Etiologic discussion and clinical relevance of thyroid ultrasonography in subclinical hypothyroidism. A retrospective study in 1845 patients.

BACKGROUND: Acquired subclinical hypothyroidism in adulthood is mainly due to autoimmune thyroiditis. In the absence of a goiter or a palpable firm thyroid, measurement of thyroid antibodies can improve the diagnosis. Whether thyroid antibodies are detected or not, what might be the clinical relevance of ultrasonography in this setting? METHODS: We studied 1845 cases of subclinical hypothyroidism in adults recruited for symptoms indicative of hypothyroidism or thyroid pathology. All patients were screened for thyroid antibodies and underwent an ultrasonographic thyroid examination. LOCALISATION: Multicentric retrospective study. RESULTS: Chronic autoimmune thyroiditis was confirmed in 70% of patients. Thyroid antibodies were undetectable in 30% of patients. In all patients, thyroid ultrasound facilitated measurement of the thyroid volume and detection of non-palpable nodules and therefore allowed biopsy. In patients negative for thyroid antibodies, ultrasonography suggested autoimmune thyroiditis in 31% of cases. Ultrasonography did not contribute to diagnosis in a large number of patients without nodules and in case of normal echostructure. The strategy of thyroid hormone replacement therapy was not influenced by ultrasonographic data. Thyroid biopsies detected smears suspected to be cancerous in 10 patients (4%). Cancer was confirmed in nine patients after surgery. Ultrasonography displayed suspicious aspects in six patients. CONCLUSION: In subclinical hypothyroidism, thyroid ultrasonography is not required for the diagnosis of autoimmune thyroiditis but is useful for patients with abnormal thyroid palpation and allows detection of non-palpable thyroid nodules. For patients that were negative for thyroid antibodies, thyroid ultrasonography can improve diagnosis for some patients, allowing detection of autoimmune thyroiditis.

Endogenous factors affecting oxidative stability of beef loin, pork loin, and chicken breast and thigh meats.

The susceptibility of meats from different animal species (chicken breast [CB] and thigh [CT], pork [PL and beef [BL]) to lipid oxidation was studied. The amounts of TBARS in raw PL, CB, and CT did not change during a 7-d storage period. TBARS values of raw BL, however, significantly increased during 7-d storage because of high heme iron content, high lipoxygenase-like activities, and low 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activities. Ferric ion reducing capacities (FRC) were detected in all raw meats, but their characteristics were different: storage-unstable in CB and CT and storage-stable in PL and BL. Ferric ion reducing capacities in raw CB and CT was higher than those of PL and BL, and could be related to their high oxidative stability. The TBARS values of cooked meat increased significantly with storage. The rates of TBARS increase in cooked CT and BL were significantly higher than those of cooked CB and PL after a 7-d storage. Nonheme iron content in cooked BL was higher than other meats and increased significantly after 7 d. Cooked BL had a higher amount of heat-stable FRC, which acted as a prooxidant in the presence of high free ionic irons, than other meats. Therefore, high heat-stable FRC and increased nonheme iron content in cooked BL were responsible for its high susceptibility to lipid oxidation. Despite relatively low nonheme iron and heat-stable FRC levels, cooked CT showed similar levels of TBARS to cooked BL after a 7-d storage because of its high PUFA content.

Investigating quality attributes and consumer acceptance of uncured, no-nitrate/nitrite-added commercial hams, bacons, and frankfurters.

Increasing demands for natural, organic, and/or preservative-free foods have resulted in the consumer availability of uncured, no-nitrate/nitrite-added processed meat and poultry products. A comprehensive understanding about the quality and sensory attributes of commercially available uncured products is unclear. The objective of this study was to determine if quality and sensory differences exist between uncured and cured meat products. Five different commercial brands (Brands A to E; 4 uncured, no-nitrate/nitrite-added, and 1 nitrite-added) of 3 product types (hams, frankfurters, and bacons) were obtained from retail supermarkets. The samples were evaluated for color, pigment content, pH, lipid oxidation, residual nitrate and nitrite content, and consumer acceptance. All brands from all product types evaluated, except for 1 bacon (Brand B), had cured color, aroma, and flavor attributes similar to the nitrite-added control (Brand E). All product types and brands contained residual nitrate and residual nitrite except for Brands B and D bacons (< 1 ppm nitrite). Lipid oxidation as measured by 2-thiobarbituric acid reactive substances revealed a large variation in the occurrence of lipid oxidation both between and within product types, with frankfurters reporting the highest levels. Color measurements indicated the majority of the brands within each product type were similar to the control. Consumer sensory ratings for surface/lean color, aroma, flavor, texture, and overall acceptance determined that variation existed. Brand E (nitrite-added control) and 1 uncured, no-nitrate/nitrite-added brand for each product type were not different (P > 0.05) for overall acceptance and received higher scores (P < 0.05) than all other brands within each product type.

