[Remission induced at the early stage of insulin-dependent diabetes: do predictive factors exist?]. / Les rémissions induites à la phase précoce du diabète insulinodépendant: existe-t-il des facteurs prédictifs?

The induction of a remission has been attempted in 28 patients with insulin-dependent diabetes of less than 3 months' duration by strictly normalizing glycemia either with a period of external artificial pancreas followed by continuous subcutaneous insulin infusion (22 patients) or with continuous subcutaneous insulin infusion alone (6 patients). HLA A, B and DR antigens were determined in every patient. Residual beta-cell function was evaluated by measuring C peptide and the ratio of C peptide to glycemia, and by testing the response to a glucagon stimulation before initiating and after withdrawing insulin treatment. Oral treatment with 15 mg glibenclamide and 840 mg metformin daily was administered when insulin had been stopped. A remission was obtained in 17 of the 28 cases. The likelihood of a remission was greater if: (1) the patient was older (mean age was 25.6 years in case of success and 16.6 Years in case of failure); (2) initial daily needs for insulin were smaller (0.88 v. 1.23 U/kg); and (3) stimulated secretion of C peptide was larger (0.22 v. 0.11 mmol/l).

[Chronic atrophic polychondritis. Critical analysis of the therapeutic efficacy of dapsone. 2 cases]. / Polychondrite chronique atrophiante. Analyse critique de l'efficacité thérapeutique de la dapsone. Deux observations.

Dapsone has been used since 1976 in the treatment of relapsing polychondritis. A critical analysis of its therapeutic effectiveness based on 2 personal cases and 14 cases reported in the literature, all treated with dapsone alone, showed that treatment had to be discontinued in 4 on account of side effects (haemolytic anaemia, erythema multiforme, somnolence, headache, nausea); 1 patient showed no improvement and 5 relapsed; 6 responded favourably and without relapse during a 3 months' to 4 years' follow-up. Considering the unpredictable course of relapsing polychondritis and the fact that some of its clinical manifestations, notably auricular chondritis, may spontaneously resolve, the response of the disease to dapsone is difficult to establish and requires to be confirmed by a controlled clinical trial.

Jejunal bleeding from a solitary large submucosal artery. Report of two cases.

Two young patients with massive intestinal bleeding resulting from a solitary submucosal arterial abnormality of the jejunum are reported. In one case, the bleeding lesion was localized only by emergency abdominal angiography, while a previous exploratory laparotomy proved negative. The vascular lesion encountered in both patients consisted of a wide caliber artery lying in the jejunal submucosa; there was no evidence of true aneurysm on serial sections. The clinicopathological picture closely resembles that of lesions previously described in the stomach under the name of "gastric submucosal aneurysms" in the English literature, or of "gastric Dieulafoy's erosion" in the French literature. It is suggested that the vascular lesions herein reported should be called "solitary large submucosal artery" or "Dieulafoy-like erosion" of the jejunum.

[Nephrotic syndrome associated with chronic lymphoid leukemia. Review of the literature apropos of a case]. / Syndrome néphrotique associé à une leucémie lymphoïde chronique. Revue de la littérature à propos d'un cas.

A case of chronic lymphoid leukaemia complicated by a nephrotic syndrome is reported. There was no evidence of amyloidosis or renal vein thrombosis. Percutaneous renal biopsy disclosed lobular membranoproliferative glomerulonephritis with subendothelial deposits of IgG, C3, C4 and C1q. Circulating immune complexes, IgG lambda cryoglobulin and low CH50 levels due to activation of the classical pathway were demonstrated in serum. Immunosuppressive treatment of the leukaemia resulted in complete regression of the nephrotic syndrome.

[Blood sugar control in diabetics with the insulin pump. Comparison with discontinuous injections]. / Contrôle glycémique des diabétiques sous pompe a insuline. Comparaison avec les injections discontinues.

