Correlation of free thyroxine index and thyroxine: thyroxine-binding globulin ratio with the free thyroxine concentration as measured by the thyroxine and thyroxine-binding globulin radioimmunoassays.

The concentration of thyroxine-binding globulin in the serum can now be measured by a simple and specific radioimmunoassay. Triiodothyronine uptake and measurement of total thyroxine have been combined to yield a free thyroxine index which has been found to correlate with the clinical state of the patients. An estimate of the free thyroxine concentration, as measured by the thyroxine and thyroxine-binding globulin radioimmunoassays, provided a good correlation with the free thyroxine index and the thyroxine: thyroxine-binding globulin ratio. However, the thyroxine: thyroxine-binding globulin ratio is inaccurate when thyroxine-binding globulin concentrations are high or low.

[Pulmonary infection caused by a rare mycobacterium, Mycobacterium malmoënse]. / Infection pulmonaire due à une mycobactérie rare Mycobacterium malmoënse.

The present case report is on a patient treated for tubercle in 1949 by an artificial pneumothorax. Thirty three years after the initial illness some radiological changes occurred suggesting a recurrence, especially as a bacteriological examination showed the presence of acid-alcohol fast bacilli on direct smear. Triple therapy (Isoniazid, Rifampicin, Streptomycin) was then prescribed, and was followed by a radiological improvement, even though the sputum remained positive. After multiple seedings, it was possible to isolate from 11 tubes and 2 expectorations a rare strain of mycobacterium: mycobacterium malmoense. The present observation seems to be the first indisputable French case of infection by this bacterium. From the opportunity presented by this observation the bacteriological characteristic of this mycobacterium, as well as the clinic aspects of the infection are discussed.

[Mycobacterium xenopi infection in emphysematous bulla. Apropos of 4 cases operated on]. / Infection à Mycobacterium xenopi dans des bulles d'emphysème. A propos de 4 cas opérés.

The authors presented their observations of four patients who were operated on for a supra-infection of emphysematous bullae by Mycobacterium xenopi. In two cases the patients were operated on without a diagnosis and excision of the right upper lobe assured their cure. The other patient underwent a decortication and ultimately relapsed. The fourth had a bilateral apical infection and underwent bilateral excision. A survey of the literature leads one to think that pulmonary infections with a Mycobacterium xenopi occur in emphysematous bullae more often than is generally thought. The unreliability of the results of antituberculous drugs, the complications of treatment and the risks of recurrence after treatment are well known. Controlled surgical excision of the lesions, which is most often followed by a definitive cure, always merits consideration as part of the therapeutic arsenal.

[Pseudo-tumoral round atelectasis without known pleural history (apropos of 2 cases)]. / Les atélectasies rondes pseudo-tumorales sans antécédents pleuraux avérés (à propos de deux cas).

The authors recall two cases of round atelectasis without any known pleural past-record. The first showed, on successive X rays, an increase in size of the image. In the second case a pleural effusion occurred after the discovery of a round opacity. They stress the various small radiological signs as a way of including the etiology of a purely mechanical atelectasis among the difficult diagnosis of intraparenchymal round opacities.

[Sarcoid nodules of the skin at the site of venipuncture (author's transl)]. / Sarcoïdes cutanées aux points de ponction veineuse.

In a 56-year-old female patient with sarcoidosis, venipuncture for withdrawal of blood specimens resulted in the formation of a histologically confirmed sarcoid granuloma at the precise site of the puncture. Eight similar cases are reported in the literature. They concern women aged 37 on average and presenting with pulmonary lesions. The sarcoid nodules, large or small, occurred earlier at the sites of venipuncture than on visible scars. One may wonder whether the formation of these nodules could be due to a hypersensitivity reaction developing as a result of blood cells extravasation during an active phase of the disease.

[Use of radioimmunoassay of "thyroxine binding globulin" to determine the concentration of free plasma thyroxine]. / Application du dosage radio-immunologique de la "thyroxine-binding globulin" à la détermination de la concentration de thyroxine plasmatique libre.

A relationship is proposed for calculating the concentration of free serum thyroxine using the measured values of thyroxine and thyroxine-binding globulin total concentrations. This calculation has been performed on a population of 335 patients. A good discrimination of the different thyroid diseases has been obtained.

[Radioimmunoassay of serum thyroxin-binding-globulin in euthryoid subjects]. / Dosage radio-immunologique de la "thyroxine-binding-globulin" sérique chez les sujets euthyroidiens.

The authors have set up a thyroxine-binding-globulin radio-immunoassay in blood serum. The standard used has been determined by gravimetry, its maximal thyroxine-binding capacity is 0,96 mole of thyroxine per mole of TBG. Serum concentration of TBG has been measured in 159 euthyroid normals. The mean value of the concentration is 20 mg/l.

