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M J Delisle

Publications and source records attributed to M J Delisle.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Role of adrenocortical scintigraphy in the exploration of incidentally discovered tumors].

To determine the utility of adrenocortical scintigraphy with I131-6 beta-iodomethyl-19-nor-cholesterol (NP59) in incidentally discovered adrenal masses, we studied 12 patients with a unilateral adrenal mass and without other primary tumors or signs of pheochromocytoma or hyperfunctioning adenoma. Ten patients had an adenoma (size: 12 to 35 mm), the diagnosis was made by surgery or by no change in size on repeated CT scans. The NP59 scintigraphy showed an increased uptake on the side of the tumor in 8 cases with a decreased uptake of contra-lateral gland in 7 cases. Hormonal investigations of glucocorticoid function suggested supranormal or fluctuant cortisol secretion in 5 cases as assessed by moderately elevated urinary free cortisol or by incomplete dexamethasone suppression test. These abnormalities disappeared after surgery. Two patients had normal bilateral uptake of NP59, the sizes of the tumors were 12 and 20 mm. Two patients had an extra-adrenal tumor. The NP59 scintigraphy showed a moderately decreased uptake on the side of the hematoma of one patient and a compression of the normal adrenal by ganglioneuroma of the other patient. Our results and those of other authors suggest that positive NP59 scintigraphy could confirm the cortical nature of an incidentally discovered adrenal mass, probably an adenoma that must be followed up morphologically and functionally. No uptake by a tumor greater than 2 cm suggests a primary malignancy or extra-adrenal origin which must be diagnosed by invasive methods.

Adenoma↗
PubMed1991

Combination therapy for anaplastic giant cell thyroid carcinoma.

Since 1981, 20 patients with anaplastic giant cell carcinoma of the thyroid have been prospectively treated according to a combination regimen of chemotherapy and external beam radiation therapy. Two types of chemotherapy were used every 4 weeks, depending on the patient's age. For those younger than 65 years, a combination of doxorubicin (60 mg/m2) and cisplatin (90 mg/m2) was given, and for older patients mitoxantrone (14 mg/m2) was used. Radiotherapy was carried out between Day 10 and Day 20 of the first four cycles of chemotherapy. It delivered 17.5 Gy in 7 fractions to the neck and the superior mediastinum. Survival exceeding 20 months was observed in three patients. Complete neck tumor response was observed in five patients, among whom four had undergone previous operations. No response was seen in distant metastases, which were the cause of death in 14 patients. These treatment modalities are effective in some patients, both in terms of survival and of local control, avoiding death from local invasion. Gross tumor resection should be performed whenever possible but should not delay the commencement of this protocol. Toxicity was high and remains the main limiting factor.

Adult↗
PubMed1991

High permanent plasma adrenaline levels: a marker of adrenal medullary disease in medullary thyroid carcinoma.

Increases in urinary, plasma and tumour adrenaline have been previously observed in MEN II patients with phaeochromocytoma. However, the sensitivity of adrenaline for early detection of adrenal medullary disease has not been accurately evaluated. Twenty-five patients with medullary thyroid carcinoma (MTC) histologically confirmed but without clinical or biological evidence of phaeochromocytoma have been studied. Medullary adrenal status was evaluated by adrenal CT-scan. MIBG scintigraphy, determination of urinary VMA, metanephrines and total catecholamine levels, measurement of nyctohemeral plasma adrenaline or noradrenaline concentrations (every 2 h during 24 h) and clonidine suppression test. Four of the 25 patients had evidence of adrenal medullary disease in view of the coexistence of CT-scan, MIBG scintigraphy and plasma adrenaline abnormalities. Moderate adrenal enlargement (unilateral, n = 3; bilateral, n = 1) was observed on scans together with a high adrenal MIBG uptake (bilateral, n = 4). Among the urinary parameters studied, a minor MN increase was observed in only one of the four patients. Plasma adrenaline levels were significantly (P less than 0.01) different from those of the other 21 patients (mean + SD 115 + 110 pmol/l). This plasma adrenaline increase is reproducible and not suppressed by clonidine. Unilateral adrenalectomy performed in one patient confirmed a phaeochromocytoma and induced normalization of plasma adrenaline levels. In contrast, the plasma noradrenaline levels of the four patients were not statistically different from those of the other 21 patients. These data suggest that persistent high plasma adrenaline levels may be selectively increased in MTC patients together with a moderate adrenal CT-scan enlargement and a high adrenal MIBG uptake, despite a normal urinary excretion of total catecholamines and catecholamines metabolites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
PubMed1991

Use of m-[131I]iodobenzylguanidine in the treatment of malignant pheochromocytoma.