Eighteen insulin-dependent diabetic patients received insulin in a continuous subcutaneous infusion delivered by a portable pump. Short-term glycemic control was evaluated on the average glycemia (serum glucose was assayed seven times per 24 hours for three to five days), on the MAGE coefficient which gives an estimate of glycemic lability, and, in eight patients, on serum C-peptide concentrations. Results were compared to those recorded with two daily subcutaneous injections of a combination of regular and intermediate insulin. The average glycemia and the MAGE coefficient were 1.32 + 0.05 milligram (m + SEM) and 1 + 0.05 milligram respectively under continuous infusion, compared to 2.05 + 0.12 and 1.76 + 0.12 milligram respectively under insulin injections. Insulin requirements were significantly lower under continuous infusion (0.99 + 0.08 U/kg versus 1.35 + 0.11 U/kg). In three patients with brittle diabetes the use of the pump ensured rapid metabolic control. The advantages and drawbacks of portable insulin pumps are discussed in the light of this experience.

[Viral etiology of aseptic lymphocytic meningitis. Twenty-four cases seen over a nine-year period (author's transl)]. / L'étiologie virale des méningites lymphocytaires aiguës bénignes. A propos de vingt-quatre cas recueillis en neuf ans.

Among 208 cases of aseptic lymphocytic meningitis seen over a nine-year period, 24 were diagnosed as viral infections. Diagnosis was established by both isolation of the virus from one or several specimens (feces, pharyngeal mucus, CSF) and significant rise in specific antibody titres. The usual clinical and epidemiological characteristics of these benign infections were demonstrated in our series: prevalence in males; recrudescence in summer; infectious syndrome associated with an unequivocal, though moderately severe, meningeal syndrome, and occasionally with various visceral manifestations (exanthema, pharyngitis, acute respiratory disease, myalgia); clear CSF usually with pleiocytosis (relative but not absolute predominance of lymphocytes) and normal chemical findings. All the cases in our series were due to enteroviruses, Echo or coxsackie. Isolation of a poliovirus (type III) in one case deserves mention. Cases where clinical examination led to unequivocal diagnosis of mumps or herpes zoster were not included in our study.

[Acute respiratory distress syndrome: indigenous Legionnaires' disease (author's transl)]. / Pneumopathie aiguë dyspnéisante grave. Maladie des légionnaires autochtones.

The possibility of indigenous Legionnaires' disease should be known as suggested by the following case : a 69-year-old man, diabetic, having never travelled out of Poitou, suffers from serious pneumonia with dyspnea needing mechanical ventilation with positive end-expiratory pressure. After failure of ampicillin, the evolution seems favourable with cotrimoxazole. However the discontinuation of this last drug is followed by a relapse which is treated with success by erythromycin. Serodiagnoses will be positive for Legionella Pneumophila serogroup I. This case, typical by its clinical features, makes itself noticed by its epidemiology and the relapse under cotrimoxazole, proving that erythromycin remains the choice antibiotic for these infections.

[Reversible bone marrow hypoplasia in a case of male anorexia nervosa]. / Hypoplasie médullaire réversible au cours d'une anorexie mentale masculine.

The authors report the case of a 17 year old boy with anorexia nervosa and bone marrow hypoplasia. After a 14 kg weight loss, the patient had pancytopenia, morphological abnormalities of the red cells (acanthocytes, schizocytes), without hemolysis, and hypogonadotropic hypogonadism. Bone marrow biopsy showed a marked reduction of hematopoietic cells with striking diffuse interstitial oedema. Clinical recovery, during the next 6 months, was associated with a return of the haematological changes to normal and to a disappearance of hypogonadism. Anorexia nervosa is a rare entity in boys. In all probability, bone marrow hypoplasia is not a well known feature of this disorder. The haematological changes are reversible with improvement of nutritional status.

[Massive digestive hemorrhage caused by arterial malformation of the jejunum. Diagnostic value of emergency arteriography]. / Hémorragie digestive cataclysmique par malformation artérielle du jéjunum. Intérêt diagnostique de l'artériographie en urgence.

A case of massive digestive bleeding due to an arterial abnormality of the jejunal wall is reported. Its interest is twofold: a) After a complete endoscopic and operative examination of the GI tract proved negative, an emergency superior mesenteric angiography was the only investigation which allowed to recognize the site and mechanism of the bleeding; b) from a nosologic point of view, the clinico-pathological picture was entirely similar to that of "Dieulafoy's erosion", a syndrome which has been only described, up to now, in the gastric mucosa.