[Coarctation of the abdominal aorta: diagnosis, pathogenesis, medical or surgical treatment. 7 cases]. / Coarctations de l'aorte abdominale: diagnostic, pathogénie, traitement médical ou chirurgical. Sept observations.

Seven cases of coarctation of the abdominal aorta are reported. The diagnosis, suggested by the presence of arterial hypertension associated with nonperception of the arterial pulse in the lower limbs and/or systolic murmur in the abdomen, is supported by non-invasive investigations, such as Döppler flowmetry of lower limb arteries and ultrasonography of the abdominal aorta. Arteriography, however, is mandatory because of frequently associated lesions of other arteries, notably renal and/or intestinal arteries. The type and location of these lesions are of prime importance to therapeutic decision. According to the results of the present study, surgery may not be required in all cases and may be replaced, in some very specific circumstances, by medical treatment. There is still disagreement concerning the congenital or acquired origin of this type of aortic coarctation and the mechanism of hypertension. The various theories put forward are discussed.

[Are the theoretical drawbacks of beta-blocker treatment in pregnancy being confirmed? A review of the literature]. / Les inconvénients théoriques des beta-bloquants durant la grossesse se confirment-ils? Une revue de la littérature.

The use of beta-blocking drugs in the treatment of hypertension during pregnancy has been the subject of controversies on the basis of theoretical hazards due to the pharmacology and pharmacokinetic characteristics of these drugs. A review of the literature on the subject shows that: The danger of premature contractions, abortion or premature delivery does not seem to increase with the use of beta-blockers. The blood supply is not more impaired with beta-blockers than with other antihypertensive drugs according to fetal growth, birth-weight, frequency of perinatal deaths or APGAR score. Although beta-blocking drugs pass into fetal circulation, neonatal bradycardia, respiratory distress or hypoglycemia do not seem more frequent with beta-blockers. Beta-blockers pass from maternal plasma into milk but the 24 hour dose brought to the newborn by maternal feeding is so slight as to be negligible. Thus, the cumulative data and the favorable opinions of many authors, the greater efficiency of beta-blockers authorizes the use of these drugs in the treatment of hypertension in pregnancy, where it seems to improve the outcome of the pregnancy and the state of the fetus at birth.

[Location of an insulinoma by transhepatic phlebography with staged insulin assays (author's transl)]. / Localisation d'un insulinome par phlébographie transhépatique avec dosages étagés de l'insulinémie.

Insulinoma was easily diagnosed in a 73-year-old woman who had organic hypoglycaemia associated with hyperinsulinism, but the tumour could not be located by echotomography and computerized tomography. The state of the patient's arteries precluded arteriography. Pancreatic phlebography was carried out by the portal transhepatic route and blood was collected at different levels for plasma insulin assays. A very high gradient at the pancreatic isthmus indicated the site of the tumour, which was found on surgery to be precisely there and could be enucleated. This technique cannot be used systematically to locate insulinomas, but it is unquestionably helpful when the tumour cannot be located by other methods or when these are contra-indicated.

[Results of treatment of Graves' disease by antithyroid drugs. Report of 90 cases (author's transl)]. / Résultats du traitement de la maladie de Basedow par les antithyroïdiens de synthèse. A propos de 90 cas.

Ninety patients with Graves' disease were given treatment with antithyroid drugs. The first course, which is almost always immediately successful, gave in the long term 46 failures and 44 successes. Among the latter, 38 had a follow up equal or greater than one year after interruption of the course. Among the 78 cases sufficiently well followed up for the whole period of treatment (of which 21 had at least two courses of treatment), we noted 23 failures and 55 successes (70%) for which the average follow up was 61 months. If one requires a follow up equal or greater than one year after the end of treatment, we noted 47 good results out of 70 fully documented cases, i. e. 67%. The possible failures almost always occurred less than one year after the end of treatment. The delay since the last interruption of antithyroid drugs is thus of prognostic value. The result of treatment was not found to be related to any of the clinical or laboratory parameters found during the initial stage of the disease, nor with the type of antithyroid drug used. The addition of thyroid hormone to antithyroid drugs does not seem to be of any use. On the other hand, delay in starting treatment seems to favour the failure of treatment. Other interesting prognostic factors may be sought in the kinetics of TSH, the T3-suppressibility, the early radioiodine uptake, the estimation of thyrostimulating antibodies, and the study of HLA histocompatibility antigens.

[Hypertensive patients treated with tielinic acid. A retrospective study of 298 cases (author's transl)]. / Hypertendus traités par l'acide tiénilique. Etude rétrospective de 298 observations.

Two-hundred and ninety-eight hypertensive patients received tielinic acid for a period of 4 to 42 months; in 295 cases the drug was combined with a potassium-sparing diuretic. No significant changes in mean serum creatinine levels were observed in the whole group. The slight rise in serum creatinine which occurred in 17 patients cannot be ascribed with certainty to the combined treatment. Two patients developed cytolytic hepatitis, and of the 253 patients whose serum transaminase levels were systematically measured, 18 had moderately increased levels; here again, the responsibility of the drug could not be fully established. These data suggest that combining tielinic acid with a potassium-sparing diuretic carries little risk of renal impairment and that this treatment can safely be used. The risk of liver damage is unquestionable but probably small no greater than that of other commonly used hepatotoxic drugs, notably allopurinol.

[Treatment of certain refractory arterial hypertensions with a monoamine oxidase inhibitor]. / Traitement de certaines hypertensions artérielles réfractaires par un inhibiteur de la mono-amino-oxydase.

