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P Lecomte

Publications and source records attributed to P Lecomte.

At least 19 recordsLinked to original sources
PubMed2006

Clinical characterization of familial isolated pituitary adenomas.

CONTEXT: Familial pituitary adenomas occur rarely in the absence of multiple endocrine neoplasia type 1 (MEN1) and Carney complex (CNC). OBJECTIVE: Our objective was to characterize the clinical and genealogical features of non-MEN1/CNC familial isolated pituitary adenomas (FIPA). DESIGN AND SETTING: We conducted a retrospective study of clinical and genealogical characteristics of FIPA cases and performed a comparison with a sporadic population at 22 university hospitals in Belgium, Italy, France, and The Netherlands. RESULTS: Sixty-four FIPA families including 138 affected individuals were identified [55 prolactinomas, 47 somatotropinomas, 28 nonsecreting adenomas (NS), and eight ACTH-secreting tumors]. Cases were MEN1/PRKAR1A-mutation negative. First-degree relationships predominated (75.6%) among affected individuals. A single tumor phenotype occurred in 30 families (homogeneous), and heterogeneous phenotypes occurred in 34 families. FIPA cases were younger at diagnosis than sporadic cases (P = 0.015); tumors were diagnosed earlier in the first vs. the second generation of multigenerational families. Macroadenomas were more frequent in heterogeneous vs. homogeneous FIPA families (P = 0.036). Prolactinomas from heterogeneous families were larger and had more frequent suprasellar extension (P = 0.004) than sporadic cases. Somatotropinomas occurred as isolated familial somatotropinoma cases and within heterogeneous FIPA families; isolated familial somatotropinoma cases represented 18% of FIPA cases and were younger at diagnosis than patients with sporadic somatotropinomas. Familial NS cases were younger at diagnosis (P = 0.03) and had more frequently invasive tumors (P = 0.024) than sporadic cases. CONCLUSIONS: Homogeneous and heterogeneous expression of prolactinomas, somatotropinomas, NS, and Cushing's disease can occur within families in the absence of MEN1/CNC. FIPA and sporadic cases have differing clinical characteristics. FIPA may represent a novel endocrine neoplasia classification that requires further genetic characterization.

Adenoma↗
PubMed2006

[Status of iodine nutrition in France: prevention of iodine deficiency in pregnant and lactating women].

Iodine intake varies with age and physiological status: in pregnant and lactating women, recommended iodine intake ranges from 200 to 250 mg/day. Recent epidemiological studies in France demonstrate the presence of moderate iodine deficiency in the majority of pregnant and lactating women. This iodine deficiency induces maternal thyroid hyperplasia and then development of goiter in women, as well as impaired thyroid parameters. Maternal hypothyroxinemia during the first trimester of pregnancy can be associated with abnormal cognitive development and intellectual outcomes in the newborn and the children. According to the recent World Health Organization recommendations for the prevention and control of iodine deficiency in pregnant and lactating women, systematic iodine supplementation is indicated in France: 100 microg/day for women of reproductive age and 200 microg/day in pregnant and lactating women in order to eradicate iodine deficiency during pregnancy and lactation, and prevent the maternal and fetal consequences.

Female↗
PubMed2006

Apolipoprotein E genotype and plasma lipid levels in Caucasian diabetic patients.

