Plasma C-peptide levels and clinical remissions in recent-onset type I diabetic patients treated with cyclosporin A and insulin.

Remission from insulin dependency in insulin-treated recent-onset type I (insulin-dependent) diabetic patients can result from a partial recovery of insulin secretion, an improvement in tissue sensitivity to insulin, or both. The same hypothesis must be analyzed when remission occurs in cyclosporin A (CsA)-treated patients. In this study, plasma C-peptide levels were serially measured in the basal state and after stimulation in 219 recent-onset type I diabetic patients; 129 received CsA, and all patients were similarly monitored and insulin treated. The results were analyzed in view of the occurrence of remission. Remission was defined as good metabolic control in the absence of hypoglycemic treatment for greater than or equal to 1 mo. Remission occurred in 44% of the CsA-treated group and lasted for mean +/- SE 10.0 +/- 0.9 mo vs. 21.6% in the non-CsA-treated group with a duration of 4.4 +/- 0.8 mo. Plasma C-peptide levels were initially dramatically lower than normal in both groups in the basal and stimulated states. C-peptide levels increased significantly later, at 3 and 6 mo, in both groups. C-peptide values were proportional to the rates of remission in both groups. In the non-CsA-treated group, C-peptide levels later decreased, and these patients inexorably relapsed to insulin dependency. In contrast, in the CsA-treated group, the initial recovery in insulin secretory capacity was maintained over the 18-24 mo of the study. Furthermore, higher remission rates and longer-lasting remission were obtained in patients who reached higher C-peptide levels at the 3rd mo of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Neurotoxicity of mitotane therapy of adrenocortical carcinoma (5 cases) and Cushing's syndrome (7 cases)]. / Neurotoxicité du traitement par le mitotane des cortico-surrénalomes (5 cas) et des syndromes de Cushing (7 cas).

Twelve patients were treated with op'DDD over a 9-year period. All presented with mild neurological symptoms, and half of them had major complications. There was no relation between the occurrence of these symptoms and the dose or duration of op'DDD therapy. The mechanisms of this neurological toxicity, both central and peripheral, are not well known, but they appear to be similar to those of certain op'DDD-related chemicals used in industry.

Cyclosporin increases the rate and length of remissions in insulin-dependent diabetes of recent onset. Results of a multicentre double-blind trial.

In a double-blind trial 122 patients aged 15-40 years with insulin-dependent diabetes of recent onset were randomly assigned to cyclosporin 7.5 mg/kg per day or placebo. At the sixth month 25.4% of the cyclosporin group and 18.6% of the placebo group were in complete remission (not a significant difference). Treatment was continued in those patients with complete or partial remission (insulin requirement less than 0.25 U/kg per day) and 106 patients were followed to nine months, at which stage 24.1% of the original cyclosporin group and 5.8% of the original placebo group were in complete remission (p less than 0.01). For those patients whose whole-blood trough cyclosporin levels in the first three months averaged 300 ng/ml or more, the rates of complete remission at six and nine months were 37.5% and 37%. The rates of partial remission were also higher in the cyclosporin group and at six months the rate of complete or partial remission was 46% in the whole cyclosporin group and 65.6% in those with an average blood level exceeding 300 ng/ml in the first three months, versus 28.8% in the placebo group. The principal side-effect of cyclosporin was a modest and reversible increase in plasma creatinine. These results indicate that cyclosporin promotes the remission of type I diabetes and suggest the need for new controlled protocols aimed at evaluating the length of the effect and selecting the best drug regimen.

[Radioimmunoassay of urinary albumin: early indicator of diabetic nephropathy?]. / Le dosage radio-immunologique de l'albumine urinaire: indicateur précoce de la néphropathie diabétique?

Microalbuminuria is now considered a good biological marker predictive of diabetic nephropathy. The degree of microalbuminuria was determined by radioimmunoassay in 23 controls and 50 insulin-dependent patients with poor control of glycaemia. Higher levels were found in diabetics, whatever the duration of the disease. At the moment, this difference, which is reversible with good metabolic control, can be explained by blood glucose balance. Several authors have established the existence of a microalbuminuria threshold predictive of nephropathy, but its level is controversial, chiefly on account of the urine collection methods.

[Should the assay of serum free thyroxine and triiodothyronine replace the other methods of evaluating thyroid function?]. / Le dosage de la thyroxine et de la tri-iodothyronine libres sériques doit-il supplanter les autres méthodes d'évaluation de la fonction thyroïdienne?

Total T4, total T3, free T4 and free T3 were measured at the same time in 633 subjects. These subjects were classified according to the clinic state and the hormonal results in 426 euthyroid, 145 hyperthyroid and 62 hypothyroid cases. The results permitted to define the sensitivity, specificity and predictive value of the different tests. When each measure was considered alone, free T4 was the most useful test for all the hormonal states. In association, FT4 + FT3 is more useful than T3T + T4T for all the diagnostic parameters and for all the clinical situations. To measure FT4 with an adequate kit appears to be in 1985 the key method for evaluating the thyroïd function. To associate FT3 is useful in some difficult cases.