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In this paper, we have compared the results obtained for hemoglobin A1c and C-peptide concentrations, was not convenient for the diagnosis of anomalies in the regulation of carbohydrate metabolism in obesity or in latent diabetes. Nevertheless, hemoglobin A1c allowed us to check carbohydrate metabolism and to discriminate diabetes treated by oral therapy from insulin dependent diabetes; in these latter cases, hemoglobin A1c concentration varied inversely as C-peptide concentration as it was shown by the method of factor analysis in particular "principal components analysis". In the control of insulin dependent diabetes in a remission, hemoglobin A1c allowed assessment of the regulation of carbohydrate metabolism after suppression of insulin therapy. Thus, hemoglobin A1c is an index of the adaptation of insulin secretion in anomalies of carbohydrate metabolism.

The authors have developed an indirect immunofluorescence technique for histochemical detection of thyroglobulin and have tested it on 66 tissue sections. Fluorescence reflecting the presence of thyroglobulin was elicited in 57 samples of differentiated thyroid tissue, including healthy or hyperfunctional tissue and primary or metastatic papillary or follicular carcinomas. Thyroglobulin was found to be distributed heterogeneously between different areas and different cells. It may occupy the whole cell, the apex, the colloid substance and sometimes extracellular spaces. No fluorescence was present in non-thyroid tissues. This technique could be applied mainly to the diagnosis of thyroid carcinomas, where 25 metastases have been examined by this method, and to clear cell carcinomas. In these two cases, thyroglobulin appeared to be a good marker of tumoral tissue.

The authors report the case of a 57 year old man who had taken for several years large quantities of alkaline drugs to relieve pain due to a gastric ulcer. This man presented acute digestive symptoms, and a confusional syndrome explained by various metabolic disturbance and especially hypercalcemia at 145 mg. Stopping the alkalis permitted within a few days the disappearance of the clinical symptoms and the correction of the laboratory disturbances. In the light of this case, the authors study the main clinical cases which have been described either in their acute form or in their chronic form (Burnett's syndrome). They discuss above all the physiopathology of these manifestations and it seems to them that the hypercalcemia is more important than the alkalosis. It remains to be explained why only a small number of subjects are exposed to these metabolic complications. There seems to be an individual hypersensitivity for under normal conditions, excess calcium is not sufficient to induce hypercalcemia.

Authors describe three cases of agranulocytosis in patients with giant cell (temporal) arterities treated with Dapsone and corticosteroids. The culture in vitro of CFU.GM. cells of two patients, four healthy subject and two patients treated with Dapsone with out granulopenia, demonstrates no any toxic effect of Dapsone. A review of the literature finds 59 cases of agranulocytosis in patients treated with Dapsone alone or in combination with other drugs. Doses of Dapsone ranged from 25 mg to 300 mg a day. Agranulocytosis occurred between the 4th and the 12th week, more often near the 8th week. Agranulocytosis occurred suddenly without previous granulocytopenia. These facts argue for immunoallergic mechanism. This Dapsone side effect requires to restrict its use and to reserve it to serious diseases or failures of other therapeutic drugs. It needs too to keep a close eye on the patients between the 6th and 12th week.

We arbitrarily define "isolated weight loss" as the loss of at least 10 p. 100 of body weight over less than one year, without any single cause being disclosed by questioning, physical examination and such paraclinical examinations as blood electrolytes, blood count and differential, routine dipstick urinalysis and X-ray of the chest. Among the 105 patients we studied, the causes of isolated weight loss were: (1) psychic disorders (chiefly depression) in 60 p. 100 of the cases; (2) a variety of organic diseases in 29 p. 100, including gastrointestinal diseases (8 p. 100), cardiovascular and respiratory diseases (6 p. 100), Horton's disease (4 p. 100), Portuguese amyloidosis (1 p. 100), unexplained inflammatory syndrome (1 p. 100), endocrine disease (hyperthyroidism, 4 p. 100) and intoxication with medicines, alcohol or heroin (5 p. 100); (3) no definite cause could be found in 11 p. 100 of the cases. We suggest a diagnostic approach involving a limited number of examinations, viz.: erythrocyte sedimentation rate, measurement of transaminases, gamma GT and alkaline phosphatase enzymes, abdominal ultrasonography and ultra-sensitive TSH assay. We consider it important to switch from useless paraclinical tests to the detection and management of psychic disorders. Weight loss is a frequent motive of consultation, but its diagnostic value is often misunderstood. The purpose of this study was to provide data for the artiological diagnosis of isolated weight loss--a relatively frequent problem in internal medicine.

