Rapid evaluation of tetanus immunity by a haemagglutination test in the injured at a hospital emergency unit.

A turkey red blood cell haemagglutination assay (TRBC HA) allowing rapid measurement of the antibodies against tetanus has been set recently. Its feasibility was evaluated in injured patients admitted into an emergency unit during summer 1987. TRBC HA was performed by the same physician who questioned the patient on his/her previous vaccinations and evaluated his/her immunization status. The rapid HA test practiced in emergency was controlled by TRBC HA and ELISA measurement of antibodies carried out in the laboratory. Each method was compared to the others: the results were fitted and no significant difference was found. The preventive procedures which would have followed the antibody measurement by immediate TRBC HA were compared to the decision resulting from clinical evaluation. The immunoprophylactic attitude would have been the same in 82% of cases. TRBC HA is a reliable test, and feasible in an emergency: it could help in making the appropriate decision for immunoprophylaxis to be applied to the injured and other patients at risk of tetanus.

The clinical variability of maternally inherited diabetes and deafness is associated with the degree of heteroplasmy in blood leukocytes.

CONTEXT: Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes with a matrilineal transmission, sensorineural hearing loss, and macular pattern dystrophy due to an A to G transition at position 3243 of mitochondrial DNA (mtDNA) (m.3243A>G). The phenotypic heterogeneity of MIDD may be the consequence of different levels of mutated mtDNA among mitochondria in a given tissue. OBJECTIVE: The aim of the present study was thus to ascertain the correlation between the severity of the phenotype in patients with MIDD and the level of heteroplasmy in the blood leukocytes. PARTICIPANTS: The GEDIAM prospective multicenter register was initiated in 1995. Eighty-nine Europid patients from this register, with MIDD and the mtDNA 3243A>G mutation, were included. Patients with MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) or with mitochondrial diabetes related to other mutations or to deletions of mtDNA were excluded. RESULTS: A significant negative correlation was found between levels of heteroplasmy and age of the patients at the time of sampling for molecular analysis, age at the diagnosis of diabetes, and body mass index. After adjustment for age at sampling for molecular study and gender, the correlation between heteroplasmy levels and age at the diagnosis of diabetes was no more significant. The two other correlations remained significant. A significant positive correlation between levels of heteroplasmy and HbA(1c) was also found and remained significant after adjustment for age at molecular sampling and gender. CONCLUSIONS: These results support the hypothesis that heteroplasmy levels are at least one of the determinants of the severity of the phenotype in MIDD.

[Pituitary-gonadal function in male diabetic patients (author's transl)]. / La fonction hypophyso-gonadique de l'homme diabétique.

Pituitary-gonadal function was studied in 50 male diabetic patients under 53 years of age. Forty-three had normal sexual activity and 7 were impotent. Plasma testosterone levels and urinary 17 ketosteroids, androsterone and dehydroepiandosterone levels were measured. LH and FSH levels before and after LHRH, and prolactin levels before and after TRH were also measured in plasma. No significant changes in pituitary-gonadal function were detected, irrespective of the patient's sexual activity. Neither the type and degree of control of diabetes nor the presence of absence of microangiopathy had any influence on the results. Basal LH and FSH levels were slightly higher in older patients. Prolactin levels after TRH were significantly higher in the later stages of the test in patients with microangiopathy.

[Partial progressive lipoatrophy. A new case-report (author's transl)]. / Lipo-atrophie partielle progressive A propos d'une nouvelle observation.

A new case of lipoatrophic diabetes with some peculiar features is reported. The disease was acquired, with onset at approximately thirty years of age, and partial, involving only the face and the upper limbs. The authors were able to observe the successive occurrence of the various symptoms: progressive lipoatrophy, hyperinsulinism, insulin-resistant diabetes, major lipid disturbances, and finally renal failure with a nephrotic syndrome and high blood pressure. Nosologic borders and physiopathology are discussed with a review of the literature.

[Association of hyperlipidemia, acute pancreatitis and diabetic keto-acidosis. A case report (author's transl)]. / Association hyperlipidémie, pancréatite aiguë, coma acido-cétosique. A propos d'un cas.

A 32-year-old man was admitted semi-comatose with digestive troubles to the hospital. A diabetic keto-acidosis was discovered. The diabetes was known by the patient for one year and a half, but it was not treated. Furthermore the laboratory studies showed a hyperlipidemia (type V) and an increase in pancreatic enzymes. The hyperlipidemia disappeared with insulin therapy. The chronology of the facts was probably: a hyperlipidemia associated with the diabetes, responsible of an acute pancreatitis, which induced a keto-acidosis.

[Calcium and phosphorus metabolism in insulin dependent and non-insulin dependent diabetics, well-controlled and poorly-controlled]. / Contribution à l'étude du métabolisme phosphocalcique chez des diabétiques insulinodépendants et non insulinodépendants bien équilibrés et mal équilibrés.

We studied phosphorus and calcium metabolism in 50 adult insulin dependent and non insulin dependent diabetics arranged in 4 groups according to therapy and control of diabetes. We observed: a low level of blood magnesium in all diabetics a lower level of P T H, more pronounced with poorly controlled diabetes. a decrease of 1-25 (OH) 2 D levels without modification of the 25 (OH) D levels in badly controlled diabetics. This decrease may be related to the low level of PTH with a 1 alpha hydroxylation defect. These results are in favor of the hypothesis of a primary bone problem leading to the pre-senile and subclinical osteoporosis observed in diabetics. Hyperglycaemia rather than insulinopenia may be involved. Rigorous diabetes control significantly decreases all the observed differences, except the low magnesium level.