Stimulated salivary pertechnetate clearance revisited: correlation with dynamic scintigraphic indices in Sicca syndrome.

PURPOSE: The stimulated salivary clearance of Tc-99m pertechnetate (SSCP) introduced in 1985 by Blue and Jackson is revisited here in patients with known or possible salivary disorders and correlated with most commonly cited and up-to-date quantitative indices obtained from standard dynamic salivary scintigraphy. METHODS: An SSCP test was performed after dynamic salivary scintigraphy in 19 patients with oral or ocular dryness, among whom 7 had Sjögren's syndrome. Many scintigraphic indices were calculated: salivary to background ratio (S/B[t]), background-corrected uptake U[t]), maximal uptake (Umax), cumulative gland uptake (CGU), initial slope of the uptake curve (IS), stimulated excretion velocity (SEV), stimulated excretion fraction (SEF), and excreted activity (EA). RESULTS: The SSCP test was well tolerated, except in two patients in whom it had to be interrupted. Clearance values ranged from 5 to 40 ml/minute, with a clear-cut bimodal distribution centered around 15 to 20 ml/ minute. Six of the seven patients with Sjögren's syndrome had values less than 15 ml/minute. SSCP was closely correlated with all uptake indices (S/B, U, Umax, CGU, and IS) and uptake-related indices (EA, ISxSEF) (P < 0.01). A poor correlation was found with the excretion index SEV (P = 0.06) and none with SEF. CONCLUSIONS: SSCP is a quick and objective means to investigate the sicca syndrome that may be useful in most clinical situations. It reflects the parenchymatous salivary gland function and will provide a means to assess and predict salivary gland involvement. Dynamic salivary scintigraphy remains necessary in very early stages because of its high sensitivity rate and ability to locate the impaired gland, or in severe stages in which lemon juice could be deleterious.

[Sternal site of sarcoidosis]. / Localisation sternale d'une sarcoïdose.

Sarcoidosis is seldom revealed by bone lesions since these are almost exclusively seen in the chronic forms of an already diagnosed disease. We report a case of sarcoidosis where sternal lesions were the first to appear. The diagnosis was suggested by radiological findings and confirmed by the presence of other manifestations of sarcoidosis, notably lymph node involvement. Pain and functional impairment were such that we had recourse to corticosteroid therapy.

[Systematic ultrasensitive determination of thyroid-stimulating hormone in 50 cases of atrial fibrillation]. / Dosage ultrasensible systématique de la thyréostimuline dans 50 cas de fibrillation auriculaire.

The incidence of hyperthyroidism in patients with continuous arrhythmia due to atrial fibrillation was evaluated prospectively by means of the "ultrasensitive" assay of thyroid-stimulating hormone (TSH). When the result was abnormal, free thyroxine fractions (FT4) and free triiodothyronine fractions (FT3) were measured, and in some cases a thyrotropin-releasing hormone (TRH) test and a thyroid gland scintigraphy were performed. Among 50 unselected patients with continuous arrhythmia due to atrial fibrillation, 12 had a low TSH baseline level. In 7 of them, high FT4 and/or FT3 levels provided evidence of hyperthyroidism. In the remaining 5 patients FT4 and FT3 levels were normal, but TSH response to TRH was suppressed and scintigraphy showed a high nodular or lobular uptake. In a control series of 50 age- and sex- matched subjects without thyroid disorders or dysrhythmia, TSH level was low in only one case with insufficient response to TRH, but the scintigraphic image did not suggest nodular hyperthyroidism. It is concluded that systematic TSH assays can detect those atrial fibrillations which are consecutive to, or aggravated by hyperthyroidism, even asymptomatic. We regard this assay as indispensable to evaluate continuous arrhythmia due to atrial fibrillation, even when an apparently causative underlying heart disease is present.

[The ultrasensitive determination of TSH permits the prediction of the response to TSH in the TRH test]. / Le dosage ultra-sensible de TSH permet de prédire la reponse de TSH au test à la TRH.

A new ultrasensitive TSH immunoradiometric assay (IRMA) using two monoclonal antibodies is now able to distinguish between euthyroid and hyperthyroid patients. The aim of this study was to compare data given by ultrasensitive basal TSH (IRMA) and by the response of TSH to TRH test considered until now as the more reliable test in case of mild or atypical hyperthyroidism. Basal plasma TSH levels were determined in euthyroid (n = 80), hyperthyroid (n = 30), hypothyroid (n = 14) and pituitary deficient patients (n = 8) before and 30 minutes after a TRH test (250 micrograms i.v.). A close linear correlation was found between basal and post-stimulative TSH levels. Normal TSH response ranged from 2 to 22 uU/ml. The sensibility and the specificity of these two parameters appeared comparable in the case of primary dysthyroidism; on the contrary basal TSH levels were not sufficient for the diagnosis of central hypothyroidism. In conclusion, excepted for pituitary deficiency, basal plasma TSH (IRMA) levels are accurate and sufficient in the evaluation of the thyroid function and make the TRH-test useless.

[Study of salivary cortisol using radioimmunological assay. Diagnostic value]. / Etude du cortisol salivaire par dosage radio-immunologique. Intérêt diagnostique.

Salivary cortisol levels reflect the biologically active "free" fraction of blood cortisol. The authors describe the results obtained with the aim of a radio-immunoassay commercial serum cortisol kit, without prealable extraction in different physiological and pathological situations. Salivary cortisol determination appears performant both in nycthemeral studies and in stimulation or freination tests.