Malades et méthodes — Cette étude rétrospective portait sur 54 malades opérés d’insulinome (n = 29) ou de gastrinome (n = 26) entre mars 1991 et mars 2000 et qui ont eu au moins un des 2 examens testés. Quarante-deux malades ont eu une scintigraphie (17 avec insulinome, 25 avec gastrinome) et 47 une échoendoscopie (28 avec insulinome, 19 gastrinome). Un des 10 malades atteints de NEM 1 avait les deux types de tumeurs. Tous les diagnostics ont été confirmés à l’examen histologique.

Aim of the study: To evaluate the efficiency of preoperative parathyroid ultrasonography and scintigraphy in the management of renal hyperparathyroidism.Patients and methods: The charts of the last consecutive 200 patients who underwent surgery for renal hyperparathyroidism from 1998 to 2003 were retrospectively reviewed to collect data concerning parathyroid gland function, results of preoperative ultrasonography and scintigraphy, as well as modalities and results of surgical exploration.Results: Ultrasonography and scintigraphy sensibilities were 36.4% and 49.3%, respectively. Efficiency of both examinations was improved when they were combined (sensibility of 64.7%) and in those patients managed for recurrent hyperparathyroidism. Were more often detected by preoperative examinations glands with high weight and/or greatest diameter, orthotopic and inferior glands as well as glands exhibiting nodular hyperplasia content upon pathological examination.Conclusion: Parathyroid ultrasonography and scintigraphy are of poor interest in the management of renal hyperparathyroidism. In a preoperative setting, they should be performed only in patients with recurrent disease. (c) 2005 Elsevier SAS. Tous droits reserves.

AIM OF THE STUDY:To evaluate the efficiency of preoperative parathyroid ultrasonography and scintigraphy in the management of renal hyperparathyroidism.PATIENTS AND METHODS:The charts of the last consecutive 200 patients who underwent surgery for renal hyperparathyroidism from 1998 to 2003 were retrospectively reviewed to collect data concerning parathyroid gland function, results of preoperative ultrasonography and scintigraphy, as well as modalities and results of surgical exploration.RESULTS:Ultrasonography and scintigraphy sensibilities were 36.4% and 49.3%, respectively. Efficiency of both examinations was improved when they were combined (sensibility of 64.7%) and in those patients managed for recurrent hyperparathyroidism. Were more often detected by preoperative examinations glands with high weight and/or greatest diameter, orthotopic and inferior glands as well as glands exhibiting nodular hyperplasia content upon pathological examination.CONCLUSION:Parathyroid ultrasonography and scintigraphy are of poor interest in the management of renal hyperparathyroidism. In a preoperative setting, they should be performed only in patients with recurrent disease.

Aim of the study. - The allograft of pancreatic islets represents a potential alternative to insulin therapy in patients suffering from the most severe forms of Type I diabetes. Here we report our experience of pancreatic procurement for isolation and islet allograft.Materials and methods. - Pancreata were procured in brain-dead donors. The islets were isolated using techniques developed and validated in pigs and men. Injection of a given preparation was decided after quantitative and qualitative controls. Islets were transplanted in Type I diabetic patients already grafted with a kidney or suffering from severe and/or unstable diabetes, after percutaneous or surgical settlement of an intra-portal catheter. Patients received an "Edmonton-like" immunosuppressive protocol. Grafts were repeated once or twice until a total quantity of 10,000 transplanted islet-equivalents was obtained.Results. - Twenty-nine pancreata were procured and 14 preparations were grafted to 7 patients. Eleven graftings were done percutaneously and three were surgical. The initial function of the 14 transplants was confirmed by secretion of C-peptide and decrease of insulin doses. Insulin therapy was completely interrupted in the 5 patients having received at least two grafts.Conclusion. - These preliminary clinical results confirmed that the isolation technique of human islets and the technique of pancreas procurement are mastered by our team. If the results of this assay (assessment one year after graft) confirm our hopes, we will be able to offer islet allografts to an increasing number of patients with severe Type I diabetes. (c) 2005 Elsevier SAS. Tous droits reserves.

This retrospective study aims. - To define a clinical and secretory profile of paragangliomas extra-adrenal chromaffin tumors.Methods. - From 1971 throughout 2002, 39 paragangliomas have been observed in 38 patients (22 male, 16 female, average age 41,2 years).Results. - Four were located above the diaphragm, 35 were sub-phrenic (6 of the organ of Zuckerkandl), 32 secreted catecholamines, 23 were hypertensive (with only one without hypersecretion of catecholamines). Among 29 I-131-metaiodobenzylguanidine scans (MIBG) reviewed, 20 tumors took up the radiopharmaceutical. The treatment was surgical in 35 cases with addition of external radiotherapy and MIBG in one case each; two patients died before any treatment. Two patients with persistent disease after surgery were successfully treated by surgery or MIBG. Histologically, 20 were malignant and 17 were seemingly benign. All exclusive dopamine secreting paragangliomas were malignant. Six patients relapsed two of which for a tumor initially classified as benign. The treatment of recurrences was surgical, by MIBG or by external radiotherapy. Nine patients had a family history of chromaffin tumor(s). The genetic survey made in five of these nine patients was positive in all cases. (c) 2004 Publie par Elsevier SAS.

