Estimating body composition is important to understand the metabolic and cardiovascular effects of adiposity. Estimating changes in body compartments arising from weight loss strategies is equally important to evaluate their benefits and risks, particularly in frail populations (elderly or diabetic), and following bariatric surgery.Body compartments were evaluated in 50 obese subjects (25 diabetic, 25 non-diabetic) before and after a 7 kg weight loss obtained after 6 months of calorie restriction and orlistat. Fat and fat-free mass (FFM) were estimated by bioelectrical impedance analysis (BIA), dual X-ray absorptiometry (DXA), plethysmography (BodPod) and a combination of these in a 3- or 4-compartment model, the latter being considered the reference method.FFM hydration was the ratio of total body water (BIA) to FFM. FFM hydration was significantly higher than classical values (75.9 3.0%, P < 0.000 1), and decreased with weight loss (74.2 +/- 3.3%). Compared to the 4-compartment, the 3-compartment model gave the most accurate fat and FFM estimation. A significant bias was observed with DXA, BodPod or BIA. Compartment changes induced by weight loss were accurately evaluated by DXA, being particularly precise in the 3-compartment analysis. No effect of diabetes per se was observed.A 3- or 4-compartmental analysis is necessary to accurately estimate body composition and its changes during weight loss. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

Objectives: To provide an updated document assessing the global, NSAID-specific, and time dependent risk of gastrointestinal (GI) complications through meta-analyses of high quality studies. Methods: An exhaustive systematic search was performed. Inclusion criteria were: RCT or controlled study, duration of 5 days at least, inactive control, assessment of minor or major NSAID adverse effects, publication range January 1985 to January 2003. The publications retrieved were assessed during a specifically dedicated WHO meeting including leading experts in all related fields. Statistics were performed conservatively. Meta-regression was performed by regressing NSAID adjusted estimates against study duration categories. Results: Among RCT data, indolic derivates provided a significantly higher risk of GI complications related to NSAID use than for non-users: RR = 2.25 (1.00; 5.08) than did other compounds: naproxen: RR = 1.83 (1.25; 2.68); diclofenac: RR = 1.73 (1.21; 2.46); piroxicam: RR = 1.66 (1.14; 2.44); tenoxicam: RR = 1.43 (0.40; 5.14); meloxicam: RR = 1.24 (0.98; 1.56), and ibuprofen: RR = 1.19 (0.93; 1.54). Indometacin users had a maximum relative risk for complication at 14 days. The other compounds presented a better profile, with a maximum risk at 50 days. Significant additional risk factors included age, dose, and underlying disease. The controlled cohort studies provided higher estimates: RR = 2.22 (1.7; 2.9). Publication bias testing was significant, towards a selective publication of deleterious effects of NSAIDs from small sized studies. Conclusion: This meta-analysis characterised the “compound” and “time” aspects of the GI toxicity of non-selective NSAIDs. The risk/benefit ratio of such compounds should thus be carefully and individually evaluated at the start of long term treatment.

The authors have studied 10 critically ill patients with acute respiratory distress syndrome who required a neuromuscular blocking drug to assist mechanical ventilation. Patients received a bolus dose of 1 mg/kg of atracurium followed by a constant infusion rate of 1 mg/kg/h of this drug for 72 hours. Neuromuscular block was monitored using an accelerograph. Blood samples were obtained over a 96‐hour period. A preliminary independent analysis was done to estimate the individual pharmacokinetic parameters; data were consistent with a one‐compartment model. The pharmacodynamic data analysis was then performed using the changes in train‐of‐four (TOF) count as an index of the therapeutic effect of atracurium. Pharmacokinetic‐dynamic variables were calculated using the Sheiner model and the Hill equation. The elimination half‐life of atracurium averaged 22 minutes. Mean volume of distribution and plasma clearance were 217 ml/kg and 550 ml/min, respectively. There was a significant hysteresis loop when the TOF count was plotted against predicted plasma atracurium concentrations. The mean sigmoidicity factor, γ, was 4.04. The concentration producing 50% of the Emax was 1.36 μg/mL, and the mean ke0 was 0.059 min−1. Recovery time ranged from 30 to 80 minutes, and none of the patients of this study had residual paralysis.

