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Biomedical subjects

J Mirouze

Publications and source records attributed to J Mirouze.

At least 91 records · Page 5Linked to original sources
PubMed1982

[Chronic insulin urticaria. Therapeutic efficacy and good tolerability of human insulins].

A case of type III (Arthus') hypersensitivity to insulin which occurred several years after insulin treatment was instituted is described. Its persistence even with highly purified insulins of bovine or porcine origin was suggestive of a direct reaction against insulin itself. The patient had no history of allergy and, contrary to most similar cases published, had not received intermittent insulin therapy. Using stimulation of lymphocyte blastogenesis, the authors were able to demonstrate the presence of specific antigen-mediated hypersensitivity to all insulins tested, including human insulins. The circulating immune complexes did not appear to be pathogenic, since the patient only had minimal retinopathy after 22 years of insulin-dependent diabetes. Human insulin was tolerated and proved effective in controlling both blood glucose levels and skin rashes in response to conventional insulins.

Adult↗
PubMed1982

Total implantation of a remotely controlled insulin minipump in a human insulin-dependent diabetic.

This study reports our first total implantation of an insulin minipump in a severely unstable 23-year-old female insulin-dependent diabetic. The implantable unit includes a stepping motor, a percutaneously refillable insulin reservoir (10 ml, U 100 special insulin), a battery with a life span of one year, and a method for prevention of overdosage. Variable continuous basal and superimposed 1-hour high rates are programmed and checked via an external remote controller. The pump was inserted in the lateral muscles of the abdomen and the insulin delivery catheter terminated in the peritoneal cavity. Excellent glycemic control was reached rapidly and has continued seven months after implantation (mean blood glucose is 123 +/- 62 mg/dl; glycosylated hemoglobin is 7.0 +/- 1.2%), with the unit providing the only source of insulin. The only negative aspects were a chronic lymphorrhea in the first two months, and a need for frequent and laborious insulin refills (every 20 days). Only slight local discomfort was experienced. Thus, although further miniaturization and autonomy are expected, these preliminary results show that with careful instruction and followup, implanted pumps could represent a reliable and safe alternative to conventional insulin therapy for selected diabetics.

Adult↗
PubMed1982

[Not Available].

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History, Modern 1601-↗
PubMed1982

[The influence of indomethacin and possible role of prostaglandin on renal calcium excretion (author's transl)].

Our aim was to evaluate the possible role of prostaglandins (PG) on renal calcium excretion in humans through the PG inhibitory effects of indomethacin. Renal calcium excretion was evaluated by a technique of impulse analysis which gives a specific index of tubular calcium transport. Several parameters were derived from this specific transport function W(t): 1) the fractional excretion of filtered calcium as % of total dose (FECa % TD); 2) the peak excretion rate; 3) the mean transit time (MTT, min). The aforementioned parameters were determined in 7 healthy subjects in basal conditions and again after 10 days of treatment with 100 mg indomethacin daily. FECa was significantly (P less than 0.02) higher with indomethacin (8.18 +/- 0.97) than under basal conditions : (5.02 +/- 0.57). The peak excretion rate and MTT remained unchanged after indomethacin. These results indicate that indomethacin increases renal calcium excretion. As indomethacin did not produce any significant change in glomerular filtration rate (125 +/- 7 ml/min before v.s. 129 +/- 9 after) one can assume that PG play a role in tubular calcium reabsorption. However the mechanism remains to be elucidated : direct action of mediated through the cyclic AMP system.

Adolescent↗
PubMed1981

[Type I multiple endocrine neoplasia with prolactin-secreting tumor revealed by pituitary apoplexy (author's transl)].

Prolactin-secreting adenoma is probably the most common functional pituitary tumour in type I multiple endocrine neoplasia (MEN I). The authors report on a case of gastrinoma and parathyroid adenoma associated with prolactinoma. The latter tumour was revealed by sudden pituitary apoplexy. The characteristic features of endocrine tumours in MEN 1 are discussed, and the relevant literature is reviewed. Emphasis is placed on the fact that prolactinomas are well tolerated, remain clinically silent for a long time and may be diagnosed only when dramatic symptoms suddenly appear.

Cerebrovascular Disorders↗
PubMed1981

[Post-hyperglycaemic hypoglycaemia: effects of somatostatin (author's transl)].