Sixteen patients with refractory hypertension were treated with the monoamine oxidase inhibitor iproclozide at doses of 10 to 30 mg/day. Its addition to the previously prescribed antihypertensive therapy resulted in normalisation of blood pressure readings in two cases, significant improvement in seven cases and no change in four cases. Side effects due to iproclozide were relatively minor, the treatment having to be discontinued in three cases. Its association with alpha methyldopa or spironolactone did not lead to any untoward complications. Despite the success of other recently introduced drugs in refractory hypertension, this study shows that MAOI may be very useful in the management of this condition.

[Effect of long-term therapy of essential hypertension on serum creatinine, electrocardiogram and eyeground status: a study of 71 patients over 7 years (author's transl)]. / Evolution du retentissement viscéral dans l'hypertension artérielle essentielle traitée.

71 patients with essential hypertension have been followed for 7 years under effective anti-hypertensive therapy. Significant decrease in mean blood pressure was noted at the end of the first year and progressed linearly thereafter. Serum creatinine rose slightly, probably due to diuretics. Eyegrounds improved sharply during the first year, but deteriorated slightly thereafter: this may be due to increasing arteriosclerosis and validity of classification is questioned. Electrocardiogram improved during the first year, singularly in men: correlation with reduction in blood pressure was not clear. This discrepancy is discussed. It is concluded that improvement is sufficient to justify a continued treatment in this type of hypertension.

[Hypertension and oral contraceptive therapy (author's transl)]. / Hypertension artérielle et contraceptifs oraux.

Twenty-nine patients, either taking oral contraceptives or having stopped since less than six months, were referred for hypertension. Three conditions have to be satisfied in order to incriminate with certainty the responsibility of oral contraceptives inducing hypertension : normal blood pressure before therapy (included pregnancies), normalization of blood pressure in a delay of three months at most after the discontinuation, no other etiology of hypertension. The small number of hypertensions really induced by oral contraceptives is opposed with the great number of hypertension (essential or not) revealed by oral contraceptives.

PIP: 29 patients were treated between 1972-77 for arterial hypertension; all patients were on OC (oral contraception). Careful investigation of these patients revealed that only in some had hypertension been caused by OC treatment, which goes against the commonly held opinion that arterial hypertension in OC patients is always caused by hormonal treatment. At least 3 conditions must be satisfied in order to incriminate the responsibility of OC in inducing hypertension: 1) normal blood pressure prior to OC treatment; 2) normalization of blood pressure within 3 months after discontinuation of OC use; and 3) no other etiology of hypertension. Arterial hypertension seems to be caused by the synthetic estrogen component of OCs; the mechanism of action is still not clear, although it has been demonstrated that it does stimulate the renin-angiotensin-aldosterone system.

[Sipple's syndrome: a study through three generations. HLA--carcino-embryonic antigen system. Preliminary results (author's transl)]. / Syndrome de Sipple: étude sur troid générations. Système HLA, antigène carcino-embryonnaire. (Résultats préliminaires).

Sipple's syndrome in three members of the same family (three successive generations) is reported, confirming that this syndrome is hereditary and transmitted in an autosomal and dominant way. Whereas pheochromocytoma was clinically detectable, medullary thyroïd carcinoma could only be detected in two cases by systematic search for high levels of calcitonin before and after stimulation. In 6 other siblings, thyroïd carcinoma was eliminated in view of negative stimulation tests. HLA groups were studied, but definite conclusions as to the interest of these data in Sipple's syndrome cannot be drawn from 10 few cases. Persistingly high levels of calcitonin after surgery is known to be of severe prognosis; in the present cases, the very short delay after surgery did not allow definite conclusion, since, according to some authors, several months are necessary to allow a return to normal levels.

[Microangiopathy of the diabetic type, without carbohydrate intolerance (author's transl)]. / Microangiopathie de type diabétique sans intolérance aux hydrates de carbone.

Pathophysiology of diabetic microangiopathy is unclear, but hyperglycemia is admitted as an important factor. In three patients having microangiopathy with lesions very similar to those of diabetes (one nodular glomerulosclerosis, two retinopathies), glucose tolerance was found normal. Such cases, already reported, but rather rare, raise the question of the validity of tests currently used in the diagnosis of diabetes, of the importance of hyperglycemia compared to others factors (specially genetic) in the occurrence of microangiopathy, and of the specificity of these lesions.

[Tomodensitometry: localizing value in hypertension of adrenal origin (author's transl)]. / Tomodensitométrie: intérêt localisateur au cours des hypertensions artérielles d'origine surrénalienne.

Computarized axial tomography has shown the localization of adrenal lesions in four cases of hypertension of adrenal origin: two phaeochromocytomas, one primary hyperaldosteronism, one Cushing's syndrome. This method has the advantage of being neither invasive, nor time-consuming. Unfortunately, it cannot localize tumors smaller than two cm in diameter. It seems to be highly beneficial in phaeochromocytoma, where it can advantageously take the place of arteriography. It is less fruitful in primary hyperaldosteronism and in Cushing's syndrome because lesions are smaller.

[Does the insulin-secretion capacity of non-diabetic subjects possess a prognostic value? (author's transl)]. / La capacité d'insulino-sécrétion des sujets non diabétiques possède-t-elle une valeur pronostique?

Twenty-two patients, whose initial oral glucose tolerance test (OGTT) was not diabetic, but who possibly had predisposition for diabetes, underwent iterative OGTT with plasma insulin determination and estimate of insulin-secretion capacity (plasma insulin area/blood glucose area ratio, and insulin-secretion coefficient). With a 30 months mean time interval between the two tests, a highly significant negative correlation was found between insulin-secretion capacity of the first test and blood glucose area of the last one. Glycemic curve of the OGTT was diabetic in 3 cases at the final test. Thus, it seems possible to select subjects most prone to future diabetes with simple parameters estimating insulin-secretion capacity during OGTT.