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Normal glucose homeostasis is characterized by appropriate insulin secretion and low HbA1c. Gene expression signatures associated with these two phenotypes could be essential for islet function and pathophysiology of type 2 diabetes (T2D). Herein, we employed a novel approach to identify candidate genes involved in T2D by correlating islet microarray gene expression data (78 donors) with insulin secretion and HbA1c level. The expression of 649 genes (P < 0.05) was correlated with insulin secretion and HbA1c. Of them, five genes (GLR1A, PPP1R1A, PLCDXD3, FAM105A and ENO2) correlated positively with insulin secretion/negatively with HbA1c and one gene (GNG5) correlated negatively with insulin secretion/positively with HbA1c were followed up. The five positively correlated genes have lower expression levels in diabetic islets, whereas GNG5 expression is higher. Exposure of human islets to high glucose for 24 h resulted in up-regulation of GNG5 and PPP1R1A expression, whereas the expression of ENO2 and GLRA1 was down-regulated. No effect was seen on the expression of FAM105A and PLCXD3. siRNA silencing in INS-1 832/13 cells showed reduction in insulin secretion for PPP1R1A, PLXCD3, ENO2, FAM105A and GNG5 but not GLRA1. Although no SNP in these gene loci passed the genome-wide significance for association with T2D in DIAGRAM+ database, four SNPs influenced gene expression in cis in human islets. In conclusion, we identified and confirmed PPP1R1A, FAM105A, ENO2, PLCDX3 and GNG5 as potential regulators of islet function. We provide a list of candidate genes as a resource for exploring their role in the pathogenesis of T2D.

The occurrence of glucosuria in the absence of hyperglycemia is distinctive for renal glucosuria. SGLT2 mutations provoke familial renal glucosuria characterized by persistent glucosuria in the absence of any other renal tubular dysfunction. Renal glucosuria associated with others proximal tubular dysfunctions points to Fanconi syndrome. This generalized dysfunction of proximal tubule needs to be treated and may progress regarding its aetiology to chronic renal failure. The development and study of models of Fanconi syndrome has recently contributed to a better knowledge of the mechanisms implicated in the tubular transport of glucose and low-molecular-weight-proteins. This article reviews these recent developments.

Congenital glucose-galactose malabsorption (CGGM) is a rare autosomal recessive disorder, which presents as a protracted diarrhea in early neonatal life. We describe the clinical history, diagnostic evaluation, and management of 7 children with CGGM in western France. There were 4 girls and 3 boys from 5 families, born between 1984 and 2010. The principal complaint was a neonatal onset of watery and acidic severe diarrhea complicated by hypertonic dehydration. The diarrhea stopped with fasting. In 2 cases, the family history supported the diagnosis. In the other cases, elimination of glucose and galactose (lactose) from the diet resulted in the complete resolution of diarrhea symptoms. In 2 cases, the H2 breath tests were positive. In 2 cases, the HGPO or oral glucose tolerance test (OGTT) demonstrated an abnormal curve with glucose and a normal curve with fructose. DNA sequencing was not used. When glucose and galactose were eliminated from the diet, the infants had normal growth and development. In conclusion, CGGM is a rare etiology of neonatal diarrhea; however, the diagnosis is easy to make and the prognosis is excellent.

International audience; Mrs B., 39 years old, hospitalized in the department of respiratory medicine for lung cancer, has an undetectable and verified venous blood glucose concentration (measured in central laboratory) less than 0.1 mmol/L. The patient feels no symptom of hypoglycemia. A concomitant capillary determination realised by a bedside glucose reader gives a result of 4.7 mmol/L. This gap is due to glucose consumption in vitro by leukocytes between the time of sampling and laboratory analysis. Indeed the leukocyte count is 86.4 G/L (92% neutrophils) probably in a context of paraneoplastic syndrome. An efficient talk between biologist and clinician identified this phenomenon for this patient. This event allows us to recall the different causes of hypoglycemia (artifactual or real), and to describe the care of patients with true hypoglycemia.

Systemic contact dermatitis is a form of delayed hypersensitivity reaction seen after systemic administration of a hapten in a subject previously sensitised via the cutaneous route. There have been few reports of this condition with nickel. In this paper, we describe four cases ascribable to the presence of nickel in a peripheral venous catheter.We reviewed the dossiers of four women developing pruriginous exanthema several hours after infusion. The same type of catheter (Optiva) was used in all cases. Epicutaneous tests were performed in all four patients, as well as a challenge test comprising a serum glucose infusion given via the incriminated catheter. Testing for the presence of nickel in the catheter was performed by means of a spot-test. Quantitative nickel assays were performed in vitro using inductively coupled plasma mass spectrometry on the glucose solution infusion kits with eight sample catheters and a negative control kit.The eruptions comprised maculopapular lesions, in some cases vesicular or bullous, arranged symmetrically around the tops of the limbs, the trunk and skin folds, with involvement of the infused forearm in most cases. Two of the four patients had previously presented a number of similar episodes. All four patients exhibited frankly positive test results for nickel and the role of the Optiva) catheter was demonstrated in all four patients by means of a challenge test. The presence of nickel in the catheter was demonstrated by a positive spot-test and was confirmed by quantitative assay demonstrating variations in nickel release for the different samples of the same Optiva) catheter model.As with the few reported cases published in the literature, our four cases of systemic contact dermatitis induced by nickel in a catheter all incriminated the same type of catheter and the tests performed clearly demonstrated the causative role of the device. The cases of systemic contact dermatitis were seen chiefly in women in the immediate postoperative period; they could be confused with adverse drug reactions and subsequently lead to inappropriate withdrawal of treatment. The diagnosis, which was suggested by the appearance of the lesions (symmetry, involvement of skinfolds and buttocks, concomitant reaction at the injection site), history of prior episodes and a frankly positive epicutaneous nickel test, may be readily confirmed using a challenge test.