Le diabète de type 2 se caractérise par deux types d’anomalies, une insulinorésistance et un défaut de l’insulinosécrétion. Les mécanismes et les relations entre ces deux phénomènes demeurent largement débattus. L’hyperglycémie du diabète de type 2 ne saurait se développer en l’absence d’anomalies de la sécrétion de l’insuline. La cellule β-pancréatique a pour principale fonction la sécrétion d’insuline, principalement en réponse à une stimulation par le glucose, l’étude des anomalies de la fonction β-pancréatique au cours du développement d’un diabète de type 2 est donc d’une très grande importance. Le modèle animal de choix pour ces études est le rat ZDF (Zucker Diabetic Fatty). Pour expliquer le déclin progressif de la fonction β-cellulaire au cours du diabète de type 2, deux hypothèses sont avancées, un phénomène de glucotoxicité lié aux effets de l’hyperglycémie chronique sur la fonction sécrétoire des cellules β et sur l’utilisation défectueuse du glucose par les muscles squelettiques, et un phénomène de lipotoxicité lié à l’accumulation de triglycérides dans les îlots de Langerhans. En fait, ces deux phénomènes sont vraisemblablement liés, cette gluco-lipotoxicité conduisant, par des mécanismes que nous décrivons, à l’apoptose cellulaire.Les thiazolidinediones (glitazones) sont des ligands synthétiques des récepteurs nucléaires PPARγ. Leurs effets bénéfiques sur le contrôle glycémique des patients diabétiques de type 2 sont maintenant bien établis. Un certain nombre d’études menées avec la rosiglitazone chez le rat ZDF, soit protocoles de prévention du diabète (avec administration précoce de la rosiglitazone), soit de correction de l’hyperglycémie (avec administration de la rosiglitazone au stade de diabète avéré), indiquent que dans ce modèle, la rosiglitazone a un effet de protection sur la cellule β-pancréatique, préservant ainsi sa fonction sécrétoire. Ces études sont décrites et discutées, ainsi que leurs implications pratiques.Type 2 diabetes is characterized by two abnormalities, insulin resistance and insulin secretion defects. Their exact mechanisms and their interrelation are still a matter of debates. Development of hyperglycaemia in type 2 diabetes requires insulin secretion abnormalities. As the principal function of pancreatic β-cell is insulin secretion, mainly in response to a glucose stimulus, it is of an upmost importance to study abnormal β-pancreatic function during the development of type 2 diabetes. The animal model of choice for such studies is the ZDF (Zucker Diabetic Fatty) rat. Two hypothesis are commonly discussed to explain the progressive β-cell failure during type 2 diabetes evolution: glucotoxicity, mainly related to chronic hyperglycaemia effect on secretory β-cell function and to defective glucose utilization in skeletal muscles, and lipotoxicity, as a consequence of triglyceride accumulation in the islets of Langerhans. In fact, likely, these two phenomenons are linked together, this glucolipotoxicity leading to a cellular apoptosis, through mechanisms we describe.Thiazolidinediones (glitazones) are synthetic PPARγ ligands. Their beneficial effect on glycaemic control in type 2 diabetic patients are well established. Several studies in ZDF rats, using rosiglitazone as a preventive diabetes treatment (early administration) or a curative one (starting administration when diabetes is well established), indicate, in this animal model, that rosiglitazone has a protective effect on pancreatic β-cell and preserve its secretory function. These studies are described and discussed, as well as their practical implications.

AIM OF THE STUDY The allograft of pancreatic islets represents a potential alternative to insulin therapy in patients suffering from the most severe forms of Type 1 diabetes. Here we report our experience of pancreatic procurement for isolation and islet allograft. MATERIALS AND METHODS Pancreata were procured in brain-dead donors. The islets were isolated using techniques developed and validated in pigs and men. Injection of a given preparation was decided after quantitative and qualitative controls. Islets were transplanted in Type 1 diabetic patients already grafted with a kidney or suffering from severe and/or unstable diabetes, after percutaneous or surgical settlement of an intra-portal catheter. Patients received an "Edmonton-like" immunosuppressive protocol. Grafts were repeated once or twice until a total quantity of 10,000 transplanted islet-equivalents was obtained. RESULTS Twenty-nine pancreata were procured and 14 preparations were grafted to 7 patients. Eleven graftings were done percutaneously and three were surgical. The initial function of the 14 transplants was confirmed by secretion of C-peptide and decrease of insulin doses. Insulin therapy was completely interrupted in the 5 patients having received at least two grafts. CONCLUSION These preliminary clinical results confirmed that the isolation technique of human islets and the technique of pancreas procurement are mastered by our team. If the results of this assay (assessment one year after graft) confirm our hopes, we will be able to offer islet allografts to an increasing number of patients with severe Type 1 diabetes.

