Estrogens control inflammation in experimental colitis.

There is now a wealth of experimental evidence indicating that the deficit in endogenous estrogen facilitates the onset of inflammation that can be antagonized by estrogen replacement therapy. This work investigated the role of estrogen in the control of intestinal inflammation in a panel of colitis models, focusing on the morphological changes, the activity of mast cells, the expression of cytokines (IL-1beta, IL-6, and TNF-alpha), fibronectin and reactive oxygen species. Two hundred adult male rats were divided into 4 groups: colitis was induced in Group I and Group II but only the latter was treated with estrogen; Group III received estrogen only, and Group IV saline. Colitis was induced in 4 models using: iodoacetamide; iodoacetamide + enteropathogenic E. coli; 2, 4, 6-Trinitrobenzene sulfonic acid; and dextran sulfate sodium salt. Macroscopic and microscopic evaluations of abdominal structures as well as molecular analysis were made on days 7, 14, 28 and 56. There was a significant improvement in the health condition of the estrogen-treated rats: the inflammation scores were reduced by at least 10-15%, the number of mast cells in the colon decreased by 30%, fibronectin expression was only 50% and reactive oxygen species decreased by 30%. In addition, there was a significant decrease in TNF-alpha, IL-6 and IL-1beta expression by about 25%. In conclusion, there was an improvement in the inflammatory status in all estrogen-treated groups through the duration of the experiment at all-time points. In addition, there was less tissue necrosis as depicted by less fibronectin and a marked antioxidant effect.

Predictors of intra-operative parathyroid hormone decline in subjects operated for primary hyperparathyroidism by minimally invasive parathyroidectomy.

BACKGROUND: The predictors of intra-operative PTH (IOPTH) decline during minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism have been but poorly studied. MATERIALS AND METHODS: This retrospective study included 108 patients who underwent MIP for a single adenoma. Serum calcium and phosphorus were measured before surgery and 1 day post-operatively. IOPTH was measured before (intra-operative preincision or PTHt0) and 10 min after removal of the adenoma (PTHt10). The Modification of Diet in Renal Disease (MDRD) equation was used to estimate the glomerular filtration rate. The weight of the adenoma was assessed in all the subjects. RESULTS: The sex ratio female/male was 5.37 with a mean age of 57.3 yr. The mean pre- and postoperative values were for calcium 2.80 and 2.19 mmol/l, respectively (p<0.0001) and for phosphorus 0.90 and 1.16 mmol/l, respectively (p<0.0001). The PTH dropped from a mean value of 184.8 to 50.8 pg/ml 10 min after adenoma resection with a mean drop of 69.7%. Thirteen patients (12%) did not achieve a PTH fall of more than 50%. In a bivariate analysis, age, an MDRD<60 ml/min and weight of adenoma were inversely associated with IOPTH fall (p=0.009, p=0.004, and p<0.001, respectively) while gender, body mass index, hypertension, diabetes, pre-operative phosphorus and calcium had no significant effects. In the multivariate analysis, age, weight of adenoma, and MDRD were still independent negative predictors of the IOPTH fall (p=0.01, p=0.018, and p<0.001, respectively). CONCLUSION: Our results suggest that during MIP the presence of a parathyroid adenoma with a high weight, in an elderly subject or in a subject with altered renal function, will result in a lesser degree of IOPTH fall.

Benign disease of the thyroid gland and vocal fold paralysis.

Development of vocal fold paralysis in the presence of thyroid disease is strongly indicative of thyroid cancer, and requires surgical exploration. At the same time, vocal fold paralysis does not relieve the surgeon of his obligation to identify and preserve the recurrent laryngeal nerves, since the cause of the paralysis may be a benign disease, with a fair chance of functional recovery after surgery. We hereby report a case of recurrent laryngeal nerve palsy secondary to a multinodular goitre.

[Significance of TSH receptor antibody determination]. / Intérêt du dosage des anticorps antirécepteurs à la TSH.

TSH receptor antibodies (TRAb) was performed by binding assay in seventy-seven patients (47 with Graves disease, 32 with other thyroid abnormalities). The sensitivity and specificity of our assay were respectively 81% and 96.5%. These results were similar to the results found in medical literature. The association of ophthalmopathy with Graves disease does not increase the sensitivity of the test. In this study we conclude that TRAb assay is of great interest in confirming the diagnosis and in the following of Graves disease.