The efficacy and safety of m-[131I]iodobenzylguanidine ([131I]MIBG) were assessed in 15 patients with malignant pheochromocytomas in a nonrandomized, single arm trial, in which patients were treated with [131I]MIBG (SA, 740 megabequerel/mg) every 3 months. Seven of these patients had bone and soft tissue metastases, 4 had only soft metastases, and 4 had only bone metastases. The follow-up period ranged from 6-54 months; the number of doses ranged from 2-11, with 2.9 (78.4 mCi) to 9.25 gigabequerel (GBq) (250 mCi)/administration and a cumulative activity from 11.1-85.90 GBq (300-2322 mCi). The absorbed cumulative dose in tumors ranged from 12-155 Gy. A beneficial effect of the treatment was observed in 9 patients (60%). No complete remission of the disease was observed. Seven patients died during the study, among whom 4 never responded to the treatment. Seven had hormonal responses (4 complete and 3 partial), with a duration ranging from 5-48 months. Among these patients, 4 relapsed, and 3 died within 3 months. Five patients had partial tumoral responses mainly located in soft tissues and for a duration ranging from 29-54 months. All patients with a hormonal response had objective improvement in clinical status and blood pressure. There was no clear-cut relationship between the cumulative dose and the responses. The main side-effect observed in 1 patient with widespread bone metastases after three doses (12.9 GBq) was a pancytopenia, which resolved after treatment was discontinued. This study suggests that repeated [131I]MIBG treatment could be effective in patients with advanced malignant pheochromocytoma.

3-Iodobenzylguanidine↗
PubMed1990

Evaluation of morphological criteria in the cytological diagnosis of thyroid cold nodules. A preliminary study.

Although cytological diagnosis plays a significant role in the management of thyroid cold nodules, the rather high rates of false negative cases diminishes its usefulness. The purpose of this preliminary study is to evaluate the utility of numerous morphological criteria used by the cytologist to exclude benign tumours. Thirty-one cytological criteria were routinely scored as binary (yes/no) or as categories: 6 referred to the general arrangement and frequency of thyroid cells, 9 to the associated cellular and cell product elements, and 16 to the morphological features of the cells. We examined the manner in which these criteria, alone or combined, contributed to the diagnosis. The data base consisted of 171 intraoperative imprint cytological samples (143 histologically benign, 1 atypical adenoma and 27 cancers), as well as 257 thyroid cold nodule aspirates from another set of patients (198 histologically benign, 7 atypical adenomas and 52 cancers). For the imprint cytology, the diagnostic power of each criterion was individually assessed by the likelihood ratio (LR) which eliminated 11 as being undiscriminatory. The remaining independent criteria were subjected to logistic regression analysis to determine the most discriminant. Three were selected: Cellular clustering organisation, nuclear hypertrophy and colloid quantity with the latter being somewhat less powerful. Furthermore, it appears that the diagnostic power of the criteria was significantly lower when there was at least one nucleolus (number of nucleoli greater than 0). The smears gave essentially the same results as the imprints.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1989

Screening for multiple endocrine neoplasia type 2a with DNA-polymorphism analysis.

Multiple endocrine neoplasia type 2a has been shown to be genetically linked to a locus near the centromere of chromosome 10. The availability of polymorphic DNA probes for the region permits the use of restriction-fragment-length polymorphisms (RFLP) to identify carriers of the gene for this cancer syndrome. As part of a French national program, DNA probes were used in a genetic-linkage study of 130 members of 11 families of European and North African origin. In these families there was no recombination between the mutation causing multiple endocrine neoplasia type 2a and two of the three probes used. All 11 families were informative for at least one of the three markers, and linkage information was adequate to provide genetic counseling to 8 families. We found that RFLP analysis is much more useful in predicting the carrier state than conventional endocrine challenge, especially in younger people, but accuracy is maximal when both methods are employed. We conclude that genetic screening allows the identification of those who are at risk for multiple endocrine neoplasia type 2a at any age with a high level of certainty. After initial screening with DNA, tests for early neoplastic change may be directed toward those determined to be at high risk.

Carcinoma↗
PubMed1988

[Treatment of hyperthyroidism by radioactive iodine in France].