Effects of varying levels of vegetable juice powder and incubation time on color, residual nitrate and nitrite, pigment, pH, and trained sensory attributes of ready-to-eat uncured ham.

Vegetable juice powder (VJP) and a starter culture containing Staphylococcus carnosus have been identified as necessary ingredients for the manufacture of uncured, no-nitrate/nitrite-added meat products with quality and sensory attributes similar to traditional cured products. The objectives of this study were to determine the effects of varying concentrations of VJP and incubation time (MIN-HOLD) on quality characteristics, including lipid oxidation, color, and cured meat pigment concentrations, of ham over a 90-d storage period, compare residual nitrate and nitrite content, and determine if differences exist in sensory properties of finished products. Four ham treatments (TRT) (TRT 1: 0.20% VJP, 0 MIN-HOLD; TRT 2: 0.20% VJP, 120 MIN-HOLD; TRT 3: 0.35% VJP, 0 MIN-HOLD; TRT 4: 0.35% VJP, 120 MIN-HOLD) and a sodium nitrite-added control (C) were used for this study. No differences (P > 0.05) were observed between TRTs and C for CIE L*, a*, b*, and cured color measured by reflectance ratio. Lipid oxidation (TBARS) for combined TRTs and C revealed little change over time while the C had less (P < 0.05) lipid oxidation than TRTs 2 and 4 for combined days. No differences (P > 0.05) were reported for cured pigment concentration between TRTs and C. Trained sensory panel intensity ratings for ham and vegetable aroma, and flavor, color, and firmness showed that a high concentration (0.35%) of VJP resulted in the highest scores for undesirable vegetable aroma and flavor. Treatment combinations with a low concentration (0.20%) of VJP were comparable to the C for all sensory attributes.

Effects of vegetable juice powder concentration and storage time on some chemical and sensory quality attributes of uncured, emulsified cooked sausages.

Uncured, no-nitrate/nitrite-added meat products can be manufactured with vegetable juice powder (VJP) and a starter culture containing Staphylococcus carnosus, resulting in quality and sensory attributes similar to traditional cured products. The 1st objective of this study was to determine the effects of varying concentrations of VJP and incubation times (MIN-HOLD) on quality characteristics, including lipid oxidation, color, and cured meat pigment concentrations, of emulsified-frankfurter-style-cooked (EFSC) sausages over a 90-d storage period. The 2nd objective was to compare residual nitrate and nitrite content resulting from different processing treatments and the 3rd objective was to assess sensory properties of finished products. Four EFSC sausage treatments (TRT) (TRT 1: 0.20% VJP, 30 MIN-HOLD; TRT 2: 0.20% VJP, 120 MIN-HOLD; TRT 3: 0.40% VJP, 30 MIN-HOLD; TRT 4: 0.40% VJP, 120 MIN-HOLD) and a sodium nitrite-added control (C) were used for this study. No differences for lipid oxidation (TBARS) between any TRTs and C or over time were observed. No differences (P > 0.05) for CIE L* values were found between TRTs. CIE a* and reflectance ratio values revealed that TRTs 2, 4, and C were redder than TRTs 1 and 3 at day 0. Trained sensory intensity ratings for cured aroma, cured color, cured flavor, uniform color, and firmness determined that all but TRT 1 were similar to C. These results indicate a longer incubation time (120 compared with 30 min) was found more critical than VJP level (0.20% or 0.40%) to result in products comparable to a sodium nitrite-added control.

Effects of oleoresin-tocopherol combinations on lipid oxidation, off-odor, and color of irradiated raw and cooked pork patties.