International audience; Deep brain stimulation (DBS) of the bilateral subthalamic nucleus (STN) in Parkinsons disease is thought to produce adverse events such as emotional disorders, and in a recent study, we found fear recognition to be impaired as a result. These changes have been attributed to disturbance of the STN's limbic territory and would appear to confirm that the negative emotion recognition network passes through the STN. In addition, it is now widely acknowledged that damage to the orbitofrontal cortex (OFC), especially the right side, can result in impaired recognition of facial emotions (RFE). In this context, we hypothesized that this reduced recognition of fear is correlated with modifications in the cerebral glucose metabolism of the right OFC. The objective of the present study was first, to reinforce our previous results by demonstrating reduced fear recognition in our Parkinsons disease patient group following STN DBS and, second, to correlate these emotional performances with glucose metabolism using (18)FDG-PET. The (18)FDG-PET and RFE tasks were both performed by a cohort of 13 Parkinson's disease patients 3 months before and 3 months after surgery for STN DBS. As predicted, we observed a significant reduction in fear recognition following surgery and obtained a positive correlation between these neuropsychological results and changes in glucose metabolism, especially in the right OFC. These results confirm the role of the STN as a key basal ganglia structure in limbic circuits.

We describe three cases of cerebral angiopathy with aneurysms caused by a meningeal varicella-zoster virus infection occurring during AIDS. The clinical picture was rather stereotyped: severe immunocompromission due to HIV infection, ongoing multifocal cerebrovascular disease with territorial infarcts, lymphocytic meningitis with normal glucose content (two cases) or hypoglycorrhachia (one case), multifocal cerebral vasculopathy with narrowings and aneurysms, healing with or without neurological sequelae after intravenous aciclovir treatment. The diagnosis of varicella-zoster virus-induced angiopathy was ascertained by the positive specific PCR in the CSF in the three cases and by the results of the cerebromeningeal biopsy in one case. Although, varicella-zoster virus is already known as a cause of cerebral angiopathy both in the immunocompetent and the immunocompromised, these three cases are the first ever described of a particular angiopathy with narrowings and ectasias complicating AIDS. The infectious treatable cause and the risk of aggravation without treatment require early active oriented investigations in case of a patient with cerebrovascular disease occurring during HIV infection, including a CSF study with varicella-zoster PCR, to allow specific antiviral treatment. In our three cases, aciclovir intravenous treatment (30mg/kg per day) enabled VZ virus clearing from the CSF and stopped the course of the vasculopathy.

Atractylis gummifera is poisonous and its ingestion causes illness, characterized principally by hepatorenal injury, often fatal. The toxicity of this plant to the fetus is not known. We report a case of poisoning during pregnancy.A 28 year-old woman was admitted to our intensive care unit for Atractylis gummifera poisoning during her 24th week of pregnancy. She showed gastrointestinal symptoms, impaired consciousness, hypoglycemia, hepatic cytolysis and decreased factor V blood levels. The mother recovered after symptomatic treatment. A healthy boy was delivered vaginally at 39 weeks and his clinical findings and laboratory results were normal at birth and a week later.Poisoning by Atractylis gummifera has not previously been reported during pregnancy. The favorable course of our patient and her infant do not rule out possible fetal damage from which he recovered, as his mother did.

Metabolic imaging with positron emission tomography (PET) provides, in neuro-oncology, information complementary to that provided by anatomic imaging obtained with CT-scanner or MRI. Only a few publications have yet reported its use in oligodendroglial tumors. These findings and partial results obtained in ongoing work, suggest some preliminary conclusions: 11C-MET (L-methyl-methionine) is a more appropriate tracer than 18F-FDG (fluoro-deoxy-glucose), in terms of both specificity and sensitivity, for the assessment of patients with this category of tumor. PET/MET allows differentiation between grade II and grade III oligodendrogliomas; better targeting for stereotactic biopsy; more accurate assessment of the post-operative residual tumor; identification of progression from low-grade to anaplastic grade during the disease course; differentiation between recurrence and a post-radiation processes. PET/MET allows, to some extent, prediction of response to radiotherapy; and, probably, to chemotherapy.

