Cognitive function and 99mTc-ECD brain SPECT are significantly correlated in patients with primary Sjogren syndrome: a case-control study.

OBJECTIVES: To assess subclinical central nervous system (CNS) involvement in primary Sjögren syndrome (pSS), by comparing standard brain MRI, in-depth neuropsychological testing and (99m)Tc-ECD brain single-photon emission computed tomography (SPECT) of patients with pSS with matched controls. METHODS: 10 women (<55 years old), with pSS defined using European-American criteria, presence of anti-SSA and/or anti-SSB antibodies and no history of neurological involvement were prospectively investigated, and compared with 10 age- and sex-matched controls. All subjects underwent, within 1 month, brain MRI, neuropsychological testing, including overall evaluation and focal cognitive function assessment, and (99m)Tc-ECD brain SPECT. RESULTS: (99m)Tc-ECD brain SPECT abnormalities were significantly more common in patients with pSS (10/10) than controls (2/10; p<0.05). Cognitive dysfunctions, mainly expressed as executive and visuospatial disorders, were also significantly more common in patients with pSS (8/10) than controls (0/10; p<0.01). Notably, between-group comparisons enabled a significant correlation to be established between neuropsychological assessment and (99m)Tc-ECD brain SPECT abnormalities in patients with pSS (r(s) = 0.49, p<0.01). MRI abnormalities in patients and controls did not differ significantly. CONCLUSIONS: Neuropsychological testing and (99m)Tc-ECD brain SPECT seem to be the most sensitive tools to detect subclinical CNS dysfunction in pSS. The strong correlation between cortical hypoperfusion in (99m)Tc-ECD brain SPECT and cognitive dysfunction suggests an organic aetiology of CNS dysfunction in pSS. These data should be confirmed in a larger study.

[Antigenic peptides for peptide splicing in the proteosome]. / Peptides antigéniques produits par épissage peptidique dans le proteasome.

These past years, we focused our researches on the identification of novel, potential peptide targets for cancer immunotherapy. Amongst the peptides we identified, two are composed of fragments originally distant in the parental protein and are produced by a novel mechanism termed peptide splicing. The peptide splicing reaction takes place in the proteasome and occurs by transpeptidation. Here, we describe the discovery of this new mechanism of production of antigenic peptides.

Proteasomes generate spliced epitopes by two different mechanisms and as efficiently as non-spliced epitopes.

Proteasome-catalyzed peptide splicing represents an additional catalytic activity of proteasomes contributing to the pool of MHC-class I-presented epitopes. We here biochemically and functionally characterized a new melanoma gp100 derived spliced epitope. We demonstrate that the gp100(mel)47-52/40-42 antigenic peptide is generated in vitro and in cellulo by a not yet described proteasomal condensation reaction. gp100(mel)47-52/40-42 generation is enhanced in the presence of the ß5i/LMP7 proteasome-subunit and elicits a peptide-specific CD8(+) T cell response. Importantly, we demonstrate that different gp100(mel)-derived spliced epitopes are generated and presented to CD8(+) T cells with efficacies comparable to non-spliced canonical tumor epitopes and that gp100(mel)-derived spliced epitopes trigger activation of CD8(+) T cells found in peripheral blood of half of the melanoma patients tested. Our data suggest that both transpeptidation and condensation reactions contribute to the frequent generation of spliced epitopes also in vivo and that their immune relevance may be comparable to non-spliced epitopes.

Somatostatin receptor imaging in small cell lung cancer.

To determine its usefulness, we evaluated 111In-DTPA-Octreotide (octreotide scintigraphy) in the initial staging of 19 patients with histologically proven small cell lung cancer (SCLC) and compared the results to those of conventional imaging. Images performed during initial staging demonstrated 21 known pulmonary lesions and two known supraclavicular nodes. We detected a previously unknown mediastinal lesion. The number of metastases was underestimated, with no liver (5), brain (1) or skin metastases detected. Bone lesions were identified in 4 out of 5 patients. There were fewer lesions detected with octreotide scintigraphy than with bone scintigraphy (except for one case). We therefore conclude that octreotide scintigraphy is a highly effective method for detecting SCLC primary tumour and supraclavicular nodes; the procedure is of limited value for distant metastasis. Further studies are needed to establish its ability for detecting residual intrathoracic disease, and confirm the value of octreotide scintigraphy in differentiating residual disease from other benign lesions.

