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Currently, the major method of adrenal gland imaging is computed tomography. This method allows demonstration of normal adrenals and the diagnosis of adrenal masses (if these are greater than 1 cm in diameter). The examination should be directed by clinical signs and known laboratory investigations. Computed tomography is therefore the first line investigation to perform. Certain lesions may be better demonstrated by other methods: MRI and MIBG scintigraphy offer a greater specificity in the investigation of pheochromocytomas. In addition, scintigraphy can identify possible ectopic tumours or recurrences. Selective catheterisation of the adrenal veins allows aldosterone and cortisone secretions to be assayed. There remains the problem of the incidental finding of adrenal masses in either an asymptomatic patient or in the context of investigation of spread of a know cancer. These lesions may benefit from diagnostic percutaneous guided biopsy.

Vitamin E (alpha-tocopherol) concentrations of plasma, platelets and erythrocytes were determined by HPLC in insulin-dependent (type I) and age-matched non-insulin-dependent (type II) diabetic patients and in two control groups. Plasma alpha-tocopherol levels were significantly increased in diabetic patients compared to control groups. Platelet and erythrocyte alpha-tocopherol levels were not significantly different in type I and type II diabetics as compared to their respective control groups, but differed from one another. Plasma vitamin E concentrations showed a significant correlation with plasma cholesterol and apoprotein B concentrations in different groups. The alpha-tocopherol/cholesterol and alpha-tocopherol/apoprotein B ratios in plasma were higher in diabetic patients, as were triglyceride contents. Platelet vitamin E levels were not significantly correlated with plasma concentrations. These findings suggest that vitamin E activity is altered in diabetic patients but that no diet supplementation seems necessary.

Microalbuminuria is considered a good predictor of diabetic nephropathy. In this study over 50% of patients with retinopathy, whatever its severity, did not show microalbuminuria. However, among patients with microalbuminuria, the percentage of retinopathy was significantly increased (75%). It is concluded that with the exception of nephropathy, microalbuminuria is not a good parameter for the detection of other microangiopathic complications of diabetes.

Twelve patients were treated with op'DDD over a 9-year period. All presented with mild neurological symptoms, and half of them had major complications. There was no relation between the occurrence of these symptoms and the dose or duration of op'DDD therapy. The mechanisms of this neurological toxicity, both central and peripheral, are not well known, but they appear to be similar to those of certain op'DDD-related chemicals used in industry.

The maximum output of half-expiration (MMFR) or DME 25-75% is studied in 136 subjects, evalued as non obstructive, after the determination of the MEVS/VC X 100. The values noted are reported to the body surface (S) in order to eliminate the biometric differences. A highly close correlation, of the exponential type, is thus put in evidence for each sex between the DME/S and the age of the subjects. The study of the DME in subjects with obstructive Tiffeneau makes possible: a) to determine an inferior limit of the normal condition; b) to bring confirmation of the fiability of the test. The study of the determination of the DME/S is then performed in subjects with normal MEVS/VC X 100 and clinically suspect of bronchial obstruction (tobacco addicts, patients at stage I of chronic bronchitis, asthmatic patients outside the attacks). The DME determination lets appear the presence of a bronchial obstruction in almost one half of the subjects submitted to study.

Plasma lipid values studied in 30 subjects with stroke at days 1, 2 and 4 of the early phase indicated a significant decrease in total cholesterol, HDL-cholesterol and apolipoprotein A1 from day 1 to 4. However, there was no significant difference between values at day 1 and during the 4th month of convalescence. Since some patients admitted to hospital are never followed up later in a hospital environment, it would seem advisable, for practical purposes, to perform plasma lipid analysis on the first day of admission.

