Use of somatostatin analog for localization and treatment of ACTH secreting bronchial carcinoid tumor.

A 29-year-old woman presenting with an ectopic adrenocorticotropic hormone syndrome and a nodule of the upper lobe of the left lung was explored by indium 111 (111In) octreotide scintigraphy. This showed a pathologic uptake by the nodule. Treatment with octreotide resulted in the rapid control of hypercortisolism prior to surgery.

[Comparative effects of couscous and pasta on glycemia in normal subjects and type I diabetics]. / Effets comparés du couscous et des pâtes alimentaires sur la glycémie des sujets sains et diabétiques de type I.

8 healthy subjects have eaten in the morning, after an overnight fast, in two separated occasions and in a randomised order 50 gr of CHO as pasta or couscous. Blood glucose after pasta ingestion was lower at 30 mn (p less than 0.05) at 45 mn (p less than 0.01) and at 60 mn (p less than 0.05). Area under the curve after pasta was significantly reduced (p less than 0.01). In a second time 6 IDDM patients have eaten in a randomised order a meal made of pasta with tomato sauce (P = 11%, F = 30%, G = 59%) or couscous with vegetables and sauce (P = 10%, F = 37%, G = 53%). Blood glucose after the pasta was lower than couscous at 90 mn (p less than 0.05) the area under the curve after the pasta ingestion was reduced of 38% but did'nt reach significance. In conclusion couscous has a higher glycemic effect than pasta although it has a similar composition. This phenomenon is still observed when the cereal products are mixed with other foods and ingested by IDDM patients.

[An association of Addison's disease, achalasia of the cardia and alacrimation. Apropos of 2 cases]. / Association d'une maladie d'Addison, d'une achalasie du cardia et d'une alacrymation. A propos de deux observations.

We report two cases of a syndrome combining Addison disease, cardial achalasia, and alacrimation in two girls aged 4 and 5 1/2 years. Moreover, these patients exhibited some unusual features: both also had mineralocorticoid deficiency, and one had loss of tongue papillae and absence of the pupillary reflex. This syndrome is infrequent. Etiology is unknown. Pathophysiology is under debate; autonomic nervous system dysfunction seems likely. We have analyzed the features of this syndrome on the basis of our two observations and the 15 previously reported cases.

[Polyradiculoneuritis revealing broncho-pulmonary cancer. A case report and brief review of the literature]. / Polyradiculonévrite révélatrice d'un cancer broncho-pulmonaire. Rapport d'un cas et revue brève de la littérature.

We report a case of a 64 year old male who was a chronic smoker who presented with walking troubles and an acute severe deterioration in his general health. Examination revealed a polyradiculoneuritis. A search for a cause revealed a poorly differentiated epidermoid carcinoma of the lung. Thus the final diagnosis was that of paraneoplastic P.R.N.

HLA A, B, and DR antigens and complotype in Tunisian patients with diabetes mellitus.

The frequency of HLA A, B, and DR antigens as well as the Bf and C4 allotypes have been investigated in insulin-dependent diabetes mellitus (IDDM) and compared to that of healthy controls in the Tunisian population. An increase of A30, DR3, DR4, BfF1, C4Ao, and C4Bo and decrease of B40, DR2, DR5, and DR6 were found in diabetics when compared to the value observed in controls. The strongest association was noticed with HLA DR3 and DR4. Heterozygotes DR3 DR4 were very frequent in diabetics: 24.2 per cent versus 3.6 per cent in controls (relative risk 7.72). The protective role of DR2 and DR5 antigens were also confirmed. No supratypes of HLA, Bf, and C4 alleles associated with IDDM have been observed among these Tunisian patients.

[Sex hormones and the skin]. / Hormones sexuelles et peau.

