[Étienne Destot (1864-1918) or the other father of French radiology]. / Étienne Destot (1864­1918) ou l'autre père de la radiologie française.

Étienne Destot is a French physician from Burgundy who benefited, during his studies in Lyon, from the quality of teaching of the best specialists of the time: Augagneur for hygiene, Testut for anatomy, Ollier for surgery, Lépine for the medical applications of electricity and the Lumière brothers for the technological development. During its experiments, he met Despeignes, the first radiation oncologist, Regaud pioneer of radiobiology and Bouchacourt who pointed out individual radiosensitivity. Less than two months after the X-rays discovery by Roentgen, he produced one of the first French radiographic views that were at the origin of our current knowledge in bone and cartilage anatomy and traumatology. He funded the first department of radiology in France in a former library of the major hospital of Lyon, where he made a number of original advances. It appears obvious that, while Antoine Beclère was the great organizer of the French radiology, Destot was its pathfinder. Destot was at the origin of several technological advances that gave stereoscopy, internal organs imaging and quantification of the heart-thorax ratio. By contrast, he was not convinced of the therapeutic properties of X-rays even if he contributed to the technological development of X-ray tubes. Victim of radiations, exhausted, Destot died on December 1918, by helping the Great War victims. His name is written in a war tribute monument in Arc-et-Senans (Burgundy).

[Diagnostic strategy for a solitary thyroid nodule. Example of development of recommendations for a practice guideline]. / La stratégie diagnostique devant un nodule thyroïdien isolé. Exemple d'élaboration de recommandations pour la pratique clinique.

The solitary thyroid nodule is frequently observed and many strategies are proposed for the diagnosis of the etiology and for the choice of treatment. Despite many discussions no clear consensus has been so far reached. The french groups concerned by this problem set up a Clinical Practice Guide line with the methodological help of Agence Nationale pour le Développement de l'Evaluation Médicale. Based upon the critical review of the literature a consensus was obtained concerning the natural history of the nodules and the diagnosis value of the complementary explorations. The clinical approach alone completed by a TSH determination gives the therapeutical choice in about 30% of the patient without any other explorations. In the remaining cases 3 methods (isotope scan, echography, cytopuncture) can be used alone or in a combined sequence. So far no strategy can be privilegiated. It is necessary to set up a systematic comparison between the possible strategies and this will be made by the french thyroid specialists after this first step of delimitation of a clinical practise guide line.

[The biological diagnosis of pheochromocytoma]. / La stratégie du diagnostic biologique du phéochromocytome.

Pheochromocytomas are tumors secreting large amount of catecholamines. Elevation of blood pressure is the classical manifestation but frequently the tumors are silent and they have to be screened systematically. The biological diagnosis is essential to affirm the tumor before any imaging procedure. It needs to select the most sensitive and specific methods. The sensitivity of VMA, urinary catecholamines and plasma catecholamines assays is respectively 70%, 75%, 85%. Determination of methoxyamines in the urine or better in the plasma reaches a sensitivities of 98%. This represents the best tool for the diagnosis of pheochromocytomas. Only renal or heart failure decrease the specificity of the plasma methoxyamines assay.

[Plasma methoxyamines assay: a practical advance for the diagnosis of pheochromocytoma]. / Le dosage des méthoxyamines plasmatiques: une avancée pratique dans le diagnostic du phéochromocytome.

Measurement of plasma methoxyamines is aimed to provide a reliable plasma marker readily available for any patient suspected of having a pheochromocytoma. The present HPLC method is able to detect methoxyamine amounts as low as 0.2 nmoles/l and allows the determination of both free or conjugated methoxyamines (metanephrine MN and normetanephrine NMN) in normal subjects, treated or untreated patients and a fortiori in pheochromocytoma. The analytical specificity is excellent. Among most usual antihypertensive drugs, only conversion enzyme inhibitors and diuretics induce in some patients a moderate increase of NMN with minor consequence in values interpretation. The kidney plays a major role in the blood clearance of methoxyamines and any alteration of renal function is associated to the increase of plasma methoxyamine levels. Plasma methoxyamines have a long half-life and are long-lasting integrated markers of catecholamine secretion; at variance with plasma free catecholamines, they are able to afford the presence of a secreting pheochromocytoma whatever the clinical presentation--asymptomatic or paroxysmal form between the crisis. The diagnostic sensitivity (at least 98%) is equal to that of urinary methoxyamines, far higher than plasma or urine catecholamines or urine VMA (60 to 70%).

[Public financial support of research on diabetes in France]. / Financement public de la recherche sur le diabète en France.

