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Biomedical subjects

Y Lorcy

Publications and source records attributed to Y Lorcy.

At least 37 records · Page 2Linked to original sources
PubMed1984

Thyroid stimulating antibodies: an aid to the strategy of treatment of Graves' disease?

In 1976 we initiated a prospective study to specify the usefulness of thyroid stimulating antibody (TSAb) determinations in predicting the outcome of post-antithyroid drug treatment for Graves' disease. This study was carried out on 55 patients, who were either treated for six (n = 16) or 18 months (n = 39) and followed up for an additional two-year period. TSAb was determined on whole serum in 29 patients before and at the end of treatment, and in 26 patients at the end of treatment only. These determinations were carried out using a sensitive and reproducible microassay based on cAMP accumulation in human thyroid cell cultures. Before treatment, TSAb ranging from 170 to 1529% was present in 28/29 patients and reached significantly low levels at the end of treatment whatever its duration. TSAb was undetectable in 24/55 patients at the end of treatment. 8/16 'short-treated' and 18/39 'long-treated' patients remained in remission. As expected, initial TSAb levels had no predictive value. End-treatment TSAb values, when low (less than 350%) or negative did not correlate with later evolution: in these 39 patients, relapse rate was 41%. In contrast, 13/16 patients with end-treatment TSAb greater than 350% relapsed. Relapses tended to occur earlier in patients with the highest TSAb levels. TSAb determined again during follow-up was negative in each of the 18 patients in remission, and positive in 8/10 patients at the time of relapse, whatever its level at the end of the drug course. This study confirms that only end-treatment TSAb levels are predictive of relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Accidents attributable to carbimazole in the treatment of Basedow's disease].

A series of 365 patients (330 women, 35 men) followed up for 9 years during treatment with 20 to 70 mg/day of carbimazole for an average duration of 18 months (range: 2 months to 6 years) was analyzed to evaluate frequency and type of accidents imputable to this synthetic antithyroid agent. Etiopathogenicity of these incidents is reviewed based on reports in the published literature. The product was extremely well tolerated by 349 patients. Minor side effects (hematologic in 0,8%, cutaneous in 1,4% and digestive in 1,6% of cases) were reported in 14 cases (3,8% of cases) and interruption of carbimazole treatment was necessary in 7 of these patients. Major accidents of favorable outcome (Lyell's syndrome, agranulocytosis) were observed in 2 patients (0,6% of cases). Two hypotheses can be evoked to explain their origin: a toxic cause mainly for the hematologic complication or an immuno-allergic mechanism suggested by the rapid onset of complications after beginning treatment. Carbimazole should not, therefore, be considered as a product lacking risks and the accidents observed strongly suggest the need for biological and particularly strict clinical surveillance of patients treated, the appearance of any sign of infection necessitating immediate full and differential blood counts and discontinuation of all therapy.

Adolescent↗
PubMed1983

[Relapse in Basedow's disease after treatment with synthetic antithyroid drugs. Prognostic value of analysis of the HLA system].

One hundred and eleven unselected patients with hyperthyroidism due to Graves' disease received decreasing doses of carbimazole for 18 months. Clinical examination and hormonal assays (serum T3, T4, free T4 index) were done at 4, 9 and 18 months of treatment. Patients were typed for 35 HLA antigens and were followed up for 2 years after withdrawal of treatment; 39 patients were excluded for various reasons and 72 were retained for study. Of the 72 patients, 37 relapsed and 35 remained in remission: 40 patients were DR3+ (20 relapsed) and 32 were DR3- (17 relapsed). HLA frequency was not significantly different in patients who relapsed and in those who remained in remission. Thus, under the conditions of this study, HLA frequency could not be used to predict relapse of hyperthyroidism due to Graves' disease. This study brings out an other interesting point: relapse frequency of about 50% focuses our attention on the limits of medical treatment.

