Asthmatic attack associated with oral clonidine test.
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Biomedical subjects
Publications and source records attributed to M Mimouni.
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Diffuse thyroid enlargement in a child is a rare presenting symptom of thyroid carcinoma. A papillary carcinoma may be hidden in a diffuse lymphocytic thyroiditis and should be carefully searched for during surgery. Furthermore, the finding, in frozen sections, of psammoma bodies in a lymphocytic thyroiditis should raise the suspicion of an occult malignant neoplasm. A case illustrating these diagnostic difficulties in a 5-year-old child is presented.
Psychogenic cough is croupy and explosive, never occurs during sleep, and is not affected by antitussive drugs. Physical and radiographic examinations of the respiratory tract and microbiological investigations are normal. Bronchial asthma manifested as chronic cough should be excluded in each patient by lung function testing.
A 2 1/2-year-old boy was examined because of swelling of the penis of six weeks' duration. Several strands of hair wrapped around the penis and buried under the epithelium were found to cause a constriction. The penile tourniquet syndrome should be suspected whenever the penis is swollen, especially in children, even if a foreign body is not visible.
Skin biopsies from children and adolescents with various syndromes of somatomedin deficiency revealed changes in structure and in distribution of the dermal elastin fibers as compared with a group of seven healthy control subjects. In 18 patients with isolated growth hormone deficiency (IGHD) and in 11 with multiple pituitary hormone deficiencies (MPHD), the number of elastin fibers was reduced; the individual fibers were shorter and slimmer than usual, and frequently arranged in groups dispersed in various directions. Skin biopsies from six patients with Laron-type dwarfism (LTD) revealed mostly thickened elastin fibers, frequently arranged in irregular bundles, but the number of elastin fibers was normal in prepubertal patients and reduced only in postpubertal patients. The reduction of elastin fibers in these patients was less prominent than in IGHD. The finding of more numerous elastin fibers in LTD than in IGHD is suggestive of a direct nonsomatomedin-mediated effect of human growth hormone on skin elastogenesis.
A 7-year-old boy with Prader-Labhart-Willi syndrome who had precocious adrenarche was found to have primary gonadal failure, as evidenced by appropriate laboratory investigations: elevated basal levels of plasma FSH and LH with exaggerated responses to LH-RH stimulation and unresponsiveness of plasma testosterone to repeated hCG stimulations. The elevated values of plasma DHEA which were found indicate an early activation of the adrenal gland. This patient demonstrates the variability of pubertal development in the Prader-Labhart-Willi syndrome, with the unusual association of primary gonadal failure and precocious adrenarche.
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A 3-month-old male infant with type I Klein-Waardenburg syndrome with an imperforated anus and a perineal fistula is reported. The possible association of this gastrointestinal malformation with the KW syndrome is discussed.
A 2 1/2-year-old girl developed arthritis in a metatarsophalangeal joint concomitantly with varicella. As she recovered within 2 days without antimicrobial treatment, it was considered that the arthritis was directly due to the viral infection. The importance of differentiating viral arthritis from septic arthritis, a well-known complication of varicella, is stressed.
Repeated hypoglycaemic attacks, associated with transient hepatomegaly, in a 12-year-old insulin-dependent diabetic girl continued despite reduction in dose and, later, complete discontinuance of insulin. The attacks ceased while she was in hospital, necessitating reinstitution of insulin. The hepatomegaly resolved when surreptitious additional insulin injections were discovered and stopped. Hepatomegaly in diabetics should arouse suspicion of overdosage with insulin.
Widespread subcutaneous lipoatrophy developed in a nineteen year old female diabetic using subcutaneous bovine NPH insulin. Neither rotation of the injection site nor injection of the same insulin into the atrophic areas affected the lesions. Replacement of the bovine insulin by a porcine preparation given by deep intramuscular injection into the center of the atrophic areas resulted in disappearance of the lesions within a short time.
The blood glucose of 271 diabetic subjects (140 boys and 131 girls), followed in a diabetes clinic, was determined by three methods: 1) Reflectance Meter (Ames), 2) Eyetone (Ames), and 3) AutoAnalyzer (Technicon). The results were statistically analyzed at four blood glucose concentration ranges (less than 100, 100 to 200, 201 to 300 and greater than 300 mg/dl). The Eyetone instrument and the Reflectance Meter were found to be simple and exact methods for instant glucose determination as compared with the standard AutoAnalyzer technique. The Reflectance Meter was inexact in the blood glucose range of 201 to 300 mg/dl. The Eyetone instrument was reliable within the range of 10 to 400 mg/dl and was found to be useful for quick glucose determination in the clinic or home.
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Six children and adolescents (aged from 2 6/12 to 16 years) with isolated hGH deficiency were subjected to a standard oral glucose tolerance test (OGTT) followed by the administration of IV glucagon at 180 mins. Three of them underwent a second test after several months of hGH therapy. Nine patients underwent a separate IV glucagon test and two of these patients had both tests. As controls served 14 endocrinologically normal children and adolescents, who underwent both tests. It was found that the patients with isolated hGH deficiency had lower basal insulin and blood glucose levels and that their insulin response to IV glucagon even after oral glucose preloading was significantly lower than in the control group. This response was partially restored by several months of hGH treatment in the three patients tested. These findings are interpreted as further evidence for an insulinotrophic effect of hGH.