The importance of insulin-like growth factor (somatomedin) measurements in the diagnosis and surveillance of acromegaly.
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Biomedical subjects
Publications and source records attributed to M Rieu.
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A 32-year-old man with insulin-dependent diabetes secondary to chronic calcifying pancreatitis of alcoholic origin in whom hypocalciuria (22 to 88 mg/24 hours) was discovered by chance, renal function being normal. Plasma phosphate levels were between 25 and 35 mg/l and the level of parathyroid hormone was at the upper limit of normal. Cervicotomy led to the discovery of three parathyroid glands which were removed. Their weight was increased and their histological appearance normal. The fourth parathyroid was not seen. Hypercalcaemia and hypocalciuria were found during the operation and persis 3 years after, with none of the usual causes being found. This patient has a certain number of characteristics reminiscent of familial hypercalcaemia-hypocalciuria syndrome: high plasma calcium levels associated with low calciuria despite normal renal function and a plasma parathyroid level normal in most cases. The physiopathology of this syndrome remains unknown. Its course is benign, without renal complications. Partial parathyroidectomy is ineffective.
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Eleven patients with kidney stone disease and idiopathic hypercalciuria (urinary calcium above 4 mg/kg/j), without phosphorus renal leak and 6 control subjects have been put for 3 days on a diet containing 1 g calcium and 1 phosphorus daily (period A), and then for 4 days on a diet containing 1 g calcium, 450 mg phosphorus and 3 g aluminium hydroxyde daily (period B). During period A, no significant difference in blood calcium, phosphorus and magnesium, not in phosphaturia, rate of phosphorus reabsorption (RPR) and ratio maximum RPR/creatinine clearance was found between the two groups. After 2 days on a low phosphate diet (period B) the blood phosphorus decreased significantly in the hypercalciuric patients but not in the control subjects, thus revealing among the forme a latent abnormality in the retention of phosphates. This abnormality could play an important role in the pathogenesis of hypercalciuria.
The biological and clinical results of vaccination against pseudomonas aeruginosa infection have been analyzed for a group of 287 burned patients having over 25% surface burnt. The vaccine used was a cellular one inactivated by heat and containing 10 different strains. The effectiveness has been judged on the one hand by the increase in the antipseudomonas antibody count and on the other by comparing a group of vaccinated patients with a non-vaccinated group. After vaccination, the antipseudomonas aeruginosa antibodies increased from the 4th-5th day and reached an impressive increase after the 10th day. Clinically, protection is almost complete if one considers that pseudomonas aeruginosa positive blood cultures appear 15 days after vaccination, and above all the prognosis of these late infections. Both locally and generally, this vaccine has always been perfectly tolerated.
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The study of blood lactate concentration after a submaximum and steadfast exercise shows a lesser rise after three weeks at middle altitude. This can be related with an increase of maximum working capacity as previously demonstrated. The obtained modifications result in part from an increase in oxydative metabolism activity and perhaps from an enhancement of lactate oxydation.
The study of resistances modifications in the femoral vascular bed during bilateral carotide occlusion supports the hypothesis of an inhibitory action of isoprenaline on norepinephrine release by the sympathetic post-ganglionnic fibres. This action explain the relations between isoprenaline vasodilator potency and sympathetic activity level.
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