Search

International audience; OC5.1Positive impact of genetic test on the management and outcome of patients with paraganglioma and/or pheochromocytomaContextParagangliomas and pheochromocytomas (PPGL) are rare neuroendocrine tumors, characterized by a strong genetic component. Indeed, up to 40% of patients carry a germline mutation in a PPGL susceptibility gene. In accordance with the international recommendations, genotyping of PPGL susceptibility genes is therefore proposed to all patients with PPGL, but it has actually never beenshown whether the identification of a germline mutation in one PPGL susceptibility gene changes the outcome of mutation-carriers.ObjectiveOur objective was to evaluate how a positive genetic test impacts the management and outcome of propositus patients with PPGL carrying a germline mutation in one of the four major PPGL susceptibility genes (SDHB, SDHD, SDHC and VHL).DesignWe performed a multicentric retrospective study on 221 propositus carrying a SDHB, SDHD, SDHC or VHL germline mutation and followed in 24 French clinical centers of the Group of Endocrine Tumors and/or the COMETE network. Patients were divided into two groups: Genetic patients, who were informed of their genetic status within the year following the first PPGL diagnosis, and Historic patients who only benefited from the genetic test several years after initial PPGL diagnosis.ResultsCompared to Historic patients, Genetic patients had a better follow-up, with a higher number of examinations and a reduced number of patients lost to follow-up (9.6% versus 72%). During follow-up, smaller (18.7 mm versus 27.6, PZ0.0128) new PPGL and metastases as well as lower metastatic spread were observed in Genetic patients. Importantly, these differences were reversed in the Historic cohort after genetic testing. Genetic patients who developed metachronous metastases had a better 5-year survival than Historic ones (PZ0.0127).ConclusionAltogether our study clearly shows the positive impact of the identification of an SDHx or VHL mutation in the management, clinical outcome and survival of patients with PPGL. It reveals, for the first time, the clinical benefits of the practice of oncogenetics for patients with a rare cancer and strongly strengthens the recommendations of the Endocrine Society to consider PPGL genetic testingin all patients affected by PPGL.DOI: 10.1530/endoabs.63.OC5.1

Members of the I-Move+hospital working group - Portugal: B. Nunes, I. Kislaya, A.P. Rodrigues (National Health Institute Doutor Ricardo Jorge, Lisbon), V. Gomes, R. Côrte-Real (Centro Hospitalar de Lisboa Central, Lisbon), J. Poças, M.J. Peres (Centro Hospitalar de Setúbal, Setúbal). In a multicentre European hospital study we measured influenza vaccine effectiveness (IVE) against A(H3N2) in 2016/17. Adjusted IVE was 17% (95% confidence interval (CI): 1 to 31) overall; 25% (95% CI: 2 to 43) among 65-79-year-olds and 13% (95% CI: -15 to 30) among those ≥ 80 years. As the A(H3N2) vaccine component has not changed for 2017/18, physicians and public health experts should be aware that IVE could be low where A(H3N2) viruses predominate. Funding: The I-MOVE+ project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634446. The Lithuanian I-MOVE+ study sites were supported by a grant from the Research Council of Lithuania (SEN-03/2015). info:eu-repo/semantics/publishedVersion

International audience; Background: The purpose was to assess the efficacy of a new closed-loop algorithm (Saddle Point Model Predictive Control, SP-MPC) in achieving nocturnal normoglycemia while reducing the risk of hypoglycemia in patients with type 1 diabetes. Method: In this randomized crossover study, 10 adult patients (mean hemoglobin A1c 7.35 ± 1.04%) were assigned to be treated overnight by open loop using sensor-augmented pump therapy (open-loop SAP) or manual closed-loop delivery. During closed loop, insulin doses were calculated using the SP-MPC algorithm and administered as manual boluses every 15 minutes from 9:00 pm to 8:00 am. Patients consumed a self-selected meal (65-125 g of carbohydrates) at 7:00 pm accompanied by their usual prandial bolus. Blood glucose was measured every 30 minutes. The primary endpoints were the time spent in target (70-145 mg/dl) and time spent below 70 mg/dl from 11:00 pm to 8:00 am. Results: Time spent in target did not differ between closed-loop and open-loop SAP. The number of hypoglycemic events (more than 70 mg/dl) was reduced 2.8-fold in closed loop (n = 5, median = 0/patient/hour; interquartile range: 0-0.11) as compared to open-loop SAP (n = 14, median = 0.22/patient/hour, 0.02-0.22) (P =.02). The area under the curve for sensor glucose values >145 mg/dl was significantly lower during closed-loop than during open-loop SAP (P =.03) as well as HBGI (P =.02). Conclusions: This pilot study suggests that the use of the SP-MPC algorithm may improve mean overnight glucose control and reduce the number of hypoglycemic events as compared to SAP therapy. © 2016 Diabetes Technology Society.