Fifty three patients with Pectus excavatum, 12.5 years of age on average, were studied. They frequently had respiratory history (in 36% of cases): asthma, repetitive bronchites or rhinopharyngites, and associated squeletal deformities (17%) : kyphoscoliosis, lordo-kyphosis and scoliosis. As far as ventilation is concerned, the restrictive syndrome was found in 49% of cases, severely in 23% (20% decrease in C. V.) An obstructive syndrome was found only in cases of associated asthma. Bodypletysmography done parallely in 5 cases puts in evidence or increases the ventilatory abnormalities. In the cardio-vascular check up, the chest X ray, E.C.G., the pulmonary scintigraphy or straight microcatheterization, usually reveal some abnormality (15% of cases). The synthesis of results points out two facts : 1) when the heart is in its position and the cardiomediastinal shadow enlarges, the E.C.G. abnormalities are unimportant; when the heart is displaced towards the left, the electrical disorders are bigger ; 2) microcatheterization done on 22 subjects revealed a gradient of systolic pressure, right ventricle-pulmonary artery, definite or severe in 4 cases, lesser in 9. Surgery rarely improves the spirometry and E.C.G. abnormalities, but does seem to cure the hemodynamic disorders.

Alcohol can cause disturbance in the main metabolic pathways. Alterations of glycoregulation are particularly frequent in chronic alcoholics as well as disorders of lipoprotein. Other biochemical abnormalities affect protein, vitamins and trace elements. But it is often difficult to decide the extent these abnormalities are the result of the direct toxic effect of alcohol or secondary to organ damage.

Out of 440 pleural biopsies done with Abrams or Castelain needle, performed over 11 years in 300 pleural effusions, only 14 incidents of accidents occurred. There were 9 minor ones (intrapleural bleeding, subcutaneous emphysema, pneumoserosa by aspiration). Neoplastic graft along the biopsy tract was observed in 5 cases, of which 4 were primitive malignant mesotheliomas and one a primitive appearing neoplastic pleurisy. The risk of parietal neoplastic seeding runs high in malignant mesothelioma, considering that 11 such cases were included in this series of biopsied patients. This risk is not specific to plaural biopsy and can be encountered in simple thoracentesis. This complication therefore is not a contra-indication to needle biopsy as it is only observed in diseases beyond surgical redemption.

This clinical report concerns a 57 year old woman with dermatomyositis and cardiac involvement. After an apparent clinical and biological improve of the muscular and myocardic symptoms, a pulmonary involvement was reported. There was a persistent high rate of lacticodeshydrogenase serum activity. Then, cutaneous ulcerations and necrosis appeared on the extremities of limbs. Dermatomyositis associated with cutaneous necrosis and pulmonary fibrosis has a very severe prognosis.

The authors report a personal experience of 1.159 bronchial fibroscopies performed in 3 years. They review the literature for the indications and results of bronchial fibroscopy (except results on trans-bronchial biopsies). The diagnostic value of this technique is highly superior, where bronchopulmonary cancers are concerned, to the traditional bronchoscopy. Besides these classical indications, the place of bronchial fibroscopy in intensive care, and its help for bacteriological and parasitological diagnoses, must be underlined.

The diagnosis of mislaying forms of pulmonary embolism, where even angiography was not pathognomonic, induced the use of a phlebography on lower limbs in patients where this diagnosis was suspected. The revelation of a distal thrombo-phlebitis and even more so an iliocaval one, becomes a major value when the clinical and paraclinical data remained arguable. The comparative study of diagnostic usual clinical and paraclinical elements (radiographies, E.C.G., gasometries and scintigraphies) confirmed, in 22 patients, the value of phlebography. On a pneumological background, it is useful to perform this examination, most of the time : a) on patients over 55, when a cardiorespiratory decompensation remained unexplained in a patient with chronic respiratory insufficiency, or even an unproved hemoptysis; b) but mostly before 55, in case of painful pneumopathy above all if it is bilateral and recurring, or in case of paroxysmal bronchospasm without atopic ground, when a belated asthma could be thought of. Finally vascular tests induced the fitting in situ of a clamp or "umbrella" in the vena cava in 7 patients out of 22.