Lipid oxidation, color, and volatiles of double-packaged pork loins with various oleoresin or oleoresin-tocopherol combinations were determined to establish the best oleoresin-tocopherol conditions that can improve the quality of irradiated raw and cooked pork loins. Rosemary and α-tocopherol combination at 0.05% and 0.02% of meat weight, respectively, showed the most potent antioxidant effects in reducing both TBARS values and the amounts of volatile aldehydes in irradiated raw and cooked pork loins. The antioxidant combination, however, did not affect the production of sulfur volatiles responsible for irradiation off-odor and showed little effects on color changes in irradiated raw and cooked pork loins. Exposing double-packaged irradiated pork to aerobic conditions for 3days during the 10-day storage was effective in controlling both lipid oxidation and irradiation off-odor, regardless of packaging sequences.

Influence of rosemary-tocopherol/packaging combination on meat quality and the survival of pathogens in restructured irradiated pork loins.

Irradiated restructured pork loins treated with rosemary-tocopherol/double-packaging had lower TBARS values than vacuum-packaged control after 10 days of refrigerated storage. The rosemary-tocopherol combination, however, had no effect on the production of sulfur volatiles responsible for the irradiation off-odor, and color changes in irradiated pork. V7/A3 double-packaging was effective in reducing the sulfur volatiles significantly. Rosemary-tocopherol combination was highly effective in reducing the volatile hexanal in irradiated restructure pork. Irradiation was effective in reducing Listeria monocytogenes and Salmonella typhimurium inoculated on the surface of restructured pork loin in dose-dependent manner. The irradiation D(10) values for L. monocytogenes and S. typhimurium were 0.58 and 0.55kGy, respectively. During the 20 days of refrigerated storage, L. monocytogenes in both nonirradiated and irradiated samples grew gradually, but the number of S. typhimurium decreased. The added rosemary-tocopherol, however, showed little bacteriocidal effects to L. monocytogenes and S. typhimurium.

[Frequency of hypothyroidism after De Quervain thyroiditis and contribution of ultrasonographic thyroid volume measurement]. / Fréquence de l'hypothyroïdie après thyroïdite de De Quervain et intérêt de la mesure échographique du volume thyroïdien.

Subacute thyroiditis conventionally recovers without after-effect. Nevertheless some data relate a 5 to 9% occurrence of final hypothyroidism 6 months after the acute stage. We herein studied end-stage hypothyroidism occurrence and effect of thyroid volume alterations on hormonal course during thyroiditis. Twenty-nine cases of subacute thyroiditis were studied. Final thyroid function remained normal in 15 patients (51%) and undetermined in 5 patients (17%). Final hypothyroidism (TSH: 4.5-14.5 microU/mL) occurred in 9 patients (31%). Mean thyroid volume was increased in acute stage in patients with final normal thyroid function (16.6+/-5.7cm(3)) and decreased by 63% during follow-up; final mean thyroid volume was 6.1+/-1.3cm(3). Mean thyroid volume was normal in acute stage in final hypothyroid patients (10.7+/-3.0cm(3)) and decreased by 72% during follow-up; final mean thyroid volume was 3.3+/-1.1cm(3). End-stage mean thyroid volume was significantly lower in final hypothyroid patients (p<0.05) compared to patients with final normal thyroid function. We conclude that the occurrence of final hypothyroidism is underestimated after subacute thyroiditis. Ultrasonographic follow-up might be helpful in the detection of final hypothyroid-risk patients: thyroid volume not increased in acute stage and lower than 5cm(3) during follow-up is one of the ultrasonographic features of these patients.

[Results of ultrasonographic and cytologic follow-up of 311 initially non-suspicious thyroid nodules]. / Résultats de la surveillance échographique et cytologique de 311 nodules thyroïdiens initialement non suspects.