International audience; BACKGROUND: Insulin pump failures had been assessed in our center by a prospective observational study from 2001 to 2007. The aim of this study was to update our data since 2008 and to determine whether there exist specific risk factors for insulin pump failures. METHODS: All insulin pump defects were prospectively collected between 2008 and 2013 in a monocentric cohort of 350 new pumps. Clinical consequences were recorded. Brand and model of pumps and type of defects and patients' characteristics (gender, type of diabetes, age at diabetes diagnosis, age at first pump, pump treatment duration, number of previous pumps, and number of previous pump failures) were tested for possible association with insulin pump failure. RESULTS: Malfunctions occurred in 239 (68%) pumps. The incidence rate was 33/100 pump-years. There were 28 (12%) complete failures, 17 (7%) alarms, 83 (35%) mechanical defects, and 105 (44%) minor defects. Survival curves did not differ according to pump brand and model. Hyperglycemia occurred in 2.9% of cases. In multivariate analysis, only patient age less than 40 years at the initiation of pump therapy was associated with higher risk of malfunction (hazard ratio 1.64; 95% confidence interval 1.19-2.24; P = 0.002). CONCLUSIONS: Pump malfunctions remain common with modern pumps. We report less complete failures than in our previous study. This could be because of improvement in quality of pumps or to our strategy of systematic screening and replacement in case of mechanical defects.

Introduction Le SITP est une maladie rare caracterisee par une insuffisance hypophysaire variable associee a des anomalies de la tige pituitaire (TP) a l’IRM. Sa physiopathologie est inconnue et sa base genetique heterogene. Objectif Determiner le phenotype gonadotrope/testiculaire d’une large serie d’hommes avec SITP. Patients/Methodes Etude multicentrique : donnees cliniques, hormonales, radiologiques de 70 hommes SITP suivis dans 12 CHU francais (2010–2018). Resultats Âge moyen : 31 ± 7 ans (18-58). Cas sporadiques : 100 %. La taille adulte moyenne : 170 ± 10,5 cm (5 cm 30 kg/m2). PA moyenne : 117/70 mmHg (± 11/9). Le LDLc moyen : 1,28 ± 0,4 g/L. Prevalence des deficits hypophysaires : somatotrope, gonadotrope, corticotrope et thyreotrope dans respectivement 92 %, 77 %, 55 % et 66 % des cas. Deux pour cent des patients avaient une hyperprolactinemie et 92 % avec prolactinemie normale. Parmi les patients, 78,6 % avaient au moins 3 deficits hypophysaires. Aucun diabete insipide. Fonctions gonadotrope/testiculaire : puberte spontanee : 20 % ; 80 % : absence de puberte car hypogonadisme hypogonadotrope (HH). Cryptorchidie 26 %. A l’âge adulte : 82 % avec volume testiculaire reduit (4–16 mL). Chez 85,4 % des patients testosterone basse ( Conclusion Nous decrivons le phenotype gonadotrope dans la plus grande serie d’hommes nes avec SITP. Malgre la forte prevalence d’HH, l’exploration de la fertilite n’est realisee que chez une minorite.

