[Plasma tumor markers (calcitonin and carcinoembryonic antigen) in medullary thyroid cancers]. / Les marqueurs tumoraux plasmatiques (calcitonine et antigène carcino-embryonnaire) au cours des cancers médullaires thyroïdiens.

The authors have studied 43 patients operated on for medullary thyroïd carcinoma. Plasma calcitonin was measured regularly in all patients, while carcinoembryonic antigen assay was performed in only 30 patients. Calcitonin assay was found to be useful for preoperative diagnosis of medullary carcinoma, and the level of plasma calcitonin appeared to be roughly correlated with tumor extension. After surgery, simultaneous assay of calcitonin and carcinoembryonic antigen was performed, in order to obtain more accurate information concerning the evolution and prognosis of the disease. In most cases in which no metastatic lymph nodes had been discovered at operation, the level of the two markers rapidly fell to undetectable values. It was observed that in patients with lymph node involvement, cervico-mediastinal radiation treatment did not change the slow and progressive evolution of the disease. However, a rapid increase in titre of carcinoembryonic antigen occurred simultaneously with the discovery of metastases, even when calcitonin levels did not dramatically change.

[Dysthyroidism caused by amiodarone. Frequency and diagnosis]. / Dysthyroïdies par amiodarone. Fréquence et diagnostic.

The frequency of dysthyroidism during treatment with amiodarone makes it necessary to watch the thyroid gland, especially since that organ may apparently be intact in such cases. Clinical observation is insufficient owing to the patients's age and to the beta-blocking effect of amiodarone. Biochemical monitoring is accurate, but amiodarone-induced abnormalities without dysthyroidism (e.g. reverse T3 levels syndrome) must be taken into account. The key to the diagnosis lies in the study of free thyroid hormones (T3 and T4), notably the ultrasensitive TSH. It is possible, although not yet demonstrated, that measuring TSH levels might be sufficient.

[Abnormalities of insulin secretion in coronary patients. Apropos of 67 cases]. / Anomalies de la sécrétion d'insuline chez les coronariens. A propos de 67 observations.

The curve of blood insulin levels recorded during the oral provoked hypoglycaemia test (OPHG) was studied in 67 proven coronary patients. None of the curves obtained was normal. The abnormalities found in this way are of two types: either a hypoinsulinaemic response, with a high non-retarded peak (type 1) or a high retarded peak (type 2), or else a hypoinsulinaemic response, with a flat curve (type 3) or a very small late peak (type 4). The possible role of these abnormalities of insulin secretion in the pathogenesis of atheroma is discussed. The correlations between age, sex, obesity, hypertriglyceridaemia, and the OPHG curve are investigated. The preliminary results of a test in which insulin levels are monitored after intravenous provoked hypoglycaemia, followed by tolbutamide, are reported.

[Hypoparathyroidism in adults (author's transl)]. / L'insuffisance parathyroïdienne de l'adulte.

The authors studied the clinical characteristics of primary and post-operative hypoparathyroidism in 39 patients. Laboratory follow-up data were compared under two different treatment programs using either AT 10 or 25 Hydroxycholecalciferol (25 OHCC). Clinical analysis revealed the atypical characteristics of primary hypoparathyroidism. From a therapeutic standpoint, AT 10 and 25 OHCC were equally effective in provoking a return to normal plasma calcium levels, except in complex cases of vitamin D resistance. 25 OHCC proved much easier to manipulate than at 10 and offered a higher security with respect tothe risk of hypercalcemia. The biological activity of 25 OHCC seems to differ from that of AT 10, especially regarding phosphorus metabolism.

[Familial primary empty sella turcica. Apropos of a family with 3 cases]. / Selle turcique vide primitive familiale. A propos d'une famille comportant 3 cas.

Three members of a family, the father and two children, present a primary empty sella. The only clinical symptom is headache. The ophthalmologic examen, and the pituitary function are quite normal. No other anomaly is associated. This type of cases has never been published.

[Treatment of Grave's disease by radio iodine. Observation of 277 patients (author's transl)]. / Le traitement de la maladie de Basedow par l'iode radio-actif. Surveillance de 277 patients de l à 23 ans.

277 patients treated by radio iodine for Graves' disease were observed during a one to twenty three years period. 24 % relapse, always during the first three years. Hypothyroidism is ineluctable : 20 % from the first year and 3,4 % more each year. Goiter increases the delay for hypothyroidism occurrence. There is no linkage between hypothyroidism and radio iodine dose. Radio iodine does not cure graves' disease but give a "non hypo-non hyper" status, before secondary hypothyroidism.

[Action of 5-hydroxytryptophan on serum thyreostimulin and prolactin in primary hypothyroidism (author's transl)]. / Action du 5 hydroxytryptophane sur les taux plasmatiques de thyréostimuline et de prolactine dans l'hypothyroïdie primitive et chez le sujet normal.

