[Surgical treatment of thyroid diseases in children]

In order to review the experience of a single institution with thyroid surgery and identify prognostic factors, we did a retrospective chart review of all patients who underwent thyroid surgery between 1980 and 1995. Fifty patients, 32 girls and 18 boys, underwent thyroid surgery. Clinical presentation include a thyroid nodule (36 patients), a family history of MEN syndrome with a positive pentagastrin stimulation test (10), diffuse nodular goitre (3) and a neonatal cervical mass (1). Radiologic investigation include ultrasonography in 58% of cases, radionucleide imaging in 70% of cases. The mean age at surgery was 13.3 years and the delay between onset of symptoms and diagnostic was 13 months. Twenty-one patients had a lobectomy +/- isthmectomy, 19 had a total thyroidectomy and 10 had a subtotal thyroidectomy. Nine patients required a second surgery to complete the surgical treatment, and perform a total or near total thyroidectomy when the final pathology showed a carcinoma. A well differentiated carcinoma was found in 52% of the patients, a medullary carcinoma in 20% and a benign lesion in 28% of cases. Nine patients had local or distant metastases at initial surgery. Post-op treatment consisted of suppressive hormonotherapy in all cases of cancer and radioactive iodine when recurrence occurred in 24% of patients and when metastasis where present. Survival remained at 100%.

CONCLUSION

Thyroid nodules should be rapidly investigated in children because of a high potential of cancerous lesions. With an aggressive surgical treatment and post-op I131 for recurrent lesions and metastasis the prognostic remains excellent.

Serum nitrates and creatinine in workers exposed to atmospheric nitrogen oxides and ammonia

An epidemiological survey was carried out on 332 workers in a nitrogen fertilizer factory exposed to various levels of NO, NO2, NO3- and NH3. The population was divided into six groups as a function of the atmospheres in the different workshops and compared with a control group recruited outside the factory. We investigated the relations between the exposures of the different groups and serum levels of three nitrogen-containing derivatives involved in arginine metabolism: nitrates, creatinine and urea. The workers most exposed to the hydrogenated and oxygenated compounds of nitrogen were found to have the highest serum nitrates. Further analysis of the results showed that inhaled nitrogen oxides and ammonia were only partly responsible for the circulating nitrates. The excess nitrates were thought to have an endogenous origin due to inflammatory reactions induced by the pollutants, especially ammonia. In addition, we showed that the workers from the two groups exposed to both NO and NH3 had significantly elevated levels of serum creatinine (P < 0.001). The excess creatinine was thought to have derived from the interaction of the exogenous NO with arginine metabolites.

Prophylactic thyroidectomy for medullary thyroid carcinoma in gene carriers of MEN2 syndrome

BACKGROUND/PURPOSE

Although medullary thyroid carcinoma (MTC) can occur sporadically, in the pediatric population it is most often associated with the multiple endocrine neoplasia syndrome (MEN type 2). Traditional screening was based on evaluation of basal and stimulated serum calcitonin levels. The recent cloning of the MEN2 gene on the RET proto-oncogene of chromosome 10 now allows for testing of gene carrier status in individuals at risk who could benefit from prophylactic treatment. The current study was undertaken to determine the appropriate age for safe total prophylactic thyroidectomy.

METHODS

Over a 16-year period, 12 patients with a family history of MEN2A and one with a MEN2B underwent total thyroidectomy and central neck dissection without parathyroid autotransplantation. Four patients (31%) were treated previously for Hirschsprung's disease.

RESULTS

In seven patients (mean age, 11.8 years) undergoing biochemical screening for diagnosis, multifocal MTC and C cell hyperplasia (CCH) were found in all the resected specimens. Of six patients identified with genetic screening (mean age, 9.1 years), two had elevated stimulated calcitonin levels, one (age 14) had evidence of MTC, and one (age 6) had CCH. Four patients with normal calcitonin levels had no evidence of MTC (ages 6, 8, 10) but there was one occurrence of CCH (age 11). No permanent postoperative hypoparathyroidism or recurrent laryngeal nerve damage occurred in this series. With a mean follow-up of 4 years (range, 1 to 14 years), the overall disease-free survival is 100%.