[Primary hyperparathyroidism. Experiences at the Hôtel Dieu. A study of 28 cases]. / Hyperparathyroïdie primaire. Expérience de l'Hôtel-Dieu. Etude de 28 cas.

Primary hyperparathyroidism is a more frequently recognized entity. The clinical picture historically severe, has changed overtime. We present herein our experience relating 28 cases with emphasis of our results compared to the medical literature.

[Importance of peptide C determination in diabetes]. / Intérêt du dosage du peptide C dans le diabète.

The peptide C, polypeptide secreted by the pancreas at the same time as insulin, presents a great interest in the evaluation of diabetic patients. First it allows a differentiation between insulin dependent diabetes (IDD) and non insulin dependent (NDD). A low and non stimulated levels of peptide C signifies an insulin dependence. Within the group of IDD patients the peptide C was low when the diabetes was discovered at a younger age and its secretion diminished as the diabetes progresses. The peptide C has also a prognostic interest in IDD. Low and non stimulable levels of peptide C signifies a difficult control of diabetes which needs two injections per day while high and stimulable levels will be seen in diabetes easy to control with one injection of insulin. Finally, values of peptide C does not permit to predict the onset of diabetic complications (retinopathy, acidocetosis) as well as the control of patients.

[A rare cause of diplopia: a sinus cavernous dural fistula. A case report]. / Une cause rare de diplopie: la fistule durale du sinus caverneux. A propos d'un cas.

Dural fistulas of the cavernous sinus represent a relatively unknown etiology for diplopia. The authors report on a case where combination of MR and transcranial Doppler (especially transocular) helped in diagnostic and therapeutic approach. They propose a new algorithm for the management of diplopia.

[Parathyroidectomy under local anesthesia. First two cases in Lebanon and review of the literature]. / Parathyroïdectomie sous anesthésie locale. Deux premiers cas au Liban et revue de la littérature.

The routine use of automated techniques to measure serum calcium levels have made disease states of the parathyroid gland a common endocrinologic problem. Because of the low sensitivity and specificity of early radiologic techniques to identify enlarged parathyroid glands, and because skilled endocrine surgeons report success rates of > 95% in identifying abnormal parathyroid glands, historically most parathyroid glands surgery consisted in a large cervicotomy under general anesthesia without preoperative localization. However, the development of sophisticated imaging techniques has now made it possible to identify the abnormal gland in a significant number of patients, leading some surgeons to choose unilateral neck exploration under local anesthesia for primary hyperparathyroidism. The success of the procedure is ascertained by measuring PTH peroperatively. We report the first two Lebanese patients, presenting with a solitary parathyroid adenoma, who underwent this easy, safe and cost-effective surgical technique.

Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region.

The prevalence of painful diabetic peripheral neuropathy (DPN) was evaluated in type 1 or type 2 diabetes mellitus patients (n = 4097) attending outpatient clinics across the Middle East. Overall, 53.7% of 3989 patients with DN4 data met the criteria for painful DPN (Douleur Neuropathique-4 [DN4] scores ≥ 4). Significant predictors of painful DPN included long history (≥ 10 years) of diabetes (odds ratio [OR] 2.43), age ≥ 65 years (OR 2.13), age 50 - 64 years (OR 1.75), presence of type 1 versus type 2 diabetes (OR 1.59), body mass index > 30 kg/m(2) (OR 1.35) and female gender (OR 1.27). Living in one of the Gulf States was associated with the lowest odds of having painful DPN (OR 0.44). The odds of painful DPN were highest among patients with peripheral vascular disease (OR 4.98), diabetic retinopathy (OR 3.90) and diabetic nephropathy (OR 3.23). Because of the high prevalence and associated suffering, disability and economic burden of painful DPN, it is important that diabetic patients are periodically screened, using a simple instrument such as the DN4, and receive appropriate treatment if symptoms develop.

[Physiology, physiopathology, and classification of polyendocrine adenomatosis (author's transl)]. / Physiologie, physiopathologie et classification des polyadénomatoses endocriniennes.

The various elements derived from the neural crest are reviewed and their relationship with the APUD system discussed. The resulting physiopathological consequences imply that there is a common embryonic origin for cells which appear to be unrelated. A classification of the various pathological affections involving these cells, is proposed.

[Classification and metabolic relationship of plasma apoproteins (author's transl)]. / Données actuelles sur les apoprotéines.

