Obesity in long-term survivors of childhood acute lymphoblastic leukemia

Rapport de synthèse : Le traitement des leucémies aiguës chez l'enfant représente un des succès de la médecine moderne avec des taux de guérison avoisinant les 80% ce qui implique la nécessité de suivre les effets secondaires à long terme des traitements chez cette population de patients. Récemment plusieurs études internationales ont relevé une prévalence plus importante de surpoids et d'obésité chez les enfants traités pour une leucémie aiguë. L'origine de ce processus reste incertaine :aux effets secondaires bien connus et décrits des traitements (stéroïdes et radiothérapie) semblent s'ajouter des facteurs génétiques, familiaux (age, BMI au diagnostic, BMI parents et fratrie), environnementaux. L'objectif de ce travail est d'estimer la prévalence et les facteurs de risque pour le surpoids et l'obésité chez les enfants traités et guéris d'une leucémie aiguë en Suisse romande et de comparer ces résultats à ceux d'études internationales. Pour répondre à ces questions nous avons inclus 54 patients (40 de Lausanne et 14 de Genève) traités pour une leucémie aiguë. Seuls les enfants à 5 ans de leur première rémission clinique, sans atteinte du système nerveux central, testiculaire ou médullaire et traités par chimiothérapie seule sont retenus. Leur poids, taille sont enregistrés durant les phases précises de traitement (au diagnostic, à la rémission, fin de consolidation, milieumaintenance et en fin de traitement) puis annuellement jusqu'à 12 ans post fin de traitement. Le BMI (kg/ml) et sa déviation standard BMI-SDS (spécifique pour Page et le sexe) pour les patients et leurs parents sont calculés selon les valeurs internationales (IOTF) respectivement BMI-SDS >1.645 (p<0.05) pour le surpoids et> 1.96 (p<0.025) pour l'obésité. Les résultats de ce travail confirment une prévalence double de surpoids (30% versus 17%) et quadruple d'obésité (18% versus 4%) au sein de la population d'enfants traités pour une leucémie aiguë comparées à la population suisse standard. Les facteurs de risque impliqués sont le BMI initial au diagnostic et le BMI maternel contrairement à Page, sexe, stéroïdes et au BMI paternel. Ces données confirment une prévalence significative d'enfants en surpoids/obèses au sein de cette population avec des résultats similaires à ceux retrouvés dans des études internationales récentes. Les facteurs de risque identifiés semblent plutôt liés à l'environnement familial qu'aux traitements. Ces constatations pourraient être le résultat d'interactions complexes entre "le background génétique", les facteurs environnementaux, les habitudes socioculturelles (activité physique, status nutritionnel) paramètres non évalués dans cette revue. Des études plus larges, prospectives sont nécessaires pour clarifier les rôles des différents facteurs de risque et de leurs interactions ;celles-ci devraient inclure des données génétiques (LEPR), taux de leptine, activité physique et le status nutritionnel. Enfin, l'identification des patients à risque est cruciale afin de prévenir les effets secondaires cardio-vasculaires, métaboliques bien connus liés au surpoids et à l'obésité.

Audit report on the AIM - Jefferson, Keokuk Early Childhood Iowa Area Board, d/b/a Jefferson/Keokuk Early Childhood Iowa Area for the year ended June 30, 2011

Audit report on the AIM - Jefferson, Keokuk Early Childhood Iowa Area Board, d/b/a Jefferson/Keokuk Early Childhood Iowa Area for the year ended June 30, 2011

Hypertension: la définition actuelle est-elle adaptée la femme [Hypertension: is the actual definition adapted to women?].

The control of blood pressure in men and women differs due to different physiological pathways. Moreover, conditions increasing the risk of hypertension, such as pre-eclampsia, exposure to oral contraceptives are specific to women. Men have a higher blood pressure than women from pubertal growth to advanced age. However, the definition of hypertension (blood pressure--140/90 mmHg) is the same for adult men and women. The management of hypertension should be based not only on the level of blood pressure, but also on the global cardiovascular risk. Sex is included in the global evaluation of the cardiovascular risk.

CO2 wedged hepatic venography in the evaluation of portal hypertension.

BACKGROUND/AIMS/METHODS During hepatic vein catheterisation, in addition to measurement of hepatic venous pressure gradient (HVPG), iodine wedged retrograde portography can be easily obtained. However, it rarely allows correct visualisation of the portal vein. Recently, CO2 has been suggested to allow better angiographic demonstration of the portal vein than iodine. In this study we investigated the efficacy of CO2 compared with iodinated contrast medium for portal vein imaging and its role in the evaluation of portal hypertension in a series of 100 patients undergoing hepatic vein catheterisation, 71 of whom had liver cirrhosis. RESULTS In the overall series, CO2 venography was markedly superior to iodine, allowing correct visualisation of the different segments of the portal venous system. In addition, CO2, but not iodine, visualised portal-systemic collaterals in 34 patients. In cirrhosis, non-visualisation of the portal vein on CO2 venography occurred in 11 cases; four had portal vein thrombosis and five had communications between different hepatic veins. Among non-cirrhotics, lack of portal vein visualisation had a 90% sensitivity, 88% specificity, 94% negative predictive value, and 83% positive predictive value in the diagnosis of pre-sinusoidal portal hypertension. CONCLUSIONS Visualisation of the venous portal system by CO2 venography is markedly superior to iodine. The use of CO2 wedged portography is a useful and safe complementary procedure during hepatic vein catheterisation which may help to detect portal thrombosis. Also, lack of demonstration of the portal vein in non-cirrhotic patients strongly suggests the presence of pre-sinusoidal portal hypertension.