Orally 5 HTP has significantly decreased serum TSH level in eight patients with primary non treated hypothyroidism, but not in five normal subjects. Serum T4 et T3 levels did not change and serum PRL did not increase in the two groups. These results indicate a possible inhibitory action of 5 HT on TSH regulation. Action of 5 HT on PRL has not been defined here.

[Minimal lipid anomalies in a group of men with early coronary disease compared to a control group]. / Anomalies lipidiques minimes dans un groupe d'hommes coronariens précoces comparé à un groupe témoin.

A group of 27 men with early coronary disease (mean age: 52 years) with cholesterol levels below 6.45 mmol/l and triglycerides levels below 2.3 mmol/l, who underwent a coronary angiography, is compared with a control group of 18 men (CG) with normal angiography. The only significant differences between the two groups are: a triglycerides levels slightly higher in the CM group (1.55 + 0.4 mmol/l) vs 1.18 +/- 0.37 mmol/l, p 0.001), a HDL-cholesterol level slightly lower in the CM group (1.08 +/- 0.19 mmol/l vs 1.26 +/- 0.21 mmol/l, p 0.01) and an Apo AI/Apo B ratio slightly lower in the CM group (1.02 +/- 0.24 vs 1.18 +/- 0.17, p 0.005). In the CM group, 21 patients in 27 present a lipid abnormality requiring, according to the European consensus recommendations, the prescription of hygieno-dietetic measures. In the CM group, 10 patients in 18 present a minimal lipid abnormality, also requiring hygieno-dietetic measures. These results are compared with the recommendations of the European consensus.

[Lipid indicators of vascular risk. A cross-sectional study of a group of coronary patients, a group of subjects with normal coronary angiography and a control group]. / Les marqueurs lipidiques du risque vasculaire. Etude transversale d'un groupe d'hommes coronariens, d'un groupe à coronaires angiographiquement normales et d'un groupe témoin.

During a transverse survey, 3 groups of men with the same weight and age were compared. Group I included 42 patients with coronary disease documented by coronarography, group 2 included 19 subjects with normal coronary angiograms, and group 3 included 27 healthy controls who had not undergone coronarography. Subjects presenting diabetes or any factor associated with secondary dyslipidemia or able to modify lipid levels were excluded from study. The following parameters were measured: total cholesterol (Chol), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), apoprotein A1 (apoA1), apoprotein B (apoB), lipoprotein (a) or Lp(a), fibrinogen, insulinemia and plasminogen activator inhibitor activity (PAI). The levels of chol, LDL-C and ApoB were the same in the 3 groups. The levels of TG, HDL-C, apoA1 and the ApoA-1/APoB ratio were significantly different between groups 1 and 2, on the one hand, and groups 1 and 3, on the other hand. The levels of Lp(a) and insulin were similar in the 3 groups. Fibrinogen levels were slightly higher in group 1 than in group 3. There was no significant difference between groups 1 and 2 with regard to any of the parameters. Subjects with angiographically normal coronary arteries and subjects with documented coronary disease exhibited similar lipid abnormalities. In this study, TG, HDL-chol, apoA1 and the apoB ratio were better predictors of cardiovascular risk than Chol, LDL-C or apoB.

[Thyroid nodules. Diagnostic value of fine-needle biopsy. 159 surgical patients]. / Nodules thyroïdiens. Valeur diagnostique de la cytoponction à l'aiguille fine. Cent cinquante-neuf malades opérés.

Between October 1980 and March 1983 we explored 269 patients who had one or several thyroid nodules with low or normal technetium 99 uptake. Each palpable nodule was aspirated 1 to 3 times, using a fine 21 G2 needle, and the aspirates were immediately spread on glass-plates and kept in alcohol-ether. After staining by the Harris- Shor method, all plates were examined by the same cytologist. Biopsies were unassessable in 50 patients (18%), mainly because they were entirely made up of red cells. Sixty patients did not undergo surgery. In the 159 patients operated upon, cytology was compared with histology which showed 139 benign and 20 malignant nodules. In 5 histologically benign nodules, cytology had shown nuclear abnormalities or enlarged cells suggestive of malignancy (false-positive results: 3.5%). Among 5 nodules diagnosed as benign at cytology, there were 2 papillary microcarcinomas , 2 to 4 mm in diameter, the course of which is little known, 1 well differentiated vesicular cancer extremely difficult to distinguish from vesicular adenoma, and 2 papillary cancers. Fine needle biopsy cytology is a harmless procedure, but it requires considerable experience on the part of cytologists. We consider that it should be performed in all cases of thyroid nodule, either to help in deciding whether or not to operate, or to guide the surgeon in deceding whether or not to operate, or to guide the surgeon in his operative strategy.