[Clinical aspect and actual frequency of bilateral squamous cell bronchial carcinoma with simultaneous revelation (author's transl)]. / Aspect clinique et fréquence actuelle des cancers bronchiques épidermoïdes bilatéraux a révélation simultanée. A propos de dix cas.

Clinical and physiopathological data about 10 cases of bilateral squamous cell bronchial carcinoma with simultaneous revelation, are reviewed. This clinical form is not rare, usually found by a systematic bilateral endoscopy. In these 10 cases, the clinical and radiological data did not allow to predict the diagnosis before the endoscopy. Physio-pathological mechanisms are not well established. Various hypotheses are propounded : air-way, blood or lymphatic metastases, simultaneous tumoral blossoming, superficial propagation, genetic factors intervention. For these 10 cases, the authors develop arguments for one or another of these mechanisms.

[Voluminous tracheal diverticulum. One case (author's transl)]. / Volumineux diverticule trachéal. A propos d'un cas.

A tracheal diverticulum, probably of congenital origin, was discovered accidentally during the course of a broncho-pulmonary affection. Diverticuli of the trachea are usually found during a simple systematic radiological examination, or when an established pulmonary condition is being investigated. Routine bronchography, alone, or associated with a tomograph, can be used to demonstrate its characteristics and precise location. Bronchoscopy may then be carried out in order to study the area surrounding the diverticular orifice more closely, and to establish the condition of its mucous lining. Several evolutive stages are involved in the pathogenesis of tracheal diverticuli, varying from a rudimentary bronchiole to megalotrachea, which, for many authors, is an autonomous condition because of its anatomical and pathological make-up, producing its own well-defined symptomatology.

Immunochemotherapy in 34 cases of oat cell carcinoma of the lung with 19 complete responses.

Thirty-four previously untreated patients with oat cell carcinoma of the lung were treated with a myelotoxic combination of cyclophosphamide, adriamycin, methotrexate, CCNU, and Corynebacterium parvum (regimen A) every 4 weeks, interspersed with a non-myelotoxic combination including bleomycin, vincristine, dehydroemetine, and Corynebacterium parvum (regimen B) weekly the other 3 weeks or when hematologic toxicity prohibited administration of regimen A. Hematologic toxicity was frequent but was never a serious problem except in two cases of profound leukopenia in which fatal supervening infection occurred. Nineteen patients in this series (56%) showed a complete response lasting from 4+ to 65+ months. Eight of these patients are still alive with a followup of 6+ to 65+ months. Nine patients (26%) showed a partial response (greater than 50%) lasting 1-10+ months. Only one patient in this group is surviving (10+ months). The overall response rate was thus 82%. It is concluded from this study that only a complete response has any significant effect on survival, the benefit of a partial response over no response being only slight. The results achieved are compared to those of available series in the literature and from this comparison strategic deductions for the treatment of oat cell carcinoma of the lung are made.

[Long-term results of a trial of short-term chemotherapy. French study 6.9.12]. / Résultats lointains d'un essai de chimiothérapie de courte durée. L'enquête française 6.9.12.

The relapse rate after short course chemotherapy is usually assessed by cases that are available for analysis, with a delay which rarely exceeds 3 years from the time of instituting therapy. This level may be disputed if too many are lost to follow up or non-compliers appearing late. To understand the true failure rate we strove to trace every patient in a trial carried out between 1969 and 1973, consisting of three groups of patients treated with the same chemotherapy: Isoniazid (450 mg/day), Rifampicin (600 mg/day) given every day but for differing durations: 6 months (Group A), 9 months (Group B), 12 months (Group C), with either daily Ethambutol or Streptomycin in addition for the first three months. Amongst the 356 patients in the trial 86 were eliminated for failure to comply with the protocol, either due to a mishap or change of treatment. Amongst the 270 remaining patients, 248 were traced with a mean delay of post-therapy follow up of 101 months for patients still living and of 72 months for patients who had died in the intervening period, but of non-tuberculous disease. In the 242 old patients whose disease could be evaluated, the number of bacteriological relapses was 4/81 (6.2 %) in group A, and 2/85 (2.3 %) in group B and 2/76 (2.6 %) in group C. There was no significant differences between the groups. From these results it is seen that the Isoniazid/Rifampicin combination given daily for 6 months is a powerful combination with few failures. Maintaining such chemotherapy for 12 months does not seem to yield substantial gains. In conclusion nine months of chemotherapy with this regime offers a sufficiently ample guarantee of cure.