[Glucose intolerance and post-stimulatory hypoglycemia secondary to a probably congenital intrahepatic portacaval anastomosis]. / Intolérance au glucose et hypoglycémie post-stimulative secondaires à une anastomose porto-cave intrahépatique vraisemblablement congénitale.

Recurrent malaise in a 63 year old woman were found to be due to hypoglycaemic episodes. During a 5 hour oral glucose tolerance test, the "impaired glucose tolerance" type initial hyperglycaemic wave was followed by a post-stimulative hypoglycaemia. Serum C-peptide levels were normal during the test, but the insulin response which was initially normal became excessive, with a consequent decrease of the C-peptide/insulin ratio, similar to that usually observed in hepatic malfunction. An hepatic ultrasonography, a cavography and a selective superior mesenteric arteriography showed an intra-hepatic porto-caval anastomosis, probably congenital in origin. This vascular abnormality accounts for the blood glucose problems: the porto-caval shunt explains the early hyperglycaemia by defective liver uptake of glucose and secondary hyperinsulinism occurs because of the reduced hepatic degradation of the insulin secreted in normal quantity. The late hyperinsulinism then leads to secondary hypoglycaemia.

[Congenital intrahepatic portacaval anastomosis: analysis of manifested glucose abnormalities]. / Anastomose congénitale porto-cave intra-hépatique; analyse des anomalies glucidiques révélatrices.

The authors report a case of a high-flow intrahepatic portacaval shunt due to a congenital venous abnormality. Suspected by digestive echography, the abnormality was confirmed by angiography. A precise analysis of glycoregulation showed an "impaired glucose tolerance", followed by post-stimulative hypoglycemia with persistant hyperinsulinemia and lowering of the C peptide/insulin ratio. These abnormalities seem to be related to the shunt only. This observation appears as an experimental model permitting the appreciation of the disturbances in glucose metabolism related to an intrahepatic shunt without any hepatic cell disorder.

[Schwannoma of the trachea: discussion of a case and review of the literature]. / Schwannome de la trachée. A propos d'un cas. Revue de la littérature.

The authors report the case of a 71 years old woman admitted for severe asthmatic condition of recent origin. The chest X ray showed the opaque image of a tumour against the clearness of the trachea. Its benignity was confirmed by endoscopy. A complete surgical exerese is impossible because of the friable nature of the tumour but was attempted to relieve a worsening respiratory distress. A new intervention was necessary because of a mediastinitis; the patient died of renal insufficiency. Only one observation of schwannoma and 3 cases of tracheo-bronchial schwannoma were found in the literature. The nosological place of these tumours was debated particularly in their relation with Recklinghausen disease. Diagnosis was usually done only a few years after an endoscopic exploration. Some symptoms could nevertheless make up a "tracheal syndrome". Endoscopic exeresis of the tumour successfully tried on some cases should be attempted on a first step.