The follow-up of initially non suspect thyroid nodules after fine needle biopsy is not completely worked out. Since 1985, we have entered upon a prospective study concerning the followup of thyroid nodules supposed to be benign after initial evaluation. What are the nature and the frequency of means to be used for their follow-up? Three hundred and eleven nodules are followed up on a mean duration of 2.44 years. The follow-up of 65 of them is 4 years or more. The follow-up of 120 others is 3 to 4 years; 197 nodules are followed up during 2 to 3 years. A physical examination, an ultrasonography completed with a fine needle biopsy or an ultrasonically guided fine needle biopsy are worked out every year. Twenty-three per cent of initial biopsies are non significant and 90% of them are ultrasonically guided biopsies. At the end of the study, the repeating biopsies reduce to 6% the non significant biopsies ratio. Four histological thyroid cancers are detected in three female patients 1 year, 2 years and 5 years after the initial evaluation. Ultrasound alterations of nodules are observed in case of very suspect biopsies. Ninety-six per cent of the followed up thyroid nodules remain not cytologically suspect. These findings allow us to propose the following guidelines for the assessment of a non suspect thyroid nodule: half-yearly or yearly physical examination, yearly or biennial ultrasonography, repeat biopsy after 2 or 3 years when clinical or ultrasound suspect modification is wanting.

[Critical study of the characterization of hyperandrogenism in a group of obese women]. / Etude critique de la caractérisation de l'hyperandrogénie dans un groupe de femmes obèses.

The authors report the hormonologic characteristics of 20 obese and hirsute women meeting the criteria for adrenaltype hyperandrogenism, suppressible by dexamethasone, without hyperprolactinemia and without any late developing partial enzyme block appearance. The laboratory profile of these women differed from that of a group of women with type 1 polycystic ovaries syndrome. In this same group obese women in whom LH/FSH ratio was below 1, there was evidence under baseline conditions of a moderate increase in testosterone and delta 4-androstenedione in relation to increased plasma levels of DHA and SDHA, plasma delta 4 and delta 5-androgen levels falling precipitalely during the dexamethasone suppression test. The ACTH stimulation test revealed greater reactivity for 17 hydroxy-pregnenolone (p < 0.001) and less for 21-deoxycortisol than in the control group of normal women (p < 0.01). The essentially adrenal origin of plasma hyperandrogenism in certain cases of obesity is discussed. Insulin could increase adrenal sensitivity to ACTH and its possible action in vivo on the activity of adrenal enzymes requires clarification. The accumulation of certain androgens in the adrenal cortex could also be responsible for dysregulation of 3 beta ol-dehydrogenase and 11-hydroxylase.

[Nodular or pseudo-nodular Hashimoto thyroiditis. Value of cytologic examination]. / Thyroïdites de hashimoto à aspect nodulaire ou pseudo-nodulaire. Intérêt de l'examen cytologique.

OBJECTIVES: Nodular or pseudo-nodular aspects of Hashimoto's thyroiditis raise the problem of the association with a differentiated carcinoma or a non Hodgkin's lymphoma. METHODS: We looked for patients needing surgery in 165 cases of Hashimoto's thyroiditis. For this purpose, we used fine needle aspiration cytology. RESULTS: We found a differentiated carcinoma in 4% of cases and a non Hodgkin's lymphoma in 1% of cases. CONCLUSION: In nodular or pseudo-nodular aspects of Hashimoto's thyroiditis, fine needle aspiration cytology is helpful for the nodule diagnosis and for the selection of suspicious nodules only to be referred to surgery.

[Recent findings concerning follicular growth]. / Données récentes concernant la croissance folliculaire.

Recent advances in molecular genetics now enable the study in vitro of follicular maturation using human recombinants of gonadostimulins (FSH and LH) and certain autocrine and paracrine ovarian regulation factors. This is leading to reevaluation of the precise role played by the various hormonal protagonists of folliculogenesis. FSH, in the presence of low levels of LH at the start of the follicular phase, has a mitotic action on estrogen-producing granulosa cells, encourages their differentiation and activates the synthesis of their genetically-determined products (essentially somatomedin, inhibin and activin) and of the LH receptor. High LH levels, during the second half of the follicular phase, stop proliferation of granulosa cells, and, synergistically with insulin-like growth factor 1, bring about an increase in estrogen synthesis from aromatisable androgens. In common with FSH, LH facilitates the production of cybernins and of essential growth factors, as well as of preovulatory progesterone. Abnormalities of endocrine, paracrine or autocrine regulation of follicular maturation may lead to atresia. Future rational uses of human FSH and LH are obvious and involve the optimisation of ovulation induction and in vitro fertilisation in sterile women.

