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J Leclere

Publications and source records attributed to J Leclere.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Treatment of Basedow disease with synthetic antithyroid drugs. Evaluation of the dose on the efficacy of the long term treatment].

A direct immunosuppressive action of antithyroid drugs (ATD) has been suggested by the progressive decrease of thyroid antibodies during treatment. High doses of ATD were then proposed to improve the level of remissions of Graves' disease but the results of such high doses remain a matter of controversies. The french Group of Research on Thyroid (GRT) underwent a multicenter study comparing the efficacy of 60 mg/d of carbimazole with the minimal dose required to obtain euthyroidism in 197 randomly and equally distributed patients. After 18 months of therapy and a 2-year follow-up the remissions are 70.9% with high and 53% with low doses (p = 0.03). After the third year of follow-up, this difference was not significative (p = 0.06). Moreover after a 3-year follow-up the remission rate of high dose (60.3%) is not different from which is obtained with intermediate one (20 to 30 mg/d) associated with a permanent decrease of TSH by thyroid hormone.

Antithyroid Agents↗
PubMed1994

[Contributions and limitations of transcutaneous ultrasonography in the preoperative evaluation for hepatic resections].

From October 1990 to January 1992, 36 patients were operated in order to perform an hepatectomy for hepatic metastases (n = 33) or primary malignant tumors (= 3). The authors evaluated the reliability of preoperative ultrasonography (US) by comparing US data to intraoperative findings without consideration of others preoperative examinations. Preoperative US detected 65 out the 78 nodules founded intra-operatively; 13 nodules (4 to 30 mm) and a micronodular dissemination were not detected (sensitivity 82% for the whole lesions). Probable causes of false negative cases (size, location and echogenicity of the nodules) are discussed. Sixty three out of the 65 nodules detected were correctly located in the hepatic segmentation by preoperative US. Hepatectomy was performed in 30 of the 36 patients (84%). The resection previously planned by preoperative US was realized in 24 patients, 5 hepatic resections (14%) had to be enlarged and one completed by a lymphadenectomy; in 6 cases (16.5%) the hepatectomy was not possible because of intraoperative findings of lesions previously not detected by preoperative examinations including US (3 with not removable hepatic nodules, 3 with lymph nodes metastases). This study confirms the reliability of US for anatomical location of hepatic lesions. US sensitivity for the detection is satisfactory. However the number of nodules was underestimated in one third of the patients. The hepatic resection previously planned was effectively realized in only 67% of the cases, in one case out of 6, the resection had to be enlarged and in one case out of 6, the resection was not possible.

Adult↗
PubMed1993

Repeat hepatectomy for cancer.

In a series of 279 hepatectomies performed for cancer between June 1984 and March 1992, 46 were repeat operations, for metastases in 41 patients. The primary tumour was in the colon and rectum (28 patients), APUDoma (five) and miscellaneous (eight). Repeat hepatectomies were performed in 26 per cent of patients who had recurrence after the first liver resection and in 40 per cent of those who had liver recurrence. An unsuspected extrahepatic recurrence was discovered and resected in eight instances and in two other cases a known extrahepatic recurrence was resected during the second hepatectomy. The hospital mortality rate was 2 per cent (one patient); the death was from nosocomial pneumonia. The total morbidity rate including minor complications was 32 per cent, with a higher frequency of haemorrhagic problems after secondary liver resection (12 per cent) than after primary hepatectomy (5 per cent). The rate of postoperative complications after repeat hepatectomy was related significantly to operative blood loss greater than 1500 ml (P = 0.04). The technical problems of repeat hepatectomy were: (1) re-exposure of the liver, considered to be difficult in 67 per cent of second liver resections and 80 per cent of third procedures; (2) the liver parenchyma, which often had histological modifications between first and second resections and was more difficult to 'work' as shown by the mean duration of clamping of the hepatic pedicle (54 min for secondary versus 36 min for primary liver resection); and (3) modification of the intraparenchymal vasculobiliary anatomy following liver regeneration after major hepatectomy. Intraoperative ultrasonography was of great benefit. Rates of crude and recurrence-free survival were relatively encouraging at 47 and 33 per cent 3 years after the second liver resection for the whole group. These values were lower for colorectal cancer (37 and 21 per cent 3 years after the second hepatectomy). These figures do not, however, convey the complete picture of the outcome for these patients. During the same follow-up period, 143 recurrences were detected and a mean of 2.9 resections per patient were performed. The indications for repeat hepatectomy are still to be clarified, although the surgical technique is safe.

Adult↗
PubMed1993

Osteogenic anaplastic carcinoma of the thyroid.

