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Biomedical subjects

P Lecomte

Publications and source records attributed to P Lecomte.

At least 55 records · Page 3Linked to original sources
PubMed1996

131I-6 beta-iodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas.

OBJECTIVE: Most incidentally discovered adrenal tumours ('incidentaloma') are benign adrenocortical adenomas. It has been suggested that 131I-6 beta-iodomethylnorcholesterol (IMC) scan could specify the degree of functional autonomy of such adenomas depending on whether they prevent contralateral adrenal tracer uptake. Our purpose was to examine this hypothesis in a correlated scintigraphic and endocrine study. DESIGN: Prospective study evaluating the prevalence of unilateral IMC uptake (tumour uptake with no visualization of the contralateral adrenal gland) and bilateral uptake (uptake in both the tumoral and the contralateral adrenal glands) in patients with unilateral incidentaloma. Comparison of adrenocortical function and of IMC scan after dexamethasone (DXM) in the two scintigraphic groups thus defined. PATIENTS: Thirty-five patients with a unilateral mass highly suggestive of benign adrenocortical adenoma on CT scan. MEASUREMENTS: The IMC scan was performed in basal conditions (baseline scan) and after DXM (suppression scan). Adrenocortical function assessment included basal measurements of 11-deoxycortisol, 17 alpha-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulphate (DHEAS), plasma cortisol and ACTH, urinary free cortisol (UFC), overnight and low-dose DXM suppression test, and CRH test. RESULTS: The baseline scan showed 16 patients (46%) with unilateral uptake (group A) and 19 (54%) with bilateral uptake (group B). Patients in group A exhibited lower ACTH values at 0800h (P = 0.05) and higher cortisol values after an overnight DXM suppression test (P = 0.02), than did patients in group B. In addition, 3 patients in group A failed the overnight and the low-dose DXM suppression tests. Adrenal masses were larger in group A than group B (P = 0.04) and an inverse correlation was found in the whole population between tumour size and ACTH value at 0800h (P = 0.05). On the suppression scan performed in 14 patients (7 in each group), patients in group A continued to exhibit unilateral tumour uptake and bilateral uptake was suppressed in 72% of patients in group B. An adrenal mass was removed in 3 patients of group A with confirmed benign adrenocortical adenomas. In the post-surgical period, the contralateral gland was again visualized in a baseline scan and the hormonal evaluation returned to the normal range. CONCLUSION: Unilateral 131I-6 beta-iodomethylnorcholesterol tumour uptake is a frequent feature in benign adrenocortical adenomas. Hormonal data and scintigraphic profiles obtained after dexamethasone, as well as hormonoscintigraphic changes observed after surgery, provide evidence that unilateral uptake is related to functioning adenomas with various degrees of autononomy and suggest that the 131I-6 beta-iodomethylnorcholesterol scan could be a valuable tool for screening 'subclinical' Cushing's adenomas.

Adenoma↗
PubMed1996

Does hormonal skin aging exist? A study of the influence of different hormone therapy regimens on the skin of postmenopausal women using non-invasive measurement techniques.

BACKGROUND AND DESIGN: The skin properties of 98 postmenopausal women with hormone replacement therapy (oestradiol gel or patches) or without hormone replacement therapy were studied using non-invasive techniques: skin thickness with skin echography, skin hydration with a dryness score and measurement of capacitance, skin surface lipids with a Sebumeter and microtopography with image analysis of cutaneous replicas. RESULTS: In this open study we demonstrated an increase in skin thickness and sebum in the treated group in comparison to the untreated group (7-15% according to area for skin thickness, 35% for sebum). Hydration and microtopography were not different in the two groups. CONCLUSIONS: Postmenopausal women who were receiving hormonal substitution have a greater thickness and casual level than untreated women. We therefore suggest that hormonal aging exists and that cutaneous atrophy can be prevented with hormone replacement therapy.

Biopsy↗
PubMed1996

Relations among night work, dietary habits, biological measure, and health status.

A cross-sectional study was conducted to investigate dietary intake, behavioral habits, and clinical and metabolic differences in night workers compared to day workers and to evaluate the metabolic differences associated with diet and body habits that occur between these two groups. Dietary habits, biological parameters, and health status were collected in 1,200 night workers and in an equal number of day workers, matched for gender, age, and socioeconomic status. Our findings demonstrated that night workers had poorer dietary habits and metabolic profile compared to day workers with a similar overall health status. These differences were associated with a higher prevalence of some cardiovascular risk factors such as smoking and obesity.