Carbimazole↗
PubMed1983

A prospective study of the relationship between relapse of hyperthyroid Graves' disease after antithyroid drugs and HLA haplotype.

One hundred and eleven unselected patients with hyperthyroidism due to Graves' disease received decreasing doses of carbimazole for 18 months. Clinical examination and hormonal assays (serum T3, T4, free T4 index) were done at 4, 9, and 18 months of treatment. Patients were typed for 35 HLA antigens and were followed for 2 yr after withdrawal of treatment; 39 patients were excluded for various reasons and 72 were retained for study. Of the 72 patients, 37 relapsed and 35 remained in remission; 40 patients were DR3+ (20 relapsed) and 32 were DR3- (17 relapsed). HLA frequency was not significantly different in patients who relapsed and those who remained in remission. Thus, under the conditions of this study, HLA frequency could not be used to predict relapse of hyperthyroidism due to Graves' disease.

Carbimazole↗
PubMed1983

Properdin factor B (Bf) and glyoxalase in Graves' disease.

Patients with Graves' disease were phenotyped for properdin factor B (Bf) and glyoxalase, which are coded for by genes mapping close to the HLA region on the sixth chromosome. Frequency data were analysed in relation to HLA-A, -B and -DR typing data. Diagnosis of Graves' disease was based on the usual criteria including elevated T3 and T4 levels and free T4 index and a homogeneous thyroid scan. Ninety-four patients with Graves' disease were phenotyped for properdin factor B (Bf) and 37 for red cells glyoxalase (GLO). HLA-A, -B and -DR antigens were typed in 94 patients using a lymphocyte microcytotoxicity assay. The frequency distribution of Bf and GLO alleles showed no significant differences from control subjects. This finding contrasts with the reports of an increased frequency of BfF1 in insulin-dependent diabetes mellitus. The difference in the two diseases which are both associated with an increased frequency of the antigen combination D8-DR3, is accounted for by linkage disequilibrium between B18 and BfF1.

Chromosome Mapping↗
PubMed1982

[Short and long term results in the treatment of obesity. A study in 173 patients (author's transl)].

Short and long term weight loss was studied in 173 obese patients treated by a low-calorie diet. Significant weight loss was observed in 78% of the patients after 6 months and in 58% after 4 years. These results are similar to those published in other studies but the comparison is difficult because the methods used are not strictly comparable. A detailed study of 116 patients showed that weight loss is not significantly influenced by such variables as age, sex, previous calorie intake, complications, and severity or duration of the obesity.

Adult↗
PubMed1982

Serum lysosomal acid hydrolase activities in Graves' disease.

The activities of seven lysosomal enzymes (alpha-D-glucosidase, beta-D-galactosidase, beta-D-glucuronidase, hexosaminidase, alpha-L-fucosidase, alpha-D-mannosidase, acid phosphatases) were studied in the serum of 31 untreated patients with Graves' disease, 30 treated hyperthyroid patients whose clinical abnormalities had disappeared and whose hormones had returned to euthyroid levels, and 34 controls. The hyperthyroid state is characterized by increased serum levels of alpha-D-glucosidase, beta-D-glucuronidase, hexosaminidase and especially of alpha-L-glucosidase and alpha-D-mannosidase. In contrast, neither beta-D-galactosidase nor acid phosphatases serum levels were significantly modified. After antithyroid treatment, the activities of these enzymes returned to normal levels, except for alpha-D-mannosidase. The interpretation of these changes in serum acid hydrolases activities is controversial.

Acid Phosphatase↗
PubMed1982

[Intestinal bypass in the treatment of obesity. Results of 14 cases (author's transl)].