CONCLUSIONS

From this study the authors conclude that total thyroidectomy can be performed safely in children and should be the treatment of choice in patients with a family history of MEN2A carrying a germinal RET mutation even if the serum basal or stimulated serum calcitonin level is normal. Total thyroidectomy should be performed as early as 5 years of age before the occurrence of CCH or MTC.

Do calcium-channel blockers and glucocorticoids impair no production in ischaemic heart disease patients?

Calcium channel blockers, as glucocorticoids, may impair generation of NO in vivo, because of urinary nitrates deficit in spite of nitrated derivatives treatment in ischaemic heart disease patients.

Influence of maternal blood flow on the placental transfer of three opioids--fentanyl, alfentanil, sufentanil

The placental transfer of three opioids used in peridural analgesia, fentanyl, alfentanil and sufentanil, and two reference substances, antipyrine and *H2O, was determined ex vivo in the human placental cotyledon system. (1) In the first set of experiments, the infusion rates were constant and fixed at physiological flow rates. Under these conditions, the magnitude of the materno-fetal transfer was in the following order: *H2O = antipyrine = fentanyl > alfentanil > sufentanil. No particular influence of molecular weight, lipophilia, pKa or the degree of ionization could be discerned. (2) In the second set of experiments, the influence of different flow rates, reflecting various pathophysiological conditions, was examined. There was a linear relationship between the maternal flow and the materno-fetal transfer of the three opioids. On the other hand, for antipyrine and tritiated water, the relationship was logarithmic, a difference attributed to the marked lipophilia of the opioids. (3) At high maternal flow rates, saturation was observed for all five substances due to the short duration of contact with the membrane. There were logarithmic relationships between the maternal flow and the materno-fetal transfer. (4) These findings emphasize the importance of the lipophilic and hydrophilic characteristics of drugs on placental transfer, especially in the event of fluctuations in maternal flow.

Effect of adrenaline on plasma concentrations of fentanyl during epidural anaesthesia for caesarean section

The present study was designed to assess the effect of adrenaline on the plasma concentrations of fentanyl in mothers and umbilical vessels after epidural administration for caesarean section. Thirty patients undergoing elective caesarean section were allocated randomly into two groups. Group 1 (n = 16) received 100 microg fentanyl, 10 ml of 0.5% bupivacaine and 10 ml 2% lidocaine, while group II (n = 14) received 100 microg fentanyl, 10 ml of 0.5% bupivacaine with adrenaline 1:200 000, and 10 ml of 2% lidocaine with adrenaline 1:80 000. Blood samples were obtained from the maternal antecubital vein (MV) at various times up to 6 hours after epidural injection, and from umbilical vein (UV) and arteries (UA) at birth for determination of plasma fentanyl by radioimmunoassay. Fentanyl Cmax and Tmax in MV did not differ significantly between the two groups. In umbilical vessels, plasma fentanyl concentrations were comparable in the two groups: (0.12 +/- 0.08 ng ml(-1) and 0.13 +/- 0.08 ng ml(-1) in UV and 0.08 +/- 0.07 ng ml(-1) and 0.06 +/- 0.05 ng ml(1) in UA of groups I and II respectively). The maximum plasma concentration in UV was 0.24 ng ml(-1) in group I and 0.25 ng ml(-1) in group II. There was no significant correlation between umbilical vessel (vein or artery):MV ratio and dose to delivery interval and no difference between the two groups in Apgar score or umbilical cord pH.

Echocardiographic detection of intracardiac thrombi complicating ventriculo-atrial shunt. Report of two cases

Right atrial thrombi are rare but serious complications of ventriculoatrial (VA) shunts. Two hydrocephalic patients who received a VA shunt developed thromboembolic complications. The initial manifestation was malfunction of the distal end of the shunt and right heart failure. Bidimensional echocardiography demonstrated an intracardiac mass on the distal intra-auricular end of the shunt. Pulmonary scan showed multiple emboli even in the asymptomatic patient. This demonstrates the important role of bidimensional echography as a noninvasive diagnostic technique for this particular complication of a VA shunt. Medical and surgical treatment modalities are discussed.