The brain is an organ elaborated and functioning from substances present in the diet. Dietary regulation of blood glucose level (via ingestion of food with a low glycemic index ensuring a low insulin level) improves the quality and duration of intellectual performance, if only because at rest the adult brain consumes 50 p. 100 of dietary carbohydrates, 80 p. 100 of them for energy purposes. The nature of the amino acid composition of dietary proteins contributes to good cerebral function; tryptophan plays a special role. Many indispensable amino acids present in dietary proteins help to elaborate neurotransmitters and neuromodulators. Omega-3 fatty acids provided the first coherent experimental demonstration of the effect of dietary nutrients on the structure and function of the brain. First it was shown that the differentiation and functioning of cultured brain cells requires omega-3 fatty acids. It was then demonstrated that alpha-linolenic acid (ALA) deficiency alters the course of brain development, perturbs the composition and physicochemical properties of brain cell membranes, neurones, oligodendrocytes, and astrocytes (ALA). This leads to physicochemical modifications, induces biochemical and physiological perturbations, and results in neurosensory and behavioral upset. Consequently, the nature of polyunsaturated fatty acids (in particular omega-3) present in formula milks for infants (premature and term) conditions the visual and cerebral abilities, including intellectual abilities. Moreover, dietary omega-3 fatty acids are certainly involved in the prevention of some aspects of cardiovascular disease (including at the level of cerebral vascularization), and in some neuropsychiatric disorders, particularly depression, as well as in dementia, notably Alzheimer's disease. Their deficiency can prevent the satisfactory renewal of membranes and thus accelerate cerebral aging. Iron is necessary to ensure oxygenation, to produce energy in the cerebral parenchyma, and for the synthesis of neurotransmitters. The iodine provided by the thyroid hormone ensures the energy metabolism of the cerebral cells. The absence of iodine during pregnancy induces severe cerebral dysfunction, leading to cretinism. Manganese, copper, and zinc participate in enzymatic mechanisms that protect against free radicals, toxic derivatives of oxygen. The use of glucose by nervous tissue implies the presence of vitamin B1. Vitamin B9 preserves memory during aging, and with vitamin B12 delays the onset of signs of dementia, provided it is administered in a precise clinical window, at the onset of the first symptoms. Vitamins B6 and B12, among others, are directly involved in the synthesis of neurotransmitters. Nerve endings contain the highest concentrations of vitamin C in the human body. Among various vitamin E components, only alpha-tocopherol is involved in nervous membranes. The objective of this update is to give an overview of the effects of dietary nutrients on the structure and certain functions of the brain.

Evra is a transdermal patch releasing 20 micrograms of ethinylestradiol and 150 micrograms of norelgestromin/day during one week. The circulating levels of steroids attained are of similar amplitude though steadier than after intake of an oral combined low-dose estrogen-progestin pill. The transdermal method is user-friendly and is abided by a high degree of acceptability, and a low level of skin irritability. Its contraceptive effectiveness is similar to that conferred by oral contraceptives except if the treated woman is over 90 kg, in which case Evra should not be prescribed. Cycle control is excellent and similar to that of triphasic pills. Adverse effects and tolerance are comparable to those described with low-dose oral contraceptives with a slight estrogen dominance. Lipid and glucose metabolism as well as coagulation are influenced in the same way. Gastrointestinal disturbances (nausea, vomiting) do not prevent the efficacy of the transdermal patch. Compliance with Evra is significantly higher than with oral combined contraceptives--a major point for an effective contraception. Accordingly, Evra constitutes an useful addition to the current array of contraceptive methods.

To examine the effects of iv compound sodium lactate (CSL) with and without caloric supplementation with dextrose on nausea, vomiting and pain following general anesthesia for laparoscopy.We compared iv fluid loading with and without supplementary dextrose for the prevention of postoperative nausea and vomiting (PONV). In a prospective double-blinded controlled trial, 120 ASA I female patients undergoing elective gynecological laparoscopy were randomized to one of three groups, and received either: (a) CSL 1.5 mL.kg(-1) per hour fasting duration; (b) CSL, 1.5 mL.kg(-1) per hour fasting duration with 0.5 g.kg(-1) dextrose added in 50% formulation (CSL/dextrose); or (c) no iv fluid (control).Compared with control the percentage of patients who had no PONV within 24 hr of anesthesia in the CSL and CSL/dextrose groups was 78% vs 83% and 71%, P = 0.81 and P = 0.683 respectively. The numbers needed-to-harm for causing PONV episodes in CSL/dextrose vs CSL or control groups were 5.7 [95% confidence interval (CI), 5.57-5.91] and 8.2 (95% CI, 8.01-8.37) respectively. The number needed-to-treat for prevention of PONV episodes in CSL vs control was 19.2 (95% CI, 19.08-19.37). A greater proportion of patients in the CSL/dextrose group required narcotic analgesia in the postanesthetic care unit compared to those in the control group (16/35 vs 7/37, P = 0.03). The CSL/dextrose group also demonstrated hyperglycemia (serum glucose 14.0 +/- 3.94 vs 5.0 +/- 1.01 vs 5.2 +/- 0.9 mmol.L(-1), P0.0001) in the postanesthetic care unit compared to the CSL and control groups. The CSL/dextrose group also reported increased thirst at 24 hr compared to control (20/35 vs 11/37, P = 0.035).These findings suggest that: 1) administration of dextrose is associated with nausea, increased opioid requirement and late thirst after elective gynecological laparoscopy; 2) iv fluids did not decrease PONV.