Journal Article↗
PubMed1996

[Tertiary hyperparathyroidism induced by the treatment of hypophosphatemic osteomalacia].

Tertiary hyperparathyroidism developed after a 30-year treatment of low phosphorus osteomalacia with phosphorus supplementation. Parathormone stimulation by exogenous phosphorus would result from sequestration of calcium leading to low plasma levels of both ionized and total calcium. In this case, decreased calcium level was favoured by renal failure. Addition of calcitriol (1.25 hydroxyvitamin D3) to the phosphorus supplementation could avoid secondary hyperparathyroidism in patients with low phosphorus osteomalacia by increasing intestinal absorption of phosphorus and inhibiting, though not totally, parathyroid stimulation. Tertiary hyperparathyroidism is thus a potential complication of long-term phosphorus supplementation in vitamin D-resistant osteomalacia. Parathormone and phosphorus should be measured regularly in order to diagnose induced hyperparathyroidism early since this state is reversible with calcitriol and reduced doses of phosphorus.

Adult↗
PubMed1996

[Treatment of morbid obesity by adjustable silicone gastric banding. A new surgical technique of gastroplasty for obesity].

Among the various procedures used for surgical treatment of morbid obesity, the adjustable silicone gastric banding is in full development. It is also a gastric restrictive procedure and in addition it enables to adjust percutaneously the size of the stoma by inflating or deflating the inflatable portion of the band via an injection reservoir placed within the rectus sheath. In a small serie of 15 patients the efficacity of adjustable silicone gastric banding seems to be similar to that of the vertical banded gastroplasty, as far as weight reduction and improvement in the obesity associated comorbidity are concerned. In addition, this technique has two major advantages: absence of failure from staple line disruption, and a good food tolerance because the stoma size is adjustable to the patient's need. In contrast to other gastroplasties, the adjustable silicone gastric banding procedure is fully reversible after cutting the prothesis, and can be done under laparoscopy.

Adult↗
PubMed1995

[Congenital adrenal hyperplasia and testicular hypertrophy].

BACKGROUND: Testicular tumors have been reported in boys and adolescents with congenital adrenal hyperplasia (CAH) inadequately controlled by hormonal therapy. CASE REPORTS: Two adolescents were treated for CAH due to 21-hydroxylase deficiency. They developed hyperplastic nodular testes at the age of 16 and 17 years, respectively. CAH in both was inadequately controlled as confirmed by hormonal studies. The tumors regressed after adequate steroid therapy in the first patient but persisted in the second patient despite normalization of 17-OH progesterone and plasma renin activity. CONCLUSION: Testicular ultrasonography should be systematic in all male patients with CAH since radiological findings are earlier than clinical manifestations. The ACTH-dependent tumors require intensification of hormonal therapy in order to obtain tumoral regression and to prevent infertility.

Adolescent↗
PubMed1995

Age modulates effects of thyroid dysfunction on sex hormone binding globulin (SHBG) levels.

Symptoms of thyroid dysfunction are difficult to detect in elderly people and TSH is sometimes unreliable. We therefore tested the value of SHBG as a marker of thyroid hormone action on the liver to determine the thyroid status of elderly people. Aging euthyroid men and women have a significant increase in SHBG (p > 0.0001). In aging women the decrease in SHBG with hypothyroidism and increase with hyperthyroidism are highly significant (p < 0.0001 and p < 0.0005 respectively). No significant variation in SHBG was observed in men with thyroid dysfunction. SHBG can help to determine the thyroid status of aging women.

Adolescent↗
PubMed1995

Effects of suppressive doses of levothyroxine treatment on sex-hormone-binding globulin and bone metabolism.

The adverse effects of suppressive thyroxine treatment have previously been investigated and conflicting results have been published. This study aimed at evaluating the effects of subclinical hyperthyroidism on the liver and bones. We investigated the action of thyroxine on the liver by measuring sex-hormone-binding globulin (SHBG) levels and on bone turnover by evaluating osteocalcin (BGP) in both pre- and postmenopausal women. We compared the levels of both proteins to those of untreated subjects matched for age, menopausal status, and weight. Bone mineral density (BMD) was evaluated by biphotonic absorptiometry only in postmenopausal women with estrogen replacement therapy (ERT) and compared to two postmenopausal estrogen-treated controls. Forty-five women with multinodular goiter (38) or postsurgical thyroid carcinoma (7) were studied. They had received LT4 for 3 to 5 years (150 +/- 34 micrograms/day for nontoxic multinodular goiter, 184 +/- 46 micrograms/day for thyroid carcinoma). All patients had normal free T3 concentrations. No significant difference was found in SHBG values between patients and controls whatever the menopausal status and the BMI; a significant increase in BGP was noted in premenopausal women (9.6 +/- 2.2 vs 6.7 +/- 2.3 ng/ml; p < 0.0006). No significant BGP and BMD variations were observed in treated postmenopausal women. In summary, the study of carefully matched patients and controls revealed that thyroxine treatment has no effect on SHBG levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Management of necrospermia].

