[Pelvic muscular metastasis of well differentiated thyroid carcinoma]. / Métastase pelvienne intramusculaire d'un carcinome différencié de la thyroïde.

Authors report on a case of one intramuscular metastasis from a non-medullary differentiated thyroid carcinoma. Muscular metastasis are rare in this pathology. Moreover, body-scanning scintigraphic interpretation is difficult for the pelvic area. False-positive are numerous and a very precise topographical diagnosis is required to choose the best surgical approach. Authors propose a specific management of different imaging methods for such a metastatic site. They associate a CT scan and a multiplanar iodine and technetium scintigraphy.

Can tumour marker assays be a guide in the prescription of bone scan for breast and lung cancers?

Considering the current need to improve cost-effectiveness in cancer patient management, a prospective study was undertaken in order to define the optimal combination of bone scan and tumour marker assays in breast and lung cancer strategies, as has been done in the case of prostate cancer. All patients with breast or lung cancer referred to the Nuclear Medicine Department of the Grenoble Teaching Hospital between December 1995 and April 1997 were included. A blood sample was drawn in each case for marker assay (CA15-3 or CEA and CYFRA 21-1) on the same day as the bone scan. Two hundred and seventy-five patients were included: 118 with lung cancer and 157 with breast cancer. With regard to lung cancer, no information useful for guiding bone scan prescription was obtained through CEA and CYFRA 21-1 assays. For breast cancer, the results suggest that in asymptomatic patients, a CA15-3 level of less than 25 U/ml (upper normal value chosen as the threshold) is strongly predictive of a negative bone scan; by contrast, high tumour marker levels are predictive of neoplastic bone involvement. When a doubtful bone scan is obtained in a patient with breast cancer, a normal marker level makes it highly probable that bone scan abnormalities are not related to malignancy.

Pre-adaptation, adaptation and de-adaptation to high altitude in humans: hormonal and biochemical changes at sea level.

High altitude residence is known to modify body biochemistry and hormone status. However, the effects of such a sojourn on these status observed at sea level both immediately and later after return are not as well established as are the effects of an intermittent acclimation. The aim of this study was therefore to investigate these changes. To achieve our objectives, nine subjects received intermittent acclimation at low pressure in a barometric chamber (8 h daily for 5 days, day 1 at 4500 m, day 5 at 8500 m) before an expedition to the Himalayas. Hormonal and biochemical changes were studied using samples of venous blood taken at sea level before and after acclimation, after return from the expedition and 1 and 2 months after descent. Concentrations of thyroid hormones, adrenaline, noradrenaline (NA), hormones of hydromineral metabolism (aldosterone, renin, arginine vasopressin, atrial natriuretic peptide) as well as prolactin, cortisol, insulin and endothelin 1 were measured. Biochemical measurements made were plasma osmolality, and concentrations of glucose, total cholesterol, total proteins, pre-albumin, transferrin, complement 3C, apolipoproteins A1 and B and serum iron. Acclimation induced no alteration in hormone (except for NA with increases of about 1.5, fold P < 0.05) and biochemistry data. After the expedition, hormone responses were characterized by a higher total triidothyronine concentration (+18%, P < 0.05) while other hormones did not vary. A linear relationship was found between thyroid-stimulating-hormone and body mass changes after the expedition (r = 0.67, P < 0.05). The observed increased concentrations of plasma proteins and total cholesterol (P < 0.05) could be related to the restoration of lean body mass. At 1 and 2 months after return, no changes in hormones were observed but a significant decrease in transferrin concentration was noticed. The higher serum iron concentration reported after 1 month (P < 0.05) could have been the result of a physiological haemolysis. It was concluded that both acclimation and the expedition in the Himalayas affected hormone status and body biochemistry status even though the observed changes were slight and rapidly reversed.

[Diagnostic value of renal scintigraphy with MAG 3 and DTPA in the diagnosis of renal artery stenosis]. / Valeur diagnostique des scintigraphies au DTPA et au MAG 3 dans le dépistage des sténoses rénales.

