[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.

[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.

[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.

[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.

[Autoimmune thyroid diseases and Gougerot-Sjögren syndrome]. / Maladies thyroïdiennes autoimmunes et syndrome de Gougerot-Sjögren.

Thyroid autoantibodies have been found in 28 to 38 per cent of Sjögren's syndrome cases. In this study, we inversely investigated, the presence of Sjögren's syndrome antibodies in autoimmune thyroid diseases, ie rheumatoid factors, antinuclear soluble antigens SSB/La and SSA/RO, anti-salivary ducts. Results show no increased incidence of these antibodies in autoimmune thyroid diseases as compared to those of control subjects. So, no significant immune abnormality association is found between these two autoimmune disorders.

[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.

[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.

[A new thyrotoxicosis index. (Calculation Basis and applications)]. / Un nouvel index de thyrotoxicose. (Bases de calcul de applications).

A new thyrotoxicosis index (pointer) is calculated according to frequency of signs and symptoms in a well documented population of 189 thyrotoxicosis and pseudo thyrotoxicosis cross maintained patients. Applied to a computerized population of 3 596 thyroid complained patients, this index provides four groups. Index greater than equal to 8,5 : thyrotoxicosis is quite sure (92.5%), 8,5 less than equal to index less than equal to 5 : 3 of 5 patients are thyrotoxicosic 5 less than index less than -- 1 : 1 of 5 patients is thyrotoxicosic (rough thyrotoxicosis, index less than equal to -- 1 : thyrotoxicosis can be refuted (98%).

[A new thyrotoxicosis index (bases for calculation and applications)]. / Un nouvel index de thyrotoxicose (bases de calcul et applications).

A new thyrotoxicosis index (pointer) is calculated according to frequency of signs and symptoms in a well documented population of 189 thyrotoxicosis and pseudo thyrotoxicosis cross matined patients. Applied to a computerized population of 3 596 thyroid complained patients, this index provides four groups. Index greater than or equal to 8,5 : thyrotoxicosis is quite sure (92.5%), 8,5 less than or equal to index less than or equal to 5 : 3 of 5 patients are thyrotoxicosic 5 less than index less than - 1:1 of 5 patients is thyrotoxicosic (rough thyrotoxicosis), index less than or equal to - 1 : thyrotoxicosis can be refuded (98%).

[Treatment of primary hypothyroidism in adults : dosage schedule and biological surveillance (author's transl)]. / Traitement des hypothyroïdies primitives de l'adulte. Posologie et contrôle.

Hypothyroidism in a disease with a poor prognosis, especially as the disorder is often unrecognised, or is treated empirically and without adequate supervision. Modern biological tests can establish the diagnosis, even in subclinical cases, and can also ensure close supervision of dosage to avoid long-term adverse effects of too low or too high dosage regimens. The authors prefer dl thyroxine (dl T4) to other currently employed products : wide variations in triiodothyronine (T3) activity in thyroid extracts, short abrupt action of T3, frequent intolerance to combined T4/T3. The dl T4 (or T4 at half the dosage), a prohormone active after transformation into T3 in the organism, appears to be much more convenient in use. Dosage, usually overestimated, should be an average of 165-200 microgram of 1 T4 (5 to 6 drops of dl T4). It should be progressively reduced as a function of age (approximately 16 micrograms per decade), falling to 66 microgram/day (2 drops) over 80 years of age. Dosage must be temporarily reduced by 50 p. cent or more during acute affections. When first instituting treatment it is imperative to administer the product in stages - of two weeks in the young and of one month in elderly or debilitated patients - because of the long half-life (7 days) of T4. Initial dosage should be half the predicted final dosage in the young, and even less in the elderly. If these rules are respected, the association of beta-blocking agents, in particular, becomes of less and less value. Supervision by repeated biological tests is essential, clinical investigations detecting subclinical over - or under - compensated forms with difficulty. Modern biology has completely changed the classical rules, and often permits reduction of dosage and subsequent suppression of many adverse reactions. Equilibrium is reached when TSH levels become normal and T3 levels within normal limits. This often leads to T4 levels slightly higher than normal, as the concentrations of T3, the only active compound, are derived from plasma T4 and not, as in normal subjects, from the plasma T4 (70 p. cent) and the thyroid (30 p. cent). The TRH test, to detect markedly subclinical biological forms of hypo - or hyper - thyroidism, is only rarely necessary.