We report three cases of Horton's disease, in which F18-Fluorine-2-Deoxy-D-Glucose (18FDG) positron emission tomography (PET) demonstrated a clinically unsuspected extra-cranial vessels hypermetabolism.Fully corrected whole-body PET was performed in three patients (two women, one man) for exploring a marked inflammatory syndrome. Scanning was acquired 60 min after i.v. injection of 222 MBq of 18FDG in average.In two patients with histologically proven Horton's disease, PET alone showed increased glucose metabolism involving the carotid and sub-clavian arteries as well as the ascending aorta, aortic arch, thoracic and abdominal aorta, and the iliac and femoral arteries. In the third patient, by detecting cervical, thoracic and abdominal vessel hypermetabolism, PET non-invasively contributed to the diagnosis of giant cell arteritis. All patients had complete clinical and biological response to corticoids. PET controls performed 3- to 6-months post-treatment, confirmed the disappearance of the metabolic stigma.18FDG PET may show an increased glucose metabolism in asymptomatic extracranial vessels locations of Horton's arterities. If these observations are confirmed on controlled trials, PET could be particularly useful for non-invasive diagnosing, staging and monitoring atypical clinical forms of Horton's disease. The metabolic imaging could also contribute to a better understanding of the pathogenesis of GCA.

Twelve of the urine parameters, namely sodium, potassium, chloride, urea, creatinine, uric acid, calcium, phosphate, protein, microalbumin, amylase and glucose, routinely measured in a biochemistry laboratory were chosen to revalue their interest in clinical practice. For each parameter, urinary collection method, physiologic review and specific indications were set out. The clinical interest of chloride, urea, phosphate or uric acid measurement seem limited to specific pathological conditions. The measurement of urine amylase is out of interest.

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycaemia. Simultaneous measurements of plasma glucose and insulin levels also allow to derive indices of insulin secretion and insulin sensitivity. Whereas OGTT is not considered anymore as the first choice for the diagnosis of diabetes mellitus, it remains useful for studying abnormalities of glucose metabolism as well as of insulin secretion and insulin action.

We report a case of a patient with carnitine palmityl deficiency in active labour. We discuss the metabolic and energetic implications of obstetrical labour in regard with the mitochondrial myopathy and we propose an optimal management. Neuroaxial analgesia and glucose infusion are indicated in early labour because it is necessary to alleviate stress and pain in order to avoid rhabdomyolysis associated with CPT deficiency. Combined spinal epidural analgesia using intrathecal opioid alone then epidural naropein should be a relevant choice because of a minimal motor blockage. Monitoring of myolysis using serum creatinine phosphokinase levels must take in account CK and MB fractions releases to the circulation during obstetrical labour.

Obesity and hypertension, the major modifiable clinical determinants of left ventricular mass, are both associated with a state of insulin resistance.To determine the relationships between glucose and insulin metabolism and left ventricular mass in a group of obese, nondiabetic, hypertensive people.Twenty-two obese, nondiabetic, hypertensive people (10 men), free of coronary or valvular heart disease, with normal left ventricular function were studied. The mean age was 55+/-12 years, body mass index 32.8+/-4.8 kg/m2, and systolic and diastolic blood pressures 149.0+/-11.0 mmHg and 98.0+/-4.0 mmHg, respectively. Left ventricular mass corrected for height (LVM/Ht) and glucose and insulin metabolism (3 h intravenous glucose tolerance test) were measured after a four- to six-week washout period of any antihypertensive medication.The mean LVM/Ht was 119.5+/-11.9 kg/m. The following metabolic measures correlated with LVM/Ht in a univariate analysis: total insulin integration area (r=0.54, P=0.008); fasting insulin (r=0.43, P=0.04); insulin at 90 min (r=0.54, P=0.013); and peak glucose levels (r=0.51, P=0.013). Stepwise multivariate linear regression analysis showed that only total insulin integration area (P=0.005) and peak glucose levels (P=0.01) correlated with LVM/Ht.In obese, nondiabetic, hypertensive people, left ventricular mass is associated with circulating glucose and insulin levels.

Primary periodic palsy is a group of muscular diseases transmitted by autosomal dominant inheritance. The characteristic features are flaccid muscular deficiency, abolition of reflexes, and dyskalemia.A 36-year-old woman presented a 5-year history of acute episodes of myalgia, muscle contracture, and muscle paralysis involving first the hand, then all four limbs and the face, sparing the respiratory muscles. The symptoms totally regressed spontaneously within one hour or in a shorter time if the patient ingested sugar. Demonstration of hyperkalemia during an acute episode led to the diagnosis of transfer hyperkalemia typical of Gamstorp's disease. Several members of the family presented identical symptoms.Despite progress in our understanding of this disease, diagnosis is often made late. The diagnostic strategy is however quite simple: serum potassium during an acute episode and provocation test with fasting and rest.

Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) is a scintigraphic imaging technique undergoing a rapid growth in the field of oncology. The constant progress of the detectors, either CDET or PET dedicated cameras, allows to obtain in routine conditions images with a 5 mm spatial resolution. Absolute tracer uptake quantification is also possible, which allows to evaluate objectively therapy efficacy. The mechanisms of FDG tissular accumulation are now better understood. Increase of glycolysis and of transmembrane transport of glucose seems to be at the origin of the high tumorous accumulation of FDG. The main current oncologic application of FDG PET is the diagnosis of malignancy of the isolated pulmonary nodules, with a sensitivity of more than 95%, and in the staging of lung cancer where PET shows higher performances than conventional imaging. The same stands in cutaneous melanoma and for malignancies of the digestive tract, either in colorectal, pancreatic or esophageal localizations. In colorectal cancers, the role of PET has for long being recognized in the differential diagnosis between recurrence and postoperative fibrosis. In the head and neck tumors, FDG also allows to differentiate between recurrence and postradiation necrosis. In lymphoma, the most suitable site for biopsy can be identified on a PET scan and therapy efficacy can also be assessed. In breast cancer, the detection of metastases seems to be possible with FDG. In brain and thyroid cancers, the role of FDG PET remains to be further determined. The low uptake of FDG in prostate cancer metastasis is not in favor of its use in this indication. In conclusion, the indications of FDG PET in oncology are now becoming more precise and it can be expected that clinical PET centers will soon appear in France.

We relate three cases of rare neurological disturbances associated with hypoglycemia (paraplegia, quadroplegia). Clinical symptoms completely disappeared within a few minutes after glucose administration. The pathogenesis of these types of deficit is not fully clarified, and a search of hypoglycemia should always be performed in these circumstances.

OBJECTIVES AND JUSTIFICATION: To describe facilitated diffusion glucose transporters (GLUT) in humans, and particularly the regulation of GLUT4 expression since it is predominantly responsible for insulin-mediated glucose transport in muscle and adipose tissue, and plays a crucial role in whole-body glucose homeostasis.Numerous studies have shown abnormal expression of GLUT4 in insulin responsive tissues in diabetes mellitus and other insulin resistant states. The recent development of transgenic mice that overexpress GLUT4 in muscle, adipose tissue, or both has also emphasized the importance of GLUT4 in glucose homeostasis.The studies performed in transgenic mice suggest that strategies to increase GLUT4 transporters in insulin responsive tissues may lead to new therapeutic possibilities to improve insulin sensitivity in insulin resistant states such as non-insulin-dependent diabetes mellitus.Glucose transport is a crucial process in mammals, which needs specific transmembrane hexose transporters. Each transporter is important in the regulation of glucose homeostasis. Advances in the knowledge of both the action and the regulation of the glucose transport system may provide new insights for the development of therapeutic interventions in diseases such as obesity or diabetes mellitus.

Four fistulated Holstein cows were arranged in a 4 x 4 Latin square design to study the effects of level and type of energy source on milk yield and composition. Treatments consisted of a basal diet fed alone (low energy treatment) or with 3.3 Mcal of net energy for lactation from extra nutrients perfused either into the rumen (either propionic acid or a mixture of volatile fatty acids) or into the duodenum (glucose). Increasing the energy input without changing the volatile fatty acid profile improved milk yield and slightly increased milk protein and fat yields. Compared with the isoenergetic mixture of volatile fatty acids, both propionic acid and glucose infusions significantly decreased fat content (-4.5 g/kg) and yields (respectively, -111 and -160 g/d), but affected fatty acid proportion and yield differently (more elongation process and less C18 with glucose infusion). Protein yield was slightly increased by propionic acid infusion but not by glucose because of the counterbalanced effects on milk yield (-1.3 kg/d) and protein content (1.5 g/kg). The coagulating properties of milk were directly linked to variations in protein, casein and mineral contents. In conclusion, propionic acid or glucose scarcely affected milk protein content, but induced a similar decrease in milk fat content probably through different metabolic pathways.

The purpose of this study was to compare the clinical efficacy of a local solution based on "pain de singe", fruit of baobab (Adansonia digitata), and the WHO standard solution in the treatment of children with acute diarrhea and resulting mild to moderate dehydration.A prospective clinical trial comparing the local solution to the standard WHO solution was conducted; in children of 6 months or older (mean age = 16.6 +/- 8.8 months), 79 received the WHO solution and 82 the local solution, and were followed for a period ranging from 4 to 48 hours. Evolution of diarrhea and weight gain were evaluated as variables of interest.WHO solution was found to be superior, but not statistically significant in term of duration of diarrhea and weight gain.The pain de singe based solution presents additional advantages: nutritional, economic and cultural; we recommend it to promote use of TRO at home.