UNLABELLED: Angiography still remains the first line investigation to demonstrate a renal artery stenosis. We have evaluated the sensitivity and the specificity of renal scintigraphy in the diagnosis of renal artery stenosis using two technetium markers, MAG 3 and DTPA. PATIENTS: 45 hypertensive (HT) patients (WHO criteria) referred for investigation of renovascular hypertension according to the criteria of the AHA Scientific Council and were found to have a unilateral renal artery stenosis of varying severity. Age was 61 > +/- 13 years; sex-ratio F/M 21/24; creatinine < 150 mumol/l. There were non insulin dependent diabetics, and none had been treated with ACE inhibitors or diuretics for 15 days. Bilateral arterial stenosis was excluded a posteriori. METHODS: MAG3 and DTPA scintigraphy were performed one hour after a dose of 25 mg of captopril plus hydration with 500 ml of intravenous saline. Blood pressure was measured by dynamap every 15 min from minus one hour to the end of the study. The principle outcome measure was nephorgram phase and the secondary measure was the angiographic phase (two images per second). The two scintigraphy techniques were performed at a mean interval of 2.9 +/- 2.1 days. Digitized angiography via the arterial route was performed using left anterior oblique and right anterior oblique images. RESULTS: [table: see text] CONCLUSION: There was only one false positive scintigraphy result with a polar artery. In contrast 45% of unilateral stenoses were not diagnosed by scintigraphy. Both markers gave similar results even if subjectively the MAG3 images were of better quality. Analysis of the angiographic phase and of the size of the kidneys did not improve the diagnostic accuracy and could lead to false positive results.

Hypothermic general cold adaptation induced by local cold acclimation.

To study relationships between local cold adaptation of the lower limbs and general cold adaptation, eight subjects were submitted both to a cold foot test (CFT, 5 degrees C water immersion, 5 min) and to a whole-body standard cold air test (SCAT, 1 degree C, 2 h, nude at rest) before and after a local cold acclimation (LCA) of the lower limbs effected by repeated cold water immersions. The LCA induced a local cold adaptation confirmed by higher skin temperatures of the lower limbs during CFT and a hypothermic insulative general cold adaptation (decreased rectal temperature and mean skin temperature P < 0.05) without a change either in metabolic heat production or in lower limb skin temperatures during SCAT after LCA. It was concluded that local cold adaptation was related to the habituation process confirmed by decreased plasma concentrations of noradrenaline (NA) during LCA (P < 0.05). However, the hypothermic insulative general cold adaptation was unrelated either to local cold adaptation or to the habituation process, because an increased NA during SCAT after LCA (P < 0.05) was observed but was rather related to a "T3 polar syndrome" occurring during LCA.

Thyroid hormone changes in a cold air environment after local cold acclimation.

Serum thyroid hormones (TH) and internal temperatures were investigated in 8 euthyroid men during a general standard cold air test (SCAT) (dry bulb temperature = 1 degree C, 2 h, nude, at rest) performed both before and after a local cold acclimation. Serum total thyroxin (TT4), total triiodothyronine (TT3), free thyroxin (FT4), free triiodothyronine (FT3), and thyrotropin (TSH) were studied during the SCT. The TH values were corrected following the plasmatic volume reduction (delta PV) calculated with Dill and Costill's formula. During SCAT, delta PV reached -9 to -11% (P < 0.05) without any effect of local cold acclimation. Slight TH changes were observed according to delta PV: TT4, TT3, and TSH increased during SCAT (P < 0.05) only before correction. FT4 and FT3 did not vary before correction but increased after correction (P < 0.05). After acclimation, a slightly decreased TT3 was observed both before and after correction (-18% and -11.7%, respectively; P < 0.05). Decreased internal temperatures after local cold acclimation suggested a hypothermic general cold adaptation. It was concluded that TH changes during SCAT differed if correction due to delta PV was applied and that the slight decrease in TT3 observed after local cold acclimation could suggest the presence of a "T3 polar syndrome."