Necrospermia is still a poorly documented cause of male infertility. Among infertile subjects, the incidence reported in the literature is 0.2 to 0.48 per cent. We undertook a retrospective study to contribute to the comprehension of this abnormality. Histories, physical examination, analysis of the semen and hormonal dosages performed in necrozoospermic subjects were reviewed. We observed that in patients with necrospermia in at least three semen samples, infections represent 40 per cent of aetiologies. In 20% of the whole population, no aetiology was observed, but abnormalities of the epididymis function was suggested. Through this study, we suggest an aetiological classification and practical guidance in case of necrozoospermia.

Decision Trees↗
PubMed1994

Combined analysis of islet cell antibodies which cross-react with mouse pancreas, antibodies to the M(r) 64,000 islet protein, and antibodies to glutamate decarboxylase in subjects at risk for IDDM.

With regard to progression to diabetes, ICA cross-reactive with mouse pancreas, antibodies to the M(r) 64,000 islet antigen (64K), antibodies immunotrapping brain GAD activity, and IAA were analysed in 53 ICA-positive first-degree relatives of IDDM patients and 18 ICA-positive schoolchildren without a family history of diabetes. Sera from 29 (55%) relatives did not bind to mouse pancreas, whereas 24 (45%) displayed cross-species reaction. ICA titres on human and mouse pancreas were weakly correlated in the overall population (p < 0.05) but more strongly (p < 0.01) in only those subjects who displayed antibodies on tissues from both species. GAD and 64K antibodies were detected in 31% and 35% of relatives. In schoolchildren, the frequencies of cross-species reactive ICA (22%), GAD antibodies (6%), 64K antibodies (22%), and IAA (6%), were lower (p < 0.05) than in relatives. A strong correlation (p < 0.0001) was observed between GAD and 64K antibodies. GAD or 64K antibodies were strongly correlated with ICA on human pancreas (p < 0.0001) but poorly with ICA on mouse pancreas (p = 0.05). After pre-incubation of sera with brain homogenate, ICA titres were unaffected on mouse pancreas but reduced on human pancreas. ICA-positive subjects who displayed neither cross-species reactive ICA nor GAD or 64K antibodies were more frequent (p < 0.05) among schoolchildren than relatives, whereas subjects who displayed all antibody specificities were more numerous (p < 0.04) in relatives. All relatives with ICA binding only to human pancreas, as well as all schoolchildren, permanently displayed an AIRG higher than the first control percentile and remained non-diabetic.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Basedow disease following autoimmune primary hypothyroidism. Apropos of 7 cases].

The evolution of Graves' disease following auto immune hypothyroidism appears to be rather infrequent. We present seven female patients with autoimmune thyroiditis, 2 with goiter and 5 with hypothyroidism who, after a few months or years, presented signs of Graves'. Therefore it is usefull to carefully monitor TSH in patients treated for autoimmune thyroiditis to detect a possible evolution towards Graves' disease. This should be mostly true in patients with TBII positive antibodies autoimmune thyroiditis. During hyperthyroidism, 123 lodine uptake is much lower than usually observed in Graves' nevertheless, it is always increased compared to the uptake measured during hypothyroidism. This could be in favor of residual functional capacity of these often small thyroid glands. The alternate action of blocking or stimulating antibodies upon the TSH receptor would probably explained the switch from hypo to hyperthyroidism, even if there is usually no correlation between antibodies levels and clinical signs.

Adolescent↗
PubMed1993

[Exploration of pathological sperm and its fertilizing power].

The exploration of human sperms has considerably progressed during the last few years, side by side with the development of medically assisted procreation techniques. The sperms are explored by a battery of techniques which evaluate their functional state and the expression of their fertilizing power. Sperm count and motility assessment remain the basic examination in the exploration of couples' infertilities but other more sophisticated techniques can be used to evaluate certain stages in the fertilization process, including the recognition by, and attachment of the sperm to the zona pellucida of the oocyte, its penetration into this zone, the fusion of sperm and oocyte membranes and the transformation of the nucleus into a male protonucleus in the cytoplasm of the oocyte. Up to now, however, most of the techniques that evaluate the functional state of the sperm cell have not been predictive, and the only feasible and repeatable means of evaluating the fertilizing power of a semen is fertilization in vitro.