Objective : A subgroup of patients with Alzheimer's disease present with visual disturbances at onset. This study investigated whether specific cortical networks associated with visual processes are preferentially affected in this subgroup and determined the clinical implications of such abnormalities. Method : Regional cerebral glucose metabolic rates were assessed with positron emission tomography and [ 18 F]2-fluoro-2-deoxy-D-glucose, and general intellectual functions, memory, and visual skills were measured with cognitive tests in patients with probable Alzheimer's disease-10 with and 22 without prominent visual symptoms-and in 25 healthy comparison subjects. Results : Both patient groups showed reduced glucose metabolism in parietal regions and in middle and superior temporal regions in comparison with the healthy subjects. The Alzheimer's disease patients without visual symptoms also showed reductions in inferior temporal, frontal, and limbic structures, as is typical of Alzheimer's disease. In contrast, the patients with visual symptoms had larger metabolic deficits than the patients without visual symptoms in the parietal and occipital cortices (including the primary visual cortex), with a relative sparing of inferior temporal, frontal, and limbic regions. Consistently, the patients with visual symptoms had significantly greater visuospatial deficits and less severe memory impairments than the patients without visual symptoms. Conclusions : Alzheimer's disease patients with visuospatial deficits who are studied while alive have a distinctive regional distribution of cerebral metabolic impairment that is related to specific cognitive deficits and that distinguishes them from patients with typical Alzheimer's disease. These findings imply that regional variations in brain dysfunction can occur in Alzheimer's disease, with differential involvement of cortical systems resulting in distinctive clinical subgroups.

Endogenous glucose production (EGP), glucose clearance and insulin sensitivity were measured in 5 subjects with insulinoma before and 3 to 6 months after surgical resection of the tumour. Endogenous glucose production and glucose clearance were evaluated by infusion of [6,6 D2] glucose, and insulin sensitivity was determined by a euglycaemic hyperinsulinaemic glucose clamp. The patients served as their own controls. The postabsorption blood glucose level was low before treatment (0.51 +/- 0.01 g/l) and EGP was 1.86 +/- 0.10 mg kg-1 min-1 (normal value: 2.2 to 2.6 mg kg-1 min-1), whereas the insulin level was relatively high (16.4 +/- 1.6 mU/l). After surgical resection of the insulinoma, the blood glucose level rose to 0.94 +/- 0.02 g/l and EGP to 2.33 +/- 0.04 mg kg-1 min-1, whereas the insulin level fell to 6.4 +/- 0.5 mU/l. Glucose metabolic clearance in the fasting state was 3.68 +2- 0.21 mg kg-1 min-1 before and 2.46 +/- 0.09 (n = 2.44 to 3.46 ml kg-1 min-1) after surgery. Clamp dose-response curves were shifted to the left and insulin sensitivity was improved after surgery. These data suggest that chronic hyperinsulinaemia is associated with inhibition of endogenous glucose production, a rise in basal glucose clearance and a state of insulin insensitivity during the clamp.

Physical exercise induces a mobilization of energy substrates in order to furnish fuel for metabolic pathways. A part of this regulation is under hormonal influences. A decrease in plasma insulin and an increase in catecholamines play a central role. It results an enhanced lipolysis. The increase in insulin sensitivity favours muscle glucose consumption in spite of hypoinsulinemia during exercise. These coordinated actions indicate that physical training is able to influence the mechanisms of type 2 diabetes with insulin resistance when the etiology of type 1 diabetes is not influenced by physical training. Physical exercise exerts a synergic effect with diet in the treatment of obesity but it is inefficient alone. The action of physical training on metabolic disease is related to the level and duration of training.

The ovarian fluid of rainbow trout (Oncorhynchus mykiss), charr (Salvelinus alpinus), lake trout (Salmo trutta f lacustris) and Danube salmon (Hucho hucho) was analyzed for its inorganic and organic composition. The qualitative composition of the ovarian fluid of the investigated species was similar, but significant quantitative differences were found. The following components were determined: sodium 106.6-142.2 mmol/l, potassium 1.7-2.7 mmol/l, calcium 0.45-0.61 mmol/l, osmolality 256.4-291.6 mosmol/kg, pH 8.4-8.8, glucose 1,698-4,195 mumol/l, fructose 17-399 mumol/l, lactate 34-227 mumol/l, cholesterol 650-1,230 mumol/l, phosphatidylcholine 0.25-3.0 mumol/l, lysophosphatidylcholine 10-100 mumol/l, choline 0-1.1 mumol/l, protein 95.0-278.4 mg/100 ml. Arginine, cystine, glycine, histidine, lysine, proline, serine, tyrosine and valine were the free amino acids occurring in concentrations of more than 10 mumol/l. Activities of alkaline phosphatase (200-6,000 mumol substrate/l/h), lactate dehydrogenase (9-690 mumol substrate/l/h), beta-D-glucuronidase (70-410 mumol substrate/l/h), proteases (140-215 mumol/l/h with collagen substrate, 25-90 mumol/h/l with gelatine substrate) and acid phosphatase (100-130 mumol substrate/l/h) were measured, but not the glucose-6-phosphate dehydrogenase and alpha-glucosidases activities.

Preoperative nutritional support is analysed from 7 prospective studies. Clinical benefits from nutrient intake and duration are not demonstrable. In one study, preoperative long-chain triglycerides infusions are associated with more postoperative complications. Postoperative nutrition is analysed from 20 articles. No one considers the clinical benefit with regard to quantitative and qualitative intakes.