OBJECTIVE: Apo E polymorphism has been shown to affect lipid profiles in non-diabetic and diabetic populations. We evaluated the relationship between Apo E phenotype and fasting lipid plasma levels in type 2 diabetes patients. METHODS: Two hundred and ten French type 2 diabetic patients (115 men and 95 women) without any lipid lowering drugs were studied. Fasting lipids were measured by usual methods and Apo E genotype was established for each patient: PCR was followed by digestion of the amplification product with restriction enzymes and separation of the fragments by polyacrylamide gel. RESULTS: Genotypes epsilon3/epsilon3, epsilon2/epsilon3 and epsilon3/epsilon4, epsilon2/epsilon2 and epsilon2/epsilon4 were found in 68.1%, 14.8%, 15.7%, 1.0% and 0.5%, respectively. No patient had the epsilon4/epsilon4 genotype. Lipid plasma levels were compared between E3 group (epsilon3/epsilon3) as a reference and E2 (epsilon2/epsilon2 or epsilon2/epsilon3) or E4 (epsilon3/epsilon4 or epsilon2/epsilon4). Total cholesterol, LDL cholesterol and Apo B levels were lower in the E2 group. Total cholesterol, LDL cholesterol and Apo B levels were higher in the E4 group. HDL cholesterol levels were increased in the E4 group, as only previously observed in Japanese populations. CONCLUSION: These results agree with those already reported in diabetic patients of several western European countries. E4 allele carriers have a greater cardio-vascular risk and this could be partially explained by the metabolic variation in lipid metabolism induced by E4 with higher LDL cholesterol and Apo B levels. These results observed in French diabetic subjects without any lipid-lowering drugs may be used as a reference for other studies performed in France.

Aged↗
PubMed2005

Preparation, characterization and in vitro release properties of ibuprofen-loaded microspheres based on polylactide, poly(epsilon-caprolactone) and their copolymers.

In this paper, ibuprofen was encapsulated into microspheres by oil-in-water (o/w) emulsion solvent evaporation method. Biodegradable polymers with certain compositions and characteristics such as polylactide (PLA), poly(epsilon-caprolactone) (PCL) and their block copolymer were used to prepare the microspheres. The results indicate that, under the same processing conditions, the drug entrapment efficiency was similar (approximately 80%) for microspheres prepared with PLA and P(LA-b-CL) (78.7/21.3 by mole), but it was only 25.4% for PCL microspheres. The in vitro drug release rate decreased in the order of PCL, P(LA-b-CL) (78.7/21.3 by mole) and PLA microspheres. PCL microspheres showed more serious burst release during the first day (almost 80%) than P(LA-b-CL) (50%) and PLA microspheres (18%). The complete ibuprofen release duration from the last two kinds of microspheres exceeded 1 month. Characterization of the microspheres by differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and polarized optical microscope (POM) revealed that ibuprofen was amorphous in PCL microspheres and partially crystalline in P(LA-b-CL) and PLA microspheres. The different release behaviour of ibuprofen from the three kinds of microspheres could be attributed to the different crystallinity of the studied polymers and drug dispersion state in polymer matrices. All the above results suggest that the copolymer with a certain ratio of lactide to -caprolactone could have potential applications for long-term ibuprofen release.

Absorption↗
PubMed2004

[Fecal incontinence following anal sphincter rupture: influence of the aetiology on the repair results].

UNLABELLED: Short-term functional results are usually good after sphincter repair but they could deteriorate with time if the disruption is due to obstetric damage. The aim of this study was to compare short and long-term results after sphincter repair according to the etiology of the damage. METHODS: Fifty-five women have been operated on for a sphincter disruption due to obstetrical damage (Ob) (28) or to postoperative damage (Op) (27) and were retrospectively studied. Surgical procedure was similar for every patients but the puborectalis muscle was also approximated in case of obstetric damage. Functional results were recorded by clinical examinations two months after the operation and during the year 2001. RESULTS: The two groups were similar, except for the rate of defunctionning stoma undergone and for the duration of symptoms before the operation. Mortality and morbidity were similar between the two groups. Short-term functional results were better in the postoperative group (96 vs 78%) (P =0.05). At the end of the follow-up the results remained significantly better in group Op (85 vs 65%; P <0.05). The cumulative rates of functional good results also decreased more rapidly in group Ob but the difference was not significant. CONCLUSION: Short and long-time functional results after sphincter repair seem to be better in case of postoperative disruption. Pudendal nerve damages frequently observed after traumatic delivery could explain this difference.

Adult↗
PubMed2004

Cigarette smoking and diabetes mellitus.