Fourteen women with severe obesity resistant to previous dietetic measures underwent intestinal bypass using Scott's method. Weight loss ranged from 1-2 kg to 50 kg (mean = 25 kg) but weas unpredictable and varied from patient to patient; most remained obese. The other results of the operation were similar to those already reported. There was a decrease in total plasma cholesterol, while HDL cholesterol remained normal. Calcaemia was in the lower range of normal values; one patient developed severe hypokaliaemia (1.8 mEq); low blood magnesium levels and steatorrhoea were common. Fibrosis of the liver was observed in one patient and probably in another. Five patients were re-operated upon for incisional hernia or intestinal occlusion. Other complications reported in the literature (pulmonary embolism, arthralgias, kidney stones and gall stones) did not occur in this series. Because of these complications we decided to stop using intestinal bypass for the treatment of severe obesity. However, in view of the potential dangers of severe obesity we feel that other surgical techniques, such as Mason's gastric bypass, should be considered in some patients.

Adult↗
PubMed1980

[Graves' disease. Predominance of the DRw3 antigen (author's transl)].

HLA-A, B, C antigens were studied in 86 white european patients with Graves' disease, using a lymphocyte toxicity microtechnique and the results were compared with those obtained in 356 healthy subjects. HLA-D (DR) antigens were studied by the same technique after prolonged incubation and the results were compared with those of 100 healthy controls. The incidence of DRw3 was 51.16% in the patients as against 20% in controls, the difference being highly significant (pc--PC less than 0.0003) - corrected p = p multiplied by the number of antigens tested. There was also a significant (pc less than 0.001) increase in HLA-BB: 44.19% against 22.47%, and in HLA-A1: 40.7% against 28.93% (pc less than 0.03). Conversely, there was a decrease in the incidence of HLA-B12: 12.79% against 31.74% (pc less than 0.01). B8 was found to be associated with DRw3 in 37 of the 86 patients, but in only 13 of the 100 controls (p less than 0.00003). There was no correlation between the HLA antigens and the clinical features of the disease (presence or absence of goitre and exophthalmos, severity of clinical or biological symptoms). These results are in agreement with those of other studies reporting an increase in HLA-B8. The increase in HLA-A1 is probably due to an accentuation of the unbalanced linkage with B8. The major finding was the predominance of the DRw3 antigen, also found by other authors working with a mixed lymphocyte culture. It seems therefore possible that the putative Graves' disease susceptibility antigen is present on the sixth chromosome, near to HLA-D (DR).

Adolescent↗
PubMed1980

HLA and Graves' disease: an association with HLA-DRw3.

HLA-A, -B, and -C antigens were tested by a standard lymphocyte microcytotoxicity technique in 86 Caucasians patients from western France with Graves' disease, and the data were compared with findings in 356 healthy controls. For HLA-DR antigen typing performed by lymphocyte microcytotoxicity testing using a long incubation time, the data were compared to findings in 100 healthy controls. An increase was found in the frequency of HLA-DRw3 [51.16% of patients vs. 20% of controls, corrected P (Pc) < 0.0003; relative risk (rr), 4.19) associated with an increased frequency of HLA-B8 (44.19% of patients vs. 22.47% of controls; Pc < 0.001; rr, 2.73) and HLA-A1 (40.7% of patients vs. 28.93% of controls; Pc < 0.03; rr, 1.71). In contrast, a diminished frequency was found for HLA-B12 (12.79% vs. 31.74%; Pc < 0.01). The antigen combination B8-DRw3 was noted in 37 of the 86 Graves' disease patients compared with 13 of 100 controls (Pc < 0.00003). No association was observed between HLA antigens and the different manifestations of the disease, such as the presence of goiter and/or exophthalmos, or the severity of clinical or biochemical signs. The present findings confirm the reported increase in the frequency of HLA-B8 in patients with Graves' disease. The most striking finding was the prevalence of HLA-DRw3, which, together with recent reports on lymphocyte-defined D locus determinants pointing to an increase frequency of HLA-Dw3, suggests that the gene or genes conferring susceptibility to Graves' disease may be located close to the HLA-D (DR) region of the sixth chromosome.

Adolescent↗