International audience; no abstract

International audience; AIM:The benefits of retrospective continuous glucose monitoring (retroCGM) recording have been widely explored in clinical studies, and many diabetes physicians routinely use this examination. However, the method of interpretation of CGM recordings has never been precisely described.METHOD:An expert French panel of physicians met for two days to discuss several aspects of retroCGM use and to produce a position statement.RESULTS:The guidelines cover the indications for retroCGM, the general organization and practical implementation of CGM recordings, a description of the different devices available and guidelines for the interpretation of retroCGM recordings.CONCLUSION:This consensus document should help clinicians in the proper use of retroCGM.

Resume Cette etude menee entre 1997 et 2003 en Bretagne sur les pneumocoques responsables d'infections invasives, evalue la sensibilite aux antibiotiques et les serogroupes des souches isolees de bacteriemies, de meningites et d'otites chez les enfants et les adultes. En 2003, 62 % des souches sont de sensibilite diminuee a la penicilline, 11 % sont resistantes. La prevalence des souches resistantes a l'erythromycine atteint 63 %. Ces taux de resistances sont les plus importants dans la population infantile. Les serogroupes 14 et 19 sont les plus frequents, surtout parmi les enfants. L'emergence notable du serogroupe 19 pourrait etre due a l'utilisation du vaccin conjugue heptavalent introduit en France en 2001. La surveillance des pneumocoques reste necessaire pour detecter les serogroupes emergents et les resistances.

Background: Pneumocystis jerovici pneumonia (PJP) remains a frequent opportunistic infection in HIV infected patients which markedly upregulates HIV replication by mechanisms so far poorly elucidated. PJP triggers the production of proinflammatory mediators with activating effects on HIV. However, anti-inflammatory factors with inhibiting effects on HIV are normally produced in parallel. We postulated that an imbalance of mediators normally controlling HIV replication could underlie its marked increase during PJP. Methods: The production of tumour necrosis factor α (TNFα), interleukins IL-6 and IL-10, and s-chemokine by bronchoalveolar lavage (BAL) cells recovered from HIV infected patients with and without PJP was compared. The pulmonary viral load was determined and correlations with cytokine and chemokine production were examined. Results: TNFα and IL-6 release was similar in patients with and without PJP but IL-10 and s-chemokine release was markedly lower in the PJP group (IL-10: p

Objectif La maladie de Cushing est une pathologie rare, responsable d’une morbi-mortalite elevee. La chirurgie hypophysaire ne garantit pas une remission complete et durable. Le but de l’etude est d’evaluer le taux de remission a 3 mois postoperatoire, le taux de recidive au cours du suivi et les facteurs peri-operatoires pronostiques. Materiel et Methodes Les patients majeurs presentant une maladie de Cushing diagnostiquee entre 1990 et 2015, recrutes par l’intermediaire des resultats anatomopathologiques des six CHU, ont ete inclus. Resultats Parmi les 176 patients inclus, 171 ont subi une chirurgie. Le taux de remission des patients a 3 mois postoperatoire etait de 78 %. La mediane de suivi etait de 5 ans. Le taux de recidive etait de 28 % avec un delai median de survenue d’une recidive de 3 ans. La taille des adenomes superieure a 10 mm, l’envahissement du sinus caverneux, l’exerese macroscopiquement incomplete et le cortisol plasmatique postoperatoire immediat non effondre etaient des facteurs de risque de non-remission. Le sexe masculin, le cortisol plasmatique postoperatoire immediat non effondre, le cortisol libre urinaire (CLU) et l’ACTH preoperatoire eleve etaient des facteurs de risque de survenue d’une recidive. Discussion Les taux de remission et de recidive ainsi que les facteurs de risque de non-remission degages par l’etude sont en accord avec les donnees de la litterature. A notre connaissance, le sexe masculin, le CLU et l’ACTH pre-operatoires eleves n’etaient pas decrits comme facteurs pronostiques d’une recidive.

