[Value and diagnostic significance of serum lactic dehydrogenase in internal medicine (author's transl)]. / Intérêt et signification diagnostique de la lacticodéshydrogénase plasmatique en médecine interne.

Among 2175 patients seen over the last three years in a non-specialized department of internal medicine with no intensive care unit, 100 had supranormal serum lactic dehydrogenase activities. These patients' case-reports have been analyzed. Nearly half the patients (47/100) had a malignant disease (cancer or hemopathy). Among the remaining patients, 19 had a hepatic disorder (alcohol hepatitis in 10, viral hepatitis in 8, and isoniazide hepatitis in 1), 7 had a heart disease (heart failure with hepatomegaly in 5, myocardial infarction in 2), and 27 had various other conditions (including hemolysis in 6 and polymyositis en 3). The value of serum LDH assay is obvious in situations other than acute conditions such as myocardial infarction of pulmonary embolism; these are better known and have not been studied here as their prevalence was low among the patients enlisted in our study. In comparison to other enzymes (alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), transaminases (GOT, GPT) that were also routinely assayed in our patients, abnormal serum LDH activities are much less common and their significance is quite different. An increase in serum and their significance is quite different. An increase in serum LDH activity indicates a serious condition, often with a fatal outcome. The "various other conditions" group includes patients with hemolysis, hepatitis and myositis; the other patients in this group either had severe infectious diseases or died suddenly in the first few days of their hospitalization before diagnosis had been established. Each etiologic group has been analyzed to asses the characteristics of patients with increased LDH activity according to each etiology. Analysis of coincident abnormalities of the other enzymes listed above shows marked differences between etiologic groups; diagnostic accuracy can thus be enhanced in certain conditions. Most patients with malignancies had poorly differentiated tumors, with metastases: 28 had an epithelial tumor, with hepatic and/or bone metastases in 23 cases, 5 had cancer of the liver, 10 had a malignant hemopathy (2 lymphomas, 5 myeloproliferative syndromes, 3 acute leukemias), and 4 had a sarcoma. Cancer of the lung is the most common malignancy (10 cases) and may be responsible for increased serum LDH activity even in patients without metastases. Serum LDH assay is of value for monitoring the course in patients with initially increased activities as it falls under effective therapy and rises during exacerbations.

[A medical investigation of 160 chronic alcoholic patients hospitalized in a department of internal medicine. Nature and pathological consequences of the intoxication (author's transl)]. / Etude de cent soixante malades alcooliques hospitalisés en médecine interne. Nature et déterminisme de l'intoxication. Corrélations avec le retentissement pathologique.

160 hospitalized chronic alcoholics (124 men and 36 women) were evaluated by the same person. 21 biologic parameters were assessed. A histopathological examination of the liver was performed in 57.5% of the cases. The average daily alcohol consumption (ADAC) during the last five years exceeded 80 g in 140 patients. Results were as follows. Alcoholics usually have a poor socio-economic and professional background and a low educational level, most of them being farmers or workers. The ADAC is 170 g/day for an average duration of 32 +/- 3 years. The diet is unbalanced. The consumption of tobacco is related to age, sex and ADAC. There is no significant correlation between hepatic lesions (cirrhosis: 37 cases, alcoholic hepatitis without cirrhosis: 83 cases, normal liver: 36 cases) and age, sex, diet, ADAC, or the duration of intoxication. Pancreatic involvement was found in 13 patients (6.8%). Neuropsychiatric features were present in 92% of the patients. A significant correlation was found between stellar angiomas, clinical liver involvement, and ADAC, between palmar erythrosis, and clinical liver involvement and between hippocratism and ADAC. VMC and Gamma GT levels are significantly correlated to liver involvement and ADAC. There is a linear correlation between VMC and Gamma GT. The Gamma GT/BUN ratio is significantly correlated to ADAC. No correlation was found between serum vitamin B12, serum folic acid and VMC. No patient was HbS antigen-positive. Anti-HbS antibodies were found in 19.2% of the cases.

[Low 25-hydroxy-vitamin D (25-OH-D) plasma levels in pathology (author's transl)]. / Diminution des taux sériques de 25-hydroxy-vitamine D en pathologie.

Between october 1976 and march 1978, 160 patients with low 25-OH-D plasma levels were observed (25-OH-D less than 7 ng/ml). In this population, a high frequency of asthenia, anorexia, vertebral demineralization were noticed. Mean plasma level of calcium was significantly lower than controls. Mean plasma level of alkalin phosphatases was significantly higher than controls. These patients presented a varied pathology. These diseases were probably responsible for the low 25-OH-D plasma level. The mechanisms were varying, but anorexia and sun exposure defect were likely the main cause of the low 25-OH-D plasma level.