OBJECTIVE: To assess whether an independent relationship between cigarette smoking and type 2 diabetes exists in both men and women selected from a French population, and to assess the effects of active smoking and smoking cessation on the prevalence of diabetes. METHODS: A population-based cross sectional study in 28,409 volunteers. RESULTS: After adjustment for age, BMI, waist-hip ratio (WHR) and alcohol, the risk of diabetes mellitus (estimated by the odds ratio) was 1.49 (1.13-1.96, P=0.004) and 1.31 (1.01-1.17, P=0.03) for current and former smoker men, respectively, as compared to non-smoker men. The risk was even higher in men aged 40 to 69. No association was found with the duration of smoking cessation. In women, the risk of diabetes associated with current smoking was much less significant [HR: 1.46 (0.92-2.22, P=0.09)], even in women aged 40 to 69 [HR: 1.60 (1.00-2.58, P=0.05)]. No relationship was found for past smoking in women. In non-diabetic men, the adjusted fasting glucose was similar in current and in non smokers, but it was higher in current smokers aged 40 to 69 (99.2 +/- 0.27 vs 98.7 +/- 0.14 mg/dl, P=0.05). It was higher in former than in non smokers (97.4 +/- 0.20 vs 96.0 +/- 0.10 mg/dl, P=0.0001), regardless of age. In non-diabetic women, the adjusted fasting glucose was lower in current than in non smokers (90.7 +/- 0.20 vs 91.4 +/- 0.12 mg/dl, P=0.0001), even in women aged 40 to 69 (93.0 +/- 0.35 vs 93.7 +/- 0.18 mg/dl, P=0.03). It was similar in former and in non smokers, regardless of the age. CONCLUSIONS: Current and past smoking are associated with a risk of diabetes mellitus essentially in men, but much less in women, and the relationship between fasting glucose and smoking appears different in men and women. No dose-relationship between the number of cigarettes smoked and diabetes mellitus was found. Smoking cessation is not associated with a reduced risk of diabetes.

Adult↗
PubMed2004

Comparison of men with impaired fasting glycaemia to controls and to diabetic subjects with fasting glycaemia from 7.0 to 7.7 mmol/l: clinical, nutritional and biological status.

OBJECTIVE: To compare medical history, clinical, nutritional and biological status of non-diabetic men to subjects with impaired fasting glycemia (glycemia 6.1-6.9 mmol/l) and to newly diagnosed type 2 diabetic subjects (7.0-7.7 mmol/l) according to the criteria proposed by the American Diabetes Association. METHODS: Cross-sectional study of a cohort of 29,992 men, who were volunteers for a free periodic check-up offered by their medical insurance. Medical history, lifestyle and nutritional habits were recorded using a self-administered questionnaire. Clinical and biological data were also studied. To compare the three groups of subjects - normal, impaired fasting glycemia and newly diagnosed diabetics - three age stratified samples were randomly designed. RESULTS: Most of the well-known risk factors for developing type 2 diabetes mellitus such as overweight, abdominal obesity, familial history of diabetes mellitus, over-consumption of fat and alcohol were present in the group with impaired fasting glycaemia which presented the same risk factors as the group of subjects with fasting glycaemia from 7.0 to 7.7 mmol/l, but to a lesser degree. Hypertension was present in more than 50% of the subjects with impaired fasting glycaemia. CONCLUSION: In this cross-sectional study, impaired fasting glycaemia is associated with the risk factors of type 2 diabetes mellitus. The subjects with impaired fasting glycaemia should be considered at risk for cardiovascular disease and might take advantage from early specific intervention about their lifestyle.

Adult↗
PubMed2004

Aberrant adrenal sensitivity to multiple ligands in unilateral incidentaloma with subclinical autonomous cortisol hypersecretion: a prospective clinical study.

