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D Glinoer

Publications and source records attributed to D Glinoer.

At least 73 records · Page 4Linked to original sources
PubMed1988

Original acquisition in the pathogenesis and the treatment of endocrine ophthalmopathy.

In the present work, we demonstrate in the serum of patients with progressive exophthalmos, the presence of circulating immunoglobulin which is able to induce an experimental exophthalmos in goldfish. This immunoglobulin disappears when exophthalmos becomes residual. In parallel, we describe an easy technique for the measurement of delayed hypersensitivity which is positive for thyroid or retroorbital antigens in progressive exophthalmos but negative in residual exophthalmos. We also demonstrate in patients with exophthalmos an increase in urinary glycosaminoglycans. We propose a new therapeutic approach in treatment of acute exophthalmos which consists of intensive plasma exchange followed during a few months, by the administration of small amounts of corticosteroids. The plasma exchange mechanism consists of the extraction of the antibody directed against retroorbital eye muscle antigen. In addition, plasma exchange produces the extraction of glycosaminoglycans from retroorbital tissue. These hygroscopic molecules are responsible for the marked oedema in retroorbital tissue.

Adult↗
PubMed1988

Beneficial effects of intensive plasma exchange followed by immunosuppressive therapy in severe Graves' ophthalmopathy.

Nine patients with severe Graves' ophthalmopathy were treated by intensive plasma exchange, followed by immunosuppression. Severity of ocular involvement and response to therapy were evaluated by numerical scoring (ophthalmopathy index) and clinically. Serum thyroid stimulating immunoglobulins (TSI) and urinary excretion of glycosaminoglycans (GAG) were measured immediately before and immediately after plasmapheresis. Plasma exchange was rapidly accompanied by marked clinical improvement in 8/9 patients. The most marked effects were on soft tissue involvement, proptosis, intraocular pressure, and visual acuity. The ophthalmopathy index decreased from 9.7 +/- 4.1 to 5.7 +/- 2.2 (p less than 0.001) after plasmapheresis. Serum TSI levels were initially elevated in 6 patients and remained positive in 3 patients after treatment. Urinary GAG excretion was initially 2- to 12-fold normal levels and was decreased by 60%. After plasmapheresis, patients received immunosuppressive drugs for 3-6 months. The follow-up period, after withdrawal of drugs, ranged from 5 to 38 months with a median of 17 months. The ocular condition remained stable in 6 patients. Three patients had a relapse 1 year after plasmapheresis: they were treated a second time by plasma exchange with subsequent improvement. In conclusion, intensive plasma exchange provided prompt and effective improvement in patients with severe progressive Graves' ophthalmopathy. This therapeutic procedure, followed by immunosuppression, gave long lasting results. Relapses were responsive to plasmapheresis therapy. The data suggest that plasma exchange may represent the best primary treatment for severe progressive Graves' ophthalmopathy.

Adult↗
PubMed1987

Abnormalities of esophageal transit in patients with sporadic nontoxic goitre.

Esophageal transit (E.T.) was investigated in 122 consecutive euthyroid patients with scintigraphically proven goitre, and compared to 26 control subjects. E.T. was quantified using the 81mKr transit time, a highly sensitive technique capable of detecting even minor E.T. disorders. Abnormal E.T. was observed in 39% of goitrous patients, while it was normal in all controls. Occurrence of delayed E.T. was not correlated with either goitre firmness, the presence of symptoms of neck discomfort, difficulties in swallowing, or nodularity. E.T. delay was more frequent and more severe with larger goitres. In addition, E.T. delay was significantly correlated with asymmetry and "low lying" goitres. In summary, the present studies are the first demonstration of frequent E.T. anomalies in goitrous patients. The data suggest that E.T. impairment could be mediated by two mechanisms: a direct compression effect in patients with large, asymmetrical, partially retrosternal goitres; and an indirect functional esophageal anomaly in patients with small goitres.

Adolescent↗
PubMed1987

Cold thyroid nodules in childhood: is surgery always necessary?

In children who present with a cold thyroid nodule the current recommendation is that surgery immediately be performed in view of the high probability of thyroid cancer. Because the incidence of thyroid cancer in children may be decreasing and because extensive experience has been gained in adults with thyroid echography and fine-needle aspiration cytology, we evaluated three consecutive children with cold thyroid nodules by means of these non-surgical techniques. The diagnoses were: thyroid cancer in one patient, thyroid abscess in one and haemorrhagic cyst of the thyroid in one. In the latter two patients, fine-needle aspiration was both diagnostic and therapeutic. We conclude that thyroid echography and fine-needle aspiration of thyroid nodules deserve more extensive evaluation in the paediatric age group.

