Long-term plasma glucose normalization in experimental diabetic rats with macroencapsulated implants of benign human insulinomas.

Permselective tubular membranes (1 mm i.d.) were filled with fragments of nine freshly resected human insulinomas, closed at both ends, and implanted in the peritoneal cavity of 30 streptozocin-induced diabetic rats. In 14 animals, nonfasting plasma glucose (PG) and insulin levels were normalized by these immunoprotected transplants for up to 1 yr (PG from 520 +/- 12 to 142 +/- 3 mg/100 ml; insulin from 6 +/- 0.5 to 44 +/- 3 microU/ml). These animals showed the same weight gain after 12 mo of observation as 20 controls. The remaining 16 animals showed an incomplete or transient correction of their diabetes and survived 4-6 mo, versus less than 8 wk in untreated animals. Removal of the membrane-encapsulated insulin-secreting tissue from 8 successfully treated rats led to hyperglycemia and death within 10 days. Histology and electron microscopy of insulinoma tissue retrieved after long-term implantation showed functionally active endocrine cells and no evidence of graft rejection. In vitro perifusion gave similar results for encapsulated and nonencapsulated insulinoma tissue. The amount of insulin secreted was quite variable, and responsiveness of the insulinoma to changes in glucose concentration of the surrounding medium was observed in three out of the five tumors studied. These observations establish the effectiveness of immunoseparation by a synthetic membrane in a pancreatic xenograft model.

[Cranial and cervical metastases of vascular nature in thyroid cancer. Apropos of 2 cases]. / Les métastases crâniennes et cervicales à caractère vasculaire des cancers thyroïdiens. A propos de 2 cas.

Vesicular and papillovesicular thyroid cancers provoke metastases in bone, but also of the pseudo-aneurysmal lymph node type. When the latter develop in the craniocervical region, they are often diagnosed as vascular tumors (arteriovenous malformation, glomus tumor). It is now possible, by embolization, to excise these lesions although this involves therapeutic audacity. Surgery is not always sufficient, and complementary 131-Iodine treatment should be used routinely, but it is justified for this type of metastasis as shown by survival rate in these patients.

[Surgical treatment of Basedow's disease. I--Traditions and new methods in preparation for thyroidectomy: use of dexamethasone]. / Traitement chirurgical de la maladie de Basedow. I--Traditions et nouveautés dans la préparation à la thyroïdectomie: utilisation de la dexaméthasone.

The combination of dexamethasone (2 mg every 6 hours) carbimazole (15 mg every 8 hours) and potassium iodide (XV drops every 8 hours) has been proposed in the preparation of 21 patients with hyperthyroid Graves' disease for surgery. The combination was administered for 6 days and the subtotal thyroidectomy was performed on day 7. All patients had normal serum Triiodothyronine levels after 4 days of such treatment. This combined drug therapy appears to be a rapid, sage and effective preparation for thyroid surgery in patients with Graves' disease and should replace conventional preparation with carbimazole and potassium iodide and beta-blocker preparation in all cases where there are no contra-indications to the use of corticosteroids.

[Surgical treatment of Basedow's disease. II--Evaluation of 36 subtotal thyroidectomies]. / Traitement chirurgical de la maladie de Basedow. II--Bilan de 36 thyroïdectomies sub-totales.

Results of subtotal thyroidectomy in 36 patients with Graves' disease emphasize the need for strict medical preparation, with the administration of corticoids more particularly, and the technical imperatives required during operation. Analysis of endocrine factors showed that euthyroidism was obtained in 76% of cases with a fairly stable state after 6 months. Hyperthyroidism was rare and developed before the end of the first year. Hypothyroidism, mainly biologic, was frequent during the immediate postoperative period but compensatory hypertrophy of remaining tissue was the usual outcome. It was persistent in 14% of cases, however, but easily compensated by substitutive therapy and a less severe complication than prolonged hyperthyroidism. Biologic hypocalcemia was also frequent but normal levels were reinstituted rapidly. Surgical treatment of Graves' disease is usually effective and rapidly performed, and is particularly indicated when socio-ethnic conditions make medical treatment difficult or impossible.

Effectiveness of intensive insulin therapy by multiple daily injections and continuous subcutaneous infusion: a comparison study in type 2 diabetes with conventional insulin regimen failure.