[Diagnostic strategy in infertility due to hyperandrogenism. Development of a decision tree]. / Stratégie diagnostique au cours de l'infertilité avec hyperandrogénie. Elaboration d'un arbre décisionnel.

The detection of clinical hyperandrogenism in women presenting with infertility requires detailed hormonal investigations using the decisional plan suggested here. Initial studies including measurement of plasma androgen, gonadotrophic hormones and prolactin levels, may be sufficient to reveal an adrenal origin or pure ovarian origin. Non-tumor androgenic hypercorticism is seen classically in late-presenting enzyme deficits, but also in other situations: excessive adrenarche, hyperprolactinemia, obesity, chronic stress. The immediate Synacthene test can then eliminate diagnostic uncertainties if it leads to the discovery of appearances of 21- or 11-hydroxylase or 3 beta-ol dehydrogenase blocks. Intense virilisation in a woman with a testosterone level above 2 ng/ml (7 nM/l) should lead to suspicion of an androgen-secreting tumor of the ovary or adrenal. CT scan of the abdomen and true pelvis is essential here since it may reveal the presence of an adrenal or ovarian mass. If no morphological abnormality is shown by this investigation, an endocrine lesion of a small ovary should be strongly suspected, the demonstration of which requires isotope techniques and/or catheterisation of the ovarian veins. Two situations also exist which are responsible for severe hyperandrogenism but less alarming in terms of their course and significance: certain homozygous forms of 21-hydroxylase deficit diagnosed late and ovarian hyperthecosis. It may happen that these hormonal investigations do not suffice alone to determine the precise origin of hyperandrogenism and its cause. The dexamethasone adrenal suppression test is useful in the diagnosis of type II micropolycystic dystrophy, in order to define the essentially ovarian, adrenal or mixed origin of hyperandrogenism.

[Treatment of female infertility due to hyperandrogenism]. / Traitement des infertilités féminines par hyperandrogénie.

This study reviews the various types of treatment used in infertility due to hyperandrogenism, with the aim of answering the following three questions: How should these drugs be prescribed? What are their side-effects? What are the best diagnostic indications? Possibilities include ovulation inducers but also all types of treatment capable of improving the fertility of these women. The treatment of infertility due to adrenal hyperandrogenism is based upon glucocorticoids. This treatment must be continued for 3 months after conception, to attempt to avoid early spontaneous abortion. The first-line inducer in ovarian hyperandrogenism is clomiphene citrate. The good results obtained using the combination of dexamethasone and clomiphene citrate are explained by an adrenal participation in this type of hyperandrogenism. In case of failure, and in addition to classical menotrophins:--pre-treatment using LHRH agonists avoids the onset of premature luteinisation but does not prevent the possibility of multiple pregnancies;--use of purified FSH reduces, though not sufficiently, the risks of multifollicular maturation but does not greatly increase the overall pregnancy rate;--the "slow" protocol with purified FSH reduces the incidence of multifollicular maturation. Should this fail, prior treatment with an LHRH agonist and if not the pulsed administration of LHRH in non-obese women can be suggested. Surgical treatment provides useful results in severe forms of sterility due to polycystic ovaries syndrome, with new per-celioscopic techniques.

[Fertility disorders in 49 hyperandrogenic women desiring pregnancy. Treatment results aimed at obtaining a pregnancy in 40 hyperandrogenic infertile women and in 9 hyperandrogenic women desiring pregnancy]. / Troubles de la fertilité chez 49 femmes hyperandrogéniques désirant une grossesse. Résultats des traitements visant à obtenir une grossesse chez 40 femmes hyperandrogéniques infertiles et chez 9 femmes hyperandrogéniques désirant une grossesse.

The clinical and therapeutic aspects of fertility due to hyperandrogenism were studied in 49 women (40 presenting with sterility and 9 for another reason but seeking to become pregnant). Patients were divided into three main etiological groups on the basis of hormonal findings: ovarian (15 cases), adrenal (16 cases) and mixed (11 cases) hyperandrogenism. This study highlighted several points. 22% of infertile women had no cutaneous signs of hyperandrogenism and menstrual disturbances were missing in 46% of cases of adrenal hyperandrogenism. Primary infertility was seen more often in all types of hyperandrogenism (28 cases) than secondary infertility (12 cases). Secondary infertility was explained by a high early spontaneous abortion rate in hyperandrogenism (40%). This was much commoner in adrenal hyperandrogenism than in ovarian or mixed hyperandrogenism. Inducing treatment based upon a combination of dexamethasone and clomiphene citrate proved to be the most effective in these infertile women (86% pregnancy rate). The frequency of spontaneous abortions in infertility due to ovarian or mixed hyperandrogenism treated by clomiphene citrate alone can probably be explained by the persistence of hyperandrogenism.