The relationship between sex hormones and the skin is increasingly considered to be very important. The skin has appropriately been called "A peripheral endocrine gland". In this review some aspects of the cutaneous metabolism of oestrogens, progestogens and particularly androgens are analyzed. Production of skin collagen is markedly enhanced by oestrogens. Progestogens with strong androgenic activity and especially androgens have a powerful stimulating action on all skin elements particularly the epidermis and the dermis the sebaceous glands and the hair. The skin manifestations of hyperandrogenism and disturbances of reproductive functions such as anovulation, oligoamenorrhoea and polycystic ovarian disease are usually the consequences of three main aetiopathogenic factors: the first is an abnormality of GnRH pulsatility related to central nervous system dysfunction and seemingly mediated by an increase in beta Endorphin, possibly related to some extent to changes in body weight and hyperinsulinism. The second aetiopathogenic approach is hyperaestronaemia secondary to obesity. Finally adrenal hyperandrogenism caused by different types of congenital adrenal hyperplasia or by increased sensitivity to ACTH may be implicated in these various clinical manifestations.

[HLA, A, B, C, DR, C4, Bf in insulin-dependent diabetics in the Tunisian population]. / Polymorphisme HLA, A, B, C, DR, C4, Bf chez les diabétiques insulinodépendants dans la population tunisienne.

There is no doubt that the autoimmune process in human disease depends on genetic factors. Varying associations were noticed between HLA DR and autoimmune disorders. The frequency of HLA-A-B and DR antigens as well as the Bf and C4 allotypes have been investigated in insulinodependant diabetes mellitus (IDDM) and compared to that of healthy controls in Tunisian population. An increase of A30, DR3, DR4, BfF1, C4AQ0 and C4BQ0 and decrease of B40, DR2, DR5 and DR6 were found in diabetes when compared to the value observation controls. The strongest association was noticed with HLA, DR3 and DR4. The prospective role of DR2 and DR5 antigens were also confirmed. Examination of HLA, Bf and C4 alleles. Two supratypes associated with IDDM have been observed among the Tunisian patients.

[Sex hormones and the metabolism of carbohydrates]. / Hormones sexuelles et métabolisme des hydrates de carbone.

PIP: Sex hormones play an important role in the control of glucose metabolism and insulin. Decreased glucose tolerance observed at the end of pregnancy in most cases remains within normal limits. Pregnancy has an important effect on the islets of Langerhans and on the growth of beta cellules. At the end of pregnancy, assimilation of glucose and triglycerides by maternal tissues is slowed and transfer to the fetus is favored. Hyperinsulinism persists but insulin resistance at the level of maternal tissue becomes very strong and the number of receptors declines. This late pregnancy insulin resistance has not been satisfactorily explained. The declining number of receptors may be a mechanism, or the "antiinsulin" pregnancy hormones which includes estrogens and progesterone may play a major role. Although other mechanisms have been proposed to explain the antiinsulin effect, the role of sex hormones and especially of progesterone (and synthetic progestins used in contraception) appears crucial. The presence of estrogen and progesterone receptors in the beta cellules of the islets of Langerhans suggests a direct effect of these hormones on the cellules. Estrogens however work by other mechanisms than insulin secretion. Experimental evidence indicates that during pregnancy, progesterone increases insulin release while human placental lactogen stimulates hyperplasia of the islets. The progestins derived from progesterone used in contraception have a parallel action. A slight elevation of blood sugar and insulinemia have been observed in oral contraceptive (OC) users. Only 3-5% of OC users develop true hyperglycemia. The changes are usually transitory and disappear on termination of OC use except in the small number of women predisposed to diabetes. The decreased glucose tolerance of OC users differs from true diabetes. Combined OCs favor vascular accidents and myocardial infarct in insulin-dependent diabetics. The mechanisms involved include deteriorating control of diabetes; effects on the serum lipids, coagulation factors, and blood pressure; and direct effects of estrogen on the vascular wall. Venous but not arterial vascular accidents decline with lower estrogen doses. Progestins probably play a more significant role from estrogens in decreasing glucose tolerance. Pregnanes, progestins derived from progesterone, do not appear to affect glucose tolerance. Among testosterone derivatives, the entrances decrease glucose tolerance slightly and the gonanes more strongly, also causing hyperinsulinism. But the new triphasic OCs with low levonorgestrel doses cause no significant changes in glucose tolerance even in women with histories of gestational diabetes. Long-acting progestin implants, vaginal rings, and injectables appear thus far to have minimal or no effects on glucose tolerance.^ieng