The plasmatic glycosyl proteins levels were measured in fifty non diabetic volunteers and thirty five patients with diabetes mellitus by the fructosamine test. The upper limit for healthy volunteers was estimated to 25 mumoles/g protein. A higher fructosamine concentration and greater spread of values were observed in the diabetic group. A very good correlation was noted in the diabetic group between A1C hemoglobin and fructosamine concentrations. This test is very reproducible, inexpensive and should be a good alternative to the A1C hemoglobin determination in some physiologic or pathologic disorders.

A residual postive pressure (R.P.P.) of low magnitude (1 to 4 cm of water) was used during assisted ventilation by pressure relaxator in an attempt to decrease the expiratory dynamic compression of the airways. A ventilatory test involving 80 respiratory insufficient patients (73 men and 7 women) shows that with assistance the tidal volume of half of the subjects increased by more than 20% (average gain: 32%). The patients with the highest RV/TC ratio benefitted most from the method. Finally, the arterial blood gases were not significantly modified. A longitudinal study involving 46 subjects observed for an average period of 24 months revealed a marked subjective improvement in the patients' condition without significant modification of the blood gas figures. No incident or accident was attributed to the use of R.P.P.

Eight clomiphene citrate (150 mg/day for 5 days)-resistant anovulatory women with polycystic ovary were included in this study. A luteinizing hormone-releasing hormone (LH-RH) analog, D-Trp-6-LH-RH, 100 micrograms subcutaneous-per day, induced a hypogonadotropic state within varying periods but at most within 3 weeks, after an initial flare-up effect characterized by slight increase in ovarian size in four patients and in the other four by cysts that disappeared rapidly. On the 28th day or 15 to 20 days after menstruation for subsequent cycles, during maintenance of D-Trp-6-LH-RH therapy, a usual gonadotropin regimen was carried out in 33 cycles. Human menopausal gonadotropins obtained follicular maturation in all cycles. However, there was never the growth of a single dominant follicle but always of several follicles. Human chorionic gonadotropin then induced ovulation in 31 cycles (94%). Luteal phase was normal in 28 and inadequate in 3 of the 31 ovulatory cycles. Hyperstimulation, generally mild to moderate but rather severe in 2 cycles, was constant. Five pregnancies were obtained. The overall pregnancy rate was 15% per cycle and 17.8% per normoovulatory cycle. This study showed that an associated treatment with an LH-RH analog enables gonadotropins to achieve ovulation regularly with an encouraging number of pregnancies but at a risk of hyperstimulation.

One of the etiological factors of female late onset asthma lies in endocrine disorders and it often occurs during a period of hormonal instability (menopause or premenopause). Moreover various studies have shown increased allergic manifestations in women with gynecological problems (dysmenorrhea, premenstrual syndrome). Gynecological pathology is found in 30% of 67 women who suffer from late onset asthma. Prospective studies were carried out in 28 women with surgical uterine fibroma, to investigate bronchial hyperreactivity (BHR). The study included atopic research through questioning and allergy skin tests; spirographic respiratory function study, airway resistance, carbachol BHR with determination of the threshold dose (FEV1 20% decrease). Carbachol BHR was found in 8/28 persons (28%), but with no clinical manifestations. None of the patients smoke and only one suffers from mite-allergic rhinitis-conjunctivitis without asthma. BHR is often found in asymptomatic women with uterine fibroma. Is this BHR due to an autonomic dysregulation or to a hormonal malfunction? This hypothesis would require further studies to elucidate, since premenstrual asthma worsening is a well known phenomenon, which can be improved by progesterone. This may suggest a possible link between hormonal malfunction and BHR in women. A long term survey will facilitate detection of late onset asthma.

Microalbuminuria is now considered a good biological marker predictive of diabetic nephropathy. The degree of microalbuminuria was determined by radioimmunoassay in 23 controls and 50 insulin-dependent patients with poor control of glycaemia. Higher levels were found in diabetics, whatever the duration of the disease. At the moment, this difference, which is reversible with good metabolic control, can be explained by blood glucose balance. Several authors have established the existence of a microalbuminuria threshold predictive of nephropathy, but its level is controversial, chiefly on account of the urine collection methods.

