Biomedical subjects
Publications and source records attributed to J Leclere.
Bone metastases of an Ewing's sarcoma were detected by magnetic resonance imaging (MRI), when bone scan, CT and plain films were still normal. This is due to the ability of MRI to detect intramedullary metastases before involvement of the cortex.
From January, 1977, through December 1983, 62 patients with thyroid edematous ophthalmopathy were given external orbital radiotherapy according to S.S. Donaldson's technique: 5,5 MV photons produced by a linear accelerator were used to irradiate the muscular conus, with a total of 20 grays in 10 sessions over 2 weeks. Good results were obtained in 46 patients (77%). This simple therapy may be a first choice in recent ophthalmopathy.
Forty thoracic CT scans have been performed on 27 patients with micronodular lung metastases of differentiated thyroid carcinoma. Lung nodules were visualized in 14 out of 19 patients (78%) with functioning lung metastases, although their chest X rays were normal. However, only a small number of peripheral micronodules can be visualized by CT scan since the central micronodules remain undistinguishable from adjacent vessel structures. A close relationship has been found between the number of micronodules and the thyroglobulin (Tg) serum level. In patients previously treated by 131I for proven lung metastases and who had no uptake for several years, but in whom Tg remained detectable in the serum, CT scans have shown micronodules in 7 of the 13 patients with normal chest X rays. The present data suggest that these nodules are mainly a result of fibrosis. CT scanning appears to be an important complementary tool with regard to 131I whole body scintigraphies in the radiologic diagnosis of lung nodules and in the assessment of radioiodine therapy.
Thyroid tissue from five patients with hyperthyroidism due to Graves' disease was transplanted into nu/nu mice (2 to 4 mice per thyroid) in order to assess whether the tissues would remain hyperfunctional. Before surgery, the patients received only propranolol and iodine for ten days. Transplants were removed from the mice after 10, 20, 30 or 57 days, and compared to the initial tissue, as well as toxic nodules from two patients and thyroid tissue from two normal subjects grafted similarly. All transplants survived, as proven by histology and autohistoradiography with 131I uptake, while all signs of hyperfunction and dysimmunity disappeared. Conversely, both transplanted toxic nodules remained hyperfunctional. These results indicate that, in spite of the in situ presence of most factors of auto-immune reactions, thyroid tissue from patients with Graves' disease is not autonomous and depends on the extra-thyroid environment.
This study analyzes the outcome of human normal and hyperfunctioning thyroid tissue transplanted to the nude mouse. Thyroid fragments from 7 patients with Graves' disease were transplanted to nude mice (nu/nu). Before surgery, the patients had been treated with propranolol and iodine; none had received antithyroid therapy. The transplants were removed on the 12th day following transplantation and were studied by light microscopy and autohistoradiography. At this time, all immunologic disorders found on the operative samples had disappeared, and the tissue had lost its hyperfunctioning characteristics. In contrast, transplants from toxic adenoma remained hyperfunctioning, with elevated serum T3 and T4 levels. Similarly, transplants from normal thyroid tissue remained unchanged, and serum T3 and T4 levels remained within the normal range, as if under the influence of the hypothalamic and pituitary regulation of the mice. These findings emphasize the role of the extrathyroid immunologic environment in the regulation of Graves' disease, whereas toxic adenoma remains autonomous.
An in situ analysis of immunological features in thyroids from 15 Graves' disease patients has been performed. This study included a search for immune complexes visualized near the follicle's basement membranes with fluorescent rabbit antisera to human IgG, IgA, IgM, C1q, C3 and C9. Cellular immunity was investigated on the humoral side by visualization of B cells and plasma cells. Two series of monoclonal antibodies (OKT3, 4 and 8, Leu 1, 2a and 3a) were used to label the infiltrating cells' membrane. These studies demonstrated the prevalence of T cells, a majority of them with OKT8/Leu 2a suppressor/cytotoxic phenotype. No correlation was found between this observation and peripheral blood T cell subsets analysis.