67Ga scintigraphy in B-cell non-Hodgkin's lymphoma: correlation of 67Ga uptake with histology and transferrin receptor expression.

UNLABELLED: 67Ga scintigraphy is routinely used in the management of non-Hodgkin's lymphomas (NHLs), but the heterogeneity of 67Ga uptake in the different NHL histological subtypes has not been clearly explained. The transferrin receptors (TfR/CD71) play an important role in the mechanisms of 67Ga uptake by tumor cells. However, the relationship between the 67Ga uptake in NHL and the TfR/CD71 expression in lymphomatous cells remains to be defined. The aim of this study was to determine the intensity of 67Ga uptake in different histological subtypes of B-cell NHL (B-NHL) and to compare this uptake with the expression of TfR/CD71 on lymphomatous cells. METHODS: 67Ga scintigraphy of 47 patients having histologically proven lymphomas was investigated. 67Ga uptake was semiquantitatively evaluated in regions of interest and was reported as 67Ga uptake index (GaUI). In all cases, biopsies were reviewed for classification of NHL. The expression of TfR/CD71 was determined on frozen sections and was semiquantitatively evaluated. The relationships between GaUI, histology and TfR/CD71 were investigated. RESULTS: The values of GaUI were significantly related to the different histological subtypes analyzed (P = 0.0007) and to the presence of a large cells component, thus demonstrating that 67Ga uptake rose with the grade of lymphoma. Moreover, the values of GaUI and TfR/CD71 were closely related in the tested cases (P = 0.0059). CONCLUSION: There were three factors influencing 67Ga uptake in NHL: histology, TfR/CD71 expression and the presence of a large cells component. This justifies the usefulness of 67Ga scintigraphy in staging the TfR/CD71-positive lymphomas.

Early and delayed brain SPECT with technetium-99m-ECD and iodine-123-IMP in subacute strokes.

UNLABELLED: The brain distribution of 99mTc-ECD versus 123I-IMP was compared in patients with subacute stroke in order to compare diagnostic accuracy. METHODS: A total of 25 patients with subacute stroke underwent early and delayed SPECT imaging with 99mTc-ECD and 123I-IMP. Washout of 99mTc-ECD was calculated and a differential percentage of activity (DPA) of ischemic versus normal zones was assessed. Images were analyzed twice by five independent observers. RESULTS: Technetium-99m-ECD clearance was 12.5% from the whole brain during early imaging. Ischemic parietal zones had higher clearance than normal parietal zones. Technetium-99m-ECD images showed larger differences between abnormal and normal brain activity than 123I-IMP images. Detection accuracy was slightly, but not significantly, higher for 99mTc-ECD and 123I-IMP (sensitivity: 73.8% as 66.6%; specificity: 81.7% as 81.6%). Reproducibility among observers was similar for 99mTc-ECD and early 123I-IMP. CONCLUSION: Technetium-99m-ECD demonstrates high diagnostic accuracy during subacute stroke, similar to 123I-IMP, but with more intense, better delineation of the perfusion defects.

Fetal weight estimation by ultrasonic measurement of abdominal circumference.

The purpose of this study was to compare ultrasonic measurements of fetal abdominal circumference to ultrasonic measurements of fetal biparietal diameter, as a means of estimating fetal body weight. Of 58 fetuses who had abdominal circumferences measured, 48 (82%) of the predicted weights were within 15% of the actual birth weights. Forty-four of the same 58 fetuses had satisfactory biparietal diameter measurements, but only 21 (48%) of the predicted weights were within 15% of the actual birthweights. Ultrasonic measurement of abdominal circumference appears to be a more reliable index of fetal body weight than other currently available techniques.

Pregnancy after embolization of uterine myoma: report of 12 cases.

