[Glucose intolerance and post-stimulatory hypoglycemia secondary to a probably congenital intrahepatic portacaval anastomosis]. / Intolérance au glucose et hypoglycémie post-stimulative secondaires à une anastomose porto-cave intrahépatique vraisemblablement congénitale.

Recurrent malaise in a 63 year old woman were found to be due to hypoglycaemic episodes. During a 5 hour oral glucose tolerance test, the "impaired glucose tolerance" type initial hyperglycaemic wave was followed by a post-stimulative hypoglycaemia. Serum C-peptide levels were normal during the test, but the insulin response which was initially normal became excessive, with a consequent decrease of the C-peptide/insulin ratio, similar to that usually observed in hepatic malfunction. An hepatic ultrasonography, a cavography and a selective superior mesenteric arteriography showed an intra-hepatic porto-caval anastomosis, probably congenital in origin. This vascular abnormality accounts for the blood glucose problems: the porto-caval shunt explains the early hyperglycaemia by defective liver uptake of glucose and secondary hyperinsulinism occurs because of the reduced hepatic degradation of the insulin secreted in normal quantity. The late hyperinsulinism then leads to secondary hypoglycaemia.

[The concept of protein profile]. / Le concept du profil protéique.

From their own experience of the simultaneous immunonephelometry of eight serum proteins, the authors propose a definition of protein profile from the point of view both of laboratory technique and interpretation. The assay should be performed quickly and the results expressed diagrammatically in normalised values, in such a way that the relative variation in protein levels can be easily visualised. A protein profile should thus comprise a minimum of proteins to be measured, chosen according to protein physiopathology and the type of abnormality under investigation. Interpretation is based on inter-protein correlations that may appear or disappear depending on the underlying physiopathology. This makes it possible to study inter-protein variation and thus avoid the probabilistic "interpretation" of single proteins taken in isolation. From this approach syndromes can be divided into two groups, elementary or complex. The authors provide examples of each, and propose an interpretation model based on this dichotomy.