate overweight, obesity, massive obesity. SETTING: Department of Obstetrics and Gynecology of Montpellier. SUBJECTS: One hundred and twelve pregnancies among 89 overweight women, compared with 54 healthy normal weight controls. MAIN OUTCOME MEASURES: Incidence of maternal complications, complications of labor, duration of hospitalization. RESULTS: Hypertension, toxemia, gestational diabetes, insulin treatment, urinary tract infections and macrosomia were positively correlated with maternal pregravid weight excess. Mean duration of hospitalization and overall cost were also strongly related to maternal weight. Cesarean section rate increased only in morbidly obese women. No materno-fetal mortality was observed in our study. CONCLUSION: Even moderate overweight is a significant risk factor for obstetrical complications and needs a multidisciplinary antenatal management in order to prevent materno-fetal complications.

Adult↗
PubMed1994

Complications of the pump pocket may represent a significant cause of incidents with implanted systems for intraperitoneal insulin delivery.

OBJECTIVE: To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs). CASES: There were 7 cases of complications associated with the pump-pocket among 40 patients treated by PIP, and we searched for risk factors. RESULTS: Seven of 40 type I diabetic patients treated by PIP presented severe complications of the pump-pocket, resulting in five definitive explanations and nine other surgical interventions. The lesions included an exudative reaction in the pump-pocket and a skin retraction or atrophy, which were complicated by skin erosion in five patients. Coagulase-negative staphylococcus was identified in the pump-pocket in four patients, including three cases of skin erosion. No specific risk of local complications could be attributed to age, sex, duration of diabetes, body mass index, presence of retinopathy or peripheral neuropathy, HbA1c level since implantation, depth of implantation in the abdominal wall, or duration of experience with PIP. Usual physical activity corresponding to > 2,000 kcal energy expenditure per week, estimated by a questionnaire, appeared to be the only identified significant risk factor. CONCLUSIONS: From these results, we suggest that physical activity should be limited to moderate exercise and exclude vigorous efforts in diabetic patients treated by PIP to avoid an increased risk of complications at the implantation site.

Adolescent↗
PubMed1994

[Perspectives in the treatment of type 2 diabetes. Role of insulin therapy?].

Independently of its initial mechanism, Type 2 diabetes associates in various degrees disorders in insulin sensibility and secretion. The dissociated insulin resistance among tissues explains the predictable imperfection of insulin therapy in this disease due to frequent weight increase and the potential risks of insulin on atherogenesis raised on the basis of experimental studies. All diabetic subjects are not equally insulin resistant and do not have the same insulin secretory capacity evaluated in practice by means of the response of insulin or C peptide plasma levels to various secreting agents. Intensity and duration of hyperglycaemia, muscular mass, physical activity and way of life, age, weight and fat patterning, the presence of complications, acceptance, education feasibility and compliance are essential in selecting towards insulin therapy. Meanwhile, as the results of the prospective studies in progress become available, it seems that insulin should be restricted to the smallest useful dosage possible and that weight change should be carefully checked within the weeks following initiation of insulin. The future of insulin therapy in Type 2 diabetes requires (1) better selection of patients showing a demonstrated beneficial effect of insulin, (2) the association of insulin with new molecules capable of reducing its dosage and preventing its deleterious effects, (3) a change in the mode of insulin administration, with an appropriate balance between comfort and efficacy, (4) change in the insulin structure towards analogues or compounds related to insulin but with less perverted effects.

Clinical Trials as Topic↗
PubMed1993

[Sex steroids. Effects on the carbohydrate metabolism before and after menopause].

The action of female sex steroids on carbohydrate metabolism has clearly been demonstrated by numerous clinical and experimental studies. A beneficial effect of 17 beta oestradiol has been reported on insulin secretion and insulin sensitivity, inducing an improvement of glucose tolerance through an increase of glucose clearance by liver, muscle and adipose tissues. Progesterone has, to a lesser degree, the same stimulant effect on insulin secretion and improves glucose assimilation by the liver, although a relative insulin resistance is observed in the other two tissues. Menopausal hormonal privation does not significantly alter glucose tolerance in the absence of such predisposition factors as overweight or history of gestational or familial diabetes mellitus. The first trials of menopausal substitution with oral synthetic oestrogens, especially in doses of more than 50 micrograms per day, were responsible for the bad reputation of oestroprogestins due to their effects on metabolic parameters. As shown by prescription for contraceptive use, replacement therapy with oral synthetic oestrogens induces a diabetogenic tendency as well as hypertensive, dyslipidaemic and thrombogenic risks, especially when associated with progestins issued from nortestosterone. Reducing the oestrogen doses, using equine sulfoconjugates and selecting non-androgenic progestins has already minimized these deleterious effects. The present availability of oral or percutaneous natural 17 beta oestradiol and of norpregnanes calls for reconsideration of the glucidic risk due to oestroprogestin prescription. A few studies have already shown that in fact they can improve glucose tolerance. The recommended substitution of menopause to prevent atherosclerosis must lead to a better characterization of its glycaemic and insulinaemic effects.

Aged↗
PubMed1993

Androgen receptor gene mutation in male breast cancer.