A 44-year old female farmer and pigeon-breeder presented with paroxysmal attacks of dyspnoea caused by recurrent subglottic laryngeal oedema. The symptoms disappeared under corticosteroid therapy but returned after discharge from hospital. The avian origin of the disease, suggested by a strongly positive search for avian precipitins, was confirmed when the attacks ceased after antigen exclusion. A realistic inhalation challenge test performed on two occasions with pigeon's feathers and droppings as antigens resulted, within 15 minutes, in a 4-hour long attack of paroxysmal laryngeal dyspnoea. The dyspnoea was caused by subglottic laryngeal oedema visualized, 15 minutes after the inhalation, by pharyngeal and bronchial fibroscopy. Nasal manifestations have been reported in patients with hypersensitivity of the lung, but it seems that no case of subglottic oedema in pigeon-breeder's disease has yet been published.

Two cases of mainly interstitial myositis with epitheloid and giant cells are reported. In the first case, the late amyotrophic-type paralysis of the two girdles, of the clinical myositis type, was associated with severe myocardial damage, the atrioventricular conduction disorder requiring a pace-maker. This observation would appear to be a true polymyositis of the collagen diseases, in view of the associated skin affection, death occurring within a year, a large increase in serum muscle enzymes and urine creatine, the existence of a rheumatoid factor and striated muscle antibodies, and a large increase in M and G immunoglobulins. In the 2nd case, the amyotrophic affection of the pelvic girdle was associated with progressive blindness, diabetes insipidus, and anterior pituitary insufficiency. Death occurred after two years and autopsy showed a suprasellar dysgerminoma (ectopic pinealoma) without any visceral localization of sarcoidosis. The authors discuss the concept of granulomatous polymyositis, autonomous with respect to the sarcoidosis, and sometimes symptomatic of an inflammatory connective tissue condition or a malignant tumor.

The binding capacity of serum TeBG (testosterone-estradiol binding globulin), the plasma concentrations of thyroid hormones and the TSH response to TRF (200 micrograms i.v.) have been measured in female patients with a solitary autonomously functioning thyroid nodule (n = 26) or with a cold thyroid nodule (n = 20). It was found that TeBG was higher than the upper limit for normal (1.77 micrograms/dl) in the patients (n = 10) with increased serum concentrations of thyroid hormones and in 5 patients among 16 with normal thyroid hormone levels. After surgical removal of the nodule, the increased TeBG levels fell down within the normal, while the response of TSH to TRF which was suppressed before surgery, was recovered. In patients with a cold nodule, the administration of dl-Thyroxine (200-300 micrograms/daily) suppressed the response of TSH to TRF and increased slightly TeBG from 0.97 +/- 0.08 to 1.29 +/- 0.10 micrograms/dl (p less than 0.05) with a value higher than 1.77 micrograms/dl in 5. These data suggested that the pituitary secretion of TSH and the liver production of TeBG have a different threshold of sensitivity to thyroid hormones action. It is proposed that the measure of TeBG is a tool for the diagnosis of thyrotoxicosis in patients with autonomous thyroid nodules.

Somatocrinin (hp-GRF-44), a growth hormone releasing factor, stimulates acute pituitary response in a 11 years and 4 months old boy, with growth hormone deficiency. The capability of the anterior pituitary to secrete growth hormone in response to an IV injection of somatocrinin (120 micrograms 4 micrograms/kg) was documented, therefore proving the hypothalamic origin of the deficit which had been suspected because of association of diabetes insipidus and hyperprolactinemia.

The authors report 7 cases of temporal arteritis, proved by biopsy, with unusual early symptoms. They emphasize dental extraction as a possible incitant of the disease. Diagnosis is very often overlooked when local symptoms of involvment of temporal arteries are lacking. Various head and neck pain, fever of unexplained origin, weight loss, when associated with erythrocyte sedimentation rate greater than 50 mm, should convince the physician to biopsy the temporal artery of people over the age of 60. Steroid therapy must begin as soon as diagnosis is made.

