Effect of exchange of ham for boiled egg on plasma glucose and insulin responses to breakfast in normal subjects.

Blood glucose (BG) and plasma insulin (IRI) were measured during two breakfasts different only by the nature of proteins--egg (E) or ham (H)--in eight normal subjects. Compared with H, E led to a flattened BG response at 30, 40, and 50 min and to a sustained BG from 150 to 240 min. Integrated BG response was not significantly different between E and H. After E, the IRI response decreased at 90 min and 120 min (P less than 0.05). Integrated IRI response with E was significantly smaller than with H (P less than 0.025). The reasons for the effect of E ingestion on BG are not obvious; pancreatic and/or intestinal mechanisms may be involved. It is suggested that greater consideration be given to the protein composition of the test meals when they are used in studies of glucose homeostasis.

The prevalence of retinopathy is similar in diabetes mellitus secondary to chronic pancreatitis with or without pancreatectomy and in idiopathic diabetes mellitus.

In a retrospective study, we compared the prevalence of retinopathy in two groups of 88 diabetic patients (84 men, 4 women) with either diabetes mellitus secondary to chronic pancreatitis (CP-DM group) or idiopathic diabetes mellitus (I-DM group). The patients of these two groups were pair-matched according to age (48.7 +/- 1.1 versus 48.8 +/- 1.0 yr in CP-DM and I-DM groups, respectively; mean +/- SEM), sex, duration of diabetes (7.96 +/- 0.56 versus 8.08 +/- 0.8 yr) and therapy (80 on insulin and 8 on oral hypoglycemic agents in each group). Retinopathy was assessed by bilateral ophthalmoscopic examination of the fundus after pupillary dilation in all 176 patients and by fluorescein angiography in 47 patients with CP-DM and 35 patients with I-DM. Forty-one percent of patients in the CP-DM group and 45.5% of patients in the I-DM group had diabetic retinopathy (P greater than 0.5). In each group, patients with retinopathy were older than patients without retinopathy (51.6 +/- 1.3 versus 46.7 +/- 1.8 yr in the CP-DM group, P less than 0.01, and 52.1 +/- 1.5 versus 46.0 +/- 1.2 yr in the ID-M group, P less than 0.01). They had diabetes of longer duration (10.9 +/- 1.0 versus 5.9 +/- 0.6 yr in the CP-DM group, P less than 0.001, and 10.5 +/- 1.0 versus 6.0 +/- 0.6 yr in the ID-M group, P less than 0.001). The prevalence of retinopathy increased parallel to the duration of diabetes in a similar way in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphometric study of human hepatic cell modifications induced by fenofibrate.

We have studied liver biopsies obtained in 12 hyperlipoproteinemic (HLP) patients (type II, 6; type IV, 6) treated with diet and fenofibrate, and in 15 patients (type II, 11; type IV, 4) receiving diet only. Electron microscopy of liver biopsies and the morphometric analysis according to the method of Weibel and Rohr showed mitrochondrial changes in patients treated with fenofibrate, these changes depending on the type of hyperlipoproteinemia. In type II HLP, we found a decreased volume of normal mitochondria (fenofibrate, 125.72 +/- 17.04 X 10(-3) cm3/cm3; diet only, 185.84 +/- 8.96 10(-3), P less than .05). In type IV HLP we found a decreased number of giant mitochondria (fenofibrate, 0.08 +/- 0.03 X 10(10) cm-3; diet only, 0.32 +/- 0.08 X 10(10) cm-3, P less than .05) and a decreased volume of altered mitochondria (fenofibrate, 6.00 +/- 1.44 X 10(-3) cm3/cm3; diet only, 13.61 +/- 1.17 X 10(-3), P less than .05). In contrast with the rodent studies, the present study shows no change in the number of volume of peroxisomes.

[Study of lipid metabolic coefficient K2 in patients with hyperlipoproteinemia type IV before and after reduction of triglyceride level by adapted diet therapy]. / Etude du coefficient d'épuration lipidique K2 chez les sujets atteints d'hyperlipoprotéinémie de type IV avant et après réduction de l'hypertriglycéridémie par un traitement diététique adapté.

An intravenous fat tolerance test (IV FTT) was performed in a group of patients with type IV hyperlipoproteinemia before and after reduction of triglyceride level, the latter is obtained through a diet adapted to the nutritional sensitivity, body weight remaining constant. Before the diet the increase in cholesterol (CT) and triglycerides (TG) was related in both obese and non-obese patients to an increase in very-low-density lipoproteins (VLDL), while other lipoprotein fractions were not affected. In these patients, K2 is significantly lower than in controls whatever the nutritional sensitivity. However, K2 is lower in obese patients than in patients with normal weight, VLDL-CT and VLDL-TG are tremendously reduced by the relevant diet and K2 is constantly and significantly increased, although it does not reach a normal value in obese subjects. There is a highly significant correlation between VLDL-TG levels and K2 in obese and non-obese subjects. Several physiopathological explanations are discussed to account for the variation of K2 according to TG levels. The results obtained support the view that the K2 defect is secondary to the hyperlipoproteinemia.