Expression of ADP-glucose pyrophosphorylase in maize (Zea mays L.) grain and source leaf during grain filling

The time course of ADP-glucose pyrophosphorylase activity and of starch accumulation rate measured in grain, from pollination to maturity, in Zea mays L. plants grown outdoors, was coincident for 2 years. No such correlation was observed in the adjacent leaf, which, furthermore, presented large year-to-year differences in starch accumulation pattern. Analysis of the expression of ADP-glucose synthase at the protein levels, using antibodies directed against the Bt2 or Sh2 subunits, established that the variation of activity in the grain was explained by parallel changes in the content of both subunits. The cDNA for Bt2 and Sh2 subunits were used as probes to quantify the corresponding messenger. In grain, the time course of Bt2 and Sh2 mRNA accumulation anticipated, with a similar pattern, the specific peptide variations, which suggests a transcriptional control of expression. By contrast, the control of leaf activity by protein content was less obvious than in the grain, and changes in leaf enzyme specific activity were suggested during the first 20 d after pollination. A clone homologous to the grain Bt2 subunit cDNA was isolated from a maize leaf cDNA library, and a sequence comparison showed that the leaf clone (L2) was a partial cDNA representing one-third of the mature peptide. A 97% homology was observed between Bt2 and L2 in their coding region, but homology was poor in the 3' noncoding border. This result demonstrates that Bt2 and L2 arise from different genes presenting a tissue-specific expression pattern and provides an explanation for the earlier reported differences between leaf and grain in the size of peptide and mRNA for the Bt2-homologous subunit.

Experimental study of transplacental passage of alpha interferon by two assay techniques

Two methods of assaying alpha interferon (IFN-alpha) were compared during an experiment aimed at determining whether IFN-alpha crosses the human placenta. Human placentas, collected after delivery following a normal pregnancy to term, were catheterized on both sides: fetal and maternal. The IFN-alpha was introduced in known amounts in the maternal circulation and was assayed in the efferent fetal fluid. The following two detection methods were used: radioimmunoassay by competition with [125I]IFN-alpha and assay with a biological system in which IFN-alpha protected Madin-Darby bovine kidney cells from destruction by vesicular stomatitis virus. The results obtained by the two methods were in perfect agreement for the efferent fetal fluid samples. They showed the absence of placental transfer of IFN-alpha. The biological method was found to be more sensitive than radioimmunoassay for low IFN-alpha titers (< 10 IU/ml) but was less reproducible, probably owing to the use of twofold dilutions. The specificities of the two methods were similar and their practicalities were equivalent; the biological method, however, was less costly. The study illustrates the complementarity of the two methods, which were based on different principles. The agreement obtained between the two methods provides a clear confirmation of the experimental results.

Abducens palsy following shunting for hydrocephalus

Over a period of 12 years, 80 patients underwent ventricular shunting for normal pressure hydrocephalus. Three developed sixth cranial nerve palsy in the first two weeks after surgery. This uncommon complication is usually transitory following the same pattern of abducens palsy after lumbar puncture or spinal anesthesia. Traction on the nerve with local ischemia has been involved as the responsible mechanism in both instances.

[Study of the transplacental transfer of interferon alfa-2a on the model of isolated perfused cotyledon]

Interferon can be used for VIH+ pregnant women, to decrease materno-fetal contamination. Added to maternal circulation, its behaviour was studied by human placental cotyledon ex vivo perfusion. Human recombinant IFN 2a and reference substance 3H2O were injected in intervillous chamber and their behaviours in venous fetal and maternal circulations was followed. At steady state, in fetal circulation 3H2O concentration was 37% of injected rate whereas no IFN transfer rate was observed. In both venous circulations IFN amounts were lower than injected ones 56% versus of 82% for water (p < 0.05). IFN didn't cross placental filter and disappeared partially during placental contact.

