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Biomedical subjects

J L Schlienger

Publications and source records attributed to J L Schlienger.

At least 19 recordsLinked to original sources
PubMed2006

[Impact of systemic disease on the pituitary gland].

Systemic diseases located in hypothalamo-pituitary region can slowly induce pituitary deficiency, diabetes insipidus and morphological abnormalities. The aim of this study is to review recent clinical data about diagnosis of these rare diseases, with a focus on granulomatous diseases: histiocytosis and sarcoidosis. Recent clinical studies on histiocytosis have improved our knowledge about endocrine expression of the disease in children and in adults as well. Diabetes insipidus is the most frequent condition, described mainly in children. GH deficiency is the most frequent pituitary deficit in children and adult patients. During neurosarcoidosis, diabetes insipidus is the most frequent condition and gonadotropic deficiency is the most frequent deficit but GH has not been systematically studied. MRI allows visualisation of some lesions and is very useful to follow the disease course. Diagnosis of these diseases is made by clinical evaluation of all the sites and by pathological analysis of biopsies of peripheral lesions. While pituitary hormone replacement therapy does not seem to raise specific problems in these diseases, etiological treatments are not yet available and indications for antimitotic or immunomodulatory treatment are sometimes discussed.

Endocrine System Diseases↗
PubMed2006

ICAPS: a multilevel program to improve physical activity in adolescents.

OBJECTIVES: ICAPS (Intervention Centred on Adolescents' Physical activity and Sedentary behaviour) is aimed at preventing excessive weight gain and cardiovascular risk in adolescents by promoting physical activity (PA) with an emphasis on recreational and daily-life PA, with a lifelong perspective. DESIGN: Randomized study designed to last for four years. Study cohort constituted of 954 first-level students (91% of eligible pupils), aged 11.7 +/- 0.6 y (mean +/- SD) from four pairs of schools randomly selected in eastern France, after sociogeographical stratification. In each pair, intervention status was randomised at school-level. The program, not limited to school settings, involves multiple partners with three objectives: 1) changing attitudes through debates and access to attractive activities during breaks and after-school hours, 2) encouraging social support, 3) providing environmental conditions that enable PA. Adapted times and places, open participation, emphasis on fun, meeting with others and absence of competitive aspects are used to reduce usual barriers to PA. Accessibility and safety are permanent concerns. RESULTS: Prevalence of overweight was 23.7%. High participation rates were attained (50% participated in at least one weekly activity). At six-month, the proportion of intervention adolescents not performing supervised PA out of academic PA was reduced by half (36% to 17% vs 42% to 42% in controls P < 10-4); the proportion of those spending > 3 h/day in sedentary occupations decreased (34% to 28% vs 27% to 36%; P < 10-4). CONCLUSION: These data demonstrate the feasibility of implementing a multilevel PA intervention program in adolescents. Six-month results document increased PA and decreased sedentary behaviour.

Adolescent↗
PubMed2006

Circulating procoagulant microparticles in obesity.

AIM: Obesity is a risk factor for cardiovascular diseases and venous thromboembolism. Circulating procoagulant microparticles (MP) have been described in various clinical situations associated with thrombosis and in diabetic patients. The aim of this preliminary study was to evaluate the presence of MP in obese patients without any other vascular risk factor in particular diabetes. METHODS: Fifty-eight obese women <50 year-old without other cardiovascular risk factors were recruited from a single out-patient nutrition clinic. They were compared to 45 age-matched healthy normal weight controls. Main outcome was MP levels in patients and controls. Relationships between MP concentrations and parameters reflecting insulin resistance in patients were also studied. RESULTS: Obese patients were 33.3 +/- 1.2 years old and had a mean BMI of 42.4 +/- 0.9 kg/m2. There vas a greater proportion of smokers in the obese group (34.5 vs 15.6%). Mean MP levels were markedly higher in obese patients compared to controls (10.6 +/- 0.5 vs 3.2 +/- 0.3 nMPSeq, P < 0.001). There was no difference in MP concentrations between smokers and non smokers. In the obese group, there was a negative correlation between MP and BMI (r = -0.265, P < 0.05) but no relationship could be established between MP concentrations and markers of insulin resistance. CONCLUSION: This increase in circulating MP levels reflects cell activation and could account for the increased risk of thrombotic complications in obesity. Further studies are ongoing to explore the relationships between MP levels and coagulation markers and to assess the effect of weight reduction.

Adult↗
PubMed2005

Hyperammonaemic encephalopathy induced by a commercial very-low-energy diet in a neglected ornithine-carbamoyltransferase-deficient woman.

This case report describes a 31-year-old woman with a neglected ornithine carbamoyltransferase deficiency, admitted for a hyperammonaemic encephalopathy induced by a commercial very low-energy diet. To our knowledge, this is the first reported case and it underlines the potential risk of such a diet in patients with undiagnosed or neglected ornithine carbamoyltransferase deficiency.

