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Biomedical subjects

J M Brun

Publications and source records attributed to J M Brun.

At least 19 recordsLinked to original sources
PubMed1994

Apolipoprotein A-IV levels and phenotype distribution in NIDDM.

OBJECTIVE: To determine plasma apolipoprotein A-IV (apoA-IV) levels and phenotype distribution in non-insulin-dependent diabetes mellitus (NIDDM) patients and to analyze the influence of apoA-IV phenotype on lipid profiles in NIDDM. RESEARCH DESIGN AND METHODS: Total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, HDL2 cholesterol, HDL3 cholesterol, free fatty acid, and apoA-IV levels were measured in 83 NIDDM patients and 100 normal control subjects. The apoA-IV phenotype was determined in each individual. RESULTS: In both sexes, NIDDM patients had significantly higher levels of triglyceride and free fatty acid and significantly lower levels of HDL cholesterol and HDL2 cholesterol than control subjects. In men and women, apoA-IV levels were significantly higher in diabetic patients than in control subjects (men: 17.1 +/- 7.9 vs. 12.3 +/- 3.6 mg/dl, P < 0.001; women: 18.9 +/- 9.9 vs. 11.9 +/- 3.5 mg/dl, P < 0.001). The multiple regression analysis showed that the apoA-IV level in NIDDM patients was significantly and independently related to log triglyceride (P = 0.0001) and HDL cholesterol (P = 0.01) levels. The apoA-IV phenotype distribution was not significantly different between NIDDM patients and control subjects. In the control subjects, the apoA-IV-1-2 phenotype was associated with significantly higher levels of HDL cholesterol (69 +/- 12 vs. 56 +/- 11 mg/dl, P < 0.01) and of HDL2 cholesterol (36 +/- 15 vs. 25 +/- 12 mg/dl, P < 0.05) compared with the apoA-IV-1-1 phenotype; on the other hand, HDL cholesterol and HDL2 cholesterol levels were not different between the two apoA-IV phenotypes in NIDDM patients. CONCLUSIONS: Plasma apoA-IV levels are increased in NIDDM patients. This increase in apoA-IV is related mainly to hypertriglyceridemia and, to a lesser extent, to HDL cholesterol level. The apoA-IV phenotype distribution is not different between NIDDM patients and nondiabetic control subjects. The potential protective lipid profile (characterized by increased HDL and HDL2 cholesterol levels) linked with apoA-IV-1-2 phenotype in control subjects is no longer found in NIDDM patients. We suggest that the metabolic state of NIDDM has erased the potential protective lipid profile associated with the apoA-IV-1-2 phenotype.

Apolipoproteins A↗
PubMed1994

Elevated serum CA19-9 levels in poorly controlled diabetic patients. Relationship with Lewis blood group.

Many non-malignant diseases may be associated with elevated serum CA19-9 levels. Recent reports suggest that diabetes mellitus may also be responsible for some elevations. In this study we investigated the influence of the glycaemic level and Lewis phenotype on the serum CA19-9 levels in diabetic patients. In 15 out of 84 patients (17.8%) serum CA19-9 exceeded 100 kU/L (highest value: 208 kU/L). CA19-9 concentrations were significantly correlated with glycosylated haemoglobin levels. On the other hand, no correlation was found between CA19-9 levels and the type of diabetes, lipase levels, or the presence of anti-islet cell antibodies. Le(a-b-) patients had significantly lower serum CA19-9 levels. This study emphasizes the frequency of CA19-9 elevations in diabetic patients without cancer.

Adult↗
PubMed1993

Results of ultrasonically guided percutaneous ethanol injection into parathyroid adenomas in primary hyperparathyroidism.

