[Hyperparathyroidism diagnosed during pregnancy]. / Hyperparathyroïdie au cours d'une grossesse.

BACKGROUND: Diagnosis of hyperparathyroidism during pregnancy is rare because symptoms are often moderate and similar to signs observed during normal pregnancy. The gravity of such an association is probably underscored. CASE REPORT: The diagnosis of hyperparathyroidism was made at 9 weeks gestation in a young woman who declined surgery. She was seen again at 32 weeks gestation for in utero fetal death. Nine months later she accepted surgery and a parathyroid adenoma was removed. DISCUSSION: Hyperparathyroidism during pregnancy is associated with significant morbidity with major maternal or fetal complications in 50% of the cases. Surgery during the second trimester of pregnancy is the treatment of choice. If hyperparathyroidism is diagnosed in young women who desire pregnancy, surgery should be performed before advising pregnancy.

Energy metabolism and substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin.

OBJECTIVE: To compare substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin. METHODS: Plasma glucose (PG), plasma insulin (PI) and substrates oxidation rates measured by indirect calorimetry were compared during a test day at 8.00 a.m. (before breakfast), 11.00 a.m. (before the lunch), 2.00 p.m. (2 h after the lunch) and at 5.00 p.m. in 56 diabetic patients treated with diet (group C, n = 14), sulphonylurea (group S, n = 14) or with a sulphonylurea-metformin combination (group SM, n = 28). RESULTS: The three groups were comparable for age, body mass index (b.m.i.), body composition and PG levels. Mean glucose oxidation (Gox) was increased since mean lipid oxidation (Lox) was decreased in group S in comparison both with group C (3.02+/-0.08 vs. 2.62+/-0.08 g/min/kg/10(3), p < 0.05; 0.53+/-0.04 vs. 0.88+/-0.09 g/min/kg/10(3), p < 0.01). Mean Lox was also decreased in group S in comparison with group SM (0.88+/-0.06 vs. 0.53+/-0.04 g/min1/kg1/10(3), p < 0.0001) whereas the difference in Gox between these latter two groups was only significant in the basal state (1.94+/-0.17 vs. 2.47+/-0.17 g/min1/kg1/10(3), p < 0.05). Mean respiratory quotient (RQ) was increased in group S (0.90+/-0.01) in comparison both with group C (0.86+/-0.01, p < 0.001) and with group SM (0.86+/-0.01, p < 0.001). Mean energy expenditure was lower in group S than in group SM (21.4+/-0.6 vs. 23.6+/-0.6 kcal/min/kg/10(3), p < 0.05). Substrates oxidative patterns, RQ values and energy expenditure were similar in group C and in group SM. CONCLUSIONS: When compared to patients treated with a sulphonylurea-metformin bitherapy, patients treated with a sulphonylurea monotherapy have a shift in their ratio of fat to carbohydrate oxidation that could make body weight loss more difficult in this latter group.

Time course of troponin I, myoglobulin, and cardiac enzyme release after electrical cardioversion.

The results of this study, conducted in 25 patients without myocardial infarction, showed that all the biologic markers of myocardial infarction, except the highly cardiospecific cardiac troponin I, increased in some patients after electrical cardioversion. These results allow us to conclude that electrical cardioversion, even preceded by a mechanical resuscitation of short duration, does not result in myocardial damage, and that cardiac troponin I is more accurate than creatine kinase-MB activity and creatine kinase-MB mass determination for the diagnosis of myocardial damage in patients who have undergone electrical cardioversion.