Adolescent↗
PubMed1987

Plasma exchange therapy for severe Graves' ophthalmopathy.

The authors report on the treatment of 11 Graves' disease patients with severe ophthalmopathy by the use of intensive plasma exchange followed by immunosuppression. Results were evaluated by comparing the ophthalmopathy index and the orbital CT scan performed before and after plasmapheresis. Favorable results were obtained in 91% of the patients. The best positive effects of plasmapheresis were observed for soft tissue involvement, proptosis, tonometry, and visual acuity. Furthermore, a significant reduction in the size and density of enlarged extraocular muscles was also found. Six months after withdrawal of immunosuppression, 4 patients presented a moderate recurrence of ophthalmopathy and were treated successfully by a second course of plasmapheresis, followed by short immunosuppression. In conclusion, the use of intensive plasma exchange associated with immunosuppression is an effective approach to the treatment of severe Graves' ophthalmopathy. It yields rapid and dramatic improvements that are maintained in most patients after withdrawal of immunosuppression. Recurrences are still responsive to the beneficial effects of this combined treatment.

Combined Modality Therapy↗
PubMed1986

In vitro effects of thyroid hormones on red blood cell Ca++-dependent ATPase activity.

Thyroid hormones (TH) have been shown to exert a direct stimulatory effect on the Ca++-dependent ATPase from human and other mammalian erythrocytes. In this in vitro system, T4 has been shown to be more effective than T3. In the present study, TH effects on Ca++-dependent ATPase were investigated, using rabbit and human erythrocyte membranes, after preincubation with 10(-10) M T4, in the presence or in the absence of exogenous calmodulin (CaM) (5.10(-12) M to 5.10(-9) M). Ca++-dependent ATPase activity was measured as inorganic phosphate (Pi) release from 1 mM ATP. The results showed that basal Ca++-dependent ATPase activity in rabbits was moderately increased by T4 (1.44 +/- 0.05 vs 1.32 +/- 0.04 mumol Pi/mg protein/90 min, mean +/- SE; p less than 0.05). The time course of Pi release did not show any stimulatory effect of T4 during the first hour of incubation. The effect of T4 became apparent, however, 1 h after the addition of ATP (delta T4: 15%). With human membranes, T4 induced a relative stimulation of the Ca++-dependent ATPase of 8-10% (p less than 0.05) in experimental conditions where the enzyme was not maximally stimulated by CaM (delta CaM over basal activity: 5-40%). In conditions of high CaM stimulation (delta CaM: 50-320%), T4 had no effect. These results confirm that Ca++-dependent ATPase activity is increased by T4. The effect of T4 is small, and appears as a late event during incubation with ATP. Stimulation by T4 is expressed in states of low enzyme activation by CaM.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Beneficial effects of intensive plasma exchange followed by immunosuppressive therapy in severe Graves' ophthalmopathy.

Nine patients with severe Graves' ophthalmopathy were treated by intensive plasma exchange, followed by immunosuppression. Severity of ocular involvement and response to therapy were evaluated clinically by numerical scoring (ophthalmopathy index). Serum thyroid stimulating immunoglobulins (TSI) and urinary excretion of glycosaminoglycans (GAG) were measured immediately before and immediately after plasmapheresis. Plasma exchange was rapidly accompanied by marked clinical improvement in 8/9 patients. The most marked effects were on soft tissue involvement, proptosis, intraocular pressure, and visual acuity. The ophthalmopathy index decreased from 9.7 +/- 4.1 to 5.7 +/- 2.2 (P less than 0.001) after plasmapheresis. Serum TSI levels were initially elevated in 6 patients and remained positive in 3 patients after treatment. Urinary GAG excretion was initially 2- to 12-fold normal levels and was decreased by 60%. After plasmapheresis, patients received immunosuppressive drugs for 3-6 months. The follow-up period, after withdrawal of drugs, ranged from 5 to 38 months with a median of 17 months. The ocular condition remained stable in 6 patients. Three patients had a relapse 1 year after plasmapheresis: they were treated a second time by plasma exchange with subsequent improvement. In conclusion, intensive plasma exchange provided prompt and effective improvement in patients with severe progressive Graves' ophthalmopathy. This therapeutic procedure, followed by immunosuppression, gave long lasting results. Relapses were responsive to plasmapheresis therapy. The data suggest that plasma exchange may represent the best primary treatment for severe progressive Graves' ophthalmopathy.

Adult↗