A change in ideas concerning the use of radioactive iodine in the treatment of hyperthyroidism has revived interest in this therapy. We report the results of an enquiry conducted in all French nuclear medicine units regarding their activity in 1985 and compare these results with those of a similar enquiry conducted simultaneously in Belgium. The amount of radioactive iodine administered in France was one-half of that administered in Belgium. Regional differences were quite marked in France, probably due to different schools of thought. Diffuse hyperthyroidism accounted for two-thirds of the indications. Most patients received one single dose. The primary objective was a return to euthyroidism, but one third of the units accepted the risk of hypothyroidism. Synthetic antithyroid drugs were often used as adjuvants. In one-half of the units, the radioactive dose administered to each patient was calculated from the effective period of the radioelement and from the thyroid mass. In 1 out of 3 units the patients were hospitalized in a controlled area for a mean period of 3 days. French doctors generally respected the 40-year age limit and systematically excluded children and teenagers. Long-term follow-up was carried out in only 50 per cent of the units.

Antithyroid Agents↗
PubMed1988

Improvement of parathyroid Tl-Tc scintigraphy by using a new image subtraction method.

Forty five thallium-technetium parathyroid scans were performed preoperatively in patients with a high suspicion of parathyroid adenoma or hyperplasia. The patients were imaged after sequential IV injection of 201Tl-thallous chloride (74 MBq) and 99mTc-pertechnetate (222 MBq) using a gamma camera with a pinhole collimator. According to surgical findings, the prevalence of parathyroid abnormalities was 42/45: single (34 patients) and double (1 patient) adenomas, hyperplasia (7 patients, 16 hyperplastic glands). Three methods of analysis of scintigraphic images were compared. Method one was the visual comparison of the thallium and the technetium images. Method two used the subtraction image obtained after normalisation. Method three used a new image comparison method which performs the geometric and gray level registrations of the two images and generates the image of the significant differences. Three observers were involved in the evaluation procedures. Surgery and histological examinations were taken as the gold standard. Results show that the sensitivity is increased by applying method three. The interobserver reproducibility of the results is also higher for method three. We conclude that an adequate image subtraction technique significantly increases the diagnostic value of parathyroid scintigraphy.

Adenoma↗
PubMed1988

Multivariate analysis in solitary cold thyroid nodules for the diagnosis of malignancy.

A stepwise logistic regression (SLR) was performed on 162 patients with a solitary and cold thyroid nodule in order to discriminate between malignant and benign lesions. Sixteen variables were recorded for each patient. The predictions of the logistic regression model were compared to the histological diagnoses in order to evaluate the accuracy of the classification. The value of the logistic function (LF) was calculated for each patient. Using the ROC curve approach, an optimum threshold value (OTV) corresponding to a 100% sensitivity was defined. The classification obtained with the OTV was validated using a cross-validation procedure (CVP). The significant variables selected by the SLR are (from the most significant to the least significant): cytologic result, sex, irregular margin on the Tc scintigraphy and homogeneity on the ultrasound examination. The OTV corresponds to a specificity of 73% for a sensitivity of 100%. The specificity and the sensitivity obtained with the CVP are 73% and 96% respectively. In conclusion, the classification of the patients according to the value of the LF is a highly accurate diagnostic procedure.

Adult↗
PubMed1988

[Diagnostic circumstances, therapeutic measures and long-term surveillance of medullary cancers of the thyroid].

Diagnosis of medullary thyroid carcinoma is often delayed as a consequence of its rarity and its recent discovery. Fine needle aspiration biopsies of all the cold thyroid nodules and plasma calcitonin (CT) measurement in case of suggestive clinical features allow an accurate pre-operative diagnosis and the best therapeutic conditions. A cervico-mediastinal check-up, a screening for a Multiple Endocrine Neoplasia type 2a or 2b, the removal of all tumoral cervico-thoracic tissue by total thyroidectomy, a careful node excision and the pathological examination by a skillful pathologist using immunohistochemistry are the main therapeutic methods. Additional treatment such as external radiotherapy, chemotherapy and radiopharmaceutics are indicated when surgery is incomplete, when the tumor is inoperable and when there are extensive distant metastases. Basal and pentagastrin stimulated CT is the best tool in post surgical follow-up. Disappearance may indicate a long remission, even a cure. Persistence of an abnormal level necessitates the search for secreting tumoral site with non invasive methods such as ultrasonography, computed tomography and scintigraphy, avoiding blind aggressive treatments. In case of recurrence or distant metastases, surgical excision has to be considered first.

Carcinoma↗
PubMed1988

[Contributions of the measurement of TSH, T4 and thyroglobulin, of 99m Tc scintigraphy and of cervical ultrasonography to the early diagnosis of congenital hypothyroidism].