OBJECTIVE: To treat uterine myomas with embolization, to look for pregnancy-induced myoma recurrences, and to assess pregnancy course and outcome after embolization. DESIGN: Observational clinical study. SETTING: University of Paris VII hospital. PATIENT(S): Nine women had embolization for symptomatic myoma, with 12 pregnancies observed. INTERVENTION(S): Embolizations were highly selective and performed bilaterally through the uterine arteries with polyvinyl alcohol. MAIN OUTCOME MEASURE(S): Pregnant women were evaluated by physical and sonographic examinations. RESULT(S): Before embolization, the mean uterine volume was 450 cm(3), and in six patients polymyomas were present. The median age at embolization was 40 years; the median delay before pregnancy was 9 months; and the median age at first pregnancy outcome was 41 years. Five early miscarriages occurred. The seven other pregnancies were uneventful, although three premature births and one case of late toxemia occurred unrelated to previous embolization. Three women delivered vaginally and four by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. CONCLUSION(S): The results of this first series of 12 pregnancies after myoma embolization are promising. If these preliminary results are confirmed, embolization could be a major breakthrough in the management of myoma and could replace conventional medical and surgical treatments.

Amines for brain tomoscintigraphy.

Amines like N-isopropyl-p-123I-iodoamphetamine (IMP) and hydroxy 123I-iodobenzyl propyl diamine (HIPDM) associated with brain tomoscintigraphy have proved their worth for detecting ischaemic abnormalities. Even though the chemistry of their metabolism and their biodistribution are not fully understood, their application in the study of parenchymal impairment in stroke and reversible ischaemia yields additional information compared to the other methods of imaging like CT or MRI. The concept of a steady state in brain with a wash in/wash out model has been considered especially with IMP, to explain the evolution of the activity pattern with time when comparing early and delayed images. (This review leads to foresee the prognosis of of ischaemic diseases when redistribution is taken into account.)

Temporal evolution of brain distribution of IMP and HIPDM. Concise communication.

Early and late brain distribution of iodine-labelled N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3-propanediamine (HIPDM) and iodine labelled N-isopropyl-p-iodoamphetamine (IMP) were compared in rat and one human patient with a recent stroke in the right middle cerebral artery area. In rat, an important 'redistribution' of cerebral activity was observed in various areas of the brain, mainly white matter, whereas no such observation was made with HIPDM. In the patient, the right area was hypoactive during the early SPECT with IMP and HIPDM, and redistribution was observed in the late SPECT only with IMP. We suggest that while HIPDM appears to reflect regional cerebral perfusion, IMP distribution is dependent upon metabolic brain activity.

Interactions of phenylalkylamines with human lung membrane and microsome preparation.

Lipophilic amines are recognized as important tracers for brain imaging. Their pulmonary accumulation was a drawback for optimal concentration in the brain. We used IMP, HIPDM, IP, amphetamine derivatives to determine the relation between structure and accumulation in the lung. The incubation of phenylalkylamines in competition with 3H-Imipramine, for human lung membrane and microsomes was performed and led to the extraction of a competitive constant (KI). The results showed that the compounds can be classified in order of their decreasing affinity: Iodoamphetamine, iodoisopropylamphetamine, dimethyliodophentermine, hydroxyiodobenzyl propane diamine (HIPDM), isopropylamphetamine and amphetamine. Iodine set in the para position of the ring seemed to increase the affinity of phenylalkylamines for the lung. Adjunction of isopropyl or methyl groups to the lateral chain decreased this affinity.

[Uterine fibroids embolization: results about 454 cases]. / Embolisation des fibromes utérins: résultats sur 454 cas.

OBJECTIVE: To determine the effectiveness of uterine arterial embolization (UAE) as primary treatment in the management of symptomatic leiomyomas. PATIENTS AND METHOD: UAE was performed on 454 patients (age range: 21-68) with menorrhagia, bulk-related symptoms or both, due to leiomyomas. The effectiveness of this therapy in the control of symptoms and reduction of uterine and leiomyoma volume was measured by clinical and imaging controls at 3, 6 and 9 months after the procedure. RESULTS: Four hundred and thirty-three patients were evaluated, and 42 failures were observed (9.6%). Six months after the procedure, 391 patients were symptom-free. Follow-up ultrasonic examination showed an average reduction of 55% in dominant myoma volume at 6 months, 70% at 1 year. Twenty-seven women became pregnant (30 pregnancies). Complications related to procedure, and requiring surgery, occurred in three cases. Principal complications are amenorrhoea and fibroid sloughs. Severe complications are rarely found. DISCUSSION AND CONCLUSION: UAE is an efficient therapy in the management of symptomatic myomas and proves to be a valid alternative to surgical procedure. The future of this mini-invasive and conservative technique appears to be a very promising one.