The apoproteins are the constitutive peptides of the plasma lipoproteins. The most widely employed nomenclature is that based on the family concept of constitutive polypeptides. The apoproteins are synthetized in the liver and/or in the intestine. During the lipolysis, apoprotein transfers and/or exchanges are observed. The apoproteins play a major role in the structure of the macromolecular lipid-protein complexes, and in the activity of several enzymes involved in the lipoprotein catabolism. An expanding information on apoprotein metabolism will allow a better comprehension of the hyperlipidemia pathogenesis.

[Neurocristopathies : embryology, physiology, and pathology of the neural crest derivatives (author's transl)]. / Les neurocristopathies. Embryologie, physiologie et pathologie des dérivés de la crête neurale.

The authors review various of the derivatives of the neural crest, consider their relationship with the APUD System, and deduce the physiopathological consequences applicable to these cells, whose only similarity lies in their common embryologic origin. They propose a system of classification of interrelated pathological conditions that these cells may show, an detail clinical information as well as the mode of genetic transmission of the principal neurocristopathic syndroms.

Panhypopituitarism secondary to head trauma: evidence for a hypothalamic origin of the deficit.

A complete endocrinological exploration was performed in a 23 year old male patient who presented clinical signs of an acquired panhypopituitarism which appeared two months after a severe head trauma, in order to determine whether the deficit lay in the hypothalamus or in the pituitary. TSH had normal basal levels, but presented a delayed rise after TRH administration. PRL rose normally after TRH administration, but presented a blunted response to both metoclopramide and insulin tolerance test. Cortisol rose significatively after lysine vasopressin, but failed to rise during insulin hypoglycaemia. These results are consistent with a hypothalamic defect. Extensive endocrinological data are often lacking in the few similar cases reported in the literature. Prl and TSH were usually found to have normal basal levels while other pituitary hormones were profoundly lowered. This was interpretated as a pituitary defect with some intact areas of the anterior lobe. However, this may also suggest a hypothalamic defect which could have been assessed by mor discriminative tests.

[Panhypopituitarism and dwarfism in a man with a primary empty sella turcica (author's transl)]. / Panhypopituitarisme et nanisme chez un homme ayant une selle turcique vide primitive.

Endocrine features associated with the primary empty sella turcica syndrom are rare; they are usually related to a pituitary microadenoma and more rarely to an idiopathic panhypop ituitarism. A pituitary dwarfism with an idiopathic panhypopituitarism of hypothalamic origin, associated with an "empty" sella turcica containing functional and stimulable pituitary tissue, is reported in a 27 year old male Moraccan.

[Male pseudohermaphroditism. State and present problems (author's transl)]. / Situation et problèmes actuels du pseudohermaphrodisme masculin.

The authors describe the male phenotypic sexual development in the fetus: transformation of the undifferentiated gonad into testis under the HY antigen influence; testicular secretion of testosterone (which allows the development of the wolffian ducts derivatives) and of MIF (which inhibits the development of the mullerian duct; masculinization of the external genitalia under the influence of dihydrotestosterone. They outline the three abnormalities which may lead to a male pseudohermaphroditism: disorders of testicular differentiation, defects of testicular function and androgen insensitiveness at the target areas. They consider the diagnostic steps and the therapeutic management especially in relation to the choice of the sex and the risk of gonadoblastoma.

[Acquired post-traumatic and idiopathic hypothalamic panhypopituitarism in adults. Three cases (author's transl)]. / Panhypopituitarismes acquis post-traumatiques, idiopathiques et d'origine hypothalamique de l'adulte. 3 observations (author's transl)]

Three cases of hypothalamic panhypopituitarism in male adults are reported. Two of them, without antidiuretic hormone deficiency, succeeded to a closed head injury. The third one was associated with impaired posterior pituitary function and presumably was of idiopathic origin, since radiological and ophthalmological investigations gave normal results, although the disease seemed to have begun some 20 years before.

[Hypertensive forms of congenital adrenal hyperplasia]. / Les formes hypertensives des hyperplasies surrénales congénitales.

The authors describe the principal clinical and biological features of congenital adrenal hyperplasia with hypertension with respect to their own experience and a review of the literature: a beta-11-hydroxylase deficiency is well-known, an alpha-17-hydroxylase deficiency is exceptionally rare. Several clinical and biological advances are discussed in the light of recent studies.