The financial support of any kind of research reveals the interest of a country in a disease. Does the diabetes represent a priority in France? The answer is difficult because the lack of analytical approach of the resources devoted to medical research. For example, many basic works (physiology of metabolism, lipids, different hormones etc.) are not officially referred to diabetes. Moreover when diabetes is a key word of an unit it general only a part of this unit is concerned. The results were provided mainly by CNRS and INSERM and they must be compared to the financial weight of this disease for the collectivity. This evaluation remains imprecise.

[Multiple endocrine neoplasia type 1. Digestive hormones in the screening]. / Néoplasie endocrinienne multiple de type 1. Hormones digestives dans le dépistage.

Detection of subjects from a multiple endocrine neoplasia type 1 family must rest on clinical, biochemical and radiological data, since study of the genome is unable to detect these subjects. In the new family described here, 6 out of the 14 subjects explored were affected. One had a confirmed pancreatic endocrine tumour and in 3 others a pancreatic endocrine tumour was highly probable, since insulin and glucagon levels, as well as ultrasonic exploration of the pancreas were pathological. Measurements of gastrointestinal hormones gave normal results in all cases. We conclude that to detect this endocrine neoplasia in subjects at risk it seems necessary to measure plasma insulin levels and perform an abdominal ultrasonography.

[Biological diagnosis of pheochromocytoma: impact of technological improvement]. / Le diagnostic biologique du phéochromocytome: l'impact de l'évolution technologique.

Laboratory diagnosis of pheochromocytoma must give evidence of increased catecholamine production. This requires measurement of catecholamines and their metabolites (normetanephrine NMN, metanephrine MN and/or VMA) in urine or in plasma. The various assays can be also performed during dynamic test that stimulate or inhibit catecholamine release. The recent introduction in biochemistry of high performance liquid chromatography coupled to electrochemical detection (HPLC-ED) has greatly reduced drug-induced interference and has therefore narrowed the reference value range. The two groups of compounds that have most benefited from such analytical improvements are urinary metanephrines and VMA. The technical progress has greatly simplified the laboratory diagnosis of pheochromocytoma both by improving the reliability of already available compounds and by favouring the development of news markers. However, the diagnostic sensitivity of the various urinary and plasmatic markers remains very unequal and the diagnosis of pheochromocytoma requires a carefully planned sequence of studies including appropriate biochemical tests able to affirm or to exclude the diagnosis with a high degree of security while reducing the duration and cost of the investigation. Among urinary markers, metanephrines remain the most direct indices of catecholamine hypersecretion and provide the most reliable biochemical indicators of the existence of pheochromocytoma. The diagnostic sensitivity of urinary metanephrines (about 98%) greatly exceeds that of catecholamines and VMA (60-70%). These differences are related to the diversity and specificity of physiological mechanisms involved in the synthesis, the release and inactivation of markers (catecholamines, metanephrines, VMA) and to the variety of clinical presentations and secretory patterns of pheochromocytomas. Considering the practical necessity of simplifying the collection of laboratory samples, use of plasma assays for the diagnosis of pheochromocytoma has become increasingly routine. However, plasma catecholamines--even when assayed during the clonidine suppression test--have not fully lived up to expectations. The diagnostic sensitivity is far better (about 98%) with the recently developed assays of plasma methoxyamines which, owing to their long half-life, provide long-lasting indicators of the catecholamine discharge and are elevated even in tumors without clinical expression. Laboratory diagnosis is relatively easy when the patient bears a large tumor releasing considerable amounts of catecholamines and metabolites; it becomes more challenging in the case of small tumors or of pretumoral hyperplasia in which only the most reliable biochemical markers are able to confirm the diagnosis of pheochromocytoma.

Malignant pheochromocytoma: a series of 14 cases observed between 1966 and 1990.

We report 14 patients (9 males, 5 females) aged 15-59 years, treated for malignant pheochromocytoma. These patients were observed during the 1966-1990 period along with 68 other patients presenting benign pheochromocytomas. From the initial general presentation of the 14 patients, two groups could be individualized. In seven patients, the initial presentation seemed benign. After the excision, the recovery was complete, but patients recurred on average 7.8 yr later (range 1-22 yr). Tumors were intraadrenal in six cases (5 single, 1 bilateral) and extraadrenal in one case. In the seven remaining patients, malignancy was evident from the first examination. The tumors were intraadrenal in 2 cases, extraadrenal in 5 cases. Frequency of extraadrenal locations (6/14) was in this series significantly higher than in benign forms (9/68). Diagnosis of malignancy was based on metastases in 12 cases (lymph nodes in 5, bones in 5, liver in 4, lung in 2, brain in 1) and on peritumoral extension in 2 cases. No biological specificity was detected in urinary excretion of catecholamines or its metabolites. In 6 patients so far studied, an uptake of 131I MIBG was found in the tumor and/or metastases. Four patients received therapeutic doses of 131I MIBG and in three of them, this treatment led to a good result within a follow-up range of 12 to 66 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[New research techniques in human nutrition]. / Techniques nouvelles d'exploration en nutrition humaine.

