[Acute ischemia of an arm manifesting Buerger's disease. Predisposing role of anorexia nervosa]. / Ischéme aiguë d'un membre supérieur révélatrice d'une maladie de Buerger. Rôle favorisant d'une anorexie mentale.

Peripheral vasomotor disorders, notably acrocyanosis, are frequent in anorexia nervosa, but ischaemic accidents are unknown. We report the case of a 32-year-old woman with a 10-year history of anorexia nervosa, who developed acute ischaemia in one of her upper limbs. In this particular case several aetiological factors may be considered: Buerger's disease, of course, as the patient smoked and had an abnormal arteriography, but also hypercholesterolaemia, thrombocytosis and disorders of platelet aggregation.

Elevated levels of paf-acether in blood of patients with type 1 diabetes mellitus.

Infusion of paf-acether (paf, first described as platelet-activating factor) into animals stimulates glycogenolysis and lipolysis and decreases insulin levels. This study reports a 50-fold increase in blood levels of paf in patients with Type 1 insulin-dependent diabetes mellitus without micro or macrovascular complications (1.07 +/- 0.42 ng/ml, n = 10) as compared with healthy volunteers (0.04 +/- 0.02 ng/ml, n = 9). By contrast, paf is not statistically elevated (p greater than 0.05) in patients with Type 2 non-insulin-dependent, diabetes mellitus with lipid abnormalities and micro or macrovascular complications (0.32 +/- 0.18 ng/ml, n = 9). In the three groups same levels of paf precursors and acetylhydrolase activity (the enzyme which inactivates paf) were noted suggesting an increase in paf biosynthesis by Type 1 diabetic patients. Elevated paf levels could perpetuate hyperglycaemia and tend to promote or accentuate micro or macrovascular complications. This study adds another biological difference between Type 1 and Type 2 diabetes.

[Treatment of prolactinoma]. / Traitement des adénomes à prolactine.

Prolactinomas rank first in frequency among hormone-secreting pituitary adenomas, but their management remains controversial. The authors present a review of the literature concerning the various therapeutic methods used and their results. As regards microadenomas, opinions are divided since the results obtained with bromocriptine and with selective adenomectomy are about the same. As regards macroadenomas, surgery exposes to more frequent complications and above all to recurrences. The majority of authors is in favour of bromocriptine first followed, if necessary, by surgical excision. Pregnancy may accelerate the development of prolactinomas. This risk is minimal with microadenomas and more real with macroadenomas, requiring more radical treatment before pregnancy and close monitoring.

Autoimmune insulin syndrome.

Initially described in Japan, the autoimmune insulin syndrome is caused by the presence of anti-insulin antibodies in patients who have never received insulin. This syndrome accounts for spontaneous or reactive hypoglycaemia with very high levels of total immuno-reactive insulin. Discordance between the levels of immunoreactive insulin and C peptide indicate the possible presence of anti-insulin antibodies; this can avoid an incorrect diagnosis of insulinoma. These autoimmune hypoglycaemias often present a difficult diagnostic problem in distinguishing them from factitious hypoglycaemia. The course of the autoimmune insulin syndrome is usually favourable, with a spontaneous rapid diminution of the levels of anti-insulin antibodies. The reasons for the appearance of anti-insulin antibodies and the exact mechanisms of the hypoglycaemia remain uncertain. However, the frequent association of the autoimmune insulin syndrome with certain autoimmune diseases suggest a common immune dysfunction. Drugs containing a sulphydryl group have been implicated in the aetiology of this syndrome.