[Morphometric study of hepatic peroxisomes in hyperlipoproteinemic patients treated with fenofibrate]. / Etude morphométrique des péroxysomes hépatiques chez des malades hyperlipoprotéinémiques traités par fénofibrate.

In rodents fenofibrate shares with other triglyceride-lowering agents the potential to increase the liver peroxisome population. It was therefore of interest to look for this effect in hyperlipoproteinemic patients receiving this drug. Light and electron microscopy of liver biopsies from a group of 10 patients treated with fenofibrate and from another group of 13 receiving diet only, show no morphological difference between both groups. In contrast with the rodent data the morphometric study reveals no significant changes in the number (fenofibrate group: 7.96 10(10) cm-3; group receiving diet alone: 8.41 10(10) peroxisomes per cm3 of liver tissue) or in the size (fenofibrate group: diameter = 0.53 +/- 0.07 micron; group receiving diet alone: 0.50 +/- 0.06) of peroxisomes. The difference between our results and those obtained consistently in rodents may be due to the relatively low dose in man and/or a species-dependant difference in enzyme content of liver peroxisomes, itself related to an apparent difference in the way in which lipids are handled.

A long term treatment with a venotropic drug. Results on efficacy and safety of Daflon 500 mg in chronic venous insufficiency.

UNLABELLED: Drugs for long term administration have to prove their efficacy and safety. Previously published double blind controlled studies (from single dose to two months treatment) have already demonstrated the phlebotropic activity of Daflon 500 mg in chronic venous insufficiency (CVI). The aim of the study was to investigate the safety of this agent during one year of continuous administration. Two-hundred and fifteen out-patients suffering from CVI received Daflon 500 mg, 2 tablets per day. Therapeutic activity was evaluated every 2 months on: 1) venous symptoms (functional discomfort, cramps, evening oedema) assessed by a 0 to 4 scale; 2) supramalleolar and calf circumferences; 3) overall assessment of efficacy (excellent, useful, nil). Acceptability was assessed by recording the side effects and measuring laboratory parameters. RESULTS: 170 patients completed the study. Functional symptoms were statistically significantly improved as shown by the following: functional discomfort: 0.55 +/- 0.06 vs 2.63 +/- 0.06, supra-malleolar circumference in cm: 22.5 +/- 0.2 vs 23.1 +/- 0.2, and calf circumference in cm: 34.7 +/- 0.3 vs 35.2 +/- 0.3. This improvement in the symptoms quickly appeared from the first control (M2) and reached about 50% of the total decrease. Overall assessment of efficacy was evaluated as follows: excellent = 58%, useful = 33%, nil = 9% of the cases. Laboratory parameters remained constant during the 12 months. Side effects were essentially gastralgia (n = 7). According to these results, it appears the efficacy and safety of Daflon 500 mg are corroborated even after a one year administration.

tcpO2, arterial blood flow and lactate/pyruvate modifications induced by a single dose of naftidrofuryl IV during stage III lower-limb arteriopathies.

A single dose of 600 mg of naftidrofuryl perfused IV during three hours in 12 stage III arteriopathic patients did not modify the average blood flow at the calf but did significantly increase transcutaneous oxygen pressure (33 vs 52 mmHg) and also improved lactates (1.44 vs 0.88 mmol/liter), pyruvate (59 vs 79 mumol/liter), and lactates-pyruvates ratio (33.48 vs 20.92).

Venous plethysmography: measuring techniques and normal values.

A fixed procedure of strain gauge plethysmography in a control population aged between 20-30 years allows normal values for venous parameters (venous distensibility, emptying, and resistance) and capillary filtration coefficient, to be determined. High speed recording reveals two phases in venous emptying, one passive, purely elastic, and a second active phase, resulting from venous constriction.

Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs.

Ninety-four patients suffering from venous insufficiency of the lower limbs participated in a multicenter, double-blind versus placebo study. After randomization, they were allotted for a treatment period of two months to one of three groups: TECA 120 mg/day, TECA 60 mg/day, or placebo. A significant difference (p less than 0.05) in favor of TECA was shown for the symptoms of heaviness in the lower limbs and edema, as well as for the overall evaluation by the patient. The venous distensibility measured by a mercury strain gauge plethysmograph at three occlusion pressures was improved for the TECA groups but aggravated for the placebo group.

[Pulsatility, flow and metabolic diseases]. / Pulsatilité, débit et maladies métaboliques.

