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Biomedical subjects

P Aubert

Publications and source records attributed to P Aubert.

At least 19 recordsLinked to original sources

[Detection and prognosis of medullary cancer of the thyroid gland. Influence of national multidisciplinary cooperation].

Medullary thyroid carcinoma is a rare and sometimes hereditary disease. The tumour can be diagnosed and followed up by measuring the amounts of calcitonin it secretes. The prognosis of this cancer largely depends on an early diagnosis and treatment. From the clinical and laboratory (calcitonin assays) data recorded in our department, we have endeavoured to determine the influence of a national multidisciplinary co-operative group (GETC: French medullary study group) on the diagnosis and prognosis of this malignancy. We are able to show that the number of medullary thyroid carcinomas detected (principally in their familial forms) has increased by 141 per cent after the GETC was created. Calcitonin levels at the time of diagnosis are significantly lower (P less than 0.05) in familial cases, which reflects an early detection. The same applies to post-operative calcitonin levels (P less than 0.005), so that in the long run a better prognosis can be expected. It seems therefore that together with a better knowledge of this cancer and its detection, the setting up of a national multidisciplinary co-operative group results in a better clinical and therapeutic approach of these patients, and particularly of the familial cases of medullary thyroid carcinoma.

Calcitonin

[ORL manifestations of gastroesophageal reflux].

In the E.N.T. area, gastro-oesophageal reflux (GOR) is manifested as atypical pharyngitis or laryngitis. E.N.T. examination is frequently negative. The diagnosis rests on demonstration of the reflux which is clinically obvious in most cases. It must be confirmed by exploratory methods, the main one being oesophageal pH measurement. Fibroscopy is useful to exclude an associated oesophagitis. GOR is very frequent in children and indeed unavoidable during the first weeks of life. It may produce inflammatory E.N.T. symptoms, but also obstructive apnoea and nocturnal cough. Management essentially consists of hygienic and dietetic measures. It is highly effective as regards both GOR and its atypical E.N.T. manifestations.

Adult

Thyroglobulin, thyrotropin and thyrotropin binding inhibiting immunoglobulins assayed at the withdrawal of antithyroid drug therapy as predictors of relapse of Graves' disease within one year.

"Sensitive" thyrotropin (TSH), thyroglobulin (TG) and even thyrotropin binding inhibiting immunoglobulins (TBII) assays are now widely available. The objective of the present study was to determine the most accurate of these three parameters to predict the relapse of Graves' disease during the year following treatment discontinuation and to evaluate whether the assay of three markers is able to improve the prediction. TSH, TG and TBII were measured in the sera of 67 Graves' disease patients after at least 12 months of medical treatment. In 52 patients, TBII had also been determined before the beginning of the medical treatment. Under treatment, all the patients were clinically and biologically euthyroid, but in 9 goitrous patients it was impossible to lower the doses of carbimazole without an immediate relapse. The TSH levels of these 9 patients were still low in all cases but one; TG and TBII levels were abnormal in all. In the other 58 patients, the treatment was discontinued; 22 relapsed within one year, more frequently when a goiter was present. The most reliable parameter for the prediction of relapse was found to be TBII, as its specificity was high (94.5%), although its sensitivity was poor (45%); TG was more sensitive (64%) but far less specific (57%); TSH and "initial" TBII appeared to be of a little interest. When TBII was elevated prior to the withdrawal of treatment, the determination of TG was useful: abnormal values of both TBII and TG were always associated with a relapse. When TBII testing was negative, the relapse risk fell to 0.26, and to 0.08 when three criteria were matched: no goiter, negative TBII, normal TG.

Antibodies

Testosterone and its binding in hyperthyroid women before and under antithyroid drug therapy.

