Bonnet F.,Rennes University Hospital Center |
Velayoudom Cephise F.-L.,University Hospital of Pointe a Pitre |
Gautier A.,Rennes University Hospital Center |
Dubois S.,University of Angers |
And 6 more authors.
Background SHBG and liver enzymes levels are both associated with the risk of type 2 diabetes. However, the relationship between SHBG with liver enzymes and intrahepatic fat content remain poorly understood. Objective To investigate whether SHBG is correlated with glucose and lipids levels and whether this association depends on fatty liver content, liver enzymes or sex hormone concentrations. Design and Patients We studied 233 dysmetabolic men with measures of plasma SHBG, total testosterone, 17β-oestradiol, glucose, adiponectin, liver enzymes and hepatokines. Intrahepatic liver fat and visceral fat contents were measured by magnetic resonance imaging in 108 of these individuals. Results After adjustment for age, SHBG concentration was inversely correlated with fasting glucose (βstandardized= -0·21, P = 0·0007), HbA1c (βstandardized= -0·27, P < 0·0001), triglycerides (βstandardized= -0·19, P = 0·003) and positively correlated with HDL-Cholesterol (βstandardized= 0·14, P = 0·03). These correlations persisted after adjustment for either total testosterone or 17β-oestradiol levels. SHBG was not related to either fetuin A or FGF 21 concentrations. The inverse association of SHBG with HbA1c and glycaemia was not altered after adjusting for liver markers but was no longer significant after adjustment for hepatic fat content. Conclusion The significant association between SHBG and fasting glycaemia, HbA1c and lipid levels in dysmetabolic men was not related to either sex hormones or markers of liver function, but was dependent on intrahepatic fat. This suggests that intrahepatic fat, but not alterations in liver function markers, may be involved in the association between SHBG and glucose and lipid metabolism. © 2012 John Wiley & Sons Ltd. Source
Friedrich G.,Medical University of Graz |
Dikkers F.G.,University of Groningen |
Arens C.,Otto Von Guericke University of Magdeburg |
Remacle M.,Leuven University Hospital of Mont Godinne |
And 6 more authors.
European Archives of Oto-Rhino-Laryngology
Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken. © 2013 Springer-Verlag Berlin Heidelberg. Source
Landais A.,University Hospital of Pointe a Pitre
Journal of Diabetes and its Complications
Hypoglycemia can manifest as a stroke. MRI diffusion-weighted imaging is the most useful technique in diagnosing early ischemic injury. We report two cases of transient MRI lesions of the splenium of the corpus callosum related to hypoglycemia. Clinicians must be aware of such cases to avoid misdiagnosis. © 2015 Elsevier Inc. All rights reserved. Source
Duvillard P.,Institute Gustave Roussy |
Foucan L.,University Hospital of Pointe a Pitre |
Guigay J.,University Paris - Sud |
Goere D.,Digestive Surgery |
And 6 more authors.
The new WHO classification of gastroenteropancreatic (GEP) neuroendocrine tumors (NET) implies that G3 neoplasms with mitotic index >20 and/or Ki67 index >20% are neuroendocrine carcinomas (NEC), described as poorly differentiated, small or large cell types, by analogy with lung NEC. To characterize the subgroup of non-small-cell-type GEP and thoracic NET with mitotic index >20 and/or Ki67 >20% according to their pathological features, response to cisplatin and overall survival (OS). We reviewed pathological and clinical presentation of G3 non-small-cell-type NET referred to our institution for 5 years. Data from 166 patients with metastatic thoracic and GEP-NET were collected. Twenty-eight patients (17%) fulfill the inclusion criteria. Tumors were classified as well-differentiated NET (G3-WDNET) in 42.8% of cases and poorly differentiated, large-cell NEC (G3-LCNEC) in 57.2% of cases. Plasma chromogranin A or neuron-specific enolase were elevated in 42 and 25% respectively of G3-WDNETand 31 and 50% of G3-LCNEC. Somatostatin receptor scintigraphy was positive in 88 and 50% of G3-WDNET or G3-LCNEC respectively. Complete or partial response to cisplatin was observed in 31% of cases, all classified as G3-LCNEC. The median OS was 41 months for G3-WDNET but 17 months for G3-LCNEC (PZ0.34). Short survival was observed in 25% of G3-WDNET but 62.5% of G3-LCNEC patients (PZ0.049). G3 ENETS GEP and thoracic neuroendocrine neoplasms (NEN) could constitute a heterogeneous subgroup of NEN as regards diagnosis, prognosis, and treatment. If confirmed, future classifications may consider splitting them into two groups according to their morphological differentiation. © 2013 Society for Endocrinology. Source
Crosby L.,University Hospital of Pointe a Pitre |
Perreau C.,Intensive Care Unit |
Madeux B.,University Hospital of Pointe a Pitre |
Cossic J.,Intensive Care Unit |
And 5 more authors.
International Journal of Infectious Diseases
Objectives: A chikungunya epidemic occurred in 2013-2014 in the Caribbean and Americas. Although the disease is usually benign, some patients required admission to the intensive care unit (ICU). The characteristics and outcomes of patients with chikungunya virus (CHIKV) infection admitted to an ICU during this epidemic are reported. Methods: An observational study of consecutive patients with confirmed CHIKV infection admitted to ICUs in Martinique and Guadeloupe, French West Indies, between January and November 2014, was performed. In addition, patients with CHIKV-related manifestations were compared with those whose manifestations were not specifically related to CHIKV infection. Results: Sixty-five patients were admitted to the ICU with CHIKV infection. Fifty-four (83%) had a pre-existing underlying disease and 27 (41.5%) were admitted due to exacerbation of a comorbidity. Thirty-seven (57%) patients were mechanically ventilated. ICU and hospital mortality rates were 26% and 27%, respectively. CHIKV-related manifestations were observed in 28 (18%) patients and were mainly encephalitis, Guillain-Barré syndrome, and severe sepsis. These patients less frequently had chronic arterial hypertension and diabetes and more frequently had autoimmune diseases compared with patients without CHIKV-related manifestations. Conclusions: Most patients admitted to the ICU with CHIKV infection had a pre-existing comorbidity. However, severe manifestations such as Guillain-Barré syndrome, encephalitis, and severe sepsis could be specifically related to CHIKV. © 2016 The Author(s). Source