Characterization of the somatostatin receptor subtype in a bronchial carcinoid tumor responsible for Cushing's syndrome.

Small ACTH-secreting carcinoid tumors responsible for Cushing's syndrome are often difficult to localize using available radiological investigations. Somatostatin receptors have been found in about 90% of carcinoid tumors studied, leading to a new approach for the localization of tumors or metastasis by using radiolabeled somatostatin analogs. We report a case of Cushing's syndrome due to an ACTH-secreting bronchial carcinoid tumor, completely suppressible with octreotide treatment and evidenced by body scintigraphy with 111In-labeled pentreotide. After removal, which led to patient recovery, the tumor was studied in vitro. In situ hybridization, using a complementary DNA probe, revealed POMC messenger ribonucleic acid in a subpopulation of tumor cells. These cells were labeled by immunochemistry using an antiserum directed against ACTH. Confocal laser scanning microscopy analysis showed that the ACTH-immunoreactive peptide was sequestered in secretory granules. Autoradiographic labeling using [125I-Tyrzero,D-Trp8]somatostatin-14 demonstrated the presence of somatostatin-binding sites in the whole tumor tissue. The relative affinities of various selective somatostatin analogs and the ability of GTP to inhibit radioligand binding suggested that the receptor expressed in the tumor cells belonged to the SSTR-2 subtype.

[Hypoparathyroidism after thyroid surgery]. / L'hypoparathyroidie apres la chirurgie thyroidienne.

The authors report their experience of hypoparathyroidism in thyroïd surgery: 538 patients underwent thyroidectomy, including 45% bilateral resections. In post operative period, accurate tests allowed to detect non permanent hypocalcemias in 60% of cases. Severe hypocalcemia (1.60 mmol/l) is necessary to engage a treatment by vitamin D. So, a soft thyroid microsurgery is the only one manner to preserve parathyroid stock. 46 patients had parathyroid transplantation, but the evaluation is difficult, because the amount of parathyroid gland without ischemia, left into the neck, is unknown. In summary, this technique is effective, but often useless in thyroid surgery.

Pharmacokinetics and efficacy of a long-acting formulation of the new somatostatin analog BIM 23014 in patients with acromegaly.

The treatment of acromegalics with somatostatin analogs requires continuous sc infusion using pumps or several sc injections daily. Long-acting formulations (BIM-LA) of BIM 23014 (BIM) using delayed microcapsules may provide a more convenient form of therapy. Fourteen acromegalics whose GH secretion had not been normalized by transphenoidal surgery followed, in 10 cases, by pituitary radiotherapy (performed at least 2 yr before the study) were studied. Eight of these patients participated in an initial study of the pharmacokinetics of BIM-LA, after which a 6-month efficacy study was undertaken. The 8 patients in the pharmacokinetic study had an initial blood sample collected for measurements of plasma GH and insulin-like growth factor-I (IGF-I) levels before the im injection of 30 mg BIM-LA, and blood samples were subsequently taken 2, 4, 6, and 8 h after injection and then twice a week for a month. Plasma IGF-I levels were measured on days 4, 14, 20, and 30 after the injection. Assays of plasma GH, IGF-I, and BIM levels were performed by RIAs. The results showed that plasma GH levels were markedly reduced from 26.0 +/- 2.0 to 2.5 +/- 0.2 micrograms/L 2 h after BIM-LA injection and remained lower than 5 micrograms/mL for the 11 following days. Plasma GH levels increased to 5.5 +/- 1.2 micrograms/L on day 14 and returned to basal values 23 days after injection. Similarly, plasma IGF-I decreased from an initial level of 656 +/- 43 to 324 +/- 23 ng/mL on day 4 and remained close to the normal range for the following 10 days. Plasma BIM levels reached a peak 2 h after the injection (7.2 +/- 2.3 ng/mL) and remained higher than or close to 1 ng/mL until the 14th day after injection. This initial study showed that a single injection of 30 mg BIM-LA effectively suppressed GH and IGF-I secretion for at least 14 days, in accordance with the kinetics of the drug in plasma. Based on the results of this initial study, 30 mg BIM-LA were injected twice monthly for 6 months in all 14 patients. All of the subjects had a basal evaluation before treatment with BIM-LA and were then subjected to assessment of clinical, pituitary, and hormonal parameters. Patients were evaluated after 3 and 6 months of treatment on the same basis as that previously used when starting the BIM-LA therapy. Plasma BIM levels were measured monthly. Clinical signs of acromegaly improved during the treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

[Treatment of acromegaly with sustained-release lanreotide. A new somatostatin analog]. / Traitement de l'acromégalie par une forme à libération prolongée du lanréotide. Un nouvel analogue de la somatostatine.

