[Virilizing ovarian tumors in the menopausal patient]. / Tumeurs virilisantes de l'ovaire chez la femme ménopausée.

Virilizing ovarian tumors are rare and can occur at any age. In postmenopausal women, they commonly present with signs of masculinization. These tumors should be suspected in any patient with virilization and high testosterone levels (>1ng/mL). Tumor localization is sometimes difficult. These tumors are usually benign; surgical resection is the accepted treatment. Masculinizing consequences of hormonal secretions may be managed by cosmetologic treatments which should not be overlooked.

Analysis and prevention of recurrent goiter.

The current study was done to analyze our experience with recurrent goiter. Prevention must be stressed because reoperations of the thyroid gland present technical difficulties and are associated with an increased risk of hypoparathyroidism and permanent hoarseness. Nodular recurrences occurred in 36 of 1,456 patients (2.5 percent) who underwent thyroidectomy between 1968 and 1983. All patients had the initial operation at Jean Bernard Hospital, Poitiers, France, and had follow-up evaluation from five to 20 years. Multinodular goiter accounted for 70 percent of the recurrences. Sixty percent of the recurrences were in patients with multinodular goiters. Recurrent goiter was usually first detected about eight years after thyroidectomy. Thirty patients with recurrence had reoperations. Two patients had paralysis of the vocal cord and one patient had permanent hypoparathyroidism. Recurrent goiter may occur because of the development of new nodules (true recurrence) or because of the growth of "residual" or persistent macroscopic or microscopic nodules left at the previous thyroid operation. Intraoperative digital palpation of the entire thyroid gland is essential for detecting residual macroscopic thyroid nodules, and all enlarged nodules should be removed. Thyroid-stimulating hormone (TSH) suppressive therapy is recommended by some authorities to prevent "true" recurrences, although its efficacy is debated. Since recurrence is uncommon in the current series, perhaps TSH suppressive therapy should only be used in high-risk patients. In the current experience, only the multinodular character of the nodules in euthyroid patients has a significant correlation with subsequent development of recurrent goiter (p < 0.01), and one must consider patients with multinodular goiter at risk for recurrence. Once TSH treatment is begun, it will logically be continued for life. Total thyroidectomy has been recommended by some endocrine surgeons for treating patients with multinodular goiter. We prefer subtotal thyroidectomy and reserve total thyroidectomy for patients when no normal thyroid tissue can be preserved because only 2.5 percent of the patients in the current study had recurrent goiter. Prevention of residual nodules is probably best assured by systematic palpation during operation of the two thyroid lobes. This considerably lessens the risk of recurrence. Since nodular recurrences occurred in only 2.5 percent of the patients in the current study, although multinodular goiter must be considered at risk for recurrence, we do not recommend systematic total thyroidectomy in multinodular goiter.

[Corticotropic macroadenoma: clinical, hormonal, radiological and immunocytochemical study of 6 cases]. / Le macroadénome corticotrope: étude clinique, hormonale, radiologique et immunocytochimique de 6 observations.

We report 6 cases of corticotroph macroadenomas which show heterogeneity of clinical and biological features (from Cushing's syndrome to silent adenoma) and heterogeneity of immunocytochemical staining. One patient reported on had skin hyperpigmentation and ACTH hypersecretion without clear abnormal adrenocortical function; we believe that this patient's plasma contained ACTH with very low bioactivity.

[Average level and variability of 24 hour blood pressure in the normotensive insulin-dependent diabetic patient]. / Niveau moyen et variabilité de la pression artérielle des 24 heures chez le diabétique insulinodépendant normotendu.

This prospective study was designed: 1. to determine both the mean level and the intrinsic variability of blood pressure (BP) and heart rate (HR) in normotensive patients with insulin-dependent diabetes mellitus (IDDM), by using a nonambulatory recorder; 2. to look for a relationship between these parameters and the indices of diabetic target-organ damage. The patient group consisted of 21 subjects with IDDM (6 females, 15 males), aged 19 to 70 years, who were normotensive according to WHO criteria. The duration of the diabetics ranged from 1.5 to 32 years. A control group of 17 age and sex-matched normal volunteers was also examined. Each subject underwent a 24 h non ambulatory BP recording, a 2-dimensional echocardiography and a pulsed doppler examination; furthermore, an index of autonomic nervous system dysfunction was established, as well as an index of microangiopathy. Twenty-four hour BP and HR mean levels appeared to be slightly higher in IDDM patients than in control group, but the difference was significant for night SBP and 24 h DBP only. No difference was found with regard to BP and HR absolute variabilities; the relative variability of night DBP was slightly lower in IDDM group (p less than 0.05). A loss of nocturnal decline in BP was noted in 2 control subjects and in 9 IDDM patients: 8 out of these IDDM patients had an autonomic dysfunction. An abnormal HR circadian pattern was seen in 1 control and in 2 IDDM subjects.(ABSTRACT TRUNCATED AT 250 WORDS)