Resume Treize laboratoires bretons ont collecte 832 souches de Streptococcus pneumoniae en 1999 chez 312 (37,5 %) femmes et 518 (62,2 %) hommes hospitalises ou consultants. Cette population comprenait 255 (30,6 %) enfants. Cent quatre-vingt-huit (22,6 %) souches ont ete isolees d’hemocultures, 16 (1,9 %) de LCR, 449 (54 %) de prelevements pulmonaires qu’ils soient proteges (8,1 %) ou non (45,9 %) et 88 (10,6 %) de pus d’otite moyenne aigue. La diminution de la sensibilite a la penicilline G (PSDP) a ete mesuree par un disque d’oxacilline 5 μg selon les recommandations du CA-SFM. Les CMI de la penicilline G, de l’amoxicilline et du cefotaxime ont ete mesurees sur une partie des PSDP par la methode de dilution en gelose. Soixante-cinq pour-cent (546/832) des pneumocoques sont des PSDP, 33,5 % des PSDP sont resistants a la penicilline G, 2,2 % sont resistants a l’amoxicilline et 0,2 % au cefotaxime. L’activite de l’erythromycine, de la tetracycline et du cotrimoxazole, determinee par diffusion en gelose, confirme l’association de la resistance a ces antibiotiques aux PSDP. Le serotypage des PSDP retrouve les types predominants 23 (23,7 %), 14 (23,5 %) et souligne l’augmentation de frequence du type 19 (19,1 %). Dans notre region, l’augmentation constante des PSDP (1993–1994 : 28,5 % ; 1997 : 56,4 % ; 1999 : 65,6 %) pourrait peut-etre etre expliquee par l’analyse des donnees sociologiques et demographiques specifiques.

Introduction Notre algorithme SP-MPC est suppose controler de maniere robuste la glycemie malgre les incertitudes du modele (par exemple: la sensibilite a l'insuline). Cette etude a evalue la capacite de SP-MPC a maintenir la normoglycemie sur la periode nocturne et a eviter les hypoglycemies. Materiels et methodes Dix patients diabetiques de type 1 traites par pompe a insuline ont ete inclus dans cette etude randomisee en cross-over, boucle ouverte (BO) vs boucle fermee (BF). En BO, ils geraient leur traitement en s'aidant de la mesure continue du glucose en temps reel (MCG-RT). En B F, les doses d'insuline etaient calculees par l'algorithme SP-MPC toutes les 15 minutes. A 19 heures, les patients consommaient un repas precede de leur bolus habituel. La glycemie plasmatique etait mesuree toutes les 30 minutes. Le critere de jugement principal etait les pourcentages de temps passe entre 70-145mg/dl et en dessous de 70mg/dl de 23 heures a 8 heures. Resultats Le temps passe dans les objectifs ne differait pas significativement entre BO et B F. Les hypoglycemies ( vs 27, p =0,02). Le taux moyen de glucose interstitiel etait inferieur en BF (128mg/dl ; IC 95 %: 112-145) par rapport a la BO (134mg/dl ; IC 95 %: 118-151), ( p p =0,03) ainsi que l'indice HBGI ( p =0,02). La dose totale d'insuline ne differait pas entre les deux boucles. Conclusion Cette etude n'a pas montre de difference concernant le temps passe dans les objectifs en comparant notre algorithme au traitement par pompe couplee a la MCG-RT. Cependant, l'utilisation de SP-MPC etait associee a une diminution du nombre d'hypoglycemies et du taux moyen de glucose. Les performances de SP-MPC seront a confirmer dans une etude incluant un plus grand nombre de patients. Declaration d’interet Les auteurs declarent ne pas avoir d'interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.

At this time, many antibiotics have decreased activity against Streptococcus pneumoniae, a major agent of infectious disease. In this study, we evaluated antibiotic susceptibility and serogroups of strains isolated from bacteraemia, meningitis and acute otitis media in adults and children over the 1997-2003 period in Brittany, France. In 2003, 62% of the isolates were not susceptible to penicillin and 11% were fully resistant. The prevalence of erythromycin resistance was 63%. Resistance rates were higher among isolates recovered from children than adults. Serogroups 19 and 14 were the most frequently isolated, especially the 19 one among children. The emergence of this serogroup might be a consequence of the use of heptavalent conjugate vaccine introduced in 2001 in France. Future surveillance after vaccination will be needed to detect emerging serogroups and resistance among S. pneumoniae.

