Françoise Fery

Correlates of fractures in elderly, diabetic outpatients

It is widely recognized that patients presenting diabetes are at increased risk for fractures. In a retrospective case-control study, 101 cases were selected from medical charts of outpatients older than 70 with diabetes mellitus and a fracture within the past 5 years. Glycosylated hemoglobin (HbA1c) had been measured within 4 months around the assessment. Each case was matched for sex and age with one control, diabetic patient with no fracture. HbA1c level was similar in both groups. Patients with fractures presented significantly lower BMIs than controls, and had a higher rate of declared osteoporosis and comorbidity. A small number of cases were using vitamin D supplements while more were treated with benzodiazepine, opiates and Selective serotonin reuptake inhibitors (SSRI). This study suggests that, rather than the tight control of blood glucose, other factors such as medication and comorbidity could be associated with fracture risk in elderly diabetics.

Bilateral Duane's syndrome associated with hypogonadotropic hypogonadism and anosmia (Kallmann's syndrome)

A case of bilateral Duanes retraction syndrome (DRS) type III associated with Kallmanns syndrome (hypogonadotropic hypogonadism and anosmia) is reported. Both anomalies may result from a disturbance of embryogenesis during the second month of gestation. The authors associate bilateral type III DRS with congenital horizontal gaze paralysis.

Beneficial Outcomes of Sleeve Gastrectomy in a Morbidly Obese Patient With Bardet-Biedl Syndrome

Context: Severe obesity is one of the major features of Bardet-Biedl syndrome (BBS) and causes reduced life expectancy. Bariatric surgery is an effective treatment of morbid obesity. Data on the effect of bariatric surgery for monogenic obesity is essentially lacking. We present the clinical and metabolic 3-year follow-up of sleeve gastrectomy in a BBS patient. Case Description: A 37-year-old obese woman with BBS (body mass index, 40 kg/m2) was referred to our clinic for uncontrolled diabetes, dyslipidemia, hypertension, and nonalcoholic fatty liver disease (NAFLD). After sleeve gastrectomy, progressive weight loss was observed, with a 32% total weight loss at 3-year follow-up. Glycemic control and NAFLD improved significantly. Blood pressure normalized, and treatment was discontinued 3 months after surgery. Conclusions: Laparoscopic sleeve gastrectomy can be a safe and effective treatment of morbid BBS-related obesity in adult patients. Significant and sustained weight loss leads to the improvement of several obesity-related comorbidities such as diabetes, hypertension, and NAFLD, as in polygenic obesity. Further data are needed to confirm the long-term efficacy and safety of bariatric surgery in BBS.

Rôle des corps cétoniques dans l'homéostasie énergétique

Resume Les corps cetoniques, produits de loxydation hepatique partielle des acides gras, jouent un role important dans la regulation de lapprovisionnement energetique de lorganisme. Lors dun jeune prolonge, modele de cetose physiologique, les corps cetoniques sont captes et oxydes par le cerveau ce qui reduit lutilisation du glucose par cet organe. La captation cerebrale est facilitee par une saturation des capacites de la masse musculaire a utiliser les corps cetoniques a haute concentration. Lhypercetonemie est remarquablement stable lorsque la duree du jeune depasse 7 a 10 jours. Ce phenomene sexplique par le fait que les corps cetoniques tendent a inhiber leur propre production en raison de leur effet insulinosecretoire et de leur action antilipolytique. Au cours de la cetose diabetique, la cetogenese nest plus correctement inhibee par ce phenomene de retrocontrole negatif en raison de labsence de secretion insulinique. Il a ete suggere que les corps cetoniques contribuent a lepargne du capital proteique caracterisant le jeune prolonge. Cette hypothese na cependant pas pu etre confirmee et lhypercetonemie est sans effet inhibiteur sur la proteolyse chez des patients atteints daffections cataboliques severes.