[Oral contraception and troleandomycin]. / Contraception orale et troléandomycine. Un nouveau cas d'ictère.

PIP: A case of jaundice appearing after 7 days of treatment with troleandomycin 1.5 g/24 hours in a 21-year old woman who had taken an oral contraceptive (OC) for 3 years is described. The young woman had tolerated Ovariostat and later Miniphase, and had never taken troleandomycin. Mild digestive trouble appeared after 48 hours, and on the 7th day the appearance of pruritus and early jaundice caused interruption of the troleandomycin and the OC. Examination disclosed hyperbilirubinemia and increased alkaline phosphatases and transaminases. Pruritus and jaundice regressed about 1 month later but did not disappear completely for 2 months. No evidence of viral hepatitus was found. Although combined pills and troleandomycin are both known to be associated with hepatic effects, jaundice is rare in both cases. From 1977-81 about 60 cases similar to the present one have been published in France. If simultaneous treatment with troleandomycin and combined OCs is the cause of the jaundice, the mechanism may be inhibition of troleandomycin metabolism by the estrogen, inhibition of estrogen metabolism by the troleandomycin, or simply the accumulation of toxicities of 2 hepatotoxic substances. Until careful, large scale studies are undertaken it seems prudent to avoid the prescription of troleandomycin in women who are taking combined oral pills or are pregnant.^ieng

[Management of hypo-uricemia (author's transl)]. / Conduite à tenir devant une hypo-uricémie.

Hypo-uricemia (under 120 mumol/L) is not uncommon (1% of the population). Two main mechanisms are responsible (abnormal synthesis and anomalies in renal excretion), but there are a great number of possible etiologies. Except for states of stress or distress (30%), etiology focuses on drugs (60%), mainly aspirin. Malignant disease, particularly myeloma and broncho-pulmonary carcinoma which can be revealed by hypo-uricemia, are much less frequent. Genetically determined cases are uncommon. The diagnostic approach for finding the etiology should be physiopathological and focused on a simple test : uric acid clearance.

[Hypersensitivity of the beta-adrenergic receptors in patients considered as spasmophilic. Results of two stimulation trials with isoprenaline in 105 patients (author's transl)]. / Hypersensibilité des récepteurs bêta-adrénergiques chez des patients classés comme spasmophiles. Résultats de deux épreuves de stimulation par l'isoprénaline chez 105 patients.

Two stimulation trials with isoprenaline were performed in two groups of 50 and 55 patients considered as spasmophilic. The first trial was to check the sensitivity of the beta 1 type cardiac receptors : the average isoprenaline hydrochloride dose raising by 50 p. 100 the rest cardiac rate was equal to 0.147 +/- 0.09 micrograms/kg for 0.23 +/- 0.09 micrograms/kg in the control group. A second trial allowed to stabilize the cardiac rate between + 40 and + 50 p. 100 of its initial value : the symptoms, reappearing during stimulation, under the influence of isoprenaline, were studied. In 43 out of the 50 investigated patients the usual symptoms reappeared, particularly the acrocontractural attacks which were observed then in 46 p. 100 of cases, and sometimes an acute tetanic attack with opisthotonus. All these signs which are characteristic of "the spasmophilic state" seem to relate to vegetative regulation in which the beta-adrenergic component would show the most important : hypersensitivity of the beta receptors might be the common physiological base.

[Hypo-uricemia due to renal uricosuria (author's transl)]. / Hypo-uricémie d'origine rénale. A propos d'un cas.

A 49 years old healthy man was found to have major hypouricemia (0.2--0.5 mg/100 ml) with normal 24 hours urinary urate excretion (300 mg). The urinary clearance of uric acid was found to be very increased (100 ml/mn), higher than the clearance of creatinine (85 ml/mn). Urinary xanthine and hypoxanthine levels were normal. There was no other clinic or biologic trouble.