Throughout 1999, clinical microbiology laboratories of 13 hospitals in Brittany have recovered Streptococcus pneumoniae isolates in 832 patients, 312 (37.5%) female and 518 (62.2%) male. Two hundred fifty five of them (30.6%) were children. One hundred eighty eight isolates were recovered from blood cultures (22.6%), 16 from CSF (1.9%), 449 from lungs (54%), and 88 from ear exsudates (10.6%).A 5 microgram oxacillin-disk test was used to detect isolates with reduced susceptibility to penicillin G. Determination of MICs of penicillin G, amoxicillin and cefotaxime were then performed by agar dilution method on 402 strains previously categorized resistant or intermediate. Five hundred forty six isolates were PSDP, 33.5% of them were resistant to penicillin G, 2.2% to amoxicillin and 0.2% to cefotaxime. As expected, a decreased susceptibility to beta-lactamins was frequently associated with resistance to macrolides, cotrimoxazole and tetracycline. Among PSDP, the most prevalent serotypes were 23 (23.7%), 14 (23.5%) and 19 (19.1%). In Brittany, the constant rise of PSDP (1993-1994: 28.5%; 1997: 56.4%; 1999: 65.6 %) could be perhaps explain by analysis of social and demographic data.

Introduction Insulin Pump-RT Advisor© (IPRA©) est une application smartphone d’aide a la decision pour les patients traites par pompe couplee a la mesure continue du glucose en temps reel (MCG-RT). IPRA© delivre des conseils pour 210 situations construites par combinaison de 4 parametres principaux (valeur et variation du glucose, horaire du repas, coucher) (cf. poster SFD2013). Notre objectif etait d’evaluer la pertinence de ces conseils par des patients experts, de recueillir leur indice de satisfaction et leurs suggestions de modifications. Patients et methodes Etude prospective de type « panel d’experts ». Six patients diabetiques de type 1 traites par pompe et utilisant la MCG-RT depuis plus de six mois ont teste IPRA© en situation reelle pendant 2 semaines. Ils remplissaient un questionnaire en ligne a chaque connexion : avant la delivrance du conseil, ils precisaient leur conduite spontanee ; ils jugeaient ensuite le conseil ; s’il paraissait inadapte, ils proposaient une alternative. En fin d’etude, un questionnaire de satisfaction leur etait soumis. Resultats 304 enregistrements ont ete analyses. Le taux d’accord global (nombre de conseils valides par les experts sur l’ensemble des conseils) a ete de 93 % (282/304). Le taux d’accord est apparu significativement plus faible pour les conseils delivres au coucher (84 % versus 96 % en preprandial et 90 % en postprandial ; p = 0,011 test exact de Fisher). La concordance (accord entre la conduite spontanee des patients et le conseil d’IPRA©), estimee par le coefficient de concordance pondere de Kappa, etait de 69 %. La moyenne des scores de satisfaction concernant l’utilite, l’ergonomie et l’impact atteignait 4,2/5. Conclusion Il s’agit d’une premiere etape de validation d’IPRA©. Nous developpons une nouvelle version tenant compte des ameliorations preconisees par les experts. Une etude d’impact d’IPRA© sur les conduites et les parametres metaboliques sera realisee chez des patients naifs vis-a-vis de la MCG-RT.

A 48-y-old woman, with a previous history of neurosurgical intervention for a trigeminal neurinoma, presented with acute meningitis due to Streptococcus salivarius. There were significant changes in the petrous region, as revealed by MRI, leading to the diagnosis of associated latent subacute mastoiditis.

