Biomedical subjects
Publications and source records attributed to A Warnet.
The authors report the case of a patient with autoimmune hemolytic anemia, due to anti-KJa antibody, and associated with primary hypothyroidism. They discuss the possible relationship between these two conditions and emphasize the particular hematological pattern related to myxoedema.
Inhibin is a peptidic gonadal hormone which preferentially suppresses FSH secretion and synthesis. As its purification is not yet achieved, only bioassays are available, performed with testicular extracts or follicular fluid. Its secretion by granulosa cells and Sertoli cells is partly spontaneous, partly stimulated by androgens and FSH. In women, folliculogenesis is controlled by inhibin induced FSH fluctuations. But inhibin acts also at the gonadal level like the cybernins, peptidic substances secreted by the ovary, which modulate ovarian effects of gonadotrophins. Five of them have been identified: the oocyte maturation inhibitor, the luteinization inhibitor, the FSH binding inhibitor (implied in follicular atresia), the LH receptor binding inhibitor (involved in luteolysis), and gonadocrinins (which bind to ovarian LHRH-receptors). The discovery of these ovarian peptids leads to new concepts in folliculogenesis and luteolysis and may provide a new therapeutic approach in contraception and sterility fields.
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The diagnosis of glucagonoma was made in a 51 year-old woman who suffered from a polymorphous dermatitis and an insulin-dependent diabetes mellitus. Denutrition was present and there was a previous history of thrombo-embolism. Immunoreactive plasma glucagon was constantly higher than 1 000 pg/ml (N less than 175). Plasma aminoacids were low. After angiographic confirmation, the tumour and part of its hepatic metastases were resected. The dermatitis disappeared soon after. Its recurrence required chemotherapy (successively mithramycin, streptozotocin, DTIC) and good clinical results were obtained. On histological examination, the cutaneous lesions consisted of an epidermal edema, and a bullous intra-epidermic detachment. The pancreatic tumour was of the trabecular type with a very important sclerosis. On electron microscopy, the tumoral cells, some with a syncitial aspect, contained granules of the D1 type. These granules are different from the typical glucagon granules. The clinical and biological features in this case are compared with those of the 41 cases of glucagonoma previously published.
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In spite of the methodological reserves that the measure of adipocyte volume and the calculation of the number of adipocytes evoke, it appeared interesting to us to study these parameters in a group of 102 obese subjects in reference to some clinical and biological criteria. The following conclusions come out of this study. The greater the obesity, the greater the adipocyte volume. There is a positive correlation between the importance of obesity and cellularity of the adipose tissue. However, this correlation is no longer found for the most obese patients, in whom adipocyte hypertrophy intervenes but no longer the multiplication of the fat cells. The onset of obesity at adolescence pairs with a number of adipocytes higher than in the other chronological forms: obesity appearing at adolescence would be thus more frequently hyperplastic. This characteristic is not discovered in the cases of obesity appearing in infancy. No relation was found between the existence of impaired glucose tolerance and mean adipocyte diameter and/or the number of adipocytes. It has been the same for the cases of hyperlipidemia.
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A retrospective study of 94 patients, who had had doubtful results in the oral provoked-hyperglycemia test, was made after an average period of 23 months. It was found that 26 patients were diabetic, 34 were normal and 34 were still doubtful. The factors which influence the evolution of these cases are the sex, a family history of diabetes (before 60 years of age), and the return to normal weight of obese patients.
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The onset of an haemorragic syndrome in a patient with chronic lymphocytic leukaemia led to the diagnosis of acquired von Willebrand's disease secondary to an anti-von Willebrand factor antibody. Multiple angiodysplasia were shown by an arteriography done for a ruptured femoral arterial aneuvrism. The relationship between angiodysplasia and acquired von Willebrand disease are discussed.
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Five women suffering from Cushing's disease were treated with ketoconazole 800 mg per day for 2 to 28 months (mean 12.4 months). Four of them had full clinical and biochemical regression. However, after 8 months of therapy the disease failed to respond in three of these four women. Increasing the ketoconazole dosage up to 1,200 mg per day was ineffective in two patients. Such an escape phenomenon, not described until now, will restrict the use of ketoconazole in the treatment of Cushing's disease, although the drug is easy to administer and well tolerated globally and by the liver in most cases.
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