Precise recordings of reactive (post-hyperglycaemic) hypoglycaemia were ensured by continuous blood glucose monitoring during oral glucose tolerance tests. The definition of hypoglycaemia was limited to the following criteria: absence of chemical diabetes; fall in blood sugar to less than 30% of the fasting level or to less than 2.50 mmol/l (0.45 g/l); development of clinical signs of hypoglycaemia. An infusion of somatostatin over 4 hours slowed down the initial rise in blood sugar during the first 90 minutes and the rise was prolonged throughout the infusion whatever its duration. The maximum glycaemia reached was 13.3 mmol/l (2.40 g/l) at the 250th minute. Interruption of the infusion led to a rapid fall in blood sugar to a level identical (2.1 and 2.5 mmol/l) with and without somatostatin respectively. Somatostatin infusions, while frankly diabetogenic in certain circumstances, do not prevent reactive hypoglycaemia but rather delay its onset.

Adult↗
PubMed1981

Effects of somatostatin added to insulin in a glucose-controlled insulin infusion system.

Five insulin treated diabetics were studied on three consecutive days. Overnight variable intravenous insulin infusions were used before each study to maintain normoglycaemia and to calculate the optimal basal insulin infusion rate (1.1 +/- 0.1 U/h) which ws then kept constant throughout the study day. A standard 400 kCal breakfast with 25 g xylose was given at 0800 h. When the blood glucose rose above 4.1 mmol/l, an external artificial pancreas was used to infuse either extra insulin (day INS) or somatostatin for either 3h (day som) or the entire 8h experimental period (day SOM). Peak post-prandial blood glucose values were similar on all three days. The blood glucose rebounded after the cessation of the somatostatin infusion on day som. Post-prandial blood xylose peaks were lowered by somatostatin on both days but rebounded after the cessation of the somatostatin infusion on day som. The area under the plasma and urinary xylose curves was lowered by somatostatin only on day SOM. Growth hormone and glucagon levels were not statistically different on all 3 days. Thus somatostatin, when added to an optimal insulin infusion, minimised the insulin requirements by slowing intestinal absorption, but led to rebound hyperglycaemia if not feed-back controlled.

Adult↗
PubMed1981

Glucagon immunoreactivity and antidiabetic action of somatostatin in the totally duodeno-pancreatectomized and gastrectomized human.

Ten patients who had been totally duodeno-pancreatectomized and totally (N = 1) or partially gastrectomized (N = 9) for chronic pancreatitis (N = 9) or pancreatic carcinoma (N = 1) were investigated. None had a measurable basal level of either plasma C-peptide or a C-peptide response to i.v. glucagon. Immunoreactive glucagon (IRG) was present in all patients, and the mean level (69 +/- 8 pg/ml) was not significantly different from the mean observed in normal subjects (81 +/- 16 pg/ml). Plasma IRG was unequivocally stimulated by arginine in 2 of the 10 subjects. The effect of somatostatin on plasma glucose and IRG during an oral glucose tolerance test was studied in 5 of the 10 patients. The effects of somatostatin on spontaneous hyperglycemia, plasma growth hormone, and IRG after withdrawal of insulin treatment was studied in 4 patients. Somatostatin blunted both the hyperglycemic and paradoxical IRG responses to the glucose challenge, and reduced the spontaneous rise of blood glucose that occurred after insulin withdrawal. This latter effect was not related to clear-cut changes in plasma growth hormone or in IRG. These data confirm the existence of circulating IRG in pancreatectomized patients and demonstrate the presence of circulating IRG in a completely gastrectomized and pancreatectomized patient. The somatostatin-induced improvement in glucose tolerance in the oral glucose tolerance test seems to be related to a reduction of the paradoxical IRG response. In contrast, the inhibition by somatostatin of the rise in blood glucose which occurs after insulin withdrawal does not seem to be mediated through IRG or growth hormone.

Adult↗
PubMed1980

[Effects of somatostatin in oesophagal bleeding (author's transl)].

We used intravenous synthetic somatostatin to stem severe bleeding from oesophagites and oesophageal ulcer associated with renal failure hyponatremia and mental confusion. The ability of somatostatin to reduce splanchnic blood flow and portal pressure and to inhibit both gastrin release and the pentagastrin-stimulated secretion of gastric acid and pepsin provides its therapeutic use in multiple alimentary bleeding. When patients is considered poor candidate for surgery, somatostatin may prove a particularly valuable alternative to conventional medical treatments. We observed no side effects, with somatostatin, during a 72 h period of treatment. Since cimetidine give rise to mental confusion in ureamia or hyponatremia, somatostatin should be looked upon with particular interest in cases of gastro-intestinal bleeding associated with renal insufficiency.

Esophageal Diseases↗