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.

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.

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.

[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.

[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.

[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.

[Treatment of hypertensive forms of congenital adrenal hyperplasia]. / Le traitement des formes hypertensives des hyperplasies surrénales congénitales.

The treatment of congenital adrenal hyperplasia (hypertensive forms) is based, as in the other forms of congenital adrenal hyperplasia, on corticosteroid therapy. The choice of drug, dosage, precocity, clinical and biological surveillance, are analysed in turn. The results on pubertal development, adult size, gonad development in the 11-betahydroxylase deficit type, are considered in the light of recent studies. The treatment of the 17-alpha-hydroxylase type is also based on the inhibition of glucocorticoid secretion. Results are satisfactory in the few cases published.

17 alpha-hydroxylase deficiency syndrome associated with bilateral streak gonads and impaired development of Müllerian ducts derivatives. Report of a case.

We report severe 17 alpha-hydroxylase deficiency in a 17 year-old black girl with 46,XX genotype. The diagnosis was suspected because of primary amenorrhoea, absence of sexual maturation, hypertension and hypokalaemia with renal potassium wasting. Endocrine investigation revealed low basal levels of all steroid hormones which require 17 alpha-hydroxylation for biosynthesis (i.e. glucocorticoids, androgens and oestrogens). No increase in their basal levels was seen following adrenal stimulation, indicating a severe block. Plasma concentrations of ACTH, FSH and LH were elevated as were progesterone, 11-deoxycorticosterone and corticosterone. Plasma renin activity was suppressed and aldosterone levels were very low. After 4 months of glucocorticoid replacement therapy, aldosterone was still low, even though the suppression was otherwise effective. Our case is unusual because bilateral streak gonads and impaired development of Müllerian ducts derivatives were also present. To our knowledge, a similar case has never been reported before.

[Inappropriate thyrotropin secretion. Part 1: tumoral (author's transl)]. / Sécrétion inappropriée de thyréostimuline. 1re partie: production tumorale.

Release of thyroxine and triiodothyronine from the thyroid gland is stimulated by the pituitary hormone thyrotropin, or thyroid-stimulating hormone (TSH). TSH secretion in turn is regulated by control mechanisms, which include a negative feedback effect of the thyroid hormones themselves and the actions of the hypothalamic peptide TRH and of several central neurotransmitters. Hyperthyroidism secondary to excessive TSH secretion is a rare entity. In most cases TSH hypersecretion results from an adenoma of the pituitary gland and may then be associated with increased prolactin or growth hormone production. It should be emphasized that most patients with pituitary adenoma have high serum levels of alpha TSH subunit and undetectable beta TSH subunit.

[Inappropriate thyrotropin secretion. Part 2: non tumoral (author's transl)]. / Sécrétion inappropriée de thyréostimuline. 2e partie: production non tumorale.

Some patients are clinically euthyroid despite high thyroid hormones levels associated with detectable but not elevated serum TSH. These patients are considered as being resistant to thyroid hormones. The resistance may be severe or partial and in most cases seems to be autosomal dominant; it affects some tissues more than others, thus giving rise to a variety of clinical symptoms. In a few patients with high TSH levels extensive studies have failed to provide evidence of pituitary tumour of resistance to thyroid hormones; the cause of TSH hypersecretion in such cases remains uncertain. Several factors (non specific serum proteins, cross-reactivity circulating antibodies) may result in falsely high T3, T4 and TSH values on radioimmune assays and must be carefully investigated in the presence of unexpectedly high serum TSH levels.

[Interference of meprobamate with adrenal hormone assays (author's transl)]. / Interférence du méprobamate avec le dosage des hormones cortico-surrénales.

The authors draw attention to the fact that the decrease in 17-hydroxycorticosteroids and 17-ketosteroids observed in patients under meprobamate treatment is probably due to chemical interference with assay methods, since normal response to metyrapone indicates that the adrenal function is unimpaired. The asthenia usually reported by these patients is due to depression and should not be blamed on deficiency of the adrenal cortex.

[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.