An unusual osteogenic anaplastic carcinoma of the thyroid developed in a 68-year-old man and showed follicular and osteosarcomatous components. Seven months after surgery and 70 mCi 131I treatment, a local tumor recurrence was found and showed an intense uptake of 99mTc-MDP on the bone scan. After a second operation, pathologic and immunostaining analysis revealed no more thyroid carcinoma but only osteosarcomatous cells. Chemotherapy was ineffective and the patient died with diffuse pulmonary metastases 26 months after the diagnosis. The importance of osteogenic sarcomatous differentiation is proven by the bone scan. Osteosarcoma of the thyroid is a rare but well known tumor. Usually these tumors do not contain any cells originating from the thyroid epithelium and only comprise sarcomatous components. Ten cases of undifferentiated carcinoma of thyroid origin with osteogenic component have been reported. These tumors have been recently included in undifferentiated carcinomas in the second edition of the WHO classification. The evolution and pathologic findings favor the hypothesis of a transdifferentiation of the thyroid cell into osteogenic cells.

Aged↗
PubMed1993

[Epidemiology].

Explore the source record for details and available documents.

Adolescent↗
PubMed1993

[Management of the thyroid nodule. Preliminary results of a practice survey of 685 general practitioners and specialists].

The authors present the preliminary results of a mailed survey of policies for the management of thyroid nodules (TN). This survey involved 685 general practitioners and specialists and was carried out at the initiative of APNET (National Educational Association for Training in Therapeutics) with the aid of ANDEM (National Agency for the Development of Medical Evaluation). Twelve percent of responders (13.1% among GPs) declare that they do not manage TNs. Those have been excluded from the analysis. The answers taken into account come from general practitioners (n = 179), endocrinologists (n = 233), specialist surgeons (n = 64), ENT practitioners (n = 93) and nuclear medicine practitioners (n = 26). The average number of patients with TN seen in a year varies according to the specialty: 6 a year for GPs, 30 in ENT, 89 for endocrinologists, 105 for surgeons. This survey reveals a number of common position: 1) the therapeutic attitude must be customized according to clinical findings and to complementary tests; 2) prescriptions are homogeneous as regards radionuclide scanning (technetium or iodine), TSH assays, ultrasonography and T4 assays; 3) ultrasonography is used in first intention; 4) ultrasonography has limitations, and is regarded by a majority or responders as unable to provide information about benignancy or malignancy. Conversely, responses are much more variable about a number of points: 1) the use of fine needle aspiration cytology which is mainly used by endocrinologists and nuclear medicine practitioners; 2) the management of nodules discovered on ultrasonography: the attitude is different from that adopted with palpable nodules for endocrinologists, surgeons and nuclear medicine practitioners, and identical for most general and ENT practitioners; 3) the usefulness of a suppressing treatment with thyroid hormones. Both general practitioners (47%) and, even more so, specialists (84%) are aware of these differences in practices. Faced to this situation, 69% of specialists are in favor of establishing consistent practices, but a minority (42%) only think that it is possible. Thus recommendations about practices may be useful only if they are adapted to the type of practice and to the conditions of access to complementary tests, and they should be aimed at rationalizing management rather than making it consistent.

Endocrinology↗
PubMed1992

[Pituitary adenoma revealed by Traquair's syndrome].

Junction scotoma is a classic field defect initially described by Traquair in 1917. Sparse cases have been reported until today. The authors report a silent pituitary adenoma in a 58 year-old female revealed by a junction scotoma. The field defects secondary to insult of chiasma from pituitary tumors besides usual bitemporal hemianopsia are reviewed by the authors. The possibility of minor ophthalmologic symptoms despite voluminous tumor has to be emphasized.

Adenoma↗
PubMed1991

Femoral infarction following intraarterial chemotherapy for osteosarcoma of the leg: a possible pitfall in magnetic resonance imaging.

Bone infarction of the distal femur is reported in two patients with osteosarcoma of the leg (1 tibia, 1 fibula) treated by preoperative chemotherapy including intraarterial chemotherapy (IAC) by Cis-platinum. Both patients were examined by magnetic resonance imaging before chemotherapy and again prior to limb salvage surgery. The location of these lesions in the distal femur must suggest bone infarction especially if the tumor has decreased in size under treatment.

Adult↗
PubMed1990

Scanning electron microscopy (SEM) of the human thyroid gland: a technical improvement for follicular cell observation.

SEM is a valuable tool for the examination of hollow organ free surfaces. It has been used in a few studies of human thyroid. The cell surface observation is usually limited by the presence of colloid in the follicular lumen. A technique of direct removal of the colloid has been previously proposed. It gives good morphological results. But this method needs preliminary fixation and critical point drying of thyroid samples. Antigenic properties of tissue blocks are then unsuitable for further staining. We describe a fast and easy technique for colloid removal by washing thyroid samples in a saline solution. Colloid is correctly removed from the tissue block surface prior to fixation. Apical cells are left undamaged. The exposure of thyroid blocks to ultrasound did not improve colloid removal. A post-fixative chemical drying in hexamethyldisilazane shortens processing time. We have studied the efficiency of this technique on 24 human thyroid samples obtained by surgery (normal tissue, Grave's disease, heteromultinodular goiter, toxic solitary adenoma). All specimens were observed by SEM and transmission electron microscopy in order to assess the good preservation of cell surface details. This easy technique could be used as a routine process.