Metabolic diseases, and particularly diabetes mellitus have a well-established vascular determinism. Diabetic arteriopathy is associated from its onset with elevated tissue blood flow at rest and blood and plasma hyperviscosity. These anomalies are corrected by the perfect equilibration of the glycemia with the artificial pancreas. In 8 to 28% of cases, according to the author, there is an original hemodynamic picture; the enhanced flow hyperpulsatile diabetic arteriopathy observed in a caricatural manner in ulcerated mutilating acropathies. The vasomotor inertia of the diabetic artery and the metabolic neuropathy suggest that surgery to increase blood flow might be of interest in diabetic patients, as a function of results of previous function tests.

[Automatic recording of venous hysteresis. Results in the normal subject and in varicose patients]. / Enregistrement automatique de l'hystérésis des veines. Résultats chez le sujet normal et le malade variqueux.

The measurement of the venous distensibility by straingauge plethysmography during a semi-continuous variation (3 mm Hg every 20 seconds) of the cuff pressure during its inflation from 0 to 100 mm Hg and its deflation allow to record the venous hysteresis and to determine accurately the venous pressure. The standardized and automatic (Periflow J.S.I.) new method is highly discriminative between controls and varicose patients.

[Sympathectomy of the digital arteries in acro-syndromes]. / Les sympathectomies des artères digitales dans les acro-syndromes.

Digital sympathectomy as proposed by Flatt and al. was performed on 12 Raynaud's diseases, 6 distal arteriopathy and 4 post-trauma ischemic syndrome. Operation was performed under tourniquet. The approach depends on the number of digits involved (Brünner at the proximal part of P1, transversal in the distal palmar crease, zigzag incision at the level of each intermetacarpal space). Under microscope, adventisectomy is started on a lateral side of the artery followed by the posterior side on at least 1 cm, using the adventitia avoid all direct manipulation of the vessels. Closing skin on an aspirative drainage and simple non compressive drainage is maintaining 4 days. Index pressure and arterial blood flow are measured. Results are bad for post-trauma ischemic syndrome and arteritis but encouraging in Raynaud's disease (7 patients asked for the same operation on the opposite side).

[The flow-volume curve. Expression of emptying as a function of venous distensibility]. / La courbe débit-volume. Expression de la vidange en fonction de la distensibilité veineuse.

Mercury strain gauge venous occlusion plethysmography is a non invasive exploration of the lower limb venous hemodynamic. Classically, venous distensibility (delta V/V %) is expressed in terms of time during venous inflow (venous occlusion) and venous outflow (after cuff deflation). The authors proposed to express the total flow Q of the limb (obtained by a differentiator of the electric signal of the strain gauge) in terms of the venous distensibility (delta V/V %) whatever recording a top each second. This new representation Q = f(delta V/V) permit a more acute visualisation of the initial part of the venous emptying: more differentiation between venous drainage and systolic arterial waves, acceleration then deceleration of the venous emptying, return of the venous wall to its initial position later than venous emptying, active venous constriction. Some parameters are proposed to described this curve and the values obtained in 50 patients without and 10 patients with deep venous thrombosis are reported.

[Study of the HLA system and glyoxalase in 31 insulin-dependent diabetics free from micro and macro-angiopathies after more than a 20-year development]. / Etude du système HLA et de la glyoxalase chez 31 sujets diabétiques insulinodépendants indemnes de micro et macro angiopathie après plus de 20 ans d'évolution.

Insulin-dependent diabetics are not equal as concerns vascular complications. Many factors have been incriminated. The object of this study was to determine if a genetic factor protected the insulin-dependent diabetic from vascular complications. The population included 31 unrelated, white insulin-dependent diabetic subjects (18 females and 13 males), with diabetes of over 20 years' duration (21 to 43 years, m +/- SD 27.82 +/- 6.03 years; age at diagnosis: 2 to 57 years, m +/- SD 22.7 +/- 15.19 years). The absence of vascular lesions was checked for by the following investigations: visual acuity, fundoscopic examination, retinal fluorescein angiography (Canon F 60 Z), systolic pressure on the thigh and ankle, Doppler velocimetry, plethysmography of the lower limbs, serum creatinine level, urinary protein. The study of the HLA A, B, DR specificities was carried out using the Tersaki microlymphocytotoxicity assay, those of C4 by high voltage gel electrophoresis followed by hemolytic detection, those of B1 using Alper's method and those of glyoxalase by gel electrophoresis followed by a glutathione redox reaction in order to test for a marker for a possible protective genetic factor against complications. The antigen frequencies found were compared with: 1) Those in the general Caucasian reference population (9th Histocompatibility Workshop, 1984). The study group presented the HLA characteristics known to occur in insulin-dependent diabetes: increase in A30, B8, B18, D6, DR3, DR4, BfF1 and decrease in A3, B7, DR2. Furthermore an increase in the frequency of DRw53, DQw2 and DQw3 alleles was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

[Holter erectometry. A new approach to erectile disorders]. / Le Holter d'érectométrie. Une nouvelle approche des troubles érectiles.

