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Euthyroid Graves' disease is defined as an ophthalmopathy without dysthyroidism. We report 8 cases in 6 women and 2 men with an average follow-up of 16 months after diagnosis.Unilateral ex-opythalmos was the first and most frequent sign. Ultrasonographic and immunological thyroid abnormalities were frequent but of questionable significance. Thyroid hormone levels continued to remain normal. The orbital CT-scan, used to screen for infra-clinical exophthalmos, evidenced focal or diffuse hypertrophy of the extraocular muscles and normal tendon insertions. More than 3 years after diagnosis, only one patient developed overt Graves' disease and clinical signs resolved spontaneously in one other.In mild to moderate forms of euthyroid Grave's disease, therapeutic abstention is advisable. Corticosteroids and orbital radiotherapy are interesting options in functionally disabling forms. Decompressive surgery is rarely needed.

The De La Chapelle syndrome (XX male) is a peripheral hypogonadism concerning males with 46,XX karyotype. We conducted a retrospective study of 18 cases and report the main clinical biological and hormonal characteristics.Clinical features (weight, height, aspect of the external genital organs, body hair, gynecomastia), hormone levels (testosterone, gonadotrophin, baseline and stimulated prolactin estradiol), and results of a Barr test and karyotype were recorded in all patients in addition to search for the SRY gene (in 8 of the 18 patients). Findings were compared with a matched male population and a Klinefelter syndrome population.Microrchidia was found in almost all the patients while the penis had a normal size. Signs of hypoandrogenism were frequent and gynecomastia was present in half the cases. De La Chapelle patients differed from Klinefelter patients by the absence of dysmorphism.Patients with De La Chapelle syndrome diagnosed around the age of 20 years do not have borderline disorders associating genitalia anomalies or sexual ambiguity. The majority of the patients bear the testis determining SRY gene on one of the X chromosomes, providing the rational explanation of the male phenotype, but 20% of the XX males doe not have this gene. The role of certain key genes that could be implicated in abnormal sexual differentiation is known, but the complexity and heterogeneous nature of this syndrome leaves many questions unanswered. Therapy is based on androgen replacement therapy given at an early stage.

Diabetes is a main cause of cardiovascular morbidity and mortality. The aim of this study was to evaluate the influence of diabetes on cardiovascular risk using prediction equations.The cardiovascular risk of 356 diabetics was calculated from the prediction equations established by the Framingham, Ducimetière, Laurier-Chau and PROCAM studies, with and without the factor "diabetes". Calculations were made according to the conditions of each equation then by applying formulae to the whole population.Diabetes increased the cardiovascular risk at 4 years from 0.7% with the Ducimetière equation to 3.6% to 8% with the Framingham equation. Formulae increased the cardiovascular risk when they were applied to the whole population. Models of prediction did not take into account however duration of diabetes and balance, parameters which are closely linked to cardiovascular risks.Absolute cardiovascular risk, whose practical interest has often been underlined, therefore has limitations in diabetes.

The aim of this study was to characterize the features of vegetative gastric neuropathy observed in diabetic patients based on surface electrogastrographic recordings.An electrogastrogram was recorded over an 8 hour 30 minute period in 63 patients with asymptomatic insulin-dependent diabetes and in 15 non-diabetic controls. Normal the electrical frequency of the stomach is 2 to 4 cycles per minute (cpm). Bradygastria is defined as a frequency below 2 cpm and tachygastria by a frequency above 4 cpm.The diabetic patients showed a below normal gastric frequency and enhanced tachygastria over the entire recording period and during the pre, per and post-prandial periods. These vagal alterations were not correlated with the principle features of diabetes.Electrogastrography confirms that vegetative gastric neuropathy occurs early in patients with asymptomatic insulin-dependent diabetes. The tachygastria could lead to the increased rate of gastroparesis reported in these patients.

Hypouricemia can be observed in uncommon situations as in our two patients with hereditary xanthinuria.In the first case, hereditary xanthinuria was discovered in a 36-year-old man when routine tests revealed hypouricemia. In the second case, a 76-year-old woman, hypouricemia was also a fortuitous discovery. She had major xanthinuria and a radiotranslucid lithiasis in the right kidney.Hereditary xanthinuria is characterized by hypouricemia, low urinary urate excretion and increased concentration of xanthine and to a lesser extent hypoxanthine. The disease results from a defect in xanthine oxidase and is considered to be transmitted by autosomal recessive heredity. This rare metabolic disorder is more often asymptomatic and detected by routine chemistry. Development of xanthine lithiasis is directly related to the low solubility of xanthine and is the main complication of the disease, occurring in 30-40% of patients. There is no effective treatment and the only useful measure is to prevent xanthine urolithiasis by maintaining urinary output above 2 l/day.

Non-steroid anti-inflammatory drugs and/or gold salts were unsuccessful alone in providing symptom relief in three men with rheumatoid psoriasis. All three were treated with bromocriptine (5 mg/d in 2 doses) after verification of normal baseline and protirelin-stimulation prolactin levels. There was a beneficial effect in nocturnal pain relief, morning stiffness, the Lee and Ritchie scores and biological markers of inflammation. Two of the patients were able to return to regular work occupation after 15 and 45 days. In the third patient, bromocriptine was discontinued due to nausea and dizziness but was reintroduced successfully in fractionated doses after recurrence of the symptomatology. Treatment was continued without secondary adverse effects for 3 to 9 months providing continued symptom relief. Bromocriptine can be an effective adjuvant for the management of rheumatoid psoriasis.