The screening for microalbuminuria in diabetic patients has been made possible by means of sufficiently sensitive and reproducible techniques. Threshold values of albumin excretion rate must be defined according to the type of urine collection and by taking into account the high variability of this parameter. The high variability of albumin excretion rate required that repeated measurements must be considered. The prevalence of microalbuminuria depends on the type of diabetes, the degree of micro- and macrovascular complications, and the presence of associated arterial hypertension. Current attempts to reduce microalbuminuria in the diabetic patients through strict glycaemic control, lowering of high blood pressure and other means, are discussed.

We have performed 7 different urinary collections to assess albumin excretion rate in insulin-dependent diabetics. The night and the 24 hours urine collections were more accepted than the others. For albumin excretion rate there was no correlation among the different collections. So, the albumin excretion rate must be done always on the same sample for one patient and be repeated to confirm pathological values.

Results of our study of 91 cases show that many indications of ventilation at home are debatable:--Tracheostomized patients submitted to continuous ventilation with short disconnected periods;--Patients using the respiratory apparatus more than 4--6 hours per day, through a mouth-piece. The existence of a reserve closely related to the intensive care department and mobile emergency unit (S.A.M.U.) facilitates supervision and eventual technical or medical assistance. In addition, the running cost remains small because of the adaptability of the system. However, it seems of interest to point out a group of 11 patients whose treatment was interrupted either because of their improvement (physical therapy, suppression of tobacco mainly), inadequate indications, or poor cooperation.

The term "microalbuminuria" qualifies an albumin excretion rate above the upper limit of normal individuals but below values giving positive results with conventional test strips. Its predictive value has been established for diabetic nephropathy in type I Diabetes, and for an excessive risk for mortality in type II Diabetes. Microalbuminuria is of glomerular origin in diabetes. It is secondary both to intra-renal haemodynamic changes and to altered permeability of the glomerular basement membrane. The various parameters involved in its genesis are reviewed.

Two groups of 10 patients with left ventricular failure during the acute phase of myocardial infarction were studied. One group were given phentolamine, the other trinitrin. The infusion rate was regulated so that the heart rate was not increased by more than 10 beats per minute, and to obtain a pulmonary arterial diastolic pressure less than 18 mmHg with a mean systemic arterial pressure remaining greater than or equal to 80 mmHg. The dose of phentolamine was 5 +/- 3 mcg/kg/mn, but using trinitrin the initial optimal dose of 0.39 +/- 0.22 mcg/kg/mn had to be progressively increased during the first 24 hours. The haemodynamic study done before treatment and after an hour at the optimal infusion rate showed that, for a similar reduction in the pulmonary arterial diastolic pressure, the mean systemic arterial pressure was reduced less by trinitrin than by phentolamine, while the stroke work index was not appreciably altered by either drug. In patients with low systemic arterial pressure, trinitrin appears to be preferable and warrants use after the possible setting up of circulatory assistance by aortic counter-pulsation.

The importance assumed by local treatment in non-tuberculous purulent pleurisy has suggested that intrapleural applications of a broad spectrum antiseptic could be as useful as in peritonitis. Fifteen adult patients with empyema secondary, in most cases, to local, usually Gram-negative, infections were treated with combined antibiotic therapy and locally administered noxytioline. The patients underwent 3 to 30 intrapleural lavages (average 9) via a pleurotomy drainage tube (11 cases) or after pleural puncture (4 cases). Results were very satisfactory in 12 out of 15 cases, with mild pleural sequelae in 8 cases. No local or systemic reactions were observed. This treatment proved particularly effective in 5 difficult cases.