Over 10 years, extending from 1978, 200,000 newborns of the Champagne-Ardennes Region have been tested within the screening program for congenital hypothyroidism. Congenital hypothyroidism was diagnosed in 96 infants (28 boys, 68 girls): 73 thyroid dysgenesis (50 ectopic glands and 23 undetectable thyroid tissue) and 23 thyroid dyshormonogenesis (14 permanent and 9 transient defects). Our local frequency was 1/2,600, significantly higher than the French and European frequencies. There was a marked shortening of the age at diagnosis during the 10 year period (mean age: 45 days between 1978 and 1980, 18 days in 1987). The TSH measurement was found to be the most sensitive tool for the diagnosis. Scintigraphy and more recently ultrasonography were performed in order to characterize the anatomical variety. For the last year, the following protocol was used: high frequency ultrasonography at first, then 123I or 99 m Tc scintigraphy (using parallel colimator and digital acquisition) depending on whether the thyroid gland was seen on ultrasound or not. Treatment of thyroid dyshormonogenesis was withdrawn after 5 years for reassessment.

Congenital Hypothyroidism↗
PubMed1988

[Thallium-technetium scintigraphy for presurgical localization of parathyroid adenomas and hyperplasia].

The purpose of this study was to assess the value of parathyroid Thallium 201-Technetium 99m scintigraphy in 45 patients with hyperplasia or parathyroid adenomas with or without associated thyroid abnormalities. The prevalence of parathyroid abnormalities found during examination was 42/45: 36 adenomas (35 patients) and 16 hyperplasias (7 patients). Seventeen patients (38%) had thyroid abnormalities. The sensitivity and specificity of the three image analysing methods (visual analysis, simple subtraction, sophisticated subtraction) were determined by assessing answers given by 3 observers. The population was divided into 6 groups: adenomas and hyperplasias with (group I, n = 42) or without (group II, n = 25) thyroid abnormalities, adenomas alone with (group III, n = 35) or without thyroid abnormalities (group IV, n = 22), hyperplasias alone with (group V, n = 7) or without thyroid abnormalities (group VI, n = 5). The highest overall sensitivity was obtained, whichever the group, by applying the sophisticated image subtraction technique; for any given method, the best results were observed in the group comprising adenomas alone, especially without associated thyroid abnormalities. On the other hand, in the groups comprising hyperplasias alone, sensitivity was low. This leads us to conclude that, together with ultrasonography, parathyroid scintigraphy is currently the best preoperative technique for localizing parathyroid adenomas, even in the presence of associated thyroid abnormalities. However this must be carried out in conjunction with a sophisticated image subtraction technique.

Adenoma↗
PubMed1987

Radioiodinated meta-iodobenzylguanidine uptake in medullary thyroid cancer. A French cooperative study.

Fifty meta-iodobenzylguanidine (MIBG) scintiscans were performed in three groups of medullary thyroid cancer (MTC) patients. Group 1 (n = 11) included treated patients with normal calcitonin levels; Group 2 (n = 24) included patients with elevated calcitonin levels due to sporadic and isolated MTC; Group 3 (n = 15) included patients with elevated calcitonin levels due to familial MTC or multiple endocrine neoplasia Type IIA syndrome (MEN). In Group 1 three pheochromocytoma were depicted by MIBG scintiscan. In Group 2 MTC was seen in a small number of patients (3 of 24). In Group 3, besides adrenal hyperplasia and pheochromocytoma four patients, MIBG scintigraphy showed where MTC had localized and spread in almost half of patients (7 of 15). MIBG uptake occurred in patients with relatively high calcitonin level (greater than 0.6 nmol/l). These data indicate that in patients with familial MTC or MEN syndrome, MIBG scintiscan can be useful not only in detecting associated pheochromocytoma, but also in showing MTC.

3-Iodobenzylguanidine↗
PubMed1987

ROC analysis in radioimmunoassay: an application to the interpretation of thyroglobulin measurement in the follow-up of thyroid carcinoma.

This study is an application of the ROC technique to the determination of threshold values (TV) for the interpretation of serum thyroglobulin (Tg) measurements in the follow-up of differentiated thyroid cancer. Serum Tg was assayed using the Henning kit in 1466 samples from 245 individuals. A local or distant recurrence was assessed by clinical examination, radiological and scintigraphic investigations, and was present in 23 patients. The measurements were divided into four groups: 1) measurements performed less than 6 months after thyroidectomy; 2) measurements performed more than 6 months after thyroidectomy; 3) measurements performed during the suppression of pituitary secretion; 4) measurements performed during withdrawal of the substitutive therapy. An ROC curve was calculated for each group and for each curve three TVs were determined: TV1, TV2, and TV3 corresponding to a high sensitivity, a high specificity and a high sum of sensitivity and specificity respectively. TV1 is 3.12 micrograms/l in the four groups. TV2 is 44 micrograms/l, 19 micrograms/l, 11 micrograms/l and 30 micrograms/l, in the first, second, third and fourth groups respectively. TV3 is 35 micrograms/l in the first group, 3.12 micrograms/l in both the second and third groups and 30 micrograms/l in the fourth group. When the classical method allows the determination of only one threshold value, the ROC technique allows us to determine threshold values adapted to both the patient clinical status and the chosen sensitivity or specificity.

