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J D Rain

Publications and source records attributed to J D Rain.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Measurement of ileal absorption of bile salts with the selenium 75 labelled homotaurocholic acid test. Validation and clinical significance].

OBJECTIVES AND METHODS: The performances and the clinical significance of a simplified version of the 75SeHCAT test which measures ileal absorption of bile salts were assessed in 23 healthy subjects and 106 patients. Corporeal retention of the marker was measured using an uncollimated gamma-camera. RESULTS: In healthy subjects, the 75SeHCAT retention was lower in the group of 9 with an osmotic diarrhoea induced by a PEG solution than in the group of 14 tested in normal conditions (22 +/- 4% vs 44 +/- 4%; P < 0.01). The reproducibility of the measure was good (r = 0.93; P < 0.001). The sensibility and specificity of the test for the diagnosis of ileal involvement were 79% and 90% respectively. Bile acid malabsorption was evidenced in 38% of patients with functional diarrhoea (59% and 28% in patients with and without previous cholecystectomy respectively; P < 0.02). In patients with fonctional diarrhoea, a correlation was evidenced between the orofaecal transit time and the 75SeHCAT retention (r = 0.66; P < 0.001) and cholestyramine improved diarrhoea in 8 out of 11 patients with 75SeHCAT malabsorption and in 2 out of 5 patients with normal test. These results show that the 75SeHCAT test is accurate and that bile acid malabsorption, frequently evidenced in functional diarrhoea, is correlated with an acceleration of intestinal transit.

Adult↗
PubMed1994

Risks and benefits of splenectomy in myelofibrosis: an analysis of 39 cases.

From 1980 to 1993, 39 splenectomies were performed in the Department of Visceral Surgery of Saint-Louis Hospital, in patients referred for myelofibrosis associated with myeloid splenomegaly. The short term morbidity was considerable: 33 serious haemorrhagic, infectious or thrombotic complications including 5 fatal accidents were observed in 18 patients. Severe thrombotic or infectious complications leading to 6 further deaths occurred in 8 patients over the two years following splenectomy, while six cases of acute leukaemia appeared between 6 months and 3 years after splenectomy. In 40% of cases with regular follow-up, the operation did not provide any haematological improvement and all these patients died. Only patients with minimally progressive or stable myelofibrosis and residual marrow activity in isotope studies showed an amelioration of general status with relief of pain and reduction of transfusional requirements. The indication for splenectomy should therefore probably be limited to such cases.

Adult↗
PubMed1994

Identifying abnormal parathyroid glands in the thyroid uptake area using technetium-99m-sestamibi and factor analysis of dynamic structures.

UNLABELLED: A rapid (25 min) single tracer scintigraphic method to localize parathyroid gland abnormalities was evaluated in 24 patients with hyperparathyroidism. METHODS: Scintigraphy was performed with 99mTc-sestamibi prior to surgery. A 25-min dynamic series centered on the neck was acquired immediately after injection of 99mTc-MIBI. Two planar static views were obtained after 1 and 2 hr. To identify abnormal parathyroid tissue in the thyroid uptake area, a factor analysis of dynamic structure (FADS) was applied to the dynamic acquisition. The results were compared to the analysis of the two planar static views. RESULTS: FADS demonstrated abnormal uptake of the tracer in the thyroid area for 26 of the 31 parathyroid glands found to be abnormal at surgery (5/6 adenomas, 21/25 hyperplastic glands). In three cases, FADS demonstrated parathyroid uptake despite the absence of parathyroid tissue at surgery. FADS revealed as specific and more sensitive than the visual analysis of the two static views, since only 13/30 glands were still visible after 1 hr, and 5/26 after 2 hr. Furthermore, a study with two static views was found to be less sensitive for the detection of hyperplastic glands. CONCLUSION: FADS99mTc-MIBI is performed in less time than existing scintigraphic protocols. It is a promising method to detect abnormal parathyroid glands in the cervical area with a single tracer.

Adenoma↗
PubMed1994

Induction of high-affinity GM-CSF receptors during all-trans retinoic acid treatment of acute promyelocytic leukemia.

Differentiation of normal myeloid cells is accompanied by the increase of high-affinity GM-CSF receptors necessary for progenitor proliferation/differentiation and mature neutrophil function. All-trans retinoic acid (ATRA) induces terminal differentiation of acute promyelocytic leukemia cells (AML3 subtype). We report in this study that AML3 cells, like other AML subtypes, harbor high-affinity GM-CSF R (n = 138.3 +/- 69.3 sites/cell, Kd = 76.9 +/- 68.8 pM). In all cases, incubation with ATRA induces either an increase in the number of affinity of GM-CSF R (n = 212.7 +/- 116.2 sites/cell, Kd = 43.2 +/- 22.5 pM). The data presented show that modulation of GM-CSF receptors cells is correlated to the degree of ATRA-induced granulocytic differentiation but not to increased cell growth.