[Induction of a "triiodothyronine polar syndrome" in man under laboratory conditions]. / Induction d'un "syndrome polaire de la tri-iodothyronine" en laboratoire chez l'homme.

To precise the thyroid hormonal changes (TH) during an acute cold exposure, 8 subjects were subjected to a cold air test (2 h, 1 degrees C nude, at rest) in a climatic chamber before and after a local cold acclimation. After cold acclimation the thyroid hormonal changes could suggest the presence of a "T3 polar syndrome" in laboratory conditions. This syndrome was up to now described only after a stay in natural cold environment.

[Barrett's esophagus, gastroesophageal acid reflux and duodenogastric reflux during the digestive and postprandial period]. / Endobrachyoesophage, reflux gastro-oesophagien acide et reflux duodénogastrique en période inter-digestive et post-prandiale.

Pathologic gastroesophageal acid reflux appears to be involved in the pathogenicity of Barrett's esophagus. The possible pathogenic role of duodenogastric reflux, however, has been suggested by several studies. The aim of this prospective study was to assess the prevalence of acid or duodenogastric reflux in patients with Barrett's esophagus. Nine patients with histologically proven Barrett's esophagus (mean length: 7.7cm; range: 2-13 cm) were studied by esophageal manometry and 24 hour pHmetry. Duodenogastric reflux was measured in the interdigestive period by aspiration and during the postprandial period using an isotopic method. The results of these different investigations were compared with healthy volunteers (n = 20 to 27). Three patients had complicated Barrett's esophagus (Barrett's ulcer: n = 2, high-grade dysplasia: n = 1). The results of the different investigations showed that a) all patients had abnormal acid exposure and an esophageal motor dysfunction (decrease in lower esophageal sphincter pressure, amplitude and duration of contractions and increase in percentage of peristaltic dysfunction); b) none of the patients had any pathologic duodenogastric reflux neither in the interdigestive nor in the postprandial period. These results a) confirm the high prevalence of acid reflux in patients with Barrett's esophagus, b) show that bile or pancreatic secretions are not involved in the pathogenicity of Barrett's esophagus.

Immunoscintigraphy using 111In-labeled F(ab')2 fragments of anticarcinoembryonic antigen monoclonal antibody for detecting recurrences of medullary thyroid carcinoma.

The only current possibility for curing medullary thyroid carcinoma (MTC), especially recurrences, is total surgical removal. Early positive diagnosis of recurrences is now possible by monitoring tumor markers such as thyrocalcitonin and carcinoembryonic antigen (CEA). However, preoperative topographic diagnosis of such recurrences remains an unresolved problem. Immunoscintigraphy (IS) using an anti-CEA monoclonal antibody is a new approach that complements morphological imaging, i.e. ultrasonography, computerized tomography, and magnetic resonance imaging. In this study, IS by means of an 111In-labeled anti-CEA monoclonal antibody F(ab')2 was performed nine times in eight patients. True positives were obtained five times (one case of cervical involvement confirmed by surgery, three cases of mediastinal involvement confirmed by computerized tomography, magnetic resonance imaging, and surgery, and one case of bone metastasis, one of them was revealed neither by x-ray nor by conventional bone scan). The remaining four tests gave a false positive, a true negative, a probably false negative, and one unconclusive result. We conclude that IS is helpful in diagnosing sites of MTC recurrence and should accompany other examinations in the evaluation of lesions.

Scintigraphic study of gallbladder emptying and duodenogastric reflux during non-ulcerous dyspepsia.