Tuberculosis (TB) contributes to the progression of HIV disease but, so far, the mechanism involved is not clear. Several cytokines accumulating in vivo at the site of mycobacterial infection up-regulate HIV expression in vitro. In this study, we assessed the role of pleural fluids recovered from seronegative patients with TB on HIV replication in acutely infected blast cells. Pleural fluids from subjects with congestive heart failure served as controls. In all cases, TB pleural fluids stimulated HIV replication in vitro. TNF-alpha, IL-6, IFN-gamma, and granulocyte/macrophage (GM)-CSF, as well as very low levels of IL-2, were detected in TB pleural fluids. An anti-IL-2 Ab preincubated with TB pleural fluids exhibited no blocking effect on HIV replication similarly to anti-IFN-gamma and anti-GM-CSF Abs. In contrast, anti-TNF-alpha and anti-IL-6 Abs decreased HIV replication by 60 and 90%, respectively. Recombinant TNF-alpha and IL-6 stimulated HIV replication, while IFN-gamma and GM-CSF had a more ambiguous role. The capacity of pleural fluids to stimulate HIV replication was specific for TB, since the capacity of control fluids was significantly lower. Finally, in contrast to PBL, which require in vitro activation for their productive infection by HIV, unstimulated tuberculous pleural lymphocytes were productively infectable by HIV. Taken together, our data suggest that the microenvironment generated by TB might increase the HIV burden in infected subjects, partly through cytokines other than IL-2, namely TNF-alpha and IL-6.

Epithelioid hemangioendothelioma of the lung, therefore labeled as IntraVascular BronchioAlveolar Tumor (IVBAT), is a tumor of endothelial origin; its presentation with multiple pulmonary nodules radiographically suggests metastatic disease. We describe here an epithelioid hemangioendothelioma with an exclusively myxoid pattern. The tumor was composed of nodules extending in a polypoid fashion from the alveolar septa. The cells within the tumor were epithelial-like and contained cytoplasmic lacunae positive for anti-FVIII, CD31 and CD34 antibodies. According to usual criteria, it was considered as a tumor of low grade malignancy, without vascular or bronchiolar extension or cytonuclear atypia and mitosis; the prognosis, difficult to determine, depends on locoregional tumor progression.

Introduction L’apport de la mesure continue du glucose (MCG) dans le diabete instable n’est pas connu. L’objectif etait d’evaluer le benefice de la MCG couplee a la pompe Paradigm® Veot chez des patients diabetiques de type 1 instables. Patients et methodes Une etude observationnelle sur six mois a ete menee chez 13 patients (9 femmes, 4 hommes, âge median 38 ans) ayant un diabete de type 1 instable, traites par pompe a insuline depuis plus de 4 mois (0,3 a 15 ans). L’HbA1c et la variabilite glycemique a l’initiation de la MCG et a six mois ont ete comparees. Les indices de variabilite glycemique SD, LBGI, HBGI, CONGA, MODD, MAGE et ADDR ont ete calcules avec le logiciel easyGV® et les aires sous la courbe (AUC) avec le logiciel CarelinkPro®. La satisfaction vis-a-vis de ce traitement a ete evaluee par une traduction du questionnaire CGM-SAT. Resultats Une reduction significative de l’HbA1c a 6 mois etait observee (mediane ; extremes : – 0,35 % ; – 1,7, +0,4) (p = 0,046). La reduction mediane de l’HbA1c etait associee a un temps de port du capteur ≥ 70 % : – 0,7 % (extremes : – 1,7, + 0,1 %), vs 0 % (– 0,5, +0,4 %) dans le groupe port du capteur Conclusion L’utilisation de la MCG-RT (Paradigm® Veot) chez ces patients au diabete instable est associee a une amelioration de l’equilibre glycemique et a une satisfaction elevee.

