[Diagnostic value of spinal puncture-biopsy in non-infectious spinal diseases. Apropos of 41 cases]. / Valeur diagnostique de la ponction-biopsie vertébrale dans les affections rachidiennes non infectieuses. A propos de 41 cas.

To evaluate the diagnostic value of percutaneous vertebral biopsy in noninfectious diseases of the spine, we retrospectively studied 41 cases seen between 1985 and 1992. The level of the lesion was lumbar in 29 cases, thoracic in 11, and cervical in one. There were 19 crush fractures, 11 lytic lesions, six sclerotic lesions, and three mixed lesions. The biopsy was done because of an abnormal magnetic resonance imaging signal in one patient and because of epiduritis in another. The thoracic and lumbar biopsies were done under x-ray guidance using the technique developed by Laredo and Bard. Computed tomography guidance was used for the cervical biopsy. There were no adverse events. The final histological diagnosis was metastatic disease in 17 cases (41.5%), myeloma or plasmacytoma in six cases (14.7%), primary vertebral neoplasia in two cases (4.8%), lymphoma in one case (2.4%), osteoporosis in nine cases (22%), Paget's disease in three cases (7.4%), amyloidosis in one case (2.4%), aseptic osteitis in one case (2.4%), and vertebral necrosis in one case (2.4%). A second biopsy procedure was done in three patients (surgically in two cases and percutaneously in one) because of discrepancies between histological findings and other data. The final diagnosis was metastatic disease in all three patients. Overall, the diagnostic yield of percutaneous vertebral biopsy was 92.6% and varied little with initial roentgenographic or computed tomographic findings. However, yield was only 56% for the diagnosis of tumorous lesions, with variations according to roentgenographic and computed tomographic changes, 90.1% for osteolytic lesions, 66.6% for mixed lesions, 47.4% for crush fractures, and 16.6% for sclerotic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Synthetic antithyroid drugs and Basedow's disease or the choice of a therapeutic strategy]. / Antithyroïdiens de synthèse et maladie de Basedow ou le choix d'une stratégie thérapeutique.

We present the conclusions of two prospective studies of patients examined at their first manifestation of Graves' disease and treated with antithyroid drugs (ATD). The purpose of the first study was to investigate the effects of long-term treatment: the patients were given carbimazole in degressive doses without hormone replacement for 18 months, the followed up for 2 to 6 years after drug withdrawal. The second study was designed to determine the effect of treatment duration on the prognosis: the patients were given an ATD according to the same protocol for a duration randomly set at either 6 or 18 months, then seen again 2 years after ATD withdrawal. The results showed that after 18 months of treatment at least 50 percent of the patients could be expected to remain in remission for 6 years. Remissions were less frequent when treatment was shorter (41.7 percent after the 6 month treatment versus 61.8 percent after the 18 month treatment, with a 2 years' follow-up; P less than 0.05). The relapses that occurred came early: 70 percent of them took place within the first post-treatment month. This article also provides evidence of high T3 and/or T4 levels without signs of thyrotoxicosis during the post-treatment clinical course; these exclusively biochemical relapses spontaneously disappeared and may have been expressing epidoses of active thyroiditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithyroid drugs and Graves' disease: a prospective randomized evaluation of the efficacy of treatment duration.

A prospective randomized study was performed in patients with hyperthyroid Graves' disease (GD) in order to compare long (18 months) and short term (6 months) antithyroid drug treatment on the remission rate. A therapeutic protocol was offered to all GD patients who had not been treated for this disease previously. All patients studied who followed the protocol were rechecked 2 yr after treatment was withdrawn, or earlier in the case of relapse. Of the patients having undergone long term treatment, 61.8% still were in remission 2 yr after treatment withdrawal, whereas only 41.7% of the patients treated for 6 months were in remission (P less than 0.05). Such findings clearly establish that treatment duration has a direct beneficial incidence on the remission rate. These results were confirmed by the fact that treatment for 18 months resulted in remission in 7 of 15 patients who had previously relapsed after a 6-month course of therapy. This improvement in relation to treatment duration might be due to the immunosuppressive action of carbimazole. No significant difference was observed between relapse and remission groups, regardless of treatment duration, for HLA ABDr, serum T3 and T4, and T3/T4 ratio determined before treatment. Only the thyroid-stimulating antibody levels determined at the time of diagnosis and at the end of treatment were higher in the relapse group, a difference that was relevant only globally, due to value scattering. Furthermore, thyroid-stimulating antibody levels at the end of treatment may indicate remission or, conversely, continuance of the pathological process.(ABSTRACT TRUNCATED AT 250 WORDS)

[Autoimmune polyendocrinopathy and chronic mucocutaneous candidiasis]. / Polyendocrinopathie auto-immune et candidose mucocutanée chronique.

The authors report the case of a child who, at the age of 18 months showed signs of hypoparathyroidism together with gastrointestinal, then buccal, then ungual candidiasis. Acute adrenal failure occurred when he was 5 1/2 years' old. At the age of 10, the patient developed alopecia areata and interstitial keratitis. Immunological investigations yielded normal results, except that serum was weakly positive for anti-adrenal antibodies at 1/10th. The mucosal and ungual candidiasis infection was cured by ketoconazole, and the various endocrine abnormalities were corrected with the appropriate replacement therapies. This case prompted the authors to review the candidiasis/"polyglandular autoimmune disease" association. Whitaker's triad consists of candidiasis, hypoparathyroidism and chronic renal failure, 2 or these 3 elements being sufficient to make the diagnosis. Numerous other associations have been described; they are presented here in table form in descending order of frequency, with candidiasis/hypoparathyroidism coming on top of the list (70 p. 100). The fairly constant chronological order in which these different pathologies appear is one of the peculiarities of the syndrome: candidiasis often precedes hypoparathyroidism and adrenal insufficiency. Alopecia areata does not seem to be frequent, but its true incidence is difficult to quantify since lesions of the scalp and/or skin appendages are poorly documented in the literature. Alopecia and keratopathy seem to be of autoimmune origin. Mucocutaneous candidiasis too is specific, the mucosae and nails being constantly involved. This type of candidiasis does not exist in other forms of hypoparathyroidism. Chronic mucocutaneous candidiasis is found in many different diseases and is due to immunodeficiency against Candida spp.(ABSTRACT TRUNCATED AT 250 WORDS)