BACKGROUND: Incidentally discovered adrenal tumours are frequently associated with subclinical autonomous cortisol hypersecretion of unknown origin. Aberrant hormone receptors have been observed in case reports of overt Cushing's syndrome. The question arises as to whether such receptors may be present in the functioning adrenal incidentaloma, which is common and might be a subclinical stage of Cushing's syndrome. PATIENTS AND METHODS: Twenty-one consecutive patients with a unilateral incidentaloma, the biochemical features of subclinical cortisol hypersecretion and/or the scintigraphic features of an autonomously functioning adrenal adenoma were investigated for plasma cortisol responses to various stimuli: upright posture, meal, combined hypothalamic-hormones, the vasopressin analogue terlipressin, glucagon, angiotensin II, the serotonin 5-HT4 agonist cisapride, and ACTH. Six normal controls were similarly investigated. All subjects were studied during 8 mg per day dexamethasone in order to avoid any ACTH-dependent variation of plasma cortisol. RESULTS: The most constant responses in adrenal incidentalomas were observed after stimulation by terlipressin (18/20 patients, 28-415% cortisol increase) and cisapride (17/21 patients, 25-364% cortisol increase). Eighteen out of 21 patients responded to several stimuli (cortisol increase >or= 25%), and all responded to at least one stimulus other than ACTH, while such responses were absent in the controls. Plasma ACTH remained suppressed in all subjects throughout the study. CONCLUSIONS: Aberrant membrane receptors detected by in vivo stimulation tests appear to be common in autonomously functioning unilateral adrenocortical adenomas. These receptors may be involved in the modulation of cortisol secretion in adrenal incidentaloma, with potential therapeutic consequences for the control of subclinical cortisol hypersecretion.

Adenoma↗
PubMed2003

Post-partum recurrent sarcoidosis associated with type 1 diabetes mellitus.

Immunologic abnormalities observed in sarcoidosis may suggest a link between this affection and autoimmune endocrine diseases. Indeed a high frequency of autoimmune thyroïd diseases is observed in sarcoidosis. However association of type 1 insulin-dependent diabetes mellitus with sarcoidosis is rare. We report the case of a type 1 diabetic woman in whom clinical and biological signs of sarcoidosis appeared after her first pregnancy with a relapse in the post-partum period of a second pregnancy. Diagnosis of sarcoidosis was established on characteristic cutaneous, articular and pulmonary manifestations associated with elevated plasma levels of angiotensin converting enzyme. From this case, association between type 1 diabetes mellitus and sarcoidosis has been discussed as well as reciprocal relationship between sarcoidosis and pregnancy. Since familial history of sarcoidosis was present in this case, familial aspects of sarcoidosis have also been reviewed.

Adult↗
PubMed2002

[Bone mineral density and biological markers of bone repair in patients with adrenal incidentaloma: effect of subclinical hypercortisolism].

PURPOSE: Some adrenal incidentalomas produce cortisol in mild excess ('subclinical' Cushing's adenomas) and can potentially induce osteopenia. Their diagnosis is usually based on exclusive tumour uptake on adrenal scintigraphy using 131I-6 beta-methyl-iodo-19-norcholesterol and on inadequate cortisol response to dexamethasone (DXM) suppression tests. The aims of the present study were to evaluate bone mineral density (BMD) and metabolic markers of bone turnover in patients with incidentalomas and to test the effect of mild hypercortisolism on bone parameters. METHODS: Thirty-five patients (13 men, 22 postmenopausal women, 49-76 years) with unilateral incidentaloma were studied. BMD was measured by dual X-ray absorptiometry. Two biochemical markers of bone formation, serum osteocalcin (BGP) and bone alkaline phosphatase (bALP), and two markers of bone resorption, urinary free deoxypyridinoline (D-Pyr) and urinary carboxy-telopeptide of bone type 1 collagen (CTX), were measured by radioimmunoassay. D-Pyr and CTX were corrected for creatinine excretion. RESULTS: Median values of lumbar and femoral T-score were -1.125 and -0.920, respectively, whereas corresponding Z-score values where normal (0.105 and 0.120, respectively). Thirty-nine percent of patients had low serum BGP values and 3% had low bALP values; 16% showed elevated D-Pyr/creatinine values and 23% increased CTX/creatinine values. Patients both with suppression of the contralateral adrenal on scintigraphy and with an inadequate cortisol response to 1 mg DXM (> 50 nmol/L) (n = 14) presented a lower femoral T-score (P < 0.02) and, to a lesser extent, a lower femoral Z-score (P = 0.11) than other patients (n = 21). The proportion of increased values of CTX/creatinine (42% versus 11%, P = 0.08) also tended to be higher in the first than in the second group of patients. These two groups of patients were similar in terms of age, but tumour size was larger (P < 0.04) and plasma ACTH value was lower (P < 0.02) in patients with scintigraphic and endocrine abnormalities. CONCLUSION: Subclinical hypercortisolism defined on the basis of scintigraphic and hormonal criteria seems to contribute to bone loss in patients with adrenal incidentaloma. As other possible side effects of mild hypercortisolism, these findings have to be taken into account in the therapeutic management of these patients.