OBJECTIVE: To compare the effectiveness of two intensified insulin regimens, i.e., pump delivery versus multiple daily injections in patients with type 2 diabetes not optimally controlled with conventional insulin therapy. RESEARCH DESIGN AND METHODS: Seventeen type 2 diabetes patients uncontrolled by two daily injections of regular plus NPH were randomly assigned in a cross-over fashion to either three daily injections of lispro plus NPH or pump device delivering lispro. HbA1c, 6 points capillary blood glucose, 24-hour continuous glucose monitoring system tracings and global satisfaction score were evaluated at the end of each 12-week treatment period. RESULTS: HbA1c decreased from 9.0+/-1.6% to 8.6+/-1.6% with multiple injections and 7.7+/-0.8% with pump device (p<0.03). Capillary blood glucose was lowered at all time-points with pump, but only at morning with multiple injections (p<0.01). Compared to conventional therapy, pump reduced hyperglycemic area under curve by 73% (p<0.01), but multiple injections by only 32% (p=0.08). Rate of hypoglycemia was not increased and patient's satisfaction was comparable with both intensive treatments. CONCLUSIONS: Pump therapy provides a better metabolic control than injection regimens, and seems to be safe and convenient in patients with type 2 diabetes who fail to respond to conventional insulin therapy.

[Hospitalization of the elderly in a department of internal medicine. Predictive elements of risk and benefit]. / Hospitalisation des personnes âgées dans un service de médecine interne. Eléments prédictifs du danger et du bénéfice.

One hundred and thirty patients over 70 years have been examined in a prospective way, so as to determine pernicious and benefic effects of hospitalization in elderly people. Deaths appear to be more frequent in old male patients, with a high cultural level on one hand, and a "reduced" independence, on the other hand (according to the "Sandoz clinical assessment of geriatrics scale"). Benefic effects appear to be essentially dependent on primary diagnosis, and on the entourage, as well as on the previous medical care, though less important.

[Preoperative localization of insulinoma is necessary]. / La localisation pré-opératoire des insulinomes est nécessaire.

Many insulinomas because of their small size are not localized by routine investigations: abdominal ultrasound, angiography, computed tomography, nor at the step of laparotomy. Biological diagnosis is far more encouraging. Percutaneous transhepatic sampling of blood in the portal venous system is very predictable for adenoma localization. Absolute reliability of this method remains to be established, nevertheless the observance of some basic requirements are already known: withdrawal of any drug interfering with insulin release several days before performing the catheterism; need of a steady, preferably low, glucose level during the whole sampling; selective samples in tiny draining veins of the whole gland, and adequate radio-immunoassay. Transhepatic sampling can detect multiple localisations and diffuse hyperplasia but angiography alone is able to show hepatic metastasis and is helpful in giving the surgeon information on local vascularization. Confrontation of both angiography and transhepatic sampling gives the best criteria of localization. In case of discrepancy, transhepatic sampling seems to be more reliable.

Prevention of deep vein thrombosis in elderly medical in-patients by a low molecular weight heparin: a randomized double-blind trial.

Two hundred and seventy patients over 65 years were included in a placebo-controlled randomized double-blind trial to determine whether a small dose of a low molecular weight (LMW) heparin prevents the occurrence of deep vein leg thrombosis (DVT) diagnosed by 125I fibrinogen scanning. LMW heparin (60 mg daily) significantly reduced the frequency of DVT from 9 to 3 percent (p = 0.03). Adverse drug reactions did not differ significantly between the 2 groups, except for the injection site hematomas that were more frequent in the LMW heparin group. In conclusion, LMW heparin appears of value in preventing the occurrence of DVT in an unselected elderly in-patient population.

Continuous subcutaneous infusion of glucagon by portable pump in non beta cell tumor hypoglycemia.

Subcutaneous infusion of glucagon by portable pump appears to give very effective symptomatic relief from non beta cell tumor hypoglycemia when surgery, radiotherapy and chemotherapy are impossible or ineffective. This mode of glucagon administration was proposed in a patient who had severe nocturnal hypoglycemic attacks. The aim of the study was to specify the modes of utilization and to test the efficiency and the tolerance of this treatment. Glucagon was infused at 400 micrograms/h during every 12 hour night. Because of the hepatic action of glucagon it is very important to use this treatment with an adequate diet and to stop the infusion during the day to reconstitute the glycogen overload. This mode of glucagon administration was very effective in over 6 months of use and well tolerated.

Effect of diltiazem on plasma glucose, insulin and glucagon during an oral glucose tolerance test in healthy volunteers.

The effect of the calcium antagonist, diltiazem, on glycoregulation was investigated in 12 healthy volunteers using a standard glucose tolerance test. No significant change was observed in plasma glucose, insulin or glucagon levels after oral treatment for B days with diltiazem 180 mg/day.