Approach to the mechanism of androgen overproduction in a case of Krukenbery tumor responsible for virilization during pregnancy.

Virilization may occur during pregnancy as the result of an ovarian Krukenberg tumor. mechanism of the androgen overproduction in this exceptional condition is still poorly understood. A new case is reported in which only in the postpartum clinical, endocrine, and endoscopic studies led to the diagnosis of an ovarian Krukenberg tumor secondary to a gastric carcinoma. In the mother, basal hormonal studies were done 1 and 4 weeks after delivery, then after gastric and ovarian surgery. Three months after delivery, ovarian steroid response to hCG (priming dose, 5000 IU; then 1500 IU every other day for 12 days) and a study of progesterone (P) metabolism at a steady state after a constant infusion of [3H]P and cold P (92 micrograms/min leads to blood production rate (BPR) of 152 mg/day designed to reproduce the BPR of P usually seen in pregnancy) were successively performed. Hormones were measured by specific RIAs after chromatographical purification. Basal hormonal levels were normal in the child. In the mother, on the 5th day postpartum, mean hormone levels (in nanograms per dl) were: testosterone (T), 4181; androstenedione (delta 4), 8876; 17 alpha-hydroxyprogesterone (17-OHP), 9746; P 1075; estrone (E1), 195; and estradiol (E2), 151. One month later, levels were normal for the follicular phase; T, 40; delta 4, 146; P, 52; E2, 9; and E2, 4.5. At both times, dehydroepiandrosterone was normal (703-750). Hormone levels increased progressively during hCG stimulation but their time course was different between hormones. At the end of the test, T. 144; delta 4, 746;' 17-OHP, 789; P, 723; E1, 37; and E2, 20. The MCR of P was decreased, 1450 liters/day (normal, 2020). Conversion ratios between products and precursor during constant infusion were normal. From these data, obtained in four different conditions (postpartum period, hCG stimulation, progesterone infusion, and after oophorectomy), the following can be concluded: adrenal production of dehydroepiandrosterone was normal; the ovarian overproduction of androgens likely resulted from the excessive reductive metabolism of both placental and ovarian P along the delta 4 steroid biosynthetic pathway by an hypertrophic stromal compartment; and HCG stimulation seems to be the necessary stimulus for this condition. The enhancement by T on its own peripheral production is also discussed.

A new method of preparation of segmental pancreatic grafts for transplantation: trials in dogs and in man.

A new method of eliminating the exocrine function of the pancreas by obstruction of pancreatic duct with neoprene was investigated in dogs and applied to three cases of human segmental pancreatic transplantation. Neoprene is a liquid synthetic rubber which flocculates with changes in pH. In animals, progressive fibrosis of the pancreatic tissue occurs after injection of neoprene in the main pancreatic duct, leaving islets well vascularized and functioning for prolonged periods. Using this technique, three severely diabetic patients received a cadaver segmental pancreatic allograft. Blood sugar returned to normal levels within the first hours or days after operation. All three grafts continue to function 1.5, 2, and 8 months, respectively, following transplantation. If these results are confirmed by further clinical experience, this method may be of considerable assistance in the treatment of severe diabetes by pancreatic transplantation.

[Postpartum thyroiditis and Basedow disease]. / Thyroïdite du post-partum et maladie de Basedow.

BACKGROUND: The postpartum period is characterized by a rebound in autoimmunity secondary to immune tolerance induced by pregnancy, creating favorable conditions for flare up of Graves' disease or autoimmune thyroiditis. Postpartum thyroiditis is a recognized clinical entity. CASE REPORT: Six years after onset of Graves' disease treated with antithyroid drugs, a 25-year-old woman had a high serum level of antithyroperoxidase antibodies a few months before she became pregnant. Six weeks after delivery, she developed signs of hyperthyroidism and goiter. The diagnosis of postpartum thyroiditis was retained. Her condition regressed spontaneously to euthyroidism then hypothyroidism. DISCUSSION: The therapeutic options involved underline the importance of distinguishing between Graves' disease and postpartum thyroiditis. The diagnosis of postpartum thyroiditis is based on history taking, clinical findings, and laboratory tests, especially isotope uptake.

[Nutritional status and food consumption in the north of the Ivory Coast]. / Situation nutrionnelle et consommation alimentaire dans le nord de la Côte-d'Ivoire.

Malnutrition is frequent in the north of Ivory Coast, catching 63,7% of the children admitted in the Korhogo hospital, 39% of the children in the out-patients services, 25% of the children living in villages and 6,9% of the admitted adults. We note animal protein and lipid deficiencies mainly. Syndrome of protein deficiency is very well known, but lipid deficiency is less; its responsibility in peripheral neuropathy, as hypothesis, is recalled. Fish and butcher's meat protein consumption remains stable, because of the economic context. Hunting meat consumption remains stable and important. Lipid intake is also under economic and cultural constraints. Development projects, and difficulties are briefly exposed.

[Tropical ataxia. Clinical and nutritional study]. / L'ataxie tropicale. Etude clinique et nutritionnelle.

The authors report on 21 cases of tropical neuropathy with simple or prevailing ataxia. They explicit the semiologic characteristics of this pattern. The difficulties of the discriminating diagnostic in the tropics are mentioned. Eleven among these patients have been submitted to a nutritional analysis, which shows a global deficiency of the contribution and strangely a lipid deficiency, the responsibility of which is debated.

[A new method of pancreatic transplantation. II. Double renal and pancreatic transplantation in a diabetic with renal failure (author's transl)]. / Une nouvelle méthode de transplantation pancréatique. II. Double transplantation pancréatique et rénale chez un diabétique en insuffisance rénale.

A 41-year-old man who had suffered from insulin-dependent diabetes since the age of twenty and who had severe degenerative complications with chronic renal failure, underwent pancreatic transplantation. The graft was prepared by intraduct injection of neoprene in order to suppress the exocrine function of the gland. It was situated in the iliac fossa and has ensured the complete correction of diabetes for more than 10 months. This favourable situation made it possible to carry out a renal transplant which could not have been envisaged previously in this patient with very unstable and progressive diabetes who was dialysed under very difficult conditions.