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The incidence of breast cancer is rising in all industrialized countries. In France, with 41,000 new cases and 11,000 deaths per year, breast cancer is still the first cause of death from cancer in women. Genetic familial breast cancer is rare (only-2% due to mutated BRCA1/2 genes). Most of the increase is due to sporadic cases associated with hormonal, reproductive and nutritional factors, some of which can be avoided. Prevention should include: - avoidance of risk factors such as alcohol, obesity, smoking, sedentarity, and, when possible, late first pregnancies and absence of breast feeding. - Lesser use of hormone replacement therapy, in order to avoid the tumor-promoting action of ovarian hormones; this is supported by the strong fall in the incidence of breast cancer in U.S.A after 2002, following a drop in the use of HRT by post-menopausal women. - For very-high-risk women (BRCA 1/2 mutations, or in situ carcinoma with proliferative atypia), chemoprevention with SERM should be authorized, based on randomized trials of tamoxifen and raloxifen. New trials of other agents should be encouraged. - Risk indexes such as that developed by the NCI should be more widely used. - More research on the early steps of human mammary carcinogenesis should be encouraged, as this should lead to individual targeted prevention.

Recent epidemiological evidence suggests that patients with obstructive sleep apnea (OSA) have an increased risk of periodontal disease. Little is known about the oral health of OSA patients treated by continuous or bi-level positive airway pressure (CPAP/BiPAP). The aim of this population-based case–control study was to compare oral health variables (amount of plaque, calculus, gingival inflammation, and masticatory function) between CPAP/BiPAP users and control subjects. The study population was retrieved from a French cohort examined between 2012 and 2013 at the Centre d’Investigations Preventives et Cliniques of Paris. Cases were selected if they reported to be treated by CPAP/BiPAP; controls were age-, gender-, and BMI-matched based on a 1:2 ratio. Univariate and logistic regression analyses were performed for group comparisons. Over a total of 20,436 subjects, 287 CPAP/BiPAP users (mean age (SD) 57.6 years (11.5); 76.3 % males) who underwent medical and dental examinations were compared with 574 matched controls (no OSA, no CPAP/BiPAP). CPAP/BiPAP users reported significantly higher prevalence of diabetes (15.6 vs. 10.3 %; p = 0.012; odds ratio (OR) 1.68), history of hypertension (36.5 vs. 26.1 %; p = 0.003; OR 1.62), cardiovascular diseases (14.1 vs. 8.8 %; p = 0.029; OR 1.69), and sleep complaints (59 vs. 34.4 %; p = 0.0001; OR 2.75). CPAP/BiPAP users also showed higher levels of depression and stress compared to controls. However, no group difference was observed for the amount of dental plaque, calculus, gingival inflammation, and masticatory function. Oral health of OSA patients treated by CPAP/BiPAP is comparable to that of matched controls in terms of amount of plaque, gingival inflammation, and masticatory function.