A high-performance liquid chromatographic (HPLC) method with ultraviolet (UV) absorbance was developed for the analysis of piperacillin-tazobactam (tazocillin), in plasma and urine. The detection was performed at 218 nm for tazobactam and 222 nm for piperacillin. The procedure for assay of these two compounds in plasma and of piperacillin in urine involves the addition of an internal standard (ceftazidime for tazobactam and benzylpenicillin for piperacillin) followed by a treatment of the samples with acetonitrile and chloroform. To quantify tazobactam in urine, diluted samples were analysed using a column-switching technique without internal standard. The HPLC column, LiChrosorb RP-select B, was equilibrated with an eluent mixture composed of acetonitrile-ammonium acetate (pH 5). The proposed technique is reproducible, selective, and reliable. The method has been validated, and stability tests under various conditions have been performed. Linear detector responses were observed for the calibration curve standards in the ranges 5–60 μg/ml for tazobactam, and 1–100 μg/ml for piperacillin and spans what is currently though to be the clinically relevant range for tazocillin concentrations in body fluids. The limit of quantification was 3 μg/ml for tazobactam and 0.5 μg/ml for piperacillin in plasma and urine. Extraction recoveries from plasma proved to be more than 85%. Precision, expressed as C.V., was in the range 0.4–18%.

We report txo cases of skeletal fluorosis in two men, 55 and 69 year-old. The physical findings and the roentgenograms were typical and chemical analysis confirmed the diagnosis. Surprisingly, fluoride concentrations in blood and urine were increased at the beginning of the hospitalizations and lower during the hospitalizations. The origin of fluor intake remained unknown, leading to consider a possible criminal poisoning.Then, we discuss the attitude of physician in a case a possible criminal poisoning : denunce the crime to the police or not, as regards french law.

We report two cases of skeletal fluorosis in two men, 55 and 69 year-old. The physical findings and the roentgenograms were typical and chemical analysis confirmed the diagnosis. Surprisingly, fluoride concentrations in blood and urine were increased at the beginning of the hospitalizations and lower during the hospitalizations. The origin of fluor intake remained unknown, leading to consider a possible criminal poisoning. Then, we discuss the attitude of physician in a case a possible criminal poisoning: denunce the crime to the police or not, as regards french law.

Les auteurs rapportent deux cas de fluorose osseuse chronique, survenus chez deux hommes de 55 et 69 ans. Ces deux cas, tout à fait typiques sur le plan clinique et radiologique et prouvés biologiquement se singularisaient par des fluctuations des dosages de fluor, qui s'abaissaient au cours des hospitalisations et remontaient lors des retours à domicile. L'interrogatoire du patient, ainsi que tous les examens effectués à la recherche de la source d'intoxication sont restés négatifs, amenant à suspecter un empoisonnement criminel. Dans l'un des cas une procédure judiciaire fut déclenchée, sans résultat.

A rare form of mastocytosis is described in a 48 years old man. Skin involvement was characterized by diffuse, non pruritic telangiectatic lesions, without Darier's phenomenon. It was associated to a diffuse osteoporosis, revealed by vertebral compression fractures. Histologic examinations showed dispersed mast cells in the skin and bone marrow.

We report a case of lead poisoning with osteoporosis. The study of ten cases of chronic lead poisoning don't show any relevant impairement of calcium metabolism and bone density. The role of lead and EDTA is discussed.

Three cases of unilateral atloido-axis arthropathy are described in women aged 39 to 69 years. The initial diagnosis of arthritis made in view of the severity of the clinical (severe pain and stiffness) and radiological (marked chondrolysis, subchondral erosions), manifestations was contested in the absence of any laboratory abnormality of an inflammatory nature, as well as any bacterial, inflammatory rheumatic or metabolic cause. The final diagnosis made at the time of hospitalisation after 8 to 9 month progression of the disease was osteoarthritis, no subject to any doubt on the basis of the subsequent course. C2-C3 block present in 2 cases was a local factor of joint wear-and-tear. Other severe manifestations of osteoarthritis were seen in 2 patients. By analogy with certain forms of destructive osteoarthritis of the fingers, the term erosive osteoarthritis of the atloido-axis joint is suggested to describe this joint lesion.