Introduction Les assistants bolus (AB) calculent automatiquement les bolus prandiaux et les corrections en cas d’hyperglycemie, apres programmation de differents parametres. Ils sont integres aux pompes a insuline, a certains lecteurs glycemiques, ou developpes comme applications pour smartphones. La prise en compte de l’insuline active residuelle (IAR) dans le calcul du bolus permet de limiter le risque d’hypoglycemies liees a des surcorrections. Notre objectif etait d’evaluer le calcul de l’IAR par differents assistants bolus et leur utilisation par les patients traites par pompe a insuline. Materiels et methodes Quatre assistants bolus ont ete etudies : Paradigm ® Veot, Animas ® Vibet, Freestyle InsuLinx ® , IOB Calc (Pancreumt). L’IAR etait mesuree apres des bolus de 5, 10, 15 et 20 unites d’insuline et apres programmation des differentes durees d’action de l’insuline disponibles dans les 4 AB. L’utilisation effective des AB a par ailleurs ete etudiee chez 395 patients traites par pompe a insuline. Resultats Le calcul de l’IAR variait suivant les dispositifs et en fonction la duree d’action de l’insuline programmee. L’IAR etait plus elevee avec Paradigm ® Veot qu’avec Animas ® Vibet, d’ou des corrections moins aggressives avec l’assistant bolus de Paradigm ® Veot. Seuls 17,3 % de nos patients utilisaient l’assistant bolus de leur pompe. La duree d’action de l’insuline progammee etait ≤ 3 heures chez 40 % des patients. Conclusion Les assistants bolus sont peu utilises malgre leur large diffusion. Leur fonctionnement est heterogene et le choix de la duree d’action de l’insuline a une influence majeure sur le calcul du bolus. L’education des patients est necessaire afin de developper une utilisation adequate de ces dispositifs.

The aim of the present study was to find out whether the elevation of the serum ceruloplasmin level, previously described in vitamin-A-deficient rats, is a specific phenomenon. Quantitative variations of serum ceruloplasmin, albumin and haptoglobin (whose concentration increased during inflammation) were determined in normal and vitamin-A-deficient rats. Concentrations of ceruloplasmin, haptoglobin, and the value of the haptoglobin to albumin ratio are increased in the serum of vitamin-A-deficient rats compared to normal rats. The results suggested that the increased serum level of ceruloplasmin in vitamin-A-deficient rats was due to the presence of inflammation.

The Moore's hypothesis concerning a relationship between the metabolism of copper and that of vitamin A led us to consider a possible relationship between this vitamin and ceruloplasmin, the carrier protein for copper. Experiments were carried out on Sprague-Dawley rats. The ceruloplasmin level of control animals and vitamin A - deficient rats was determined An average increase between 22 and 33% was observed in the animals with vitamin A deficiency, the highest levels being observed in the females. These results are in agreement with Peterson's previous work. A second type of experiment was carried out to confirm these results. The rats were raised in a copper-deficient diet and the vitamin A level was regularly determined. In these conditions serum and liver levels of vitamin A are normal and do not vary, ceruloplasmin level is zero; however apoceruloplasmin is still being synthetized : Nevertheless at the ultime state of the deficiency vitamin A level decreases while apoceruloplasmin increases. These results raise the following question. Could the relationship between ceruloplasmin and vitamin A be possibly due to an inflammatory state in vitamin A deficient rats. In this respect a third series of experiments were undertaken and are in progress; the vitamin A and ceruloplasmin levels are regularly determined.

The purpose of this study was to evaluate protein-losing enteropathy in cirrhotic patients by assaying the intestinal clearance of alpha 1 antitrypsin (C alpha 1), 28 patients were divided into 5 groups: group A = 4 controls, group B = 6 patients with peptic ulcer, group C = 5 cirrhotic patients without esophageal varices (EV), group D = 6 cirrhotic patients with EV but without ascites, group E = 7 cirrhotic patients with EV and ascites. A significant increase in C alpha 1 was found only in groups D and E. The C 1 level was equal to the mean level found in controls multiplied by 2.5 and added to 2 standard deviations. Increases in C alpha 1 levels were not statistically significant when ascites or gastrointestinal involvement were present. C alpha 1 was significantly correlated to the size of EV (p greater than 0.05) and with the Child ratio (p greater than 0.01). No significant correlation was found between C alpha 1 and serum albumin or prothrombin.

The aim of the present study was to find out whether the elevation of the serum ceruloplasmin level, previously described in vitamin-A-deficient rats, is a specific phenomenon. Quantitative variations of serum ceruloplasmin, albumin and haptoglobin (whose concentration increased during inflammation) were determined in normal and vitamin-A-deficient rats. Concentrations of ceruloplasmin, haptoglobin, and the value of the haptoglobin to albumin ratio are increased in the serum of vitamin-A-deficient rats compared to normal rats. The results suggested that the increased serum level of ceruloplasmin in vitamin-A-deficient rats was due to the presence of inflammation.