Plasma levels of ICAM-1 and circulating endothelial cells are elevated in unstable types 1 and 2 diabetes.

OBJECTIVE: To investigate the expression and release of vascular cell-adhesion molecule (VCAM)-1, intercellular adhesion molecule (ICAM)-1, endothelial leukocyte adhesion molecule (ELAM)-1 and von Willebrand factor (vWF), as well as circulating endothelial cells (CEC) and circulating endothelial progenitor cells (CEPC), as markers of endothelial dysfunction in uncontrolled, well controlled types 1 and 2 diabetic patients and non diabetic patients. METHODS: In this observational trans section study, soluble adhesion molecules concentrations were measured by enzyme linked immunosorbent assays and flow cytometry to detect circulating cells in 49 patients, stratified in 3 groups: G1: uncontrolled types 1 and 2 diabetic patients (n=16); G2: well controlled diabetic (types 1 and 2) patients (n=13); and G3: non diabetic patients (n=20), of whom a blood sample was obtained on admission. RESULTS: ICAM-1 increased significantly in uncontrolled versus well controlled and non diabetic patients (721 vs. 702.45 vs. 473.46 ng/ml, p=0.016). In unstable diabetic patients, CEC were higher than in the well controlled ones (7.75 vs. 4.3/ml, p=0.386) whereas CEPC were lower in unstable diabetics (56.5 vs. 72/ml, p=0.068). CONCLUSIONS: This study showed a continuous rise in ICAM-1 and CEC levels as stable, well controlled diabetic patients shift towards decompensation. In unstable diabetic patients, the relationship between CEC and CEPC can be represented as [CEC] alpha 1/[CEPC].

[Recent advances in post-therapeutic hormonal surveillance of prolactin adenomas (author's transl)]. / Progrès actuels dans la surveillance hormonale post-thérapeutique des adénomes à prolactine.

Therapeutic results in 80 cases of pituitary prolactin adenomas, grouped according to Hardy's neurosurgical classification, are discussed as a function of the 5 types of treatment administered. These were: selective adenomectomy by the trans-sphenoidal approach under microscopic supervision; bromocriptine usually at doses of 5 to 7.5 mg per day; combined surgery and radiotherapy (50 to 60 grays 5 times per week for 5 to 6 weeks); surgery plus bromocriptine; surgery plus radiotherapy plus bromocriptine. Selective adenomectomy gives excellent results in stages 1 and 2, if performed by an experienced surgeon. Bromocriptine was remarkably effective in all cases, whatever the level of blood prolactin and the size of the adenoma. Prolactin levels never returned to normal after radiotherapy, which also markedly increased the frequency of post-therapeutic hormonal insufficiencies.

[Fine-needle aspiration (F.N.A.) of thyroid cold nodules (author's transl)]. / Place de la ponction á l'aiguille fine (P.A.F.) dans le diagnostic clinique du nodule thyroïdien froid.

In a retrospective study of 100 patients operated on between 1974 and 1979 in our institution for thyroid cold nodules, an 8% incidence of thyroid cancer was found at surgery. Since 1979, F.N.A. was performed in 160 patients with thyroid cold nodules. Adequate cytological material was aspirated in 90% (144) of the cases; of those, a benign cytological lesion was diagnosed in 128 (89%) and suspicion of cancer in 16 (11%). To date fifty-one patients were operated: 41 with benign cytology and 10 with cancer suspicion; benignity was confirmed in 39/41 cases with benign cytology and malignity in 5/10 with suspect cytology. In conclusion, clinical diagnosis of thyroid cold nodules is greatly improved by the use of F.N.A. Despite the limitations of the technique, preoperative suspicion of cancer was increased 7-fold. Caution is recommended in the follow-up cases with benign cytology since, in these preliminary results, 2 false-negatives were found.

[Use of plasmapheresis in a case of Graves' disease with malignant ophthalmopathy (author's transl)]. / Exophtalmie maligne traitée par échange plasmatique. Rapport d'un cas.

A short trial with high doses of prednisolone to treat a 62 year-old woman with malignant ophthalmopathy due to Graves disease yielded an unsatisfactory improvement after 5-6 days. The authors decided therefore to use plasmapheresis, 4 plasma exchanges of 2.5 liters each associated with prednisolone (80 ng/day) and azathioprine (100 mg/day). This therapeutic approach resulted in a spectacular improvement obtained after less than 2 weeks: normalization of thyroid function, improvement of all ophthalmological indices confirmed by radiology (C.A.T.) of the retroocular region. The rapid and important improvement obtained after such a short period of time is in favor or the major role of plasmapheresis in this combined therapy of malignant Graves' ophthalmopathy.