Cancer et Hérédité

Sans résumé     

Radiopharmaceutiques et réglementations

The radiopharmaceuticals are products that combine two very stringent regulatory requirements from two different authorities: as medicine from a pharmaceutical point of view (Afssaps) and as radioactive source with specific authorization (ASN). This article discusses the different regulatory constraints imposed by these authorities but suggests also that legislation is supposed to be modified in the coming years in collaboration with nuclear physicians and their Society (SFMN).     

Hypoglycémie spontanée et insuffisance rénale chronique.

Although glucose intolerance occurs as a consequence of chronic renal failure, improvement of a diabetic state by deterioration of renal function is a well known phenomenon. Recently occasional cases of spontaneous hypoglycemia in patients with chronic renal failure have been reported; two such cases and the results of metabolic studies are described in this paper. Pituitary, thyroid and adrenal function appeared to be normal. The results of an oral glucose tolerance test were normal; an appropriate insulin response was demonstrated in one patient, and a slightly elevated basal insulin value with a delayed insulin response to oral administration of glucose was demonstrated in the other. An insulin tolerance test did not support the hypothesis of increased insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concentration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concnetration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase in insulin values. The plasma alanine concentration was low and the proinsulin/insulin ratio was increased. The origin of this hypoglycemia is not clear but is probably multifactorial. However, low hepatic glycogen stores and inadequate gluconeogenesis due to substrate deficiency seem to be involved.     

Synthèses et réductions de sucres fonctionnels mono et diinsaturés

Attempts to prepare 1,2:5,6 and 2,3:5,6 di-unsaturated sugars starting from 3,4,6-tri-O-acetyl-1,5-anhydro-1,2-dideo xy-d-arabino-hex-1-enitol or from ethyl 4,6-di-O-acetyl-1,5-anhydro-2,3-dideoxy-α-d-erythro-hex-2-enopyranoside led to 1,5-anhydro-1,2,6-trideoxy-l-threo-hex-5-enitol and its 3,4-diacetate. Hydrogenation and hydrogenolysis of the unsaturated chloro and fluoro derivatives afforded 1,5-anhydro-1,2,6-trideoxy-d-arabino-hexitol and ethyl 4-O-acetyl-2,3,6-trideoxy-α-d-erythro-hexopyranoside.     

Familles moléculaires et réactions croisées en allergie

Le risque pour une personne de développer des manifestations allergiques est plus grand si elle a des antécédents familiaux d’allergie: on parle de terrain atopique.     

Scintigraphie de perfusion cérébrale positionnelle : résultats physiologiques et applications cliniques

To assess the impact of standing on brain perfusion, 125 brain perfusion scans in the upright and supine position were performed, including 108 patients. Perfusion values were compared using a relative quantitative approach and a segmentation of vascular territories with the help of an atlas of brain perfusion. We found a change in the distribution of the perfusion in favor of the vertebro-basilar system in the upright position. We discuss the case of a patient whose symptoms could be explained with the help of the comparison of brain perfusion scans in the upright and supine position. Atheromatous and post-dissection stenosis and their influence on perfusion are also discussed.     

L'AMP chez les blessés médullaires: indication et résultats

Spinal cord-injured men with ejaculation disorders can have children by means of Assisted Reproduction Techniques (ART). The possibilities of procreation of couples in which the man is praplegic or tetraplegic, have been improved over the this last decade by progress in the treatment of ejaculation disorders and the development of new ART techniques such as ICSI. Sperm quality is usually impaired in these patients. The indications for ART in spinal cord-injured patients are similar to those of other forms of male infertility. According to WHO recommendations, sperm preparation must be performed together with morphological study of spermatozoa to select the most appropriate ART technique, giving preference to so-called “simple” ART techniques, such as Intra-Uterine Insemination (IUI). Small studies have been conducted and showed that the clinical pregnancy rate per cycle was comparable to that observed in non-neurological patients. Autopreservation of sperm must be rapidly programmed to avoid repreated electrostimulation techniques and as a security measure before performing ART. A multicenter study should be conducted to pool data from all French centres.