[Evolution of the indications for cesareans. Comparison of 1971-1976 and 1976-1979 at the Maternity Center of the Louis-Mourier Hospital. Review of the literature]. / Evolution des indications de césariennes. Comparaison entre 1971-1976 et 1976-1979 à la Maternité de l'Hôpital Louis-Mourier. Revue de la littérature.

Changes in the indications for caesarean operations were studied over a period of 9 years from 1971-1979 and two periods from 1971-1975 and 1976-1979 were compared. The principal changes that show up are: an increase in the total number of caesarean sections from 5.3% in 1971 to 15.4% in 1979; modifications in the indications which were mainly due to much greater use of electronic means of monitoring the fetus and an improvement in the methods of resuscitation of the newborn (there were approximately the same number of caesareans for breech presentations, an increase in the number of repeat caesarean operations and of caesarean operations for fetal distress and for dystocia as well as for toxaemia of pregnancy); the improvement in the state of infants at birth seems to be parallelled by the increase in the number of caesarean operations. Though there was 8% neonatal morbidity, only 1% of these at the most could be put down to the caesarean; no maternal death occurred, although caesarean section is accompanied by an increased maternal morbidity of 27%. Reviewing the literature shows that the same tendencies occur in other places. This makes it possible to point out the ways in which action can be taken to limit the number of caesareans in those categories where the indications seem to be most frequent, namely dystocia, repeat caesareans, fetal distress and breech presentation. The optimum level of caesarean sections at 15% with 9% being first caesareans and 6% repeat caesareans should be kept to.

[Pneumococcal peritonitis. An unusual diagnosis in gynecology]. / La péritonite à pneumocoque. Un diagnostic inhabituel en gynécologie.

The authors, having had a case of primary pneumococcal peritonitis, review the features of this pathological condition which has become rare, and of gynaecological pneumococcal infections. Pneumococcal peritonitis presents as a very serious peritonitis and the usual diagnosis that is first made is peritonitis due to appendicitis. Pneumococcal peritonitis can be primary but it is possible that it is often secondary to genital pneumococcal infections. Treatment should always be by laparotomy to confirm the diagnosis, with a peritoneal toilet which is needed in order to stop a pelvic abscess developing. Antibiotics, which are usually of the penicillin group, should be given for at least 15 days. The treatment can be varied in those rare cases where cirrhotic ascites or serious nephrotic syndromes develop in children. Putting in drains and removing the appendix when it is normal are both useless.

[Antenatal diagnosis of holoprosencephaly and its consequences. Apropos of 2 cases]. / Le diagnostic anténatal de l'holoprosencéphalie et ses conséquences. A propos de 2 observations.

Cyclops represents the worst form of a rare malformation of the brain and face: holoprosencephaly. Two cases are reported, including one that was diagnosed at the 23rd week of pregnancy. Now, ultrasonography makes it possible to diagnose early; as soon as the 15th week of gestation. Ultrasound diagnosis is based on hypotelorism and anomalies of the mid-line, with or without facial abnormalities. The outcome is always poor. This malformation is associated with various conditions and a complete assessment, including the karyotype, morphologic studies of the fetus and of his family, and search for related minor facial dysmorphias (median labial or cleft palate with, with a single upper incisor) is mandatory. The condition recurs in 2 to 50% of cases depending on various associated conditions and on the family histories.

[Incidence of pulmonary tuberculosis in a population of pregnant women at risk]. / Incidence de la tuberculose pulmonaire dans une population de femmes enceintes à risques.

So long as the diagnosis is made early and treatment is prolonged adequately pulmonary tuberculosis in pregnant women has been shown to have a much better prognosis than formerly. 13 new pregnant women were found to have tuberculosis in 18 months, which gave an incidence of 32 per 10,000 population. This is 5 times more than the mean incidence in France; and makes it worth while screening for the condition, particularly among immigrant.