Cell Differentiation↗
PubMed1994

Clinical and laboratory assessment and therapeutic problems in longstanding polycythaemia vera.

With the very long life expectancy of Polycythaemia Vera late complications are often observed: progressive resistance to treatment, bad tolerance to maintenance by phlebotomy, progression towards myelofibrosis. Resistance to phosphorus 32 is reflected by a progressive reduction in the duration of remission and by a gradually decreasing remission rate. A complete resistance appears after a mean duration of disease of 7 years. In the maintenance treatment by hydroxyurea, there is a secondary resistance in one third of cases with a poor control of the excess platelets. Resistance to Pipobroman is less frequent (10%). The phosphorus resistance could be delayed by addition of maintenance treatment by Hydroxyurea. In the presence of resistance to 32 P, Hydroxyurea and Pipobroman often remain effective. In the case of resistance to Hydroxyurea or Pipobroman, we have several possibilities: inversion of chemotherapy, other chemotherapy as Busulfan, 32 phosphorus. Intolerance of phlebotomy as baseline treatment is almost constant. Three complications lead to discontinuation of phlebotomy: development of cardiovascular complications, raised platelet count to above 800,000 and often more than 1 million, progressive increase in the size of the spleen with appearance of signs of myeloid splenomegaly. Exclusive phlebotomies are not indicated as baseline treatment of Polycythaemia Vera. The progression towards myelofibrosis (spent phase, post polycythaemia myeloid splenomegaly) increases with the duration of the disease and the frequency of transformation differs according to the type of treatment. The time to transformation is much shorter in the patients treated by phlebotomy. The transformation towards myelofibrosis is demonstrated by bone marrow biopsy and isotope investigations (bone marrow scintigraphy and kinetic by iron 59 and chromium 51).(ABSTRACT TRUNCATED AT 250 WORDS)

Bloodletting↗
PubMed1994

The mechanism of thrombocytopenia in patients with HIV infection.

From a retrospective analysis of 85 patients with thrombocytopenia and HIV infection, in whom platelet production and destruction were studied by isotopic methods, the following conclusions are drawn. In most recently infected patients thrombocytopenia is due to accelerated platelet destruction; in these patients the platelet sequestration is predominantly splenic, and splenectomy is usually effective. The same pattern is seen in approximately one third of patients with more advanced disease (i.e., those with AIDS-related complex or frank AIDS). In most patients with AIDS-related complex or AIDS, the thrombocytopenia is due chiefly to a platelet production defect; splenectomy is less likely to help and is thus generally inadvisable. When the patients who were receiving zidovudine were examined separately, they were found to have a lesser rate of platelet destruction but also to have a more prominent defect in platelet production defect. This suggests that the drug may help blunt platelet destruction but may do so at a price in marrow response to the thrombocytolysis.

Adolescent↗
PubMed1993

[Treatment of polycythemia with 32P with or without hydroxyurea maintenance therapy. Preliminary results in 237 elderly and high vascular risk subjects studied since 1980].

Between 1980 and 1992, 237 polycythaemic patients aged 65 or more, or with high vascular risk factors were treated with 32P according to a protocol using, or not, maintenance therapy with low-dose hydroxy-urea (500 mg/day). The present follow-up covers 1448 years/patient. Maintenance therapy was seldom discontinued because of blood toxicity or gastrointestinal intolerance, but it was stopped in 20 percent of the cases because monitoring was difficult in very old patients. Maintenance therapy reduced the mean annual 32P dose by at least 50 percent. However, the actual risk of malignant blood diseases (myelodysplasia, acute leukaemia, lymphoma) was similar in the two arms of the protocol: 14 percent at the 10th year. Compared with the French population of the same age-groups, there was no excess of epithelial cancers in both arms. Maintenance therapy did not control platelet counts perfectly. The risk of severe vascular events was identical in both arms; probably no higher than expected at that age and significantly lower than in previously published data. The actuarial survival curves in both groups showed a 50 percent survival of about 11 years, i.e. very near to that of the reference French population (12.5 years) of similar sex and age.

Age Factors↗
PubMed1993

[Bone marrow scintigraphy. Contribution to the diagnosis and the prognosis of myelofibrosis].