Adrenal Gland Neoplasms↗
PubMed2002

[Diagnostic strategy in persistent hyperparathyroidism. Report of two cases and review of the literature].

Ectopic adenoma is the main cause of surgery failure in the treatment of primary hyperparathyroidism (HPT). Localization of the abnormal glands is therefore necessary before a reoperation. We report two cases illustrating the interest of MRI and selective venous sampling of parathormone. In two patients with persistent hyperparathyroidism, ultrasound and sestamibi scanning failed to localize the ectopic glands. MRI suggested the presence of an adenoma in the mediastinum for the first patient and inside the thyroid for the second. In both cases, the localisation was confirmed by venous sampling and the reoperation was a success. We review the recent literature on this topic and we propose a diagnostic approach of persistent HPT.

Adenoma↗
PubMed2002

Impaired fasting glycaemia and undiagnosed diabetes: prevalence, cardiovascular and behavioural risk factors.

BACKGROUND: Early discovery of type 2 DM (NIDDM) is essential. The diagnostic criteria of DM have been recently modified (FBG 126 vs 140 mg/dl) and the characteristics of undiagnosed subjects in large populations must be defined. At the same time subjects with impaired FBG need to be studied mainly for their cardiovascular complications. METHODS: During 14 months, 61,724 male and female subjects (mean age 40) were explored in the French Institute for Health Protection (I.R.S.A). Clinical data, FPG, CV risk factors and dietary habits collected. Cut-off value for FPG: 110-125 mg/dl (IFG) (G2), 126-139 mg/dl defining undiagnosed diabetes with no history of diabetes. Subjects with FPG >=140 mg/dl (G4) former ADA/WHO criteria for diabetes and with the new criteria (FPG: 126-139 mg/dl) (G3) were compared to IFG (G2) and controls<110 mg/dl (G1). RESULTS: With the new criteria (>=126 mg/dl) the prevalence of unknown diabetes in the cohort was 1.2% accounting for 41% of the overall prevalence of the disease (known + unknown). This is nearly 2.5 times more than with the previous criteria, > 140 mg/dl, (1.2 vs 0.5%). In G2/G1 and G3/G2 highest FPG had higher BMI, H/W ratio, heart rate (male only G3/G2), BP, gamma GT (role of alcohol in males), uric acid and TG. A role of absence of breakfast, low dairy products consumption is found. No difference between G4 and G3 found. CONCLUSION: These results support the new criteria of FPG 126 mg/dl and suggest that it would be necessary to investigate and prevent cardiovascular risk factors as soon as fasting glycaemia is found to be over 110 mg/dl. Nutritional and behavioural education should be given at this early stage of the disease.

Adult↗
PubMed2001

Behavior of hexavalent chromium in a polluted groundwater: redox processes and immobilization in soils.