[Adrenal enzymatic block with late-onset caused by 11-hydroxylase deficiency. Apropos of 29 cases]. / Blocs enzymatiques surrénaliens à révélation tardive par déficit de la 11-hydroxylase. A propos de 29 observations.

Late-onset congenital adrenal hyperplasia is a cause of a spectrum of clinical manifestations of postnatal androgen excess. In these cases, ACTH stimulation test with measurement of 17-Hydroxyprogesterone (17OHP) is usually done to assess 21-hydroxylase (21-OH) deficiency. Determination of the 11-deoxycortisol (S) and the S to cortisol ratio is rarely done, so that 11 beta-hydroxylase (11-OH) deficiency seems unusual. We systematically investigated this biosynthetic defect among women complaining of hyperandrogenism (n = 519) and, comparing the patient's hormonal responses to ACTH with those of 31 normal women, found 29 11-OH deficiency (5.6%): this is the largest group ever reported. S was elevated only 9 times, so that using this single determination, diagnosis of 20 enzymatic defects would not have been made. Only three of the patients (10%) had hypertension, even though the pathway of aldosterone was involved in 33% of cases (criteria: elevation of the ratio desoxycorticosterone to corticosterone). We also described one new patient with both 11-OH and 3-beta-hydroxysteroid dehydrogenase deficiencies. The patho-physiology is particularly interesting in these cases. It is concluded that the single research for 21-OH deficiency is inadequate among women complaining of hyperandrogenism: the screening for 11-OH deficiency should be made, even if blood pressure is normal.

Hormonal profile of benign breast disease and premenstrual mastodynia.

The Authors report their own results concerning plasma hormonal dosages in Benign Breast Disease (BBD) and Premenstrual Mastodynia (PM). Dosages were realized during the second phase of the cycle, 4 to 8 days following ovulation, according to the basal body temperature. 171 Patients were studied: fibro-cystic disease 82 cases; BBD + severe PM 71 cases; and isolated PM 18 cases. It was shown that the levels of Estradiol and Progesterone were within normal ranges in a great majority of cases; it was the same for the PG/E2 Ratio. The Prolactin levels were within the physiological norms; the responses to TRH were normal, and elevated only in a few cases. Based only on hormonal dosages, we concluded that there was no estrogeno-luteal imbalance nor dysprolactinemia in BBD and/or PM.

Restructured Beef Steaks Manufactured Using Carbon Dioxide, Oxygen and Carbon Monoxide Gas.

Restructured beef steaks were manufactured from boneless, tenderized USDA Utility inside cow rounds (semimembranosus) and USDA Choice beef plates which were treated with oxygen, carbon dioxide or a combination of carbon monoxide and nitrogen gas during the mixing stage of the manufacturing process. Treatments were preformulated to 15% fat and mixed for 15 min during which time the various gas atmospheres were incorporated into the mixer. All treatments received 2% water and 0.75% sodium chloride during the mixing cycle. Proximate analysis, objective and subjective color, mechanical shear and binding strength were examined. Gaseous treatments had no effect (P>0.05) on moisture, fat or protein percentages. Carbon monoxide (10.01% carbon monoxide mixed with nitrogen) treatment increased Hunter "a" and "b" and reflectance (685 nm) values. Oxygen treatment had no effect (P>0.05) on Hunter "L", "a" or "b" values or reflectance (685 nm) values. Carbon dioxide decreased (P<0.05) both Hunter "b" and reflectance (685 nm) values. Subjective scores indicated more discoloration (P<0.05) for the carbon dioxide treatment than the carbon monoxide or oxygen treatments, but none of the treatment groups was different from the control. Shear (Kramer) and binding (Instron) values were unaffected (P>0.05) by the treatments.