Adult↗
PubMed2005

Physical activity is inversely related to waist circumference in 12-y-old French adolescents.

BACKGROUND AND OBJECTIVE: Waist circumference (W) has been shown to be a good predictor of cardiovascular risk. The aim of this study was to investigate whether physical activity (PA) is related to W in adolescents as previously shown in adults. DESIGN AND SUBJECTS: Cross-sectional population-based survey of 2,714 12-y-old adolescents from the eastern part of France. MEASUREMENTS: Body mass index (BMI) and W were measured. Structured PA, active commuting to and from school and sedentary activities (SED), for example television viewing, computer/video games and reading and different potential confounders (dietary habits, parental overweight, family annual income tax and educational level) were assessed by a questionnaire. RESULTS: The adolescents had a mean BMI of 19.0+/-3.4 kg/m2, and 20.2% of them were overweight, with no gender difference. Boys had a greater W than girls (67.6+/-9.1 vs 65.7+/-8.9 cm, P<0.0001). In all, 42% of the girls and 25% of the boys did not practice any structured PA outside school and less than 40% of the adolescents commuted actively to school more than 20 min/day. About one-third of the adolescents devoted more than 2 h/day to SED. In univariate analyses, BMI was negatively associated with structured PA but significantly only for girls (P<0.01) and positively associated with SED for both genders (P<0.0001 for girls, P<0.01 for boys). W was negatively associated with structured PA and positively associated with SED both in girls (P<0.0001 and P=0.03, respectively) and boys (P<0.01 and P=0.08, respectively). Multiple general linear models show that SED is associated with BMI, independently of structured PA, in both genders. On the other hand, structured PA was inversely associated with W, independently of SED. The inverse relation between structured PA and W persisted after additional adjustment on BMI, with a greater effect of PA for the adolescents with higher BMI. CONCLUSIONS: In 12-y-old adolescents, structured PA is inversely associated with W, an indicator of total adiposity but also more specifically of abdominal fat. This suggests that PA may have a beneficial effect on youth metabolic and cardiovascular risks, in particular in the presence of overweight..

Abdomen↗
PubMed2004

Sympathovagal response to orthostatism in overt and in subclinical hyperthyroidism.

Heart rate variability (HRV) is a measure of the physiological variation of R-R intervals, reflecting the sympathovagal balance. In both overt and subclinical hyperthyroidism, a relative increase in sympathetic activity has been demonstrated, mainly due to a decrease in vagal activity. The modifications of HRV during orthostatism in normal subjects resemble those seen in hyperthyroidism. We have studied the response of 19 patients with overt hyperthyroidism and 12 with subclinical hyperthyroidism during orthostatism using HRV and compared the results to those of 32 healthy controls. In the three groups, the R-R intervals decreased in the same proportion after orthostatism. The low frequency power (LF)/[LF + high frequency power (HF)] ratio, which reflects the sympathetic tone, also increased in the same proportion in the three groups. However, the mechanisms of the modulation of the sympathovagal balance during orthostatism were different among the three groups. In controls, the relative increase of sympathetic tone after orthostatism was due principally to a decrease in vagal tone (reflected by decreased power in the HF band), while in overt hyperthyroidism, where the power in the HF band was already minimal in the lying position, there was a clear increase in the LF band power during orthostatism. The results were intermediate in the subclinical hyperthyroidism group, reflecting a continuum of effects of the thyroid hormone excess on the autonomic nervous system. Our study shows that despite an apparent normal cardiovascular adaptation to orthostatism in hyperthyroidism, the modulation of the autonomic nervous system is profoundly modified.

Adult↗
PubMed2004

Retrospective study of laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity: results and complications in 127 patients.

OBJECTIVES: Laparoscopic gastric banding is currently the most popular surgical technique for morbId obesity. This wIdespread use of surgery has been evaluated by a number of clinical studies, particularly on weight change. METHODS: In a retrospective study of 127 obese patients operated between 1996 and 2000, data were collected for weight change, medical and surgical complications. RESULTS: Of 127 patients, failures of gastric banding were noted during 2 surgical operations. The average follow-up period was 33 +/- 20 Months. Average weight loss in all patients was 19.9 +/- 5.3 kg (15.3 +/- 4.2%). No difference in weight loss was observed between diabetic and non-diabetic patients. During the follow-up, data were collected on 53 complications (42.4% of all gastric banding operations). 3 main types of complication were found: access port related complications (22.6% of the total), band slippage (20.7% of the total) and tubing related complications (16.9% of the total). No prognostic factor for these complications could be Identified from multivariate analysis. CONCLUSIONS: Our results are very similar to those of other weight evolution studies. We found that there was a significant incIdence of surgical and medical complications during the follow-up because of the meticulous way all complications were recorded, even the most insignificant. This morbIdity must be borne in mind before surgery is performed.