Fertilization↗
PubMed1992

[Tubular gastrostomy using celioscopy].

Surgical feeding gastrostomy is attended by a significant morbidity and mortality. Today, the percutaneous endoscopic route is regarded as the best method, but it is not feasible in case of pharyngo-oesophageal stenosis and has its own drawbacks. A new method using laparoscopy to perform a Depage-Janeway gastrostomy is presented here. The theoretical advantages of this method are clear: the limited parietal damage should avoid cicatricial complications, and the limited ventilatory aggression should reduce the amplitude of respiratory complications. Moreover, in surgical practice this is a simple, rapid and efficient operation.

Aged↗
PubMed1992

[Primary amenorrhea revealing micropolycystic ovary syndrome].

Nine patients with polycystic ovary syndrome revealed by primary amenorrhea were studied clinically, biochemically and ultrasonographically. One of them had excess weight, four had hirsutism and five acne. Testosterone and delta 4-androstenedione levels were high in all patients. Luteinizing hormone (LH) basal levels were increased in five patients. Basal values of follicle-stimulating hormone (FSH) remained within normal range. The LH to FSH ratio was elevated (over 2) in six patients. The LSH response to gonadotropin-releasing hormone (GnRH) was explosive in all patients. Ultrasonography showed that three out of five patients had enlarged ovaries with multiple follicles not exceeding 8 mm. Following treatment, two patients had children after ovulation was induced with clomiphene citrate, one patient became pregnant spontaneously but thereafter opted for voluntary interruption; two patients are still on ovulation-inducing therapy; four patients still have contraception. These results indicate the clinical heterogeneity and the diagnostic problems that surround this uncommon form of a frequently observed disease.

Adolescent↗
PubMed1992

[One hundred and twenty-five consecutive choledochotomies for suspected lithiasis without mortality. Current state of complications from common bile duct surgery].

The postoperative courses of 125 consecutive surgical common bile duct explorations performed between 1983 and 1990 were analysed. All cases of common bile duct lithiasis, but three, were operated on. Intraoperative cholangiography was performed in 98 percent and cholangioscopy in 92 percent of patients; common bile duct stones were found in 95 patients (76 percent); the common bile duct was sutured without drainage in 78 patients (58 percent). There were no deaths. Morbidity was 14 percent, of which 10 percent were serious. Four percent of common bile ducts retained stones. The specific morbidity was 4 percent. These results confirm the reliability of surgical management of common bile duct stones and therefore should be considered for the evaluation of new procedures, such as laparoscopic treatment of common duct stones, or combined laparoscopic cholecystectomy and endoscopic sphincterotomy.

Aged↗
PubMed1990

[Phosphorus-calcium metabolism in hyperthyroidism].

Because of the bone remodelling it induces, hyperthyroidism modifies the parameters of calcium-phosphorus metabolism. For a better determination of the mechanism involved, we studied 13 patients with Graves' disease compared with 13 controls. We measured the various parameters of calcium-phosphorus metabolism, notably the levels of parathormone, 25-hydroxycholecalciferol, 1-25 dihydroxycholecalciferol and ostocalcin; 8 patients were re-examined in euthyroidism. Total and corrected values of calcaemia (P less than 0.05 and P less than 0.01), phosphoreamie (P less than 0.01), alkaline phosphatase (P less than 0.01), calciuria (P less than 0.01) and hydroxyprolinuria (P less than 0.01) were significantly higher in patients with hyperthyroidism. Osteocalcin also was significantly increased (P less than 0.01) and correlated with thyroid hormone levels, thus confirming its usefulness as marker of bone remodelling in hyperthyroidism. Creatininaemia was significantly lowered (P less than 0.01). The intestinal absorption of calcium after injection of 1 g of calcium was reduced. Parathormone and 25-hydroxycholecalciferol levels were not significantly different in patients and in controls. In patients who were re-examined in euthyroidism, there was a significant increase in parathormone and in 1-25 dihydroxycholecalciferol levels (P less than 0.05). Thus, in situations of hyperthyroidism 2 elements contribute to a deficit in calcium balance: (a) a fall in parathormone level, consecutive to a rise in calcaemia, induces hypercalciuria; and (b) a fall in 1-25 dihydroxycholecalciferol level, consecutive to functional hypoparathyroidism and hyperphosphoraemia, results in a decrease of intestinal calcium absorption.

Adolescent↗