A Holter-type portable computerised electronic system for measurement of the apparent volume of the penis, eye movements and heart rate over 12 hours, enables investigation of erectile disorders by the patient himself, under more physiological conditions at home. Data processing and ease of use will permit scientific use on a large scale.

[Impotence in the diabetic]. / L'impuissance chez le diabétique.

Two-hundred-and-two impotent diabetic patients gave their consent to be investigated. Impotence is linked to diabetes mellitus in 58.9% of patients so all the other etiologies have to be systematically eliminated. Neuropathy or arteriopathy, when isolated, are found with the same frequency, but these 2 etiologies are often associated (47 patients). No statistical difference between IDDM and NIDDM was found. Mercury strain gauge plethysmography and venous occlusion coupled to ECG allows detection of arterial lesions in diabetic impotence. Patients agreed to submit to all of the various therapeutic possibilities. Combination of alpha-blockade and good glycemic control induced the best results.

[Variations in blood viscosity of insulin-dependent diabetic subjects controlled by artificial pancreas (author's transl)]. / Variations de la viscosité sanguine de sujets diabétiques insulinodépendants équilibrés par pancréas artificiel.

A study of blood viscosity at 3 rates of determination (0.232-0.348 and 1.16 sec-1) in insulin-dependent diabetic subjects controlled by artificial pancreas, shows a reduction in this parameter after 30 hours of feed back control. The relationship between these variations, the mechanical cohesion of the agglutinated red cells, and the deformability of these structures are discussed.

Modifications in apoprotein C composition of very low density lipoproteins in type IV hyperlipoproteinemic subjects after dietetic triglyceridemia reduction.

Variations in peptide composition of apoprotein C from very low density lipoproteins were studied in 10 type IV hyperlipoproteinemics, before and after triglyceridemia normalization through appropriate diet. The subjects were sensitive to carbohydrates or alcohol : a reduction or elimination of the inducing nutrient led to a decrease in serum triacylglycerol levels, correlated with an increase in the proportion of apo CII and a decrease in the proportion of apo CIII1. Apo CIII2 was not affected. This led to an increased ratio, apo CII/apo CIII1. The percentage of variation of different lipid (triacylglycerols and cholesterol) and protein (apoproteins CII, CIII2) parameters were also studied.

[Metatarsophalangeal lesions of the diabetic foot. Radiologic outcome]. / Lésions métatarso-phalangiennes du pied diabétique. Evolution radiologique.

Radiological evidence of progression of diabetic foot lesions was studied in 31 patients. Three types of progression could be distinguished: lesions became worse (16 cases), improved (8 cases), or fluctuated in extent (6 cases). Mechanisms of production of the lesions and their prognostic significance are analyzed. Progression of the lesion is usually the result of infection. Reconstructive therapy requires evidence of a satisfactory vascular integrity in patients with associated arterial and neurological disorders. A fluctuating course is a typical finding in diabetic osteoarthropathy.

[Metabolism of insulin and immunoreactive insulin-like substances (proinsulin, HWIRI) in vivo in man]. / Métabolisme de l'insuline et des substances à immunoréactivité insulinique (proinsuline, HWIRI) chez l'homme in vivo.

Immunoreactive insulin (IRI) and its three constituents as determined by gel filtration: high molecular weight substances with insulin immunoreactivity (HWIRI), proinsulin (PI) and insulin (I), were measured hourly during 28 hours in the portal, hepatic and peripheral venous systems of a patient operated for a nesidioblastoma. The PI levels were constant from one system to the other (7.1 +/- 0.8 microU/ml; 7.3 +/- 0.8 microU/ml; 9.2 +/- 1.2 microU/ml). The I levels decreased from the portal (53.3 +/- 5.2 microU/ml) to the hepatic venous system (28.0 +/- 1.0 microU/ml) and from the latter to the peripheral venous system (19.8 +/- 2.0 microU/ml). The HWIRI levels were stable between the portal and the hepatic venous systems (4.7 +/- 0.7 microU/ml; 4.8 +/- 0.6 microU/ml) and higher in the peripheral system (8.2 +/- 1.2 microU/ml). Our results demonstrate that: --I is essentially degraded by the liver. --There is no variation of PI in the three compartments. --HWIRI is formed in the circulation. --Variations of IRI levels between venous systems acquire physiological significance only when accompanied by the variations of the levels of each constituent.