Introduction: High BP at exercice precedes hypertension at rest, a common cardiovascular risk factor, in obese adults. The goals of this study are to detect high BP at increasing exercice intensities in obese adolescents, analyze correlations to body composition in order to adapt physical training procedures during a weight reduction program. Methods: 55 obese adolescents (girls = 33, boys = 22) were investigated before (T1, BMI = 38.4 ± 8.0 kg/m2) and at the end (T2, BMI = 28.4 ± 4.1 kg/m2, p <0.0001) of a multidisciplinary weight reduction program lasting 9 ± 3 months. Bod composition was assessed by DEXA (Hologic QRD 1000®). Systolic(SBP) and diastolic blood pressure (DBP) were measured at rest and until VO2 max was achieved on a mechanical braked cycle ergometer (Monark 824®, Se). Individual regression equations between heart rate (HR) and BP were calculated. Data are compared to reference values for healthy subjects at 3 intensity levels: rest, 150 bpm HR and peak exercice. Results: At T1, 25 subjects had high SBP at rest and 14 at exercice and 18 and 7, high DBP. Only 3 had high BP at rest and exercice. At T2, corresponding figures for SBP were 9 (p = 0.001) and 4 (p= 0.04) and 7 and 2 for DBP (ns). In boys only, SBP at rest was correlated to fat mass (FM) (p=0.008) and DBP to lean mass (LM) (p = 0.048) at T1 and no correlation was found at T2. At peak exercice at T1, SBP correlated to LM (p=0.0005) and DBP to FM (p= 0.0005). At T2, SBP and DBP in boys and girls became correlated to LM (p <0.01). At 150 bpm, a positive U shaped correlation (p <0.005) was found in both sexes between LM and SBP in hypertensive subjects. Conclusion: High BP is a common condition that should be detected in obese adolescents and taken into account during obesity management. Exercice testing markedly improves the number of subjects detected. Correlations between SBP and DBP and FM and LM differ among boys and girls, with exercice intensity and FM reduction. Weight loss allows a marked reduction of mean levels of all BP.
When managing patients with cancer, lymphedema of the lower limbs (LLL) is commonly reported as secondary to the surgical excision and/or irradiation of lymph nodes (LNs). In the framework of lymphoscintigraphic imaging performed to evaluate secondary LLL, some lympho-nodal presentations have been observed that could not be explained by the applied treatments, suggesting that these LLL might be primary. Therefore, all our lymphoscintigraphic examinations that were performed in patients for LLL after surgery for gynecological or urological cancer were retrospectively analyzed in order to evaluate the frequency in which these LLL might not be secondary (either completely or partially) but primary in origin.Lymphoscintigraphies performed in 33 patients who underwent LN dissection (limited to the intra-abdominal LN) with or without radiotherapy for histologically confirmed ovarian cancer (n = 6), uterine cancer (n = 14 with cervical cancer and n = 7 with endometrial cancer), or prostate cancer (n = 6) were compared to lymphoscintigraphies obtained in primary LLL.In 12 (33% of the) patients (3 men plus 9 women, 4 with cervical cancer and 5 with endometrial cancer), scintigraphy of the lower limbs revealed lympho-nodal presentation that did not match with the expected consequences of the surgical and/or radiological treatments and were either suggestive or typical of primary lymphedema.This retrospective analysis of a limited but well-defined series of patients suggests that the appearance of LLL might not be related to cancer treatment(s) but that these LLL may represent the development of a primary lymphatic disease latent prior to the therapeutic interventions.
Sentinel lymph node biopsy is a new technique in staging the clinically NO neck. Tumour spread to the neck is the most important prognostic factor in head and neck squamous cell carcinoma (HNSCC).Patients with histologically confirmed HNSCC, with no clinical and no radiological (CT or MRI) evidence of cervical lymph node involvement were eligible for this prospective study. The lymph node mapping was performed by preoperative lymphoscintigraphy and intraoperative use of hand-held gamma probe. Four injections (with Tc 99m-labeled nanocolloids) were performed around the primary tumour. The SLN, as indicated by dynamic scintigraphy and the neck dissection specimen, were sent separately for histological analysis. The presence of occult metastasis in the SLN and in the neck dissection specimen were compared.Ten consecutive patients (8 males ; 2 females) with a mean age of 61 years (range 47 to 74 years) were prospectively entered into the study. The primary tumour was located on the oral tongue in 4 cases, in the floor of the mouth in 5 cases and in the oropharynx in 1 case. Primary tumours were staged T2 in nine cases, one tumour was staged T1 according to UICC 1997. All the tumours were clinically staged cN0 by palpation and computed tomography (or MRI). Lymphoscintigraphy was performed and revealed a SLN in all cases. The sentinel node biopsy technique permitted an upstaging of the clinically cN0 neck in 3/10 cases. The SLN technique was false negative in one patient with a skip metastasis.SLN evaluation in HNSCC is feasible and provides a highly accurate staging of NO necks in oral and oropharyngeal carcinomas.
Hydroxychloroquine (HCQ) is an important medication for treating systemic lupus erythematosus (SLE). Its blood concentration ([HCQ]) varies widely between patients and is a marker and predictor of SLE flares. This prospective randomised, double-blind, placebo-controlled, multicentre study sought to compare standard and adjusted HCQ dosing schedules that target [HCQ] ≥1000 ng/ml to reduce SLE flares. [HCQ] was measured in 573 patients with SLE (stable disease and SELENA-SLEDAI≤12) treated with HCQ for at least 6 months. Patients with [HCQ] from 100 to 750 ng/ml were randomised to one of two treatment groups: no daily dose change (group 1) or increased HCQ dose to achieve the target [HCQ] (group 2). The primary end point was the number of patients with flares during 7 months of follow-up. Overall, mean [HCQ] was 918±451 ng/ml. Active SLE was less prevalent in patients with higher [HCQ]. A total of 171 patients were randomised and followed for 7 months. SLE flare rates were similar in the two groups (25% in group 1 vs 27.6% in group 2; p=0.7), but a significant spontaneous increase in [HCQ] in both groups between inclusion and randomisation strongly suggested improved treatment adherence. Patients at the therapeutic target throughout follow-up tended to have fewer flares than those with low [HCQ] (20.5% vs 35.1%, p=0.12). Although low [HCQ] is associated with higher SLE activity, adapting the HCQ dose did not reduce SLE flares over a 7-month follow-up.
Edema of the upper limb, without any doubt, constitutes the most invalidating complication of breast carcinoma treatment. The swelling of the limb results from decreased liquid evacuation by surgical intervention at the axillary level and also by the eventual treatment by cobaltotherapy.The physical treatment for edema of the limb consists of a combination of therapies that were tested for their effectiveness in laboratories on healthy students and also on patients who underwent surgery for breast carcinoma. The treatment consists of the application of manual lymphatic drainage (type Leduc), the use of multilayered bandages, and the use of intermittent pneumatic compression. The population studied was represented by 220 patients who underwent breast surgery. The authors followed their evolution during the first 2 weeks of treatment. Patients were not hospitalized. The edema was measured by using marks tattooed on the skin.The limb that developed edema was compared with the healthy limb. The most important reduction was obtained in the first week. The decrease was equivalent to 50% of the average of the difference between both upper limbs. During the second week, the results obtained stabilized; however, there was a slight decrease at the end of the second week.The physical treatment of edema represents the preferred therapeutic approach. However, it must answer to well-defined criteria to be efficient and for long-lasting effects. The physical treatment is used to treat outpatients, allowing them to follow a normal lifestyle.
