[Relationship between lipoprotein (a) and vascular complications in diabetes mellitus].
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Biomedical subjects
Publications and source records attributed to E Baudin.
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OBJECTIVE: Thyroid dysfunction has been reported as a complication of interferon therapy. The aim of our study was to assess the risk factors and reversibility of thyroid disorders induced by interferon therapy. DESIGN: Prospective study. PATIENTS: A series of 68 patients with chronic hepatitis C completed a therapeutic trial of interferon alpha 2b (IFN), randomized for dose adaptation, lasting for 24 weeks. MEASUREMENTS: TSH and autoantibodies against thyroid were looked for at (-2) weeks and 24 weeks in all patients. Blood samples obtained at (-2), 12, and 24 weeks were stored for additional hormonal studies in patients who developed thyroid dysfunction. Such patients with thyroid dysfunction were followed up for at least one year. RESULTS: Only one out of 68 patients had abnormal TSH levels, and two had thyroid autoantibodies prior to interferon therapy. Eight patients (12%) developed thyroid dysfunction (five hypothyroidism and three hyperthyroidism) during treatment. In four patients (all of them with thyroid dysfunction, P < 0.001) antimicrosomal, antithyroglobulin, and/or anti-TSH receptor antibodies appeared during interferon therapy. All patients recovered normal thyroid function within 1.5 years after interferon withdrawal. No pretreatment risk factor was identified. The patients with thyroid dysfunction did not significantly differ from the others as regards the dose of interferon they received or the rate of normalization of transaminases. CONCLUSION: (i) A 12% incidence of thyroid dysfunction was observed under interferon therapy; (ii) secondary appearance under interferon therapy of elevated thyroid autoantibodies was a risk factor; (iii) the thyroid disorders induced by interferon were reversible.
OBJECTIVE: The reproducibility of glucose and insulin responses to a mixed meal were studied in 24 consecutive non-insulin-dependent (type II) diabetic patients, the diet of which matched the tested diet. Patients received their usual treatment throughout the study. RESEARCH DESIGN AND METHODS: A standardized diet was followed for 3 days, and responses were measured on the 2nd and 3rd days. Glucose and insulin responses were studied after lunches with the 180-min positive area under the curve, and were analyzed with paired t test and Pearson's linear regression. RESULTS: Glucose responses did not vary (217 +/- 50 vs. 217 +/- 38 min x mM, NS) and were significantly correlated (r = 0.64, P less than 0.01). Insulin responses did not vary (35,224 +/- 5768 vs. 35,305 +/- 7779 min x pM, NS) and were strongly correlated (r = 0.83, P less than 0.001). CONCLUSIONS: These results suggest that glucose and insulin responses to a test meal are reproducible in type II diabetic patients.
To specify the influence of methods used in estimating area under the curve (AUC) and the meaning of total and incremental AUC, 75 glycemic responses to a mixed meal were studied in 75 diabetic patients, 39 with insulin-dependent diabetes mellitus and 36 with non-insulin-dependent diabetes mellitus. AUC was integrated with five computerized methods: polynomial interpolation of third and fourth degree, trapezoidal rule, Simpson's integration, and cubic interpolatory splines. Although these methods gave significantly different results (P less than 0.001), a strong correlation was found between estimations of AUC with different methods (r greater than 0.99, P less than 0.001). In addition, variation between methods was less than or equal to 2%, whereas the coefficient of variation between subjects was 38%. Total AUC was strongly correlated with basal blood glucose value (r = 0.90, P less than 0.001), whereas incremental and positive AUC were not (r = 0.12 and 0.07, respectively, NS). Incremental and positive AUC were strongly correlated with glycemic rise (r = 0.89 and 0.93, respectively, P less than 0.001), whereas total AUC was only slightly so (r = 0.31, P less than 0.01). Incremental and positive AUC gave slightly but significantly different information on glucose response. These results suggest that variations related to the method used in estimating AUC are not clinically relevant and that a simple method such as trapezoidal rule can be used. Total AUC is a descriptive factor related to basal blood glucose value, whereas incremental and positive AUC more accurately describe glycemic response to foods.
Three cases of Riedel's thyroiditis are reported. The clinical presentation varied, with thyroid nodule in 2 cases (associated with cervical lymph node enlargement in 1 case) and compressive goitre with mediastinal involvement in the third case. The histological diagnosis of Riedel's thyroiditis is difficult and was made retrospectively in these 3 patients; it is based on the absence of malignant cells and the presence of fibrosis, inflammatory infiltrates and, inconstantly, vascular lesions of the occlusive phlebitis type.
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In order to study the influence of non-carbohydrate foods on responses to carbohydrates during mixed meals, 30 Type 2 (non-insulin-dependent) diabetic patients followed a standardized diet for 5 consecutive days. On days 2, 3, 4, and 5, four different lunches were eaten in a randomized order. Lunches consisted of rice or glucose (50 g carbohydrate) eaten either alone, or as part of a mixed meal (32 g protein, 20 g fat). Glucose and insulin levels prior to the lunches did not differ significantly. Glucose and insulin responses differed (p less than 0.001), responses to rice being lower than responses to glucose, and responses to the meal plus rice lower than responses to the meal plus glucose. The ratios of glucose responses to rice and glucose (glycaemic index) were similar (alone, 47 +/- 4%; meal, 47 +/- 4%; NS). The ratios of the insulin responses did not differ (78 +/- 8 vs 96 +/- 7%; NS). The blood glucose responses to mixed meals were lower than responses to the carbohydrates eaten alone, the ratios being similar (rice, 52 +/- 3%; glucose, 58 +/- 5%; NS). Serum insulin responses were however higher, and the ratios differed (172 +/- 13 vs 138 +/- 14%; p = 0.05). These results suggest that the glycaemic index of isolated carbohydrate foods can predict the relative response to mixed meals in the same individuals with Type 2 diabetes. They also support the insulin secretagogue effect of non-carbohydrate foods, which may vary according to the source of carbohydrate in the meal.
BACKGROUND/AIMS: The aims of this study were to assess response rates, evaluate side effects and determine prognostic factors for both response and toxicity in patients with liver metastasis from endocrine tumors treated with chemoembolization. METHODOLOGY: Data concerning 64 patients who underwent a total of 186 sessions of chemoembolization were retrospectively evaluated and correlated with response and toxicity after chemoembolization. RESULTS: Overall clinical, morphological and biological response rates were 93%, 74% and 52% respectively. Complete control of hormone-related symptoms was obtained in 59% of patients with a mean duration of response of 15 months. Transient major complications occurred after 5.9% of sessions and 3 patients died. In the univariate and multivariate analyses, a non-pancreatic primary and chemoembolization as first-line non-surgical treatment were prognostic factors for clinical response, and <30% of liver involvement for morphological response. A significant increase in morbidity was noted in patients with more than 70% of liver involvement. CONCLUSIONS: Hormone-related symptoms were controlled in the majority of patients with a non-pancreatic primary and in those treated with chemoembolization as first-line therapy. Morphological response and toxicity were respectively correlated with liver involvement of less than 30% and greater than 70%.
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