Effect of carbohydrate on portal vein blood flow during exercise.

Effects of carbohydrate ingestion and exercise on portal vein blood flow were studied. Flow was measured by pulsed-electronic Doppler. Eight male subjects performed four tests after a standardised breakfast and 5 h fast. Beverages were CHO (10 % glucose, 30 mmol . l (-1) NaCl) and W (water, 30 mmol . l (-1) NaCl). Exercise experiments comprised a resting measurement, 10 min warm-up and 60 min 70 % VO(2)max cycling. Every 10 min subjects stopped cycling briefly (approximately 30 s) for measurements. Beverage was consumed after warm-up (500 ml) and at 20 and 40 min (250 ml). Similar tests were done at rest. Blood samples were taken concurrently with flow measurements for hormonal concentrations. Exercise decreased blood flow (repeated measures ANOVA, p < 0.0001) and carbohydrate ingestion increased flow (p = 0.015). At rest, flow was greater with CHO than with W at 20 (177 +/- 31; 101 +/- 25 %, resp.) (mean +/- SE), 30 (209 +/- 37; 120 +/- 20 %), 40 (188 +/- 32; 108 +/- 12 %), and 60 min (195 +/- 19; 112 +/- 12 %) (1-way ANOVA, Fisher's PLSD, p < 0.05). Flow was similar during exercise with CHO and W, with a tendency for CHO to maintain flow better, at 10 (124 +/- 27; 77 +/- 21 %), 20 (81 +/- 10; 60 +/- 13 %), 30 (106 +/- 26; 56 +/- 10 %), 40 (109 +/- 28; 54 +/- 8 %), 50 (85 +/- 17; 54 +/- 13 %), and 60 min (61 +/- 15; 47 +/- 7 %). A positive correlation between glucagon and flow and an inverse correlation between noradrenaline and flow were observed. Exercise reduces, and carbohydrate increases, portal vein flow. Changes in plasma concentrations suggest that noradrenaline and glucagon, respectively, may play a role in modulating flow.

[Contribution of comparative x-rays for infantile traumatology]. / Intérêt des radiographies ostéo-articulaires comparatives en traumatologie de l'enfant.

PURPOSE OF THE STUDY: There is a controversy over whether or not routine comparative x-rays should be prescribed for young children with bone and joint trauma. We conducted a retrospective analysis to assess the contribution of such x-rays. MATERIAL AND METHODS: The series included 203 children aged less than fifteen years who had experienced bone and joint trauma. Two junior orthopedic surgeons, two senior orthopedic surgeons and two pediatric radiologists reread the x-rays to establish the diagnosis, using comparative x-rays to make any necessary correction of the diagnosis. The surgeons were asked to propose a therapeutic strategy for each diagnosis and the radiologists were asked to judge the value of the comparative x-rays. RESULTS: The comparative x-rays were found to be reliable in only 87.5% of the cases, and were useful for diagnosis in only 8.8%. There were statistically significant differences depending on the localization, the patient's age, and the physician's experience. DISCUSSION: Systematic use of comparative x-rays should be discouraged. Only trauma affecting the elbow in older children can, in particular cases, warrant prescription of comparative x-rays.

US demonstration of a thrombosed persistent median artery in carpal tunnel syndrome.

Median artery of the forearm and wrist is not very frequently observed because it normally involutes before birth. Only a few cases of persistent median artery thrombosis associated with compression of the median nerve in the carpal tunnel have been reported. In these cases symptoms arise suddenly and surgery consists of the excision of the thrombosed arterial branch. In cases of large persistent unthrombosed median artery associated with carpal tunnel syndrome (CTS), excision of the unthrombosed median artery is not indicated because it may sometimes substantially contribute to the circulation of the hand. We report the case of a 39-year-old man with CTS associated with a thrombosis of a persistent median artery detected by high-resolution US and Doppler ultrasound. US can be also useful to exclude other causes of CTS such as tenosynovitis of the flexor tendons, ganglion cyst, musculotendinous variants, and various soft tissue tumors.

Familial adrenocorticotropin unresponsiveness associated with alacrima and achalasia: biochemical and molecular studies in two siblings with clinical heterogeneity.

UNLABELLED: The syndrome of familial adrenocorticotropin (ACTH) unresponsiveness is a rare form of primary adrenal insufficiency, usually without mineralocorticoid deficiency. It is characterized by elevated plasma ACTH concentrations and undetectable plasma cortisol levels not responding to exogenous ACTH. Alacrima and achalasia have also been occasionally associated with adrenal insufficiency (triple A syndrome). Pathogenetic mutations have been identified in the ACTH receptor gene in families with isolated familial ACTH unresponsiveness. Whether the ACTH receptor represents the locus of the defect for the triple A syndrome is not known. Here we report two siblings with familial ACTH unresponsiveness who were discrepant for skin pigmentation and mineralocorticoid function. In addition, achalasia and alacrima were documented only in the older sibling. The boy, studied at the age of 2 years, was hyperpigmented, in contrast to his normally pigmented sister, studied at the age of 9 years; basal plasma alpha-melanocyte stimulating hormone immunureactivity levels were 79 and 38 pg/ml, respectively (normal < 40 pg/ml). Furosemide-induced diuresis resulted in normal rises of plasma renin activity in both patients; however, plasma aldosterone levels increased only in the boy and not in his sister. Screening for abnormalities of the ACTH receptor gene by single strand conformation polymorphism analysis revealed no abnormality. Direct sequencing of the entire coding area of the ACTH receptor gene was also normal. CONCLUSION: The syndrome of familial ACTH unresponsiveness can vary clinically and biologically within the same family.(ABSTRACT TRUNCATED AT 250 WORDS)

Achalasia-alacrima-ACTH insensitivity syndrome (Triple-A-syndrome).

Achalasia is a rare pathology in infancy. It is still more infrequent when associated with adrenal insufficiency and alacrima, a disorder known as Allgrove's syndrome, the etiology of which remains unclear. We describe a 9-year-old girl who presents with glucocorticoid insufficiency, partial mineralocorticoid deficiency, achalasia, and alacrima.