Follow-Up Studies↗
PubMed1987

[Metastatic cancers of the thyroid gland. Diagnostic difficulties].

Metastatic carcinoma of the thyroid is uncommon in surgical pathology and may masquerade as primary thyroid cancer. We studied 6 cases of biopsied and/or surgically resected metastatic carcinoma of the thyroid and their corresponding primary carcinoma, with emphasis on the differential diagnosis. There were 4 men and 2 women patients aged 44 to 77. The primary carcinoma was a breast infiltrating duct carcinoma (3 cases), a colorectal adenocarcinoma (2 cases) and a bronchial oat-cell carcinoma (1 case). The interval between primary carcinoma and secondary thyroid carcinoma was 2 to 9 years in 4 cases; 2 other cases showed simultaneous occurrence. Five patients died with widespread metastases 1 to 14 months following the diagnosis of secondary carcinoma of the thyroid; 1 patient was alive after 24 months. The histological differentiation of secondary from primary thyroid cancer may be difficult in the following situations: clear-cell, Hürthle-cell and signet ring cell changes; positivity of mucins stains; production of melanin; epidermoid differentiation; very rare miscellaneous tumours ("columnar cell carcinoma" and primary thymoma of the thyroid). Immunoperoxidase methods and mucin histochemistry may help.

Adenocarcinoma↗
PubMed1986

Multifactorial analysis of survival in thyroid cancer. Pitfalls of applying the results of published studies to another population.

Multifactorial analyses (MFAs) of survival data of thyroid carcinoma patients have already been published by the European Organization for Research and Treatment of Cancer EORTC, the Institut Curie (IC), and the Institut Gustave Roussy (IGR). The aim of this study was to find out if the results obtained in these MFAs could be applied to a new population of 480 patients. To determine this, three MFAs were carried out on the new population. Each of these MFAs is based on exactly the same methodology as one of the three reference studies. Using the EORTC methodology, five significant factors were retained: age, principal cell type, anaplastic, T-category, and metastatic sites (The significant factors in the EORTC study also included the sex factor, which was not significant for the current study). Using their own prognostic index instead of the EORTC index, gave the authors a better classification of the patients and better survival prediction. Using the IC methodology, four significant factors were retained: age, histology, T-category, and metastatic sites (the significant factors in the IC study were age, histology and sex). Using the IGR methodology, two significant factors were retained: age and N-category (the significant factors in the IGR study also included sex and histology). The authors' results differ from those published by the previous groups. Therefore, one should hesitate before applying the results obtained by other groups for thyroid carcinoma to another population. It would seem necessary to carry out one's own MFA before determining a prognostic index.

Age Factors↗
PubMed1986

[Ultrasensitive TSH : a new diagnostic approach to hyperthyroidism].

The value of new ultrasensitive and rapid immunoradiometric assay of thyroid stimulating hormone (TSH) for the diagnosis of hyperthyroidism was assessed in 130 patients with suspected hyperthyroidism and in 330 controls. The diagnosis was established by the clinical evaluation, thyroid scintigraphy and serum concentrations of thyroid hormones. Using the ROC (Receiver Operating Characteristic) curve methodology which allows the optimization of sensitivity and specificity, the physician can choose the "Cut-off" value between hyperthyroidism and euthyroidism. Two points of the curve seem to be interesting : using the "cut-off" value of 0.1 mUI/l, sensitivity is 0.98 and specificity is 0.98 ; using the "cut-off" value of 0.3 mUI/l, sensitivity is 1.00 and specificity is 0.92. Using the association TSH and FT4 (Free Thyroxin), sensitivity is 0.94 and specificity is 0.99. Sixty four per cent of euthyroid patients with TSH under 0.3 mUI/l have one or several hot nodules and only two have no thyroid disease. A TRH (Thyrotrophin Releasing Hormone) test was carried out in 63 patients with suspected thyrotoxicosis : basal and TRH stimulated TSH levels were under 0.1 mUI/l. This immunoradiometric assay for TSH may simplify the approach to thyroid function testing in patients with suspected thyrotoxicosis : a basal TSH under 0.3 mUI/l is sufficient to confirm a clinical suspicion of thyrotoxicosis without TRH test within four hours. In a department devoted to testing thyroid function, this new method provides a great benefit in cost and work.

Antibodies, Monoclonal↗