We screened thirteen male breast cancers for the presence of germline mutations in exons 2 and 3 encoding the DNA-binding domain of the androgen receptor. These two exons were amplified from genomic DNA extracted from patients' white blood cells. In one of these thirteen patients, single strand conformation polymorphism and direct sequencing detected a guanine-adenine point mutation at nucleotide 2185 that changes Arg608 into Lys in a highly conserved region of the second zinc finger of the androgen receptor. This mutation occurred in a 38 year old man with partial androgen insensitivity syndrome and normal androgen-binding capacity in cultured genital skin fibroblasts. To our knowledge, only one germline Arg to Gln androgen receptor gene mutation has been previously reported at position 607 in male breast cancer. This androgen receptor mutation along with the Arg608 into Lys mutation we describe, suggests that this genetic abnormality is not fortuitous: a decrease in androgen action within the breast cells could account for the development of male breast cancer by the loss of a protective effect of androgens on these cells. Activation of estrogen regulated genes by the change of DNA-binding characteristics of the mutant androgen receptor cannot, however, be ruled out.

Adult↗
PubMed1993

[Familial form of partial androgen insensitivity (Reifenstein syndrome): arginine-histidine mutation in position 840 in the androgen receptor].

In a large kindred with Reifenstein syndrome, we performed the molecular analysis of the androgen receptor gene. Since the biochemical characteristics of the androgen receptor, determined on the cultured genital skin fibroblasts, showed a drastic decrease of the androgen binding capacity, we assumed that a point mutation was located in exons 4-8 encoding the carboxy-terminal domain of the receptor. Enzymatic amplifications of these exons did not point out any deletions. Direct sequencing showed a G-A point mutation at position 2818 of exon 7 responsible for an arginine-histidine substitution at position 840 of the androgen receptor. The presence of the same mutation has been reported by other groups in four unrelated patients. Its association with different phenotypes of androgen insensitivity and different biochemical characteristics of the androgen receptor pointed out the complexity of the genotype-phenotype relationship in androgen insensitivity. Moreover the identification of the point mutation gave us the opportunity to perform a prenatal exclusion diagnosis of Reifenstein syndrome in this high-risk family.

Arginine↗
PubMed1993

[The use of growth hormone (hGH) in ovulation induction in women].

Number of in vitro experiments have shown increasing evidence for local ovarian actions of GH by demonstrating: the presence of receptors for GH in human granulosa cells; the ability of GH to enhance estradiol (E2) production by human granulosa cells withdrawn in late follicular phase; the increasing effect of GH on progesterone (P) biosynthesis by human luteal cells. Moreover, GH being the main regulator of IGF-I plasma levels, its indirect effect by means of hepatic and/or ovarian IGF-I production remains possible. Few patients have been included in randomized studies using hGH with gonadotropins for induction of ovulation and their selection criteria were heterogeneous so that no definitive conclusion can be drawn about the beneficial effect of GH in facilitating ovulation. The reduction both in duration of stimulation and in the requirement for menopausal gonadotropins found in some studies have been challenged by others. The recombinant human growth hormone (hGH) is able to modify the game of intraovarian regulators and may affects ovocyte and embryo. Such a potential impact cannot be occulted, justifying to develop larger in vivo animal experimentation before new further clinical studies.

Clinical Trials as Topic↗
PubMed1993

[Dilated cardiomyopathy in acromegaly worsening under octreotide treatment. Apropos of a case].

Dilated cardiomyopathy associated with acromegaly is rare, but may improve with octreotide, a somatostatin analogue. The authors give the first description here of paradoxical worsening in cardiac function during such treatment, with the onset of episodes of acute decompensation following each attempt at starting treatment. Thus worsening was confirmed objectively by a challenge test with octreotide: increased dyspnea, fall in shortening fraction and in echocardiographic cardiac output (of 17 to 14% and 4 to 3 l/min respectively), a decrease in isotopic ejection fraction from 15 to 6% and this in parallel with efficacy regarding hormone levels of GH and IGF1 and a reduction in tumour size by CT scan. No further episode of decompensation occurred after treatment was stopped permanently. The patient underwent a transplant 3 months later. Suppression of the positive inotropic effect of GH by octreotide, associated with an increase in peripheral resistance is suggested. A negative inotropic effect of this hormonal analogue on too advanced a case of heart disease is also a possibility.

Acromegaly↗
PubMed1992

Norgestimate: a clinical overview of a new progestin.

The efficacy and safety of a new monophasic oral contraceptive, norgestimate/ethinyl estradiol, containing the third-generation progestin, norgestimate (250 micrograms), and ethinyl estradiol (35 micrograms), are reviewed. Norgestimate/ethinyl estradiol demonstrates excellent contraceptive efficacy, with a Pearl index of 0.25. Cycle control is reliable, with a low incidence of breakthrough bleeding and spotting. Because of the minimal androgenicity of norgestimate, norgestimate/ethinyl estradiol has a low impact on carbohydrate and lipid metabolism. It neither reduces the vasodilatory and antiaggregatory prostacyclin nor increases its endogenous antagonist, thromboxane. Norgestimate/ethinyl estradiol has no significant effect on blood coagulation factors. All these characteristics suggest that norgestimate/ethinyl estradiol may be associated with a lower risk of cardiovascular disease than other oral contraceptives currently available. Epidemiologic data, however, are not available, and physicians should be reluctant to prescribe it or any oral contraceptive to patients who have a history of vascular or thrombotic disorders.

Female↗