During the last three years 77 patients with myelofibrosis were studied by scintigraphy, using 99m Tc colloids and 111 In transferrin as tracers. Low axial uptake of the colloids, extension of the indium uptake beyond the axis towards the knees and sometimes the ankles and elbows, and splenic indium uptake are valuable diagnostic criteria, particularly useful to exclude myelofibrosis associated with a malignant disorder. The clinical severity of the disease, and in particular the disappearance of a physiologically active bone marrow (indium uptake) can be predicted from isotopic studies. Bone marrow scintigraphy could contribute to the difficult decision of splenectomy.

Adult↗
PubMed1993

[Gallium-67 scintigraphy in malignant lymphoma].

The presence of a residual mass is a frequent and difficult problem in the treatment of Hodgkin's or non-Hodgkin's lymphoma: since it is of major importance to determine whether the lesion is a fibrous mass or a still progressing tumour requiring additional therapy. Gallium-67 scanning, performed in a series of 52 patients, provides an answer to this question since there is an excellent correlation between gallium uptake by the tumoral masses and their progressiveness. Magnetic resonance imaging was carried out in half of our patients: the finding of a low-intensity signal on T2-weighted sequences proved that the residual mass was fibrous, whereas a high-intensity signal on T2-weighted sequences did not distinguish between fibrous and tumour masses. The priceless information provided by the simple and non invasive method that is gallium scanning is extremely useful to evaluate the extension of lymphomas and to determine whether residual masses are tumoral or fibrous.

Adult↗
PubMed1993

Platelet production in idiopathic thrombocytopenic purpura.

522 patients with chronic thrombocytopenia were studied over a period of three years. 252 of them suffered from idiopathic, acquired, thrombocytopenic purpura with excessive platelet destruction (platelet count less than 50,000 and mean survival less than 3 days). All of these cases were studied by using Indium oxinate labelled autologous platelets. The essential finding in these cases was the absent or only slight reactive hyperproduction, regardless of age and regardless of the severity of platelet destruction. No significant modification in platelet production was observed in the presence or in the absence of anti-platelet antibodies. No significant difference in the haematopoietic response, which was only exceptionally greater than twice the normal value, was observed whether thrombocytopenia was or not very long-standing, very severe, or affected a child or an adult. Megakaryocytosis, assessed on smears or biopsy sections, and the mean platelet volume do not constitute parameters for measuring platelet production. These findings confirm previous findings reported in the 1970s using radioactive chromium as the tracer. They demonstrate that the regulation of megakaryocyte production differs from that of erythropoietic production. They also show that determination of platelet production based on the survival of autologous platelets is able to distinguish between excessive destruction, even in the absence of a haematopoietic response, and defective production, demonstrated when the haematopoietic response is less than 50% of the normal value.

Adult↗
PubMed1993

Residual mediastinal mass in malignant lymphoma: value of magnetic resonance imaging and gallium scan.

Following treatment for mediastinal lymphoma, residual masses are defined as a mass greater than 2 cm observed on the CT scan in the absence of other evolutive signs of lymphoma. In this study, we examined 55 patients with residual mediastinal mass after optimal therapy, using gallium scan (37 cases) or magnetic resonance imaging (MRI, 44 cases). The group comprised 41 subjects with Hodgkin's disease and 14 with non Hodgkin's lymphoma, stages I and II (32 cases) and stages III and IV (23 cases); 35 subjects (64%) having bulky mediastinal involvement at diagnosis. A negative gallium scan or fibrotic signal on MRI was correlated with complete remission in 48 cases (87%). In seven of these 48 patients, MRI was not conclusive with a high signal of indeterminate tissue following radiotherapy, but four of the seven had fibrotic tissue on biopsy and none relapsed. Positive gallium scan was observed in six cases. In conclusion, we suggest performing a gallium scan at the end of induction chemotherapy and when it is negative, treatment may be continued without surgical biopsy or salvage therapy. MRI is of value when it shows fibrotic tissue but can be inconclusive.

Adolescent↗
PubMed1993

Bone marrow scintigraphy in myelofibrosis.

Seventy-seven patients with myelo-fibrosis have been studied during the last three years, by using as tracers 99m Tc- colloids and 111 In-transferrin. A low axial uptake of the colloids, an extension of the indium uptake beyond the axis towards the knees and sometimes ankles and elbows, the splenic indium uptake, are valuable diagnostic criteria, particularly useful for excluding a myelo-fibrosis associated to a malignant disorder. The clinical severity of the disease may be predicted from isotopic studies, particularly the disappearance of a physiologically active bone marrow (indium uptake). The bone marrow scintigraphy could contribute to the difficult decision of splenectomy.