Alimentation et hypertension artérielle: au-delà du sel de table [Nutrition and hypertension: more than table salt].

The role of dietary sodium intake in the development, and its impact on the treatment, of hypertension are well recognized. However, many other nutritional compounds have been shown, or are believed, to influence blood pressure. Some compounds, such as caffeine and fructose, may raise arterial blood pressure, whereas others might lower arterial blood pressure, for example garlic, dark chocolate, fibers and potassium. In this article, we review several alimentary compounds and their (hypothesized) mechanisms of action, as well as the available evidence supporting a role of these compounds in the "non pharmacological" treatment and prevention of hypertension.

Physical training and hypertension have opposite effects on endothelial brain-derived neurotrophic factor expression.

AIMS: Changes in circulating brain-derived neurotrophic factor (BDNF) levels were reported in patients with or at risk for cardiovascular diseases associated with endothelial dysfunction, suggesting a link between BDNF and endothelial functionality. However, little is known on cardiovascular BDNF. Our aim was to investigate levels/localization, function, and relevance of cardiovascular BDNF. METHODS AND RESULTS: BDNF levels (western blotting) and localization (immunostaining) were assessed in the heart and aorta from rats with impaired (spontaneously hypertensive rats [SHR]), normal (Wistar Kyoto rats [WKY]), and improved (SHR and WKY subjected to physical training) endothelial function. BDNF levels were also measured in cultured endothelial cells (CECs) subjected to low and high shear stress. The cardiovascular effects of BDNF were investigated in isolated aortic rings and hearts. The results showed high BDNF levels in the heart and aorta, the expression being prominent in endothelial cells as compared with other cell types. Exogenous BDNF vasodilated aortic rings but changed neither coronary flow nor cardiac contractility. Hypertension was associated with decreased expression of BDNF in the endothelium, whereas physical training led to endothelial BDNF up-regulation not only in WKY but also in SHR. Exposure of CECs to high shear stress stimulated BDNF production and secretion. CONCLUSION: Cardiovascular BDNF is mainly localized within endothelial cells in which its expression is dependent on endothelial function. These results open new perspectives on the role of endothelial BDNF in cardiovascular health.

Early childhood network, 2005.

This brochure states the mission of the Early Childhood Network along with contact names and addresses of the specialists and consultants in the Iowa Department of Education and the Iowa Area Education Agencies for the years 2005/2006.

Transcatheter renal denervation for the treatment of resistant arterial hypertension: the Swiss expert consensus.

Transcatheter (or percutaneous) renal denervation is a novel technique developed for the treatment of resistant hypertension. So far, only one randomised controlled trial has been published, which has shown a reduction of office blood pressure. The Swiss Society of Hypertension, the Swiss Society of Cardiology, The Swiss Society of Angiology and the Swiss Society of Interventional Radiology decided to establish recommendations to practicing physicians and specialists for good clinical practice. The eligibility of patients for transcatheter renal denervation needs (1.) confirmation of truly resistant hypertension, (2.) exclusion of secondary forms of hypertension, (3.) a multidisciplinary decision confirming the eligibility, (4.) facilities that guarantee procedural safety and (5.) a long-term follow-up of the patients, if possible in cooperation with a hypertension specialist. These steps are essential until long-term data on safety and efficacy are available.

A patient with Hypertension Uncontrolled by Previous treatment

Co-administration of antihypertensive agents with different modes of action is required in most hypertensive patients to control blood pressure. This led to the development of fixed-dose combinations of established efficacy and tolerability, with the convenience of a single tablet facilitating long-term adherence with therapy. Blockade of the renin-angiotensin system (RAS) is widely used in hypertensive patients, particularly in those at high risk of cardiovascular or renal diseases. There is therefore a strong rationale for including a blocker of the RAS in fixed combinations, together with either a diuretic or a calcium antagonist. Patient characteristics and cardiovascular risk profiles are useful in guiding the choice of combinations administered. Adding a diuretic or a calciumantagonist to aRAS blocker is a valuable option in practically all patients, whether or not they have comorbidities. Amajor task is to individualize the treatment, ie, to find a drug regimen that normalizes the patient's blood pressure while preserving his or her quality of life. This can be achieved in most patients using the fixeddose combination containing the angiotensin-converting enzyme inhibitor perindopril and the diuretic indapamide. A number of trials have established the antihypertensive efficacy and the protective effects of this combination in hypertensive patients, which justifies its broad use in patients with blood pressure uncontrolled by other blood pressure-lowering agents.