Intraventricular central neurocytoma

A case of central neurocytoma treated surgically is described. The authors review the literature. Emphasis is placed on radiological and pathological features not previously described. In particular, the intra-operative ultrasound appearance is described. The role of adjunctive radiotherapy is also discussed.

Placental transfer of glycosaminoglycans in the human perfused placental cotyledon model

Placental transfer of unfractionated heparin (UH), of low molecular weight heparin CY 216 (LMWH) and of Dermatan sulphate (DS) was studied using the human perfused placental cotyledon model. Two different techniques were used to assess the transfer: labelled molecules and biological activities as measured by antifactor Xa or antifactor IIa activities. No biological activity was present in the fetal circulation, for any of the drugs used; however, very low fractions of the perfused radioactivity were recorded, 0.76% +/- 0.36%, 1.46% +/- 1.44% and 2.37% +/- 0.89% for DS, UH and LMWH, respectively.

Maternal and umbilical cord concentrations of fentanyl after epidural analgesia for cesarean section

The maternal and umbilical concentrations of fentanyl were measured after epidural analgesia for cesarean section, using a highly sensitive radioimmunoassay method. Sixteen parturients were anesthetized with a single epidural injection of a mixture of 85 mg bupivacaine 0.5%, 60 mg etidocaine 1%, and 100 micrograms fentanyl with epinephrine 1:200,000. Apparent maternal individual maximum peak concentration (Cmax) of fentanyl was 0.38 +/- 0.16 ng/ml (mean +/- SD) (range 0.12-0.59 ng/ml) and the time to reach Cmax (Tmax) was 24 +/- 14 min (range 5-60 min). Infants were born 19 to 42 min after epidural administration of fentanyl (mean 27 min). Fentanyl concentrations in neonates was 0.13 +/- 0.04 ng/ml for the umbilical vein and 0.06 +/- 0.03 ng/ml for the artery. The fetus extraction ratio was 53 +/- 19% (range 20-83%). The large difference between arterial and venous concentrations of fentanyl may be due to a metabolization by the fetus and/or an uptake of the drug in the fetal tissues. Thus, even if fentanyl levels reaching the fetus after cesarean section under epidural anesthesia, using local anesthetics with 100 micrograms of fentanyl, are within safe range values, the likelihood of fentanyl uptake by fetal tissues calls for a cautious use of repeated fentanyl administration.

[Respiratory symptoms in schoolchildren in Toulouse. Influence of atmospheric pollution]

In order to get a better knowledge on respiratory illnesses of children in Toulouse, and to evaluate the influence of air pollution, 1,000 children between 8 and 11 years of age, living in five different areas of the city were observed during one year (March 1985-March 1986), together with the measure of twenty pollutants. A questionnaire was used to assess the history of respiratory diseases and the chronic respiratory pathology. According to the areas, no difference appeared, other than the frequent cough which is more important in an area with lower social income (p less than 0.01). The acute respiratory illnesses, as noted during the year of observation, had a different pattern according to the areas (p less than 0.0001). Amongst the five pollutants used for the analytic study through the cross-correlations, four: nitrogen monoxide and dioxide, black fumes, and ammonia particulate derivatives are related to the respiratory diseases.

Transcutaneous carbon dioxide measurements in the fetus during labor

Continuous transcutaneous carbon dioxide partial pressure (tcPco2) was monitored in 40 spontaneous labors. The electrode was attached by glue fixation. An interpretable tracing was obtained in 36 cases. All cases but 2 were normal pregnancies. Thirty-two patients had epidural analgesia while the others had no analgesia. All infants had an Apgar score above 7 at five minutes after delivery and only two had a pH of the umbilical artery of less than 7.16. Mean duration of the recordings was 116 minutes (range: 15-300) and mean time for reaching steady-state was 27 minutes (range: 10-45 minutes). Mean value of tcPco2 was 48 mmHg (SD: 6) before 6 cm of dilatation, 47 mmHg (SD: 8) between 6 and 10 cm, and 47 mmHg (SD: 15) at the second stage of labor. Mean umbilical artery Pco2 was 48 mmHg (SD: 14) and mean umbilical artery pH was 7.25 (SD: 0.06). The range of tcPco2 obtained in these normal cases was 20 to 62 mmHg. Comparison of the results with those of other authors and with previous studies of normal labor and epidural analgesia show a higher tcPco2 compared to scalp Pco2. In contrast to other studies in these series no correlation was found in the series between umbilical artery Pco2 and tcPco2 values. This lack of correlation could be explained either by the small number of cases in which both measurements were available (9 cases) and by the small range of variation or by some inaccuracy in the measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of suloctidil on platelet function in patients with shortened platelet survival time