The serum concentrations of the different forms of circulating testosterone, total testosterone, free testosterone and non-sex-hormone binding globulin bound testosterone (albumin bound + free fractions) which is considered as the bioavailable hormone, were measured in 15 hyperthyroid women before and after anti-thyroid drug therapy and in 15 age-matched healthy women. Sex-hormone binding globulin and albumin were quantified. Total testosterone was significantly higher in hyperthyroid women before treatment, whereas free testosterone and non sex-hormone binding globulin bound testosterone were significantly decreased. After recovery, all the parameters returned to the normal range. In hyperthyroid patients, the variations in the different fractions of testosterone can be related to the rise of sex-hormone binding globulin. These variations could be explained by the displacement of the equilibrium defined by the binding equation.

Adult

[Submucosal resection of the inferior nasal turbinates].

Nasal obstruction is frequently related to hypertrophy of the bony inferior nasal conchae. Medical management and/or isolated correction of deviation of the nasal septum are often inadequate. Surgical management, although it has raised controversy, becomes the only therapeutical course. Submucosal resection of the conchae was performed in 104 patients between 1986 and 1988. Subjective analysis of postoperative data shows 82% of successful surgery cases yielding good nasal repermeabilization with some minor unpleasant effects, such as nasal crusts or discharge in 46% of cases. The authors describe the surgical technique as well as its indications, and its advantages as compared to medical treatment, cauterization or subtotal resection of the conchae in incapacitating nasal obstruction cases.

Adult

[Parotid tumors of intermediate malignancy. Prognostic assessment. Review of the literature].

In 264 patients operated at Hôpital Boucicault for neoplasma of the parotid gland, 9 presented mucoepidermoid carcinoma and 4 had acinic cell adenocarcinoma. These latter 13 cases of intermediate malignancy tumors were assessed, although the retrospective follow-up period was insufficient to formulate an estimate on the survival rate of these patients. The authors further review the bibliographical data useful in evaluating the prognosis for such neoplasia. They stress the controversy existing around opinions concerning histology-based prognosis and recent advance on nuclear DNA. Indications for postoperative radiotherapy is discussed.

Carcinoma

Clinical value of thyrotropin binding inhibiting immunoglobulins (TBII) assay in hyperthyroidism.

More than 500 sera were assayed for TBII under routine conditions using "Trak" assay in order to evaluate the sensitivity, specificity and prognostic interest of this determination in hyperthyroidism. The sensitivity for the diagnosis of Graves' disease was 83.5%, better in ophthalmopathic patients (93%) than in non ophthalmopathic patients (75%). The specificity was 99.4% with only one false positive in a hypothyroid patient. TBII level significantly decreases with carbimazole treatment except in patients who remain hyperthyroid. Determination of TBII before stopping carbimazole treatment or after surgery has a prognostic significance as a positive value indicates a relapse in almost all cases. Conversely, a fall of TBII to normal levels with treatment is insufficient to assess recovery. High levels are frequently observed after radioiodine therapy but do not indicate a poor prognosis.

Carbimazole

[Therapeutics future of liposomes (author's transl)].

The possibility to use the liposomes as drug vehicles has been largely investigated in recent years. Most of the studies have been carried out in animals and are related to disease involving predominantly the reticulohistiocytic system. Attempts to use these liposomes orally (induced diabetes) or locally (induced arthritis) are also reported. Further trials are required to get a better knowledge of the mechanisms involved in the exchanges between the cell membrane and the liposome the latter being variable as regards its composition, size and permeability according to the various investigators; the adjustment to the liposome of a complex capable to electively direct it towards the target organ is studied.

Administration, Oral

[Stenosis of the aqueduct of Sylvius and their endocrine manifestations (author's transl)].

In a 14-year-old boy, neurological signs (fall in visual acuity, signs of raised intracranial pressure) led to a diagnosis of stenosis of the aqueduct of Sylvius. Cure was obtained by insertion of a ventriculo-cardiac bypass (Holter's valve). Endocrine signs (delayed growth, excessweight, loss of circadian variations in cortisol levels) regressed in a few months after the operation. Amongst endocrine manifestations of stenosis of the aqueduct, delayed growth and disturbances in gonadal function are the most common, together with obesity. They usually regress after neurosurgical treatment.

Adolescent