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Thirty-four members of a single family were studied and 9 of them were found to be suffering from hyperthyroidism associated with diffuse goitre. Exophthalmos was absent and transmission seemed to be independent of HLA type. Four of the 9 were studied prior to treatment but in all cases serum immunoglobulin levels were normal, antithyroglobulin and antimicrosomal antibodies absent, thyroid stimulating antibodies negative and the lymphocyte transformation responses to mitogens not different from those of controls. The results of testing the euthyroid family members were similarly negative, except in the case of a woman with type I diabetes mellitus who showed a low titre of antimicrosomal antibody. Seven of the patients underwent subtotal thyroidectomy. Lymphocytic infiltration of the excised portion was rarely present. Four of the glands were subjected to immunofluorescent and electron microscopy but neither immunosecreting cells nor immune complex deposits were found. These results point to the existence of a non-autoimmune form of goitrous hyperthyroidism, different from Graves' disease.
Diffuse non auto-immune hyperthyroidism is a rare entity, classically restricted to cases with hypersecretion of TSH, hCG or related molecule and to a few reports of proven paraneoplastic origin. The authors try to individualize another type of diffuse hyperthyroidism, previously considered to belong to Graves' disease, but without any sign of disimmunity. They present a familial form with several hyperthyroidic patients who showed neither change in humoral immunity nor immunological abnormality within the thyroid gland, even in those that were operated upon without prior antithyroid medication. Similar findings occurred within several series of hyperthyroid glands separately studied by the authors, using different techniques: histomorphometric quantification of lymphocytic infiltration, immunofluorescence in the search of IgG, IgA, IgM, C1 q, C3 and C9 fractions, or T-lymphocyte subsets. These techniques generally tend to yield positive results, that agree with an auto-immune pathogenesis, but totally negative findings do occur. This type of diffuse hyperthyroidism should be delineated from the common auto-immune type, and might be called toxic hyperplasia.
Three cases of liver hydatid cysts are reported. They showed the interest of arteriography in the treatment. Actually, resection of the adventice is the best surgical treatment not to miss a small cyst in the adventice of a large one and to let an hepatic cavity which quickly disappear. Nevertheless, in some cases arteriography contraindicates total resection of the adventice if it seem dangerous or if vessels ligation and large hepatic resection may occur.
A 42-year-old woman, who had been taking oral contraceptives for 10 years, developed a primary carcinoma of the liver. The diagnosis was made by biopsy under laparoscopic control. Twenty one cases have already been reported in the literature. The aetiological role of contraceptives in the development of generally benign (approximately 200 published cases) and sometime malignant hepatic lesions, has not been definitely proven. The regression of certain benign tumours when contraceptives are stopped is the essential argument. In some patients, the association of benign lesions and of hepatic carcinoma suggests a single pathogenesis. The early recognition of such lesions justifies their being sought routinely in patients taking oral contraceptives (palpation of the liver, questioning concerning pain in the hepatic region). A national register will be required in order to determine their exact prevalence.
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The authors report the action of bromergocryptine in 12 patients who were suffering from a syndrome of amenorrhoea with galactorrhoea and hyperprolactinism. None of these 12 patients had a pituitary tumour; or else they had been operated on before treatment. Only in one case was the syndrome linked to taking oral contraceptives, which had been stopped more than six months previously. The dose of bromergocryptine was 5 mg. a day. If this dose fails it is possible to raise it after two months' observation. The galactorrhoea disappeared or markedly decreased in 8 out of the 12 cases. Ovulatory cycles started in 9 out of the 12. 5 of the women wanted a pregnancy: 4 succeeded and 2 of them have already been delivered of normal children. Bromergocryptine (CB 154) has thus proved itself to be remarkably effective in hyperprolactinism, not caused by a pituitary tumour, which gives rise to amenorrhoea and galactorrhoea. All the same, its long-term use, especially after stopping treatment, is still to be evaluated.