The effect of suloctidil (600 mg/day) on platelet survival time (PST) and plasma and urine betathromboglobulin (BTG) was studied in a double-blind, placebo-controlled six-week crossover trial in 13 patients with shortened PST (less than 110 hrs, exponential model). Mean PST after suloctidil (110.6 hrs) was significantly higher than in the placebo phase (94.5 hrs) (p = 0.04). Mean plasma BTG was significantly lower during the suloctidil phase (42.8 ng/ml) compared with the placebo phase (65.8 ng/ml) (p = 0.02), but there was no significant difference in urine BTG. These results suggest that suloctidil provides a platelet protective effect and therefore may be of benefit in reducing the frequency of platelet mediated thromboembolic events.

Study of fluorescent treponemal antibody test on cerebrospinal fluid using monospecific anti-immunoglobulin conjugates IgG, IgM, and IgA

The fluorescent treponemal antibody test for cerebrospinal fluid (FTA-CSF) using monospecific conjugates anti-IgG, IgM, and IgA was used to determine the presence of anti-treponemal antibodies in the spinal fluid of 335 patients with primary, secondary, and latent syphilis and symptomatic and asymptomatic neurosyphilis and of patients with certain neurological disorders. Of these, 230 (68·65%) patients had non-reactive results to this test. Of the remaining 105 patients, 78, 63, and 10 had reactive results with anti-IgG, IgM, and IgA conjugates respectively. Of the 129 cases of known syphilis, 11 were diagnosed as primary, 32 as secondary, and 50 as latent, and 36 patients had neurosyphilis. None of the specimens from the patients with primary syphilis gave reactive results to the test. Specimens from 21 (65·62%) of the 32 patients with secondary syphilis, 30 (60%) of the 50 patients with latent syphilis, and all (97·22%), except one, of the 36 patients with neurosyphilis gave reactive results to one at least of the IgG, IgM, or IgA FTA-CSF tests. Among the specimens from patients with secondary syphilis twice as many gave reactive results with anti-IgG conjugate than with anti-IgM conjugate. However, with specimens from patients with latent syphilis and neurosyphilis this ratio was diminished to 1·5:1. The Kolmer complement-fixation test, although superior in sensitivity and specificity to the Venereal Disease Research Laboratory (VDRL) test, in patients with secondary and latent syphilis and neurosyphilis, was greatly inferior to the FTA-CSF test. Data indicate that anti-treponemal antibodies can be detected in the spinal fluid even in patients with no neurological symptoms in cases of secondary syphilis and that the FTA-CSF test can be a valuable tool in the early detection of an immunological response to treponemal infection in the spinal fluid.

Refractometer associated with the fabry-perot spectrometer

This paper describes the principles, realization, and characteristics of a refractometer used as a reference for measuring the scanning of a high resolution, photoelectric Fabry-Perot spectrometer. The precision of the measurements on this refractometer is approximately one order of magnitude greater than that obtainable with other instruments.

Study of the use of lincomycin aerosols in dogs

This paper reports studies on different aspects of the administration of lincomycin by aerosol in dogs.The purpose of the study was to determine the depth of penetration of the drug into the lungs and its transfer into the blood, urine and tissues when administered as an aerosol.Special consideration was given to the possibility of side effects at the level of the bronchial mucosa, since this study was viewed as preliminary to the use of the antibiotic in humans.