RESUME Les THS compensent l’arret de secretion ovarienne survenant a la menopause en associant un estrogene et un progestatif par voie generale qui protege du risque de cancer de l’endometre. Chez la femme ayant subi une hysterectomie, les risques d'un TES avec estrogene seul sont moins connus. L’objectif de ces substitutions est double : — le traitement des symptomes de carence en estrogenes lors de l’installation de la menopause (bouffees de chaleur, insomnie, secheresse vaginale, etc). — la prevention de la perte osseuse post-menopausique et des fractures. Il s'agit d'un probleme de sante majeur. Plus de 10 millions de femmes sont menopausees en France, et un THS est prescrit a environ 2 millions de ces femmes. Depuis son introduction (1942 aux USA. 1965 en France) la majorite des etudes biologiques et des etudes epidemiologiques d’observation indiquaient nettement plus de benefices (cardio vasculaire, osteoporose, neuronal, qualite de vie) que de risques (thrombo-embolies, cancer du sein). A partir de 2002. les essais randomises a grande echelle(HERS. WHI) confirment l'effet protecteur contre l’osteoporose et les fractures et l’effet deletere sur les thrombo- embolies. Ils demontrent des effets nefastes (cancer du sein, infarctus du myocarde et A V C) qui inversent le rapport benefices / risques d'un THS prolonge quand on considere le nombre d'evenements graves. Les etudes HERS et WHI portaient sur une association estro progestative, peu utilisee en France. En 2003. la Million Women Study (M W S) rapporte avec certains des THS et TES utilises en Europe et sur plus d'un million de femmes Britanniques de 50 a 64 ans, un risque de cancer du sein superieur avec des progestatifs utilises en France (RR = 2.17a + de 5 ans) que sans progestatif (RR = 1.25). Bien qu'aucune etude controlee a grande echelle n'ait ete initiee a ce jour en France, il est vraisemblable que ces resultats sont extrapolables a notre population. La neuro protection (Alzheimer) a ete envisagee, mais reste a demontrer. Les effets opposes sur les cancers colo-rectaux et ovariens sont a confirmer. Sur la base de ces resultats un groupe de travail de l’Academie nationale de Medecine, constitue de representants des diverses disciplines medicales concernees, emet des recommandations sur 2 points : — la prise en charge par le medecin des femmes menopausees (diminution des indications en prevention de l’osteoporose, conservation du THS pour le traitement des symptomes vaso moteurs quand ils sont importants — la necessite d’accentuer les recherches (cliniques et biologiques) en Europe pour valider et faciliter l’utilisation des THS actuels et inventer des THS aussi efficaces mais moins agressifs.

Uterine oestrogen (ER) and progesterone (PR) receptors are subject to fine hormonal control by oestradiol and progesterone. In order to assess the role of ER and PR measurement in the evaluation of endometrial maturation, both receptors were studied by immunocytochemical techniques using monoclonal antibodies during the menstrual cycle, and in women with inactive ovaries treated by different regimens of hormonal substitution with oestradiol and progesterone. During the normal menstrual cycle, the concentrations and distribution of ER and PR changed markedly. During the mid follicular period (days 7-8), a small proportion of stromal and glandular cells stained positively for PR while staining for ER was more intense and more frequent. During the late follicular phase and early luteal period (days 9-19), the staining for PR increased markedly in glandular cells. During the mid and late luteal phase (days 21-27), ER and PR staining disappeared in glandular cells. Thus, while oestradiol increases the staining for ER and PR in both glands and stroma, progesterone decreases ER and PR staining in the glands in a dramatic fashion. These variations, especially the disappearance of PR under the effect of progesterone, are potentially useful for studying the cumulative effect of progesterone on endometrial maturation. This was confirmed in anovulatory women, where a late luteal phase aspect was observed, i.e. the absence of a reduction in ER and PR in glandular cells. In women with ovarian failure, the disappearance of ER and PR in glandular cells is correlated with the duration of progesterone therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrinologists at Hospital Bicetre in France studied the mechanisms of action of the 2nd generation gonadotropin releasing hormone (GnRH) antagonist Nal-Glu by administering it to castrated rams to those whose testes had not descended and to intact rams. It caused a significant and precipitous reduction in luteinizing hormone (LH) plasma levels within 2 hours in castrated rams. Yet it caused a rise in portal blood GnRH levels and in GnRH pulse frequency in intact rams and rams with undescended testes. Thus Nal-Glu did not influence the hypothalamus except to undo the negative feedback of testosterone. The researchers also injected 10 mg Nal-Glu on the 10th day of the follicular phase in normal women which lengthened the follicular phase from 16-22.8 days. Nal-Glu administration on day 10 also reduced plasma LH for 24 hours and estradiol levels for 72 hours; yet the reduction in plasma follicle stimulating hormone levels was not significant. The researchers administered 10 mg Nal-Glu to 5 other women on day 1 7 14 and 21 of their cycle which delayed ovulation and reduced mean estradiol levels. Further when researchers injected 10 20 or 30 mg Nal-Glu before ovulation and if estradiol levels were at least 150 pg/ml on the day of injection the preovulatory follicle was more or less independent and ovulation was not always delayed. Still ovulation did not occur in the original women during treatment. When the endocrinologists injected Nal-Glu during the luteal phase the corpus luteum function declined as the Nal-Glu dose size increased. They learned also that administration of low dose human chorionic gonadotropin (hCG) can restore corpus luteum function only if hCG is not blocked from the corpus luteum for more than 48 hours. These results indicated that clinicians can probably use GnRH antagonists in women to prevent LH surges in controlled ovarian hyperstimulation.