Surgery is the usual treatment for primary hyperparathyroidism. However, some patients with high surgical risks are not suitable for surgery. For such patients, we propose, as an alternative treatment, ultrasonically guided percutaneous ethanol injection into parathyroid adenomas, in order to induce necrosis of the tumor. We report, here, the results of ultrasonically guided percutaneous ethanol injection into parathyroid adenomas, during a prolonged follow-up period up to 49 months, in a group of 13 patients (median age 79 years) with primary hyperparathyroidism and contraindications for surgery. In seven patients, complete normalization of plasma calcium, phosphorus and parathyroid hormone (PTH) levels was achieved after ethanol injections, with no recurrence of hypercalcemia during a median follow-up period of 28 months (total success). In these seven patients, plasma calcium, phosphorus and PTH levels were normalized 48 h after the successful ethanol injection. In four patients, a partial success was obtained with clinical improvement and normalization of plasma calcium levels but without complete normalization of plasma PTH levels. This partial success is due to incomplete necrosis of the adenoma, as has been confirmed in one patient by histopathological examination. The ethanol injection treatment failed in only two patients. This treatment was always well tolerated and no major side-effects were observed. In conclusion, our results give evidence that ultrasonically guided percutaneous ethanol injection into parathyroid adenomas can be a very useful alternative therapy in patients not suitable for surgery.

Adenoma↗
PubMed1992

[Antidiabetic efficacy of benfluorex. Clinical data].

We compared the effect of 3 months of treatment by either benfluorex (B) or metformin (M) on hyperinsulinism and high blood glucose levels in overweight patients with non-insulin-dependent diabetes mellitus (NIDDM). All patients had previously complied with a low-calorie diet that had resulted in loss of more than 1.5 kg in one month, but had failed to ensure metabolic control. Weight changes under treatment were identical in both groups (B and M). Both treatments had a comparable effect on blood glucose levels, and this effect was more marked following an oral glucose load. However, a decrease in serum insulin levels and in the fasting serum insulin/fasting serum glucose ratio was seen with benfluorex only. The differences between the two treatment groups were especially marked among the subgroup of patients who responded poorly to the trial diet (fasting I/fasting G: + 1.82 under M., -3.37 under B, P interaction = 0.029). Clinical tolerance was comparable for both drugs. However, a significant rise in serum lactic acid was seen with metformin. The effect of benfluorex on hyperinsulinism in overweight patients with glucose intolerance or mildly increased fasting blood glucose levels is valuable in these high vascular risk patients. The results of this study open the way to a new approach to the treatment of diabetes which should be confirmed by a longer term study currently underway. However, already, these results encourage the evaluation of the benefit provided by benfluorex in combination with classical hypoglycemic drugs.

Blood Glucose↗
PubMed1992

[Substernal goiters. 218 operated cases].

The authors are presenting a retrospective study on 218 retrosternal goiters operated between 1968 and 1991. 33% of the goiters were incidentally discovered on a plain X-ray of the chest. Symptoms of compression were present in 50.5% of patients and hyperthyroidism in 16.5%. Respiratory manifestations were more frequent and more severe in patients aged 70 and more. Moreover 90% of those old patients were symptomatic. Goiters migrated anteriorly in 57.7% of cases, posteriorly in 33.9%, both anteriorly and posteriorly in 5.5%. Type of migration was unknown in 2.5%. 3.7% were malignant. 27 patients with respiratory symptoms received corticosteroids to reduce the airway compression. Among 52 patients with hyperthyroidism, 36 were given antithyroid drugs. Among them, some received corticosteroid drugs in order to reduce risks of mediastinal compression. A simple cervicotomy was adequate in 92.7% of case and was completed by sternotomy in 7.3%. The operation was iterative for relapsing or forgotten thoracic goiters in 24 cases. Morbidity was slight even for sternotomized patients. Mortality was noted in 2 cases (0.9%) one of them operated on for poorly-differentiated and suffocating carcinoma of the thyroid. We advise a straightforward surgical attitude as a result of the slight morbidity and mortality, even in sternotomized patients in order to avoid severe compressive complications of the airways.

Adult↗
PubMed1989

Adrenal function in HIV infected patients.