[Endogenous digitalis-like substances in umbilical cord blood: analytical interference or new hormones?]. / Composés digitaliques endogènes dans le sérum de cordon: interférences analytiques ou nouvelles hormones?

Endogenous substances with a digitalis-like action have been found in the newborn and in women in the first three months of pregnancy. These substances have three properties that are characteristic of cardiotonic heterosides: a positive inotropic effect; inhibition of Na+, K+-ATPase and binding with anti-digoxin antibodies. The result of this last property, when immunological methods are used to calculate the levels of digoxin, is that significant concentrations of "apparent digoxin" seem to be present although neither the mother nor the newborn child have received any digoxin. We describe the existence of concentrations of the "apparent digoxin" found in 37 cord sera using two radioimmunological methods. In the one, the concentrations were 0.88 +/- 0.20 nmol/L, and in the other 0.17 +/- 0.10 nmol/L. These results emphasize the significant differences obtained when the two methods are used for calculating levels (p less than 0.01). There was no significant variation as far as the geographical origin, the sex of the infant and associated therapy carried out at the delivery. The nature of the interference is not yet known. It could be due to natriuretic hormones or steroids. Its existence gives rise to numerous problems: the physiological role, the validity of pharmacokinetic studies and the control of treatment with digoxin in pregnant women and in the newborn.

[Drug addiction and pregnancy. Principal obstetrical and pediatric complications]. / Toxicomanie et grossesse. Principales conséquences obstétricales et pédiatriques.

The principal obstetrical and paediatric sequelae were studied in 22 heroin addicts who were followed up at Lariboisière Hospital in Paris between 1980 and 1984. The main effects were on the fetus with 45% showing growth retardation below the 10th percentile, 65% fetal distress, 9% prematurity; 33% had infections and 66% had the withdrawal syndrome. Because of this pathology a high number had to be transferred. Considering the period of study, HIV infection could not be evaluated. The most dramatic result seems to be the long-term effect on these children because only a third apparently live with their families and several suffer from abnormalities in psychomotor development.

[Arterial embolization of uterine myoma: results apropos of 286 cases]. / Embolisation artérielle des myomes utérins.

OBJECTIVE: Report outcome in non-surgical treatment of symptomatic uterine myomata by particulate arterial embolization. PATIENTS: and method: Two hundred eighty-six women aged 21 to 53 years with symptomatic uterine fibroids initially programmed for surgery were studied. The size and number of myomata were determined by pelvic ultrasound. After retrograde transfemoral introduction of a 4 French catheter, the left and right uterine arteries were successively catheterized. PVA particles were injected by free flow until devascularization. RESULTS: Two hundred sixty-two patients were evaluable. Complete resolution of symptoms was obtained in 245 cases. There were 17 failures. A marked reduction in the size of the myomata was observed (60% at six months). Hemorrhage disappeared in 80% of the cases immediately. Thirteen pregnancies were observed. No recurrence were observed. Complications were rare. CONCLUSION: Particulate embolization is a new minimally invasive treatment for uterine myomata which provides a alternative to hysterectomy and can replace myomectomy in young women.

[Assay of plasma hCG. Our experience with the diagnosis of extra-uterine pregnancies. Apropos of 45 cases]. / Dosage de hCG plasmatiques. Notre expérience dans le diagnostic des grossesses extra-utérines. A propos de 45 observations.

Two groups of patients who were admitted to hospital with a possible diagnosis of ectopic pregnancy were compared. The levels of HCG in the plasma were obtained as an emergency in the first group (45 cases). The levels were not obtained in the second group (34 cases). Only those cases in the first group where the assays had shown the presence of HCG underwent laparoscopy: 12 laparoscopies revealed 7 extra-uterine pregnancies. In the second group, on the other hand, all 34 patients had laparoscopy; only 8 extra-uterine pregnancies were discovered by this method. Because of this study we found that when HCG assays were carried out there was no false positive or negative. When we wanted to rule out an L.H. peak in a doubtful case the assay was repeated. The comparison between the two groups underlines the importance of carrying out the assay: it avoids useless laparoscopies but it also shortens the length of stay in hospital.