The recovery of acromegaly is not obtained in about 50 percent of cases treated with radiotherapy and/or transsphenoidal surgery. Somatostatin analogs prescribed in such cases are effective but need either several subcutaneous injections a day or continuous infusions with pumps. Long-acting formulations of the new somatostatin analog lanreotide should avoid such drawbacks. Nine acromegalics, not cured by pituitary surgery (associated with radiotherapy in 7) received on IM injection of a long acting formulation of lanreotide twice a month for one year. Basal evaluation included: clinical examination, routine analyses, gall bladder ultrasonography, hormonal investigation of pituitary function including GH and IgF-1 measurements, visual field evaluation and pituitary scanning. A similar evaluation was performed on months 6 and 12 of treatment. The clinical symptoms of acromegaly progressively improved during therapy. Plasma GH levels decreased significantly (P < 0.01) from 24.2 +/- 2.1 to 9.3 +/- 1.2, 6.4 +/- 1.4 and 7.9 +/- 1.1 micrograms/l on months 3, 6 and 12, respectively. Plasma IgF-1 levels were normalized, decreasing from 676 +/- 40 to 331 +/- 30, 350 +/- 36, and 317 +/- 29 ng/ml on months 3, 6 and 12, respectively. Plasma lanreotide levels remained stable throughout the treatment. Side-effects included slight and transient diarrhoea and abdominal cramps which disappeared after 6 months of treatment. No gallstones appeared during treatment. These results show that one injection, twice a month, of a long-acting formulation containing 30 mg lanreotide is able to control the evolutivity of acromegalies not cured by pituitary radiotherapy and/or transsphenoidal surgery. Such formulations are well tolerated and avoid the drawbacks of either several subcutaneous injections a day or continuous infusions of somatostatin analogs.

[Cure of chronic hepatitis B after treatment with basic aluminum hydroxide. One case report (author's transl)]. / Guérison d'ue hépatite chronique après traitement par l'hydroxyde d'aluminium injectable. Relation d'un cas.

The authors describe a case of cure of chronic hepatitis B. This therapy chronic hepatitis B was corticotherapy dependent and the cure appeared during a treatment with basic aluminum hydroxide. This drug is an adjuvant of immunity. Clinical and biological disturbances disappeared. An improvement of the histological liver disturbances during hepatitis cure had been noticed. Three years later no recurrence was observed. After a short review of published literature, the authors discuss the mode of action of basic aluminum hydroxide.

[Intestinal malabsorption with a dissociated deficiency of immunoglobulins (author's transl)]. / Syndrome de malabsorption en rapport avec une carence dissociée en immunoglobulines. Relation d'un cas et revue de la littérature.

The case of a 42-year-old-man with dissociated deficiency of immunoglobulins and intestinal malabsorption is presented. The gastrointestinal symptoms included post-prandial pains and steatorrhea. Histologic and immunohistochemistry studies of small intestinal biopsies revealed subtotal villous atrophy and absence of IgA producing plasma cells. The deficiency of immunoglobulins was total for IgA and moderate for IgM. IgG was increased. HLA B8 haplotype was present Gluten-free diet gave dramatic improvement in few days on clinic symptoms. Recovery of the villi was observed within three months. The cases reported in the published literature are reviewed and the physiopathologic hypothesis and nosology limits of the syndrome are discussed.

[Mixed idiopathic cryoglobulinemia and glomerulonephritis (author's transl)]. / Cryoglobulinémie mixte essentielle et néphropathie glomérulaire.

Mixed idiopathic cryoglobulinemia may be associated with renal failure. When this occurrence appears some characteristic lesions may be observed on renal biopsies. The authors describe a case of mixed idiopathic cryoglobulinemia with nephrotic syndrome and hypertension. Histologic data and immunofluorescence study of renal biopsies are similar to those described in the published literature. If antigen-antibody complex seems to be for all authors the etiological feature of renal disease, the treatment to apply is not well known. The related case had been treated by plasmapheresis and the authors give their results to short and mean term.

[Papillary thyroid cancer lying within a toxic adenoma (author's transl)]. / Découverte d'un cancer papillaire de la thyroïde au sein d'un adénome toxique.

The association of hyperthyroidism and thyroid cancer is rare. The commonest finding is multilobular goitres. When a toxic adenoma is associated with a thyroid cancer they are usually clearly separate lesions. A thyroid cancer lying within a toxic adenoma, as in this case, is a much rarer occurrence, and a review of the published literature suggests that the relatively frequent association of the two lesions is fortuitous. The possibility of a cancer occurring near, or within a toxic adenoma, is an argument in of surgical treatment of these formations.

[A comparative study of standard electroencephalographic techniques and telemetry (author's transl)]. / Apport de la télémétrie en e.e.g. comparée a celle de l'e.e.g. standard.

The authors have used radio-telemetry to perform long duration studies and to study the variations in cerebral electrical activity. They presented a quantitative study of the distribution of paroxysmal activity in the epileptic, based on an experimental observation and confirmed as a result of the methods used. They were able to show a relationship between the severity and temporal distribution of paroxysmal activity which was confirmed statistically. Further observations were made on the distribution and onset of epileptic discharges but more detailed analysis is required before general electrophysiological conclusions can be made.

[Considerations relating to the choice of criteria of automatic detection in tele-E.E.G (author's transl)]. / Considérations sur le choix des critères de détection automatique en télé-e.e.g.

The authors retrace their pragmatic approach, by stages, to analysis the "unsorted" signal of cerebral activity, transmitted by telemetry. They use the selective properties of frequency filters associated with energy level thresholds, in order to obtain discrimination of the events appearing in the E.E.G. They emphasise the learning of objective reading, in its electrical composition, of the E.E.G. signal, and the need for good function of the telemeasure systems which transmit the information. The final stage involves a discriminator of paroxysmal electrical activity, programmable in its selective functions and in its association logic, essential for analysis by calculator, for statistical studies and in order to detect any electro-clinical correlation.