Cholescintigraphy with technetium 99m hydroxy imino diacetic acid (99mTc-HIDA) was used to study gallbladder emptying (GE) and duodenogastric reflux (DGR) simultaneously during the postprandial period in humans. Two groups of subjects were examined prospectively; one was a group of healthy volunteers (n = 14) and the other a group of patients with non-ulcerous dyspepsia (NUD) (n = 22). Symptoms were quantified using a clinical score (CS). GE kinetics was quantified according to two indices. DGR episodes were detected by an image-subtraction method and quantified. The group of patients with NUD showed significant early acceleration of GE (P less than 0.01). One DGR episode equivalent to 1% of the injected dose was observed in 1 of the 14 control subjects, and greater than 1% in 3 of the 22 NUD patients. However, there was no correlation between the CS, GE kinetics and DGR episodes. The physiopathological mechanism and clinical significance of these digestive motility anomalies remain to be demonstrated.

Scintigraphic study of duodenogastric reflux. Value of a computerized image-subtraction method.

Duodenogastric reflux (DGR) could be implicated in several esophageal and gastric diseases. Establishing its pathophysiological role however is difficult because of the problems in the demonstration and quantification of DGR episodes. The aim of this study was to improve a scintigraphic method of detection and quantification of DGR episodes during the postprandial period in man. The study was carried out in 14 control subjects (7 males and 7 females, median age = 25 years, range: 22-35 years). As scintigraphic recording was continuous during 150 min, all DGR episodes were revealed. In order to improve visual detection of DGR episodes, images were treated by a computerized image subtraction method. The visual detection limit of DGR episodes determined by comparison to test images was 0.6 p. 100 of the dose injected intravenously or 17 microCi. A DGR episode was demonstrated in one of the 14 control subjects. The quantity of refluxed liquid was estimated, in this case, at 30 microCi, and the duration of the reflux greater than 2 min. Continuous scintigraphic recording in association with a computer based technique of image subtraction seems to improve scintigraphic performance in the study of DGR episodes under pathological conditions.

[Tumors of the organ of Zuckerlandl. Diagnostic approach apropos of 2 cases]. / Tumeurs de l'organe de Zuckerkandl. Démarche diagnostique à propos de 2 cas.

We report 2 cases of both functional and non functional paragangliomas. Emphasis is put on preoperative localization. CT along with echography is recommended as the initial radiographic procedure. If the tumor is not detected or in case of multiple tumors, a scintigram using MIBG is performed as a second still difficult to define. This feature is of importance in the long term follow up.

Effect of parenteral nutrition on muscle amino acid output and 3-methylhistidine excretion in septic patients.

The effects of adequate total parenteral nutrition (TPN) on nitrogen excretion, urea N percentage, 3-methylhistidine excretion, and leg amino acid output, were studied during the ten-day period following abdominal surgery for generalized peritonitis in nine patients. The first two postoperative days were without nutritional intake, TPN was started on the third postoperative day (57 cal/KgBW--40% as Intralipid--0.30 g of N/KgBW). Leg amino acid outputs were done before TPN (DO), then two days (D2) and eight days (D8) after TPN. Total nitrogen and urea N percentage did not significantly differ before and after TPN. Between DO and D2 there was a significant reduction of urinary 3-methylhistidine (467 +/- 37 to 280 +/- 29 mumol/24 h-P less than 0.001) and leg amino acid release (604 +/- 103 to 254 +/- 87 nmol/mn/100 g of calf muscle--P less than 0.01) reflecting reduction in muscle hypercatabolism despite the persistence of the septic state. Between D2 and D8, 3-methylhistidine remained stable while leg amino acid release continued to decrease (254 +/- 87 to 68 +/- 40 nmol/mn/100 g--P less than 0.05). This association suggests an increased muscle protein synthesis. A closer examination of the clinical evolution of these patients, especially concerning their septic evolution, shows that only improved patients with recovery from sepsis increased their muscle protein synthesis. Thus, in septic hypercatabolic patients TPN seems to be able to reduce muscle catabolism while the increase in protein synthesis is mainly the consequence of recovery from the septic state. In such patients TPN should be used as a preventive therapeutic measure.