Ex-situ protection of donor organs for transplantation with initial cold perfusion is routinely used. The superiority of the Histidin-Tryptophyn-Ketoglutarate solution (HTK) has been demonstrated in animal models and clinical use. On the other hand, nephron sparing surgery for surgical or functional solitary kidneys has been proved effective for many years. Due to widely used ultrasound and computerized tomography, the incidence of small renal tumors has increased. Therefore, new concepts in conservative renal surgery are gaining more popularity. In this study we report about 11 patients with renal masses in a functional solitary kidney. For the first time, all enucleations were performed with continuous in-situ perfusion with HTK-solution. Despite extensive tumors with central extension, complete in-situ tumor resection and kidney reconstruction were possible. There were no intraoperative complications. Postoperatively, one kidney was lost secondary to renal artery embolism. Urine production started within one hour postoperatively in all cases. No further patient needs haemodialysis. Postoperatively, renal function was largely unchanged except for a transient minor elevation of the serum creatinine. There were no changes of serum creatinine. There were no changes of serum electrolytes and no cardiac failures under HTK. The indication, the surgical procédures and the first clinical results of continuous in-situ perfusion with HTK-solution for conservative renal surgery are presented.

Trauma and surgery induce extensive physiological changes, commonly denominated the acute phase reaction (APR). This APR is activated by various kinds of stimuli, namely nociceptive stimulations, tissue injury, tissue ischaemia and reperfusion as well as by haemodynamic disturbances which occur commonly in such patients. APR is mainly characterised by the release of counter-regulatory hormones, complex metabolic changes and by the hepatic synthesis of numerous acute phase factors (C-reactive protein, haptoglobin, complement protein, etc). In addition, fever is typically present and there is a resistance to the nutritional support. The intensity of APR is variable, according to the extent of surgery, the subsequent course, occurrence of complications and to various factors related to the patient and its treatment. In patients with non complicated surgery and low or moderate severity trauma, the metabolic changes are minor and self-limited. In such a condition, there is no need for nutritional support. Conservely, in patients with complicated surgery or major trauma, there is an extensive APR, which can be very prolonged. This results in important and sustained metabolic changes, leading to extensive catabolism and progressive loss of body cell mass. The latter is amplified by the decreased body ability to adapt to starvation and by the resistance to the nutritional support that typically occur in complicated postoperative and trauma patients. Total parenteral nutrition does not prevent from metabolic changes occurring in surgical patients. By contrast, several experimental and human studies have shown that early enteral nutrition may alleviate both the endocrine and metabolic responses in such conditions. Regional anaesthesia, particularly by the epidural route, may also decrease but not abolish the extent of APR.

The two most widely used methods for studying insulin sensitivity in man are the euglycaemic hyperinsulinaemic clamp and the intravenous glucose tolerance test with minimal model assessment. The glucose clamp is the reference method, well validated and easy to interpret, which allows various extensions to the basic experimental procedure in order to obtain more valuable information on the specific effects of insulin on the various aspects of glucose metabolism. However, it is time-consuming and labour-intensive. In contrast, the intravenous glucose tolerance test is easier to perform, but its interpretation is much more difficult and requires a modeling approach called the "minimal model". If the intravenous glucose tolerance test probably represents a good screening test, mainly on a population basis, the glucose clamp still remains the gold standard method to study insulin sensitivity in man.

An 11-year-old girl developed signs of intracranial hypertension after status epilepticus with convulsive movements of her right upper limb. Computerized tomography revealed left hemispheric hypodensity with mass effect, attributed to vasogenic edema. Intracranial hypertension was controlled under intracranial pressure monitoring and clinical status slowly improved. The patient was aphasic and right hemiplegic when she recovered consciousness but she remarkably recovered from her neurological deficits during the following two years despite neuroradiological evolution demonstrating extensive destruction of the left cortex and white matter. Two positron emission tomography (PET) scans were performed respectively six weeks and eight months after status epilepticus, and both demonstrated profound left hemispheric hypometabolism except in the lenticular nucleus and a restricted area of motor/premotor cortex. On the other hand, glucose metabolism in the right hemisphere was heterogeneously increased on the second PET when compared with the first PET. We concluded that, in this case, clinical recovery might have implicated functional reorganization arising from the intact hemisphere.

Estrogen and progestogen effects on lipid and carbohydrate metabolism are reviewed. Their actions depend on the type and dosage of molecules and their route of administration. Steroid replacement therapy in post menopausal women results in most cases in beneficial effect on lipids without alteration of carbohydrate metabolism. Therapeutic implications in women with metabolic disturbances as hyperlipidemia or diabetes are discussed.