Accurate determination of energy requirement and nutrients metabolism is essential to improve physiological knowledge and for physiopathological purpose in human nutrition. This evaluation is an absolute necessity for food industry. Energy expenditure could be precisely determined by indirect calorimetry or doubly labeled water technic. Nutrients metabolism and substrates turn-over studies are now accessible without health hazard using tracers labelled with stable isotopes. These three methods are the basic tools for the new Research Nutrition Center which are now in progress.

[Pheochromocytoma. Study of a personal series of 85 cases]. / Le phéochromocytome. Enseignements tirés d'une série de 85 cas personnels.

The study of a personal series of 85 cases observed by the same endocrinologist over a period of 40 years shows the modifications of clinical presentation and biological methods of diagnosis and treatment. There is a striking increase in the percentage of patients without any cardiac or vascular manifestations. The methoxyamines assay has the best sensitivity and specificity even in asymptomatic tumors. The recent development of this assay in the blood is very efficient. The tumor may be found with an abdominal CT scan. The use of NMR is not fruitful. The 131I MIBG scintigraphy is necessary if the CT scan is not informative and in malignant forms. The malignancy is more frequent (16.5%) than classical according to the long duration of the disease. The quite good prognosis is improved by the administration of 131I MIBG. The surgery was safer and without mortality over the last 15 years.

13C appearance in plasma glucose and breath CO2 during feeding with naturally 13C-enriched starchy food in normal humans.

We have used a recently developed technique (isotope-ratio mass spectrometer) to measure 13C appearance in plasma glucose and breath CO2 in eight normal subjects during feeding with naturally 13C-enriched starch. 13C in CO2 and plasma glucose, metabolites and insulin concentrations, carbohydrates, and lipid oxidation were measured after ingestion of 76 g glucose equivalent of crackers, pasta, or polenta. 13C in plasma glucose displays a very different pattern from plasma glucose concentration. It increases steadily for 90 min before reaching a plateau for approximately 2 h and slowly declines during the last 2 h of the study. No significant difference was observed with the three different starchy foods tested although plasma glucose tended to be higher during feeding with polenta. In summary measurement of 13C in plasma glucose during feeding with naturally 13C-labeled carbohydrates yields new insight in the study of carbohydrate bioavailability in humans.

MRI and CT in a case of pituitary abscess.

We report the case of a woman admitted for hypopituitarism of sudden onset, in whom conventional radiography, CT and MRT suggested a pituitary tumour with supra- and intrasellar extensions. The surgical findings and the clinical course under antibiotic therapy transformed this diagnosis into one of pituitary abscess by a pyogenic micro-organism. Pituitary abscess is an exceptional lesion. Despite the advent of CT and MRI, its preoperative diagnosis remains difficult. However, the presence of an intrasellar expansive process with liquid centre and contrast-enhanced outline should suggest the possibility of an abscess, particularly when the pituitary lesion is associated with a sphenoidal sinus effusion.

Effect of physiological concentrations of insulin and glucagon on the relationship between nonesterified fatty acids availability and ketone body production in humans.

To determine the effect of insulin and glucagon on the transformation of nonesterified fatty acids (NEFA) into ketone bodies (KB), we measured simultaneously in normal subjects NEFA and KB kinetics at different NEFA levels in the presence of basal (control test) or increasing insulin concentrations with glucagopenia (somatostatin + insulin infusion, insulin test) and without glucagopenia (somatostatin + insulin + glucagon infusion, glucagon test). NEFA levels were controlled during these tests by an intravenous (IV) infusion of a triglyceride emulsion. During the control test, a moderate increase of NEFA (464 +/- 30 to 715 +/- 56 mumol/L) increased the percentage of NEFA converted into KB (13.3% +/- 1.4% to 26.4% +/- 2.1%, P less than .05), and there was a linear relationship between this percentage and NEFA levels (r = .788, P less than .01). During the insulin and glucagon tests, the progressive increase in NEFA induced by the triglyceride emulsion infusion was associated, despite the increase of insulinemia, with an increase in KB production rate (P less than .05) and in the proportion of NEFA used for ketogenesis in the presence (8.1% +/- 1.2% to 14.2% +/- 6.3%, P less than .05) and absence (15.7% +/- 2.8% to 25.2% +/- 3.99%, P less than 0.05) of glucagopenia. In both tests, this percentage was always linearly related with NEFA levels (P less than .05) and the slopes of these relationships were comparable to that observed in the control test. However, the fraction of NEFA used for ketogenesis was always higher (P less than .05) during glucagon substitution than in its absence.(ABSTRACT TRUNCATED AT 250 WORDS)