Two groups of infertile males (65 and 132 patients) have been investigated in two different laboratories, with two different methods to obtain semen. The bacteriological results are quite similar in the two groups. The microorganisms which have been isolated are : beta-hemolytic Streptococcus, Proteus, Epidermidis staphylococcus, Micrococcus, Corynebacter, Viridans streptococcus, Klebsiella, Pseudomonas, Enterobacter, Bacillus, Neisseria, Escherichia coli, anaerobic Staphylococcus, anaerobic Streptococcus, anaerobic Corynebacter type IV. Fungus, Achromobacter, 20 p. cent of the patients are chronically infected without any clinical signs. This infection is probably of prostatic origin with an important number of bacteria in the semen (more than 3 000/ml). No relation has been shown between the bacteriological data and the physical and cytological characteristics of the sperm, except the pH : semens with a low pH are generally azoospermic and highly contaminated.

On 91 patients with temporal arteritis (TA) and/or polymyalgia rheumatica (PMR), we observed 7 females aged 62 to 73 years with upper extremities ischemia. Arm claudication and/or Raynaud's phenomenon were the initial manifestations of the disease in 2 cases, or appeared simultaneously with other symptoms in 2 cases, or complicated decreasing corticosteroid therapy in 3 cases. A temporal artery biopsy was performed on 6 patients with, in all of them, typical giant cell granulomatous arteritis pathology findings. Angiograms showed, in all cases, multiple bilateral smooth stenosis and/or obliterations of post vertebral subclavian arteries and/or axillary arteries. Symptoms always improved on corticosteroid treatment and no patient needed reconstructive surgery. In conclusion, large arteries involvement, which can occur in TA and/or PMR, affect in our experience most commonly the subclavian and axillary arteries, with female predominance as found in Takayasu's arteries. These disorders should be considered in cases of occlusive disease of the arms in elderly women and the response to steroids is usually adequate to eliminate the need for early surgical intervention. Early recognition of asymptomatic large artery involvement by Doppler evaluation, in all TA and/or PMR patients, and transient anticoagulant therapy might prevent vessels occlusions.

Twelve patients suffering from mental anorexia were examined on clinical and biological grounds, based on the hypothesis of the functional depression of the noradrenergic track. The initial values of MHPG and of catecholamines were below normal. The quantitative results for depression and retardation were lessened significantly under beta-stimulant treatment. Only glucuro-conjugate MHPG excretion increased significantly, but the MHPG values were much lower than normal at the end of the treatment. The correlations between biochemical and behavioural parameters were worth noticing as far as the retardation scale was concerned. The present study shows the advantage of the dexamethasone suppression test and of the response of TSH under TRH.

The authors report a case of coma due to peripheral myxoedema with severe hyponatremia (111 mq) and low urinary sodium. The clinical and metabolic disorders regressed within ten days under treatment with thyroid. The frequency of hyponatremia during myxoedema coma is recalled and the pathogenic mechanism discussed. Although the adrenal origin seems excluded, there is possibly some hypervasopresinism, but it seems finally that the thyroxin-dependent hyponatremia is of renal origin.

Ocular complications occurring in temporal arteritis are of different severities. These manifestations of the disease occurred in a population of 57 patients with diagnosis of temporal arteritis, in 16 of them (28%). The diagnosis was suggested by finding an inflammatory syndrome (high erythrocyte sedimentation rate) and confirmed by temporal artery biopsy. In making this diagnosis, it was helpful to find a history of characteristic temporal headaches, neckache, jaw claudication, fever and malaise or weight loss in addition to polymyalgia and polyarthralgia. 6 patients presented with diplopia and different ocular muscle or nerve palsies. The 10 others came for sudden loss of vision due to ischemic anterior or posterior neuropathy and in one case, central artery obliteration. Prompt treatment with steroids gave good results on oculomotor troubles and in preventing the risk of involvement of the fellow eye. But loss of vision did not regress with this treatment. That means the importance in making this diagnosis and starting very promptly this treatment.

About a case of Von Hippel-Lindau syndrome with association of retinal angioma, bilateral pheochromocytomas, bilateral renal cysts, the authors had many difficulties to confirm associated unilateral renal cell carcinoma. Three solid left renal tumors were not seen neither with abdominal ultrasound, nor with CT scan, but only with hypervascularity on renal angiography. Even intra-operative histologic examination fail to confirm the malignity. After the complete histologic examination of the tumorectomy piece, the unilateral renal cell carcinoma was secondary managed by radical nephrectomy, although the risk of bilateral carcinoma is known in this disease.