Bone Marrow↗
PubMed1992

Right and left colonic transit after eating assessed by a dual isotopic technique in healthy humans.

Propulsion of colonic contents after eating in the whole colon was studied in 15 volunteers by scintigraphy with injection of 111In-diethylenetriamine-pentaacetic acid and 99mTc-sulfur colloid into the colon through a nasogastric tube. The radionuclide was injected into the cecoascending colon (n = 7), the hepatic flexure (n = 6), the splenic flexure (n = 9), and the descending colon (n = 4). Changes of activity in the regions distal from and proximal to the injection points were determined before and after a 1000-kcal meal. Isotopic movements were also analyzed when a simultaneous injection of the two markers in the right and left parts of the colon was achieved (n = 11). During fasting, no significant change of activity was seen. After eating, radioactivity injected into the cecoascending and the hepatic flexure was transferred distally (P less than 0.01 and P = 0.07); radioactivity injected into the splenic flexure was transferred both distally (P = 0.07) and proximally (P less than 0.02); and no significant change of activity was seen proximally from or distally to the descending colon. Both antegrade and retrograde isotopic movements increased after eating (P less than 0.01), but the number of antegrade movements was significantly greater (P less than 0.05). This study confirms the colonic propulsive effect of eating and shows that this response is different in the right and left parts of the colon.

Adult↗
PubMed1991

The site of platelet destruction in thrombocytopenic purpura as a predictive index of the efficacy of splenectomy.

The significance of the site of platelet sequestration in determining the indication for splenectomy in idiopathic thrombocytopenic purpura (ITP) is a controversial subject. However, most of the negative conclusions are based on 51chromium labelling of homologous platelets. We report here the results of an analysis of 222 cases in which the kinetic study of 111indium-oxinate-labelled autologous platelets was performed under homogeneous technical conditions. 103 of these patients subsequently underwent splenectomy. This study demonstrates that the site of platelet sequestration in active ITP constitutes a variable independent of the patient's age, history of the disease and its severity (platelet count, lifespan). The sequestration site is a good predictive element of the short-term efficacy of splenectomy (71/76 cases with splenic sequestration obtained a platelet count exceeding 100 x 10(9)/l versus 7/13 cases with mixed sequestration and 1/14 cases with hepatic sequestration), and the long-term results (6 months to 5 years after splenectomy) do confirm the clinical value of this study.

Adolescent↗
PubMed1991

The sequestration of 111-In-labelled autologous platelets and the efficiency of splenectomy.

The main information is the excellent correlation between the site of sequestration of autologous platelets (the use of 111-indium allows autologous labelling even in case of severe thrombocytopenia) and the efficiency of splenectomy. From 76 cases with splenic sequestration studied 2 to 10 weeks after splenectomy, an excellent increase of the platelet count (higher than 300 10(9)/l) was observed in 65 cases, a moderate increase (100-300) in 6, a failure in 5. In contrast, in the 16 cases with hepatic sequestration, only one success did occur, and failure (platelet count lower than 100) occurred 15 times. Beyond the 6th month, in spite of some relapses, the prediction remains excellent. From the 67 evaluated cases with initial splenic sequestration, 58 have a platelet count higher than 100 10(9)/l. From the 14 cases with hepatic sequestration, 13 have, at long term, less than 100 10(9)/l platelets.

Blood Platelets↗
PubMed1991

Value of imaging for the diagnosis of residual mediastinal mass in malignant lymphomas.

UNLABELLED: After optimal therapy, residual masses are defined as a mass greater than 2 cm of CT scann, and are present in 15 to 20% of mediastinal lymphomas. We prospectively studied 50 pts with gallium scan (32 cases) and a MRI (41 cases) after the diagnosis of residual masses. There were 38 Hodgkin's disease and 12 non Hodgkin lymphomas; stage I and II: 29 pts; stage III and IV: 21 pts; 32 cases had bulky mediastinal involvement at diagnosis. RESULTS: A negative gallium scan and/or a fibrotic signal on MRI was correlated with a complete remission in 43/50 cases. We observed 2 false positive with gallium scan and 7 cases were MRI was not conclusive with a high signal of indeterminate tissue. CONCLUSION: We propose to perform a gallium scan as soon as the residual mass is detected, than the follow up will be made an MRI. Surgical biopsy must be proposed only when both exams positive or not conclusive.

Adolescent↗