This work describes the chemical mechanisms governing transport and reduction of hexavalent chromium in soils of a contaminated industrial waste landfill. Groundwater and soil analyses indicate that the main source of chromium is a slag heap essentially consisting of mill tailings. In the groundwater, downstream migration of Cr(IV) is limited thanks to a redox mechanism involving chromate ions and ferrous ions or Fe(II)-bearing minerals. High Fe2+ concentrations in the groundwater are a result of pyrite residues from old activities at the site. Analyses of soil samples reveal that chromium is preferentially located in the soil profile at the fluctuation of the groundwater level. Grain size fractionation of four soil samples was performed, and fraction analyses show that chromium is preferentially accumulated in the clay fraction (<2 microm) and more specifically associated with montmorillonite particles. This work is a demonstration of the reduction of Cr(VI) by Fe(II) studied previously in the laboratory (Buerge, I. J.; Hug, S. J. Environ. Sci. Technol. 1997, 31, 1426-1432; Fendorf, S. E.; Li, G. Environ. Sci. Technol. 1996, 30, 1614-1617; Sedlak, D. L.; Chan, P. G. Geochim. Cosmochim. Acta 1997, 11, 2185-2192) in a field setting. Cr(VI) migration into the groundwater is stopped vertically by the very thick green clay unit and horizontally by the presence of Fe(II) acting as a chemical barrier. The specific site conditions safely prevent any extension of the Cr pollution.

Carcinogens, Environmental↗
PubMed2001

Pheochromocytoma in multiple endocrine neoplasia type 2: a prospective study.

OBJECTIVE: The aim of this prospective study is to update our knowledge of the chronology of pheochromocytoma occurrence in multiple endocrine neoplasia type 2 (MEN 2), and to better manage MEN 2 patients after the genetic diagnosis. DESIGN: Eighty-seven non-index gene carrier MEN 2 patients were included in this prospective study: 84 patients with MEN 2A (from 52 families) and 3 with MEN 2B (from 3 families). METHODS: Medullary thyroid carcinoma (MTC) was diagnosed by measuring plasma calcitonin in basal conditions or after pentagastrin stimulation. The search for pheochromocytoma consisted of clinical evaluation, 24 h determination of urinary catecholamines and adrenal imaging. The mean age at genetic diagnosis of MEN 2 was 14.0+/-7.0 years, the mean duration for the follow-up was 7.6+/-2.8 years. RESULTS: All 87 patients had a MTC detected at the same time as the genetic diagnosis was made. Urinary catecholamine measurements led to the diagnosis of pheochromocytoma and a combination of imaging techniques enabled the correct localization of both unilateral or bilateral adrenal involvement. Pheochromocytoma was detected simultaneously with MTC in only seven patients, and seven others were detected throughout the follow-up. Of the 14 patients with pheochromocytoma, 11 had bilateral involvement: nine were initially bilateral and two became so during follow-up. CONCLUSION: This study demonstrates that in MEN 2, MTC is the lesion which appears earliest. Pheochromocytoma develops later during the evolution of the disease, and necessitates regular clinical and biological monitoring throughout follow-up. Determination of urinary and/or plasma catecholamines and metanephrines should be performed to detect pheochromocytoma. Imaging techniques lead to the detection of both unilateral and bilateral pheochromocytoma, thus making video-assisted laparoscopic adrenalectomy possible.

Adolescent↗
PubMed2001

[Malt lymphoma of the thyroid and Graves'disease].

Maltoma of the thyroid associated to Graves'disease is not such a frequently described association. We report a case of Maltoma of the thyroid gland in a patient with Grave's disease. The diagnosis was established by histological examination after total thyroidectomy. Slow enlargement of the thyroid gland despite a clinically successful antithyroid drug therapy could be considered as an advocating clinical manifestation. Associated anti-neoplastic chemotherapy and cervical irradiation resulted in good outcome with six years follow-up. A review is presented on treatment and prognosis of these tumors.

Antithyroid Agents↗