Adenoma↗
PubMed1989

Decreased lymphocyte function-associated antigen-1 molecule expression on peripheral blood lymphocytes from patients with Graves' disease.

Humoral and cellular abnormalities have been described in autoimmune thyroid diseases, but a deficient cooperation between humoral and cellular systems has been poorly investigated in such diseases. Lymphocyte function-associated antigen-1 (LFA-1), a glycoprotein expressed on T- and B-lymphocytes, plays an important role in cell-cell interaction mechanisms and is involved in the homing phenomenon. The expression of this molecule was investigated on peripheral blood lymphocytes from patients suffering from various thyroid disorders. Decreased numbers of LFA-1-positive cells were observed in 30 patients with Graves' disease, while normal values were present in 8 patients with Hashimoto's thyroiditis and 37 subjects with nonautoimmune thyroid disorders. Treatment-induced improvement of Graves' disease was associated with an increase in LFA-1-positive cell number.

Adult↗
PubMed1989

[Prevalence of non-thyroid autoantibodies in autoimmune dysthyroidies].

Organ- and non organ-specific autoantibodies can be detected in patients with AITD but large comparative studies have seldom been performed. This study evaluated the prevalence of anti-thyroid, -smooth muscle, -mitochondria, -parietal gastric cells, -salivary duct, -nuclear and -ds DNA autoantibodies assayed by indirect immunofluorescence in 224 patients with Graves' disease or Hashimoto's thyroiditis. Results evidenced a high prevalence of antinuclear antibodies, mostly of non homogenous fluorescence in Graves' (63.1%) and Hashimoto's patients (65.5%), as well as for antisalivary duct antibodies (55.2 and 75%). No positive anti-ds DNA were noticed. No correlation was found between antithyroid antibodies and the others. Different hypothesis could explain this observation which favours a general dysregulation of the autoimmune system.

Adolescent↗
PubMed1987

Prospective comparison of ultrasound and computed tomography in the evaluation of the size of the uterus: can these methods be used for intracavitary treatment planning of carcinoma of the uterus?

A prospective evaluation of computed tomography and ultrasound was performed on 34 patients with Stage I and II endometrial carcinoma. All patients underwent immediate surgery following intracavitary treatment directed to vaginal mucosa. Pathologic measurements of the uterus were compared to those obtained by imaging technologies. The results of the study suggest that all but height measurements were rather accurately determined by both ultrasound and CT scan. However ultrasound was significantly better in determining the size of the cervix. Therefore ultrasound measurements could be used routinely for intracavitary treatment planning in endocervical carcinoma and endometrial carcinoma.

Brachytherapy↗
PubMed1987

Lack of linkage between HLA and multiple endocrine neoplasia type 2 in a French family.

In this study, linkage between HLA and a dominant gene determining multiple endocrine neoplasia type 2 (MEN 2) in a large pedigree was investigated. All lod scores for recombination fractions ranging from 0 to 0.45 were negative. If we pool data from our family and the families studied by Jackson et al. (1976) and Simpson & Falk (1982), a link between HLA and the locus for MEN 2 can be excluded. Linkage studies with various markers and pooled data should be pursued to permit detection of high risk individuals and to identify a genetic defect.

Genetic Linkage↗
PubMed1987

[Ultrastructural analysis of anionic sites of the basal membrane of the seminiferous tubules of subjects with severe oligospermia].

Several morphological alterations of the basement membrane of the seminiferous tubules have been reported in the patients presenting with a testicular sterility. The proteoglycans are one of the major components of the basal membrane and may be ultrastructurally defined by the use of the cationic marker polyethyleneimine (PEI). In comparaison to the normal distribution of the anionic sites labelled by PEI which is characterized by a regular pattern of distribution along both the epithelial and the interstitial faces of the lamina densa, the pattern of distribution of the sites is largely altered in 6 patients, 27 to 40 years of age, with oligo- or azoospermia. Several types of alterations are reported: parallel thickening of the lamina densa with an abnormal distribution of the anionic sites inside the lamina densa, stratifications of the basal membrane depressing the seminiferous epithelium with anionic sites labelled on both faces of the lamina densa-like layers, massive expansions of the lamina densa with either a regularly circumferential labelling of the sites or a random type of distribution. The digestion of the sites by the enzyme heparitinase is highly suggestive of the presence of proteo-heparan-sulfate. The analysis of the distribution of the anionic sites may represent a usefull tool for studying the pathogenesis of testicular sterility.

Adult↗