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Pseudo-hyperkaliemia is a biochemical abnormality suspected when the blood level of K is increased, contrasting with the absence of usual symptoms of hyperkaliemia. The diagnosis is confirmed by the discrepancy between K+ blood levels which are normal if measured immediately after the blood sample is drawn, and increased if the blood sample is incubated at room temperature. In our case, the pseudo-hyperkaliemia is due to the passage of K outside the erythrocytes through increased passive membrane permeability to K. In vivo, this increased passive outflow of K seems to be compensated by an increased active inflow of K dependent on the sodium pump. This explains the absence of true hyperkaliemia and clinical symptoms. In vitro, it seems that the sodium pump is no longer able to ensure this increased activity. Therefore, the abnormality becomes overt, mirrored by a delayed increase in kaliemia.

In obesity resistant to traditional low calory diets, the authors alternated short periods of moderate low calory intake (600 to 1,000 calories) with periods of very restrictive low calory intake (230 to 300 calories). The results of this method are analysed in 105 patients. This method permits loss of weight in difficult cases of obesity, both during intensely low calory diets and during less severe low calory diets. This technique is well accepted by the patients and is less monotonous than very unbalanced multi-fractionated diets or with prolonged courses of fasting. The results are all the more satisfactory when the patient is young, when the obesity is recent and marked, which does not, however, exclude its efficacy in long-standing cases of obesity.

Dietary and drug treatments of calcium nephrolithiasis depend mainly on the mineral composition of renal stones: calcium oxalate, phosphate or mixed stones. The association with an hypercalciuria is an important factor which must be taken into account because oxalates and phosphates precipitate as calcium crystals in case of urinnary oversaturation. Despite many therapies have been proposed, their efficiency seems to be rather small when they are used alone. Usually, it is necessary to act on several factors with a combination of therapeutic methods. Absorptive hypercalciuria are improved with both low calcium diets and inhibitors of calcium absorption. In renal hypercalciuria, the treatment is based on the administration of thiazide diuretics which enhance calcium renal tubular reabsorption. The other therapeutic methods depend on the nature of renal stones: urinary acidification for calcium phosphate; administration of succinimide, oral phosphate or organic phosphonates for calcium oxalate stones; association with purine biosynthesis inhibitors in case of the presence of urates in renal calculi.

12 recent acute-onset ketotic juvenile diabetics were optimally treated during 5 +/- days by means of an external artificial pancreas. Remission of diabetes occurred in 9 patients (75%). In a comparative group of 28 patients treated by conventional subcutaneous insulin, only 3 (11%) steady remissions were obtained. In a third group of 6 patients treated by insulin infusion without feed-back control, only 1 remission (17%) was obtained. The difference between these two groups and the first group (patients treated by the artificial pancreas) is significant (p less than 0.01). Urinary C-peptide/blood glucose ratio showed a steady improvement of insulin secretion during the remission period. At this time, actuarial analysis shows that the number of patients still in remission decreases during the first 10 months but seems to stabilize after this period. Duration of our remissions is equal to the duration of the "spontaneous" remissions taken from the literature. New treatment able to sustain the residual insulinsecretion during the remission phase (with presently can be induced frequently with our technique) are still to be found.

The diet with individual evaluation of the "caloric level" consists in a severe hypocaloric diet (400-800 calories) gradually increased by 100-200 calories every 2-3 days in order to find the level at which the weight loss ceases. This level is usually far higher than that of a conventional diet. The final diet is then obtained by decreasing the intake again by 200 to 300 calories. These diets have been studied in hospitalized then ambulatory patients. 429 patients, some of whom have been followed for over six years, have been studied. The results show that, although the initial weight loss is less important than with a conventional diet, the long-term results are satisfactory in 2/3 of the patients. Patients are distributed equally into four groups according to the degree of weight loss: -10 to -15%, -15 to -20%, -20 to -30%, greater than -30%. Maintenance of the weight loss is as good or even better than with a conventional diet, but with a more liberal program.