Among the low dose oral contraceptives that is to say less than 50 mcg of ethinylestradiol per pill one must single out the pills made of a third generation progestagen (desogestrel, gestodene, norgestimate) from the others. The contraceptive efficacy (tested on the Pearl index) according to the files of government authorities visa (AMM) is equivalent for all the oral contraceptives whatever their composition (between 0 to 0.07 women year). The clinical tolerance of the low dose pills of the 3rd generation is comparable to that of the other low dose pills. Is there any advantage then in prescribing them? The most important advantage is the decrease of metabolic and vascular effects. The use of so-called third generation progestive, besides the beneficial effects an lipidic and glucidic metabolisms, has mainly enabled the decrease of the estrogen doses of progestagens. The ethinylestradiol is directly implicated in the risk of venous thrombosis: hemostasis the modifications are less important with 30 mcg than with 50, 20 than 30 mcg. Relying on theoretical arguments one could have estimated that minipills would lead to an insufficient ovarian slow down. These hypothesis are contradicted by recent studies from Falsetti and Benagiano who studied the rates of FSH and LH under minipills. This does not include the variability and the individual sensitiveness of the patients and as well the reason following which minipills would favor functional ovarian cysts, lies on the confusion made between a cyst and a 20 mm diameter follicule.(ABSTRACT TRUNCATED AT 250 WORDS)

Women rarely depend on progestational contraception. In France, physicians are unsure of its indications. Progestational contraception presents advantages for certain indications where a particular condition exists and, more particularly, for women aged 40 and over. Women who can use it are those who have contraindications to estrogen use. These contraindications include uterine fibroids, endometrial hyperplasia, endometriosis, and fibro-cystic disease of the breast. It does produces side effects but those affecting metabolism seem to be almost negligible, like those of the third generation progestins. These side effects are metrorrhagias, amenorrhea, weight gain, and atherogenic metabolic changes. Yet, the nor-pregnane derivatives (which do effectively suppress ovulation) do not adversely affect glucose and lipid parameters. Progestational contraception probably cannot assure absolute safety as can combined oral contraceptives. It is not yet clear whether women who have been treated for breast cancer should use progestational contraception.

We studied cerebral glucose metabolism, using Positron Emission Tomography (PET) and (F-18) fluorodeoxyglucose, in 15 young schizophrenic patients compare to 15 age-matched healthy volunteers. The PET investigation was made in a quiet room with a dimly light. Each subject remained in a supine resting state with eyes closed. Results failed to demonstrate any differences in glucose utilization between schizophrenic patients and control subjects, as far as absolute or relative, left and right values are concerned. Besides, variability of metabolic values was significantly higher in schizophrenics than in controls.

Elevated serum angiotensin I-converting enzyme activity may occur in diabetic subjects. This may signal alteration of vascular endothelium. To study the effect of acute glucose change on serum Angiotensin Converting Enzyme (ACE), we performed an oral glucose tolerance test in 17 obese subjects (7M/10F), (Body Mass Index, (BMI): 31 +/- 1 kg/m2), aged 48 +/- 3 years. We measured serum ACE activity (Lieberman's method), active renin (RIA Pasteur kit), and aldosterone (RIA, Cis-International kit), before and 2 hours after oral glucose intake (75 g), and plasma glucose and insulin every 30 min. After oral glucose tolerance test, subjects were classified as 6 Non Insulin-Dependent Diabetic (NIDD), 8 Glucose intolerant (GI), and 3 NormoGlycaemic (NG) subjects. Active renin did not vary after glucose loading (14 +/- 2 vs 15 +/- 2 pg/ml) nor aldosterone (104 +/- 14 vs 133 +/- 18 pg/ml), while ACE activity rose significantly (229 +/- 25 vs 277 +/- 28 IU/l; p = 0.02). Serum ACE activity were different in the 3 groups before glucose loading (NIDD: 266 +/- 37, GI: 252 +/- 32, NG: 90 +/- 21 IU/l; Kruskal-Wallis H = 7.03; p = 0.03), but not after 2 hours (NIDD: 297 +/- 42, GI: 275 +/- 36, NG: 204 +/- 113 IU/l; ns).(ABSTRACT TRUNCATED AT 250 WORDS)

Up till now, in the French Polynesia and in New Caledonia, people showing ciguatera intoxication receive a standard treatment: calcium + vitamins B6 and C by intravenous way and in addition, some drugs arriving to cure some symptomatic manifestations. In 1988, an investigation carried out in Majuro, Marshall Islands concluded that intravenous mannitol is efficient in the treatment of serious intoxications with suspecting cerebral oedema. Since, such a treatment has been utilized with success in several endemic areas. Our therapeutic evaluation was arrived to determine whether mannitol's efficiency is higher than the standard treatment in the ciguatera intoxications of mean seriousness. This investigation was carried out on two randomized groups: The first one receiving mannitol (250 cc intravenous at 20% injected in 1 h) the second one receiving the standard treatment (intravenous perfusion glucose serum 250 cc with 1 g of vitamins C, 250 mg of vitamin B6 and 1 g of calcium gluconate injected in 1 h). Seriousness of clinical status was evaluated according to a scale of score from 0 to 50, based on the importance of the clinical manifestations paresthesia, aches, asthenia, cardiovascular and digestive signs. Only patients getting a score at least 20 were included in this investigation. Clinical status of each patient was evaluated before any treatment (initial score) at the end of perfusion and at the 24th hour. Efficiency of each treatment respectively was evaluated according to the differences between these three different scores. CHI 2 and U Mann's and Whitney's tests were utilized for the statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Several studies using positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG) have revealed functional hypofrontality in schizophrenia. However, frontal hypometabolism is not consistently found and is not specific to schizophrenia. Basal ganglia glucose hypermetabolism related to neuroleptic treatment has been demonstrated. Methodological and clinical differences between studies are discussed in this paper.