UNLABELLED: Since anatomopathological lesions of the adrenal gland have been frequently observed at autopsy in AIDS, we investigated the glucocorticoid function in 63 patients (51 men, 12 women) infected by the human immunodeficiency virus (HIV) in order to determine the incidence and the nature of any adrenocortical abnormalities at various stages of HIV infection. The patients were classified according to the Centers for Disease Control (CDC) recommendations into group II (asymptomatic; N = 13), group III (lymphadenopathy; N = 27) and group IV (clinical manifestations; N = 23). Plasma ACTH and cortisol before and after an exogenous ACTH stimulation test were measured in patients as in 30 age-matched controls. Plasma renin activity and plasma aldosterone before and after ACTH stimulation were also measured in 31 patients (group II: 12; group III: 10; group IV: 9). Compared with controls patients from group II-III had higher levels of ACTH (39.11 +/- 17.01 vs 29.73 +/- 8.53 ng/l; p = 0.003) and basal cortisol (232 +/- 91.2 vs 184.3 +/- 30.9 micrograms/l; p = 0.03). No significant differences were noted between group IV patients and controls as to ACTH and basal and stimulated cortisol levels. Among the 63 patients, only one from group IV had a blunted cortisol response after ACTH stimulation test. Plasma renin activity, and basal and stimulated aldosterone levels in the 3 groups of patients were not different from control values. IN CONCLUSION: 1. Adrenal insufficiency does not seem very frequent in group IV patients and is likely to be a late complication in AIDS. 2. The increased ACTH and basal cortisol levels found in group II and group III patients argue for an early dysregulation of the adrenocortical axis in HIV infection. The exact physiopathological mechanism is not yet known, but an enhanced CRH production by interleukin 1 and/or a direct role of the HIV envelope glycoprotein (gp 120) may explain the high ACTH level in HIV patients.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Influence of acute hyperinsulinism on arterial pressure of diabetics. Reproducibility of the hypotensive effect].

We have observed effects of acute hyperinsulinaemia on arterial pressure of five diabetics and tested the reproducibility of this action. Systolic (TAS) and diastolic (TAD) arterial pressure were studied during two hyperinsulinaemic-euglycaemic clamps effected with Artificial Pancreas (Biostator CGIIS, Miles) at one month of interval. During the first clamp, between the beginning of insulin infusion and the end of 4th stage, we have observed a fall of TAS (115 +/- 4, VS 137 +/- 6 mmHg; moy +/- SEM; p less than 0.05) and in less degree of TAD (76 +/- 2, VS 86 +/- 4 mmHg; NS). These modifications of arterial pressure were associated with no changes of heart rate and urinary sodium flow. On the other hand, we have observed a fall of serum levels of sodium (139 +/- 1, VS 141 +/- 1 mEq/l; p less than 0.05), urea (0.20 +/- 0.01, VS 0.32 +/- 0.02 g/l; p less than 0.001) whereas, balance-sheet of water was positive (+445 +/- 338 ml) at the end of clamp. During the second clamp, the fall of pressure has been reproducible, relating to the TAS (123 +/- 5, VS 145 +/- 4 mmHg; p less than 0.01) and non significantly to the TAD (78 +/- 2, VS 88 +/- 5 mmHg; NS). During the two tests, the mean of tension fall was identical (22 +/- 6 mmHg during first clamp, 22 +/- 4 mmHg during second one). So, acute hyperinsulinaemia induces a fall of arterial pressure, probably in bringing an influence on arterial vasodilatation since heart rate and urinary sodium excretion are unchanged and water balance-sheet is positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1984

[Amiodarone and hyperthyroidism].

22 cases of hyperthyroidism occurring during or following treatment with amiodarone are reported and compared with more than 15 cases in the literature. The specific clinical features of these cases of hyperthyroidism are presented and the problems in interpretation of the laboratory thyroid function tests are discussed. A study of the course of these cases reveals a number of prognostic factors. Finally, the authors describe the practical management of this form of hyperthyroidism.

Adult↗
PubMed1982

Juvenile autoimmune polyendocrinopathy.

Juvenile autoimmune polyendocrinopathies are characterized by the coexistence of hypoparathyroidism, chronic candidiasis and adrenal insufficiency. This is in contrast with associated autoimmune endocrine diseases in the adult. Gonadal insufficiency is frequently encountered as well. Some other diseases can also be associated to these endocrinopathies: alopecia, diarrhea, malabsorption or chronic active hepatitis. The pathophysiological aspects of this syndrome are discussed.

Addison Disease↗