37 subjects with stable asthma and a mean age of 50.3 undertook a protocol to study the cardiac tolerance to a spray B2SM. A Holter monitor was performed before and 48 hours after the institution of a Fenoterol spray in 4 daily doses of 600 micrograms at fixed times. Before starting treatment with a beta 2 sympathomimetic spray (B2SM) 11 subjects had abnormal traces with significant auricular extra-systoles in 4, ventricular extra-systoles in 5 and both in one subject: one patient had a run of ventricular tachycardia without symptoms. On Fenoterol, a worsening of pre-existing extra systoles was noted thrice, one was auricular the other two ventricular. Two patients had brief runs of ventricular tachycardia but the role of Fenoterol was uncertain; one of the patients was very elderly and hypoxaemic. In the second and elevated theophylline level of 20 micrograms/l was noted. The arrythmogenic power of a B2SM seems weak, but in certain situations such as hypoxaemia, metabolic acidosis and overdosage of theophylline, over consumption of B2SM in association with the above factors could contribute to serious arrhythmias. Also in this study in which there was a protocol limited in time, no premature conclusion should be made on the crucial problem of the cardiovascular risks of B2SM in the basic treatment of asthma but raises the problem of the arrythmogenic potential of the drug association of Theophylline + B2SM.

The phospholipid content of bronchoalveolar lavage (LBA) has been little studied till now. This work involved 96 LBA on 7 cases of allergic alveolitis, 11 cases of diffuse interstitial fibrosis (FID) and 42 of sarcoidosis. The liquid collected was submitted to a cellular study (cellularity, total and differential) and biochemical (total proteins, total phospholipids separated into their different fractions by chromatography which enabled the identification of phosphatidyl-choline, phosphatidyl-serine and phosphatidyl-inositol in particular). The cytological results were close to the classical data, a rise in the lymphocyte level in allergic alveolitis and active sarcoid, a rise in polymorphonuclear cells in FID. Biochemical analysis showed a fall in total phospholipids for the whole group, the drop being the greatest in the FID. Phosphatidyl-choline, the principle phospholipid of surfactant in normals, was reduced in all three groups of patient when expressed as a percentage of total phospholipids. This fall was greatest with an allergic alveolitis and occurred on a pro rata basis with a rise in phosphatidyl-serine and inositol. The protein phospholipid ratio (PL/P) expressed in micrograms of phospholipid and milligrams of protein fell in a significant fashion in all the pathological groups. This fall was significantly larger in allergic alveolitis than FID and active sarcoid. The PL/P ratio seems to be a good marker of active sarcoid, correlating with the activity of the disease inversely with the lymphocyte level, and was unchanged by steroids unlike the lymphocyte count. A rise in this ratio correlates with an improvement in the radiological and clinical state.

Mercury gauge plethysmography with venous occlusion (PJC) is an atraumatic procedure for the diagnosis of deep venous thrombosis (TVP) of the lower limbs: 103 patients were studied both by plethysmography and phlebography (the reference examination). 54 were hospitalised for a suspicion of pulmonary emboli (EP), 21 for clinical phlebitis and finally 28 subjects had the studies as part of a systematic work-up. 60 cases of TVP of the lower limbs were discovered: 47 were recent, 34 were proximal and 13 sural. The clinical examination failed to reveal these in 36% of cases; the phlebographic and PJC results were concordant for 75% of cases: PJC seemed particularly to be the technique of high sensibility for the early diagnosis of proximal TVP but of a lesser interest for the early diagnosis of peripheral TVP (sensibility 69%). This examination makes an important contribution: for the early diagnosis of hidden proximal TVP; for the diagnosis of EP in its deceptive forms where the presence of a peripheral embolic focus constitutes one weighing factor towards the diagnosis of peripheral thrombo-embolic disease (MIE); for the control of anti-coagulant therapy in the clinic where the local inflammatory process and the biology controlling the consumption of heparin are jointly observed and the study of venous drainage allows an appropriate decision to be made as to the cessation of anticoagulant therapy and minimises the risk of recurrence or avoiding postphlebitis disease by a prolonged treatment.