Two observations of operated thyrotrope adenoma are reported. So as not to misjudge this very rare pathology, mixing both T 4 L and ultrasensible T.S.H. must be mentioned again as very important. Both the measuring out of sub-unit and the T.R.H. test allow the watch, and the detection of a possible recurrence. The importance of the medical treatment with Octreotide must be underlined.

Four patients, treated with pentamidine because of Pneumocystis carinii pneumonitis, displayed severe fasting hypoglycemia during this treatment. Diabetes mellitus appeared later, requiring insulin therapy in the three of them who survived more than a few weeks. The metabolic study, performed in two cases during the hypoglycemic period, demonstrated inappropriately high insulin levels in the postaborptive state. 28 ± 1 μU/ml (blood glucose 41 ± 4 mg/dl) and 86 ± 5 μU/ml (blood glucose 15 ± 5 mg/dl) vs. 15 ± 3 μU/ml in 10 control subjects and 55 ± 3 μU/ml in 6 patients with a verified B-cell tumor, respectively. Poor B-cell secretory responses followed the stimulations by oral glucose (maximal increment over basal: +5 μU/ml vs. +40 μU/ml in control group and +77 μU/ml in the insulinoma group), by i.v. arginine (maximal increment +10 and +28 μU/ml, respectively, vs. +55 in the controls and +90 μU/ml in the insulinoma group) and by i.v. glucagon (+10 and +23 μU/ml, respectively) vs. +40 μU/ml in both the control and the insulinoma groups). Plasma cortisol and glucagon, and the A-cell response to arginine were higher than normal. These high, nonsuppressible, nonstimulable insulin levels and the sequence of hypoglycemia followed by insulin-dependent diabetes mellitus is consistent with the hypothesis of a selective toxicity turned towards the B-cells. In vitro incubation of islets with pentamidine 10−10 M produced a passive release of insulin, followed by a significant decrease in B-cell response to glucose + theophylline. It is suggested that pentamidine can induce hypoglycemia because of an early cytolytic release of insulin, and then diabetes mellitus because of B-cell destruction and insulin deficiency.

In a study of nonsurgical therapy of Cushing's disease, 62 patients received O,p'-dichlorodiphenyldichloroethane (O,p'DDD), 16 of whom also received cobalt irradiation of the pituitary. After an initial treatment period averaging eight months, a remission of the disease was obtained in 38 of the 46 patients given O,p'DDD alone and in all patients who received drug combined with radiation. Although 60 per cent of these patients subsequently relapsed, additional courses of drug or radiation therapy were usually effective, and 63 per cent of the entire group of patients have so far been kept under control without adrenalectomy. (Forty patients have been followed for at least two years after the initial course of treatment.). O,p'DDD produced little gastrointestinal discomfort; an increased serum cholesterol was the main side effect. This drug allows long-term medical management of Cushings disease in most cases. Whether the combination of O'p'DDD with pituitary radiation is the best therapy has not been established.

We report the magnetic resonance findings in a case of post-traumatic diabetes insipidus (DI). They consisted of pituitary stalk rupture shown on both coronal and sagittal planes with associated disappearance of the normal high signal intensity of the posterior lobe on T1 images. This last sign, previously described in nontraumatic DI, appears to represent a finding indicating nonfunctioning neurohypophysis.