These preliminary clinical results confirmed that the isolation technique of human islets and the technique of pancreas procurement are mastered by our team. If the results of this assay (assessment one year after graft) confirm our hopes, we will be able to offer islet allografts to an increasing number of patients with severe Type 1 diabetes.

L’association d’une pancréatite chronique calcifiante et d’une tumeur endocrine du pancréas est rare. Les remaniements pancréatiques rendent le diagnostic difficile. Au travers de ce cas, nous faisons une revue de la littérature et décrivons la sémiologie scanographique. Patient de 50 ans porteur d’une pancréatite chronique calcifiante diagnostiquée en 1987 d’origine exogène bénéficiant de contrôles scanographiques lors des événements sentinelles (poussée de pancréatite, douleurs) en 1989, 1993, 1994 et altération de l’état général en 2001. Le scanner montre des calcifications, une dilatation du canal de Wirsung, un pseudokyste céphalique, une zone hypodense caudale, une thrombose segmentaire avec circulation collatérale veineuse correspondant à la pancréatopathie. Evolution sur les scanners de contrôle de l’hypodensité caudale devenant une masse de 80 mm de diamètre en 1994 avec une exploration chirurgicale en faveur d’une masse inflammatoire. Le diagnostic de carcinome endocrine du pancréas était réalisé après ponction d’une masse hypervascularisée avec des zones de nécrose et de calcifications en 2001 associée à une hypercalcémie, hypercalcitoninémie et hypersécrétion de PTHrp. La revue de la littérature retrouve trois cas de tumeur endocrine sur pancréatite chronique préexistante. Intérêt du scanner comparatif dans le suivi des pancréatites chroniques.

AIM:The postoperative pancreatitis was a classical complication in the historical series of primary hyperparathyroidism (HPT), but the causal association was never demonstrated and even recent studies denied it. The aim of this study was to determine the augmentation of postoperative amylasemia, and its possible clinical traduction in patients operated for primary HPT.MATERIAL AND METHODS:Fifty consecutive patients operated for cure of a primary HPT were included in this study. Total amylase, as well as isoenzyme fractions P (pancreatic) and S (salivary), calcium, phosphorus and intact PTH serum concentrations were determined on the days prior and after parathyroidectomy. Fifteen normocalcemic patients operated for secondary HPT constituted the control group.RESULTS:The study deals with 42 female and eight male patients, their mean age was 58.5 years (range 19-89 years). All patients underwent parathyroidectomy for adenoma or hyperplasia. No patient had pancreatitis before parathyroidectomy. Postoperative amylasemia developed in four patients (8%), one with increased total amylase and P fraction, one with only increased total amylase, and two with increased total amylase and S fraction. No patients exhibited abdominal symptoms suggesting acute pancreatitis in the postoperative period. There was no correlation between pre- and post-operative calcium serum levels and pre- and post-operative amylasemia. In the secondary HPT group no significant diminution of the total amylasemia or of P and S fractions were observed.CONCLUSIONS:These results indicate that acute pancreatitis is an exceptional postoperative complication of primary HPT nowadays. The 8% incidence reported in the present study matches the incidence of hyperamylasemia reported postoperatively in non-abdominal or non-parathyroid surgery.

Aim. - The postoperative pancreatitis was a classical complication in the historical series of primary hyperparathyroidism (HPT), but the causal association was never demonstrated and even recent studies denied it. The aim of this study was to determine the augmentation of postoperative amylasemia, and its possible clinical traduction in patients operated for primary HPT.Material and methods. - Fifty consecutive patients operated for cure of a primary HPT were included in this study. Total amylase, as well as isoenzyme fractions P (pancreatic) and S (salivary), calcium, phosphorus and intact PTH serum concentrations were determined on the days prior and after parathyroidectomy. Fifteen normocalcemic patients operated for secondary HPT constituted the control group.Results. - The study deals with 42 female and eight male patients, their mean age was 58.5 years (range 19-89 years). All patients underwent parathyroidectomy for adenoma or hyperplasia. No patient had pancreatitis before parathyroidectomy. Postoperative amylasemia developed in four patients (8%), one with increased total amylase and P fraction, one with only increased total amylase, and two with increased total amylase and S fraction. No patients exhibited abdominal symptoms suggesting acute pancreatitis in the postoperative period. There was wno correlation between pre- and post-operative calcium serum levels and pre- and post-operative amylasemia. In the secondary HPT group no significant diminution of the total amylasemia or of P and S fractions were observed.Conclusions. - These results indicate that acute pancreatitis is an exceptional postoperative complication of primary HPT nowadays. The 8% incidence reported in the present study matches the incidence of hyperamylasemia reported postoperatively in non-abdominal or non-parathyroid surgery. (C) 2003 Elsevier SAS. Tons droits reserves.