Adult↗
PubMed2004

Parent-child physical activity relationships in 12-year old French students do not depend on family socioeconomic status.

OBJECTIVES: Regular physical activity (PA) in young needs to be promoted to prevent obesity and subsequent diabetes. Influences of parental PA on adolescents' activity level have been studied with discordant results and the effect of socioeconomic status (SES) on these relationships is not clarified. METHODS: Cross-sectional population-based survey of about 3000 12-year old French students and their parents. Familial associations were assessed with logistic regression models taking into account SES and children's and parents' corpulence. Sport involvement and sedentary behaviors were assessed by standardized questionnaires filled out separately by children and parents, the latter also reporting their educational data and family income tax. RESULTS: Participation in structured PA outside school was higher for boys (74%) than for girls (58%, p<10-5) and a high sedentary behavior (watching television, playing computer/video games and reading > or =2h/day) was observed in one-third of the sample, both in boys and in girls. Children were more likely to participate in structured PA outside school when both parents practiced sport as compared to neither parent practicing it, with an odd ratio OR (95%CI) of 1.97 (1.4-2.8) for boys and 1.56 (1.2-2.1) for girls. Familial associations of inactivity were significant for boys only. A greater percentage of adolescents had a high level of sedentary behavior when both parents versus no parents watched television > 2h/day (OR 1.95 (1.52.6)). Parent-child physical activity relationships were not modified by the family SES or the children's or parents' weight status. CONCLUSION: Parental involvement in sport is an important correlate of a young adolescent's participation in structured PA outside school, whatever the family SES or corpulence of the family members.

Adolescent↗
PubMed2003

[Gastroplasty: complications and their prevention].

Bariatric surgery is now frequently proposed for the treatment of morbid or complicated obesity since the introduction of minimally invasive laparoscopic anti-obesity operations such as the adjustable silicone gastric binding gastroplasty. However this reversible procedure in not always as safe as presumed and the results in weight loss may be sometimes disappointing. Side effects are common and early or late complications occured in more than 20% out of the patients. They are favoured by post operative eating disorders. Nutritional consequences are probably underestimated and are not limited to uncomfortable digestive symptoms. Some deficiencies in micronutriments have been described. The worsening of previous eating disorders or psychosocial abnormalities are not seldom. Gastroplasty is not an harmless procedure. A good selection in patients, a regular follow up, nutritional advices and psychosocial management by a multidisciplinar team are required to reduce complications after gastroplasty.

Gastroplasty↗
PubMed2003

[Smoking and the thyroid].

The effects of smoking on the thyroid gland have been studied for years. The consequences of smoking on thyroid function and size are however still controversial. It is accepted that an increase in serum thyiocyanate, a potent inhibitor of iodine transport, may contribute to the development of thyroid dysfunction, particularly in geographical areas with borderline iodine deficiency. In the general population, smoking is associated with normal thyroid hormone levels, with a tendency to lower TSH levels and enlargement of thyroid size. There is an increased risk of developing over thyroid disease. The relationship between smoking and relapse of Graves' disease and the incidence and severity of Graves' ophthalmopathy are constantly reported. Smoking also has a potent nodular goitrigenic effect in low iodine areas. Despite the fact that smoking decrease both thyroid secretion and thyroid hormone action, hypothyroidism does not appear to be more frequent. Smoking does however increase the metabolic effects of hypothyroidism. Active and passive smoking have proven deleterious effects on the fetal thyroid. Paradoxically, there is evidence of reduced risk for thyroid cancer in smokers.

Goiter, Nodular↗
PubMed2002

[DHEA: an unknown star].

PURPOSE: To clarify the physiological function of dehydroepiandrosterone (DHEA), the most abundant steroid in human plasma, which remains poorly understood. To analyse the beneficial effects of a supplementation in order to alleviate its decrease in ageing and improve well-being. CURRENT KNOWLEDGE AND KEY POINTS: DHEA (and its sulfate) acts on peripheral tissues as an androgenic and estrogenic precursor. It is also considered as a neurosteroid. DHEA administration in several pathological animal models is promising, especially in metabolic diseases such as obesity and insulin resistance. It appears like a factor of immunomodulation and facilitates cognitive acquisition. In humans there is little evidence that DHEA may be useful in characterized pathologies apart from adrenal insufficiency. An interesting effect was also noted in severe systemic lupus erythematosus. The effects on cognitive and neuropsychiatric diseases such as midlife dysthymia are not yet convincing. Prospective studies of supplementation versus placebo indicate inconstant improvement in well-being in the post-menopausal state. DHEA is not a panacea against ageing despite there being a well-established aging-related decrease of DHEA. Contrary to some assertions there are no proven relations between cardiovascular or cancer risk. FUTURE PROSPECTS AND PROJECTS: Until now adrenal insufficiency has been the only well-documented indication of an oral DHEA supplementation. However, DHEA may be a good way for androgen supplementation in menopausal men. Further investigations are needed to better know the anti-inflammatory and immunomodulation properties of DHEA. At the least, prospective studies on large populations are necessary to assess the true benefits and dangers of DHEA in prevention of ageing.

Androgens↗
PubMed2002

[Development and long-term prognosis of unexplained persistent inflammatory biologic syndromes].

PURPOSE: Unexplained inflammatory syndrome is a frequent and worrying condition in Internal Medicine. However, the long-term clinical outcome of these patients cannot be inferred from the literature. The aim of this study is to describe the long-term follow-up and the prognosis of a group of patients hospitalised for an inflammatory syndrome and discharged without causal diagnosis. METHODS: This retrospective study was carried out on 46 patients, 15 men and 31 women, aged 21 to 90 years, hospitalised between 1992 and 1999. Data concerning the hospital stay were obtained from the patients' medical record. Follow-up was performed by consulting the treating physician. RESULTS: The prognosis of these patients is fairly good. In one third of the cases, the inflammatory syndrome resolved spontaneously (n = 13). In the second third, a definite diagnosis was established after discharge (n = 14) and consisted mainly of chronic inflammatory diseases (n = 9), cured with a specific treatment. In the remaining third (n = 12), the inflammatory syndrome persisted, in clinically asymptomatic patients. CONCLUSION: These results suggest that the persistence of an inflammatory syndrome is not a poor prognostic factor. Thus we propose for patients discharged with an undiagnosed persistent inflammatory syndrome despite thorough investigations, a simple clinical and biological follow-up instead of repeated etiological investigations.

Adult↗
PubMed2002

Ten-year trends of dietary intake in a middle-aged French population: relationship with educational level.

OBJECTIVE: To compare dietary intakes at a 10 y interval of a population aged 35-64 living in France. Trends in nutrient intake and food consumption were examined with a special emphasis on the relationships between educational level and dietary behaviour. DESIGN: Two independent surveys conducted in 1985-1987 (S1) and 1995-1997 (S2) in the framework of the WHO MONICA project. Dietary intake was assessed with a 3-day record method and a food frequency questionnaire. The samples analysed included 416 men and 446 women for S1, 393 men and 409 women for S2. RESULTS: A significant improvement of the quality of fat intake was observed between S1 and S2, independently of educational level, with an increase of the age adjusted P/S ratio from 0.42 to 0.50 in men (P=10(-4)) and from 0.41 to 0.50 in women (P=10(-4)), whereas the daily cholesterol intake dropped from 552.0 to 466.9 mg and from 447.2 to 384.6 mg in men and women, respectively (P=10(-4)). These variations were associated with a decrease in the consumption of high-fat foods and an increase in that of low-fat products (poultry, low-fat dairy foods, fish) in all educational classes. By contrast, the consumption of fruit and vegetables, which was highly associated with educational level, varied little over time. CONCLUSIONS: Our results indicate slight improvement in fat quality, independently of educational level, while fruit and vegetable intake, which appeared more dependent on educational level, was only poorly modified over the 10 y interval.

Adult↗
PubMed2002

Changes in physical performance in elderly Europeans. SENECA 1993 - 1999.

OBJECTIVE: To assess longitudinal changes in subjective and objective measures of physical performance in elderly Europeans. DESIGN: Longitudinal study including SENECA measurements 1993-1999. SETTING: Data were collected in 9 'traditional' European towns. SUBJECTS AND METHODS: In total 444 men and women, born 1913-1918 participated both in the follow-up survey in 1993 and in the finale in 1999. Changes in Activities of Daily Living (ADL), the 7 item Physical Performance Test (PPT) and in the ability to perform the chair stand and the tandem test were measured. RESULTS: ADL and PPT did not change significantly between the 2 surveys, while participants needed more time to perform the chair stand (p<0.02) and their balance declined according to the tandem test (p< 0.01). Men were significantly better than women, in all measures of physical performance. However, the decline in functioning was of the same magnitude. All tests showed significant variation between centres in physical function. Significant cross cultural variation was found for changes in the capacity to perform the objective tests. Tests of distributions showed good association between the self reported and objective measures of physical performance. Rather than assessing the same task in several ways, the measures may reflect different levels of disability, and as such be important end point measures. CONCLUSIONS: Both ADL and objective tests of simple functions applied well in the SENECA population. Physical performance declines with age. Across European towns variation in physical performance was identified.

Activities of Daily Living↗