Thyroid function in women with breast cancer

The thyroid function was evaluated in a study group of 226 breast cancer patients and in control groups, consisting of 125 patients with various other malignancies, 61 women with benign breast disease and 166 healthy blood donors. The mean serum concentrations of total T3 and T4 were significantly higher in the breast cancer group than in the controls. The mean TFI (thyroid function index), measured by two indirect techniques (T3RU, T4/TBG) or by direct free T4 measurement, was also significantly higher in this group of patients than in controls. Individual values of TFI exceeding the upper limit of the normal range were related with elevated total T4 levels and not with abnormal concentrations of total TBG. Eight women with breast cancer (3.5%) and one patient with head and neck cancer were clinically hyperthyroid. No case of overt hypothyroidism was observed. There was no relation between thyroid function and spread of the disease (TNM). The control groups, including patients with other-than-breast cancers, did not show any significant modification of the thyroid function tests. In the present study, breast cancer patients, as a group, show a thyroid dysfunction distinct from the non-specific abnormalities (low T3 syndrome) frequently observed in patients with a variety of acute or chronic non-thyroidal illnesses.

Dose response relationships for radiation induced chromosome aberrations in human lymphocytes in vivo and in vitro

Chromosome aberrations have been analysed in cultured lymphocytes from a patient undergoing whole-body treatment with split doses of gamma-rays up to a cumulative dose of 1.4 Gy. The dependence on dose of the yield of dicentrics was best fitted to the linear-quadratic relationship with a linear component predominating in the low dose range (below 0.56 Gy). These observations were compared with the data obtained when blood samples were exposed in vitro to low acute doses of gamma-rays (from 0.05 up to 2.0 Gy). The frequencies of induced chromosome aberrations were similar in both cases and little deviation was found between the dose response curves (a/b ratio equal to 0.56 and 0.69 Gy, respectively in vivo and in vitro). These results confirm that in vitro calibration curves can be utilized confidently for the biological estimate of an in vivo absorbed dose.

Reinforcement of tendons and ligaments with carbon fibers. Four years, 1300 cases

Carbon fibers have a remarkable quality of compatibility with the ability to induce collagenous tissue, but the growth cannot be controlled and may be troublesome if excessive. Replacement of tendons and ligaments by carbon fibers requires a minimum of three months of immobilization, the time necessary for the newly formed tissue to be effective. It is possible if there is no other choice, as, for example, in surgery of old Achilles tendon ruptures, or in reconstruction of ligaments if all autogenous material has been used in previous operations. The author currently uses carbon fibers not to replace tendons or ligaments but to reinforce some weakness of their surgery. The technique of the reinforcement in surgery of the medical collateral ligament of the knee, in reconstruction of the medial patellar retinaculum, and in surgery of tendinitis of Achilles tendon or patellar ligament has been developed in the treatment of more than 1300 cases.

[An unrecognized cause of spinal pain : meningoradiculitis. Apropos of 3 cases with predominant spinal pain]

Meningoradiculitis can present as a very short episode of radicular pain in addition to vertebral column pain without stiffness, as described in these three cases. The diagnosis requires examination of the cerebrospinal fluid, which should be a routine part of the diagnostic work up for back pain when an inflammatory etiology can not be identified.

Apparent dose-dependent oral absorption of cyclosporin A in rats

The oral absorption of cyclosporin A (CyA) was studied in rats after 6, 12, 18, and 23 mg kg-1 doses were given in an olive oil solution to determine if CyA absorption from the gastrointestinal tract was dose-dependent. Using serial blood samples obtained at various times after the respective doses, analysis of the resultant blood CyA concentration-time curves suggested that the rate of CyA absorption for all four doses was an apparent zero-order process. Moreover, the rate of CyA absorption appeared to be dose-dependent, increasing as the dose of CyA increased. Similarly, the extent of CyA absorption (F) also exhibited dose-dependent characteristics in this study. F increased from 0.13 after the 6 mg kg-1 dose to 0.22 with the 18 and 23 mg kg-1 doses (p less than 0.05). In the present investigation, the observed values for the duration of drug absorption (T), terminal first-order rate constant (beta) and corresponding elimination half-life (T 1/2 beta) of approximately 4-5 h, 0.030 h-1 and 21-28 h, respectively, were similar for all CyA doses. Moreover, no difference in beta was observed after oral or intravenous drug administration. Absorption lag times of 1-2 h were found. The results suggested that the dose-dependent absorption of CyA observed in the present study was possibly related to the effects of olive oil on gastric emptying and that CyA might be unstable in the gastric fluids and/or metabolized by the gastric mucosa.

Study of the diagnostic value of the dexamethasone suppression test in endogenous depression

The diagnostic value of the dexamethasone suppression test (DST) in "endogenous" depression was evaluated in 209 psychiatric inpatients. A high incidence of abnormal DST results was observed in "endogenous" depressives (52%), schizo-affective (69%) and borderline patients (38%). However, 25% of the patients with other psychiatric disease also failed to suppress on the DST. Diagnostic criteria, previous history of alcoholism, psychiatric drug treatment, age and sex did not significantly affect DST performance. The present data do not indicate that the DST represents a highly specific marker of "endogenous" depression.

Self-renewal and maturation of immature T-cell progenitors within PHA-induced agar T-cell colonies

T-cell colonies derived from peripheral blood mononuclear cells plated in agar with phytohemagglutinin (PHA) contain about 5-7% E-, OKT3-, OKT6-, TdT-, SIg- cells phenotypically similar to bone marrow precursors since they are also RFB1+, OKT10+, HLA-DR+, and PNA+. These cells can generate secondary E+, OKT3+ T-cell colonies when replated in the presence of both PHA and a colony-promoting activity distinct from the T-cell growth factor, Interleukin 2. These observations suggest that E-, OKT3- cells detected in primary PHA-induced T-cell colonies belong to a pool of prethymic cells which are able to mature into T-lymphocytes of T4 and T8 type in the absence of the thymic microenvironment.

Intravenous cyclosporine kinetics in renal failure

Kinetics of the novel immunosuppressive cyclosporine were determined in four patients with terminal renal failure. After a short intravenous infusion (2.05 to 3.5 mg/kg in 4 hr), blood and plasma concentrations were measured (HPLC and radioimmunoassay [RIA] up to 36 hr. After infusion, concentration curves of the drug were characterized by a rapid initial fall (t 1/2 alpha 0.10 +/- 0.03 hr), followed by a biphasic elimination phase with corresponding t 1/2s of 1.08 +/- 0.25 hr (t 1/2 beta) and 15.8 +/- 8.4 hr (t 1/2 gamma). The volumes of distribution, calculated from whole blood concentrations (HPLC), were 0.140 +/- 0.48 l/kg (volume of the central compartment) and 3.49 +/- 2.65 l/kg (volume of distribution at steady state), whereas systemic clearances were 0.369 +/- 0.08 l/hr/kg. Blood levels measured by RIA exceeded the HPLC values after the fourth hour by up to 100%, indicating the production of cross-reacting cyclosporine metabolites. Plasma concentrations were considerably lower than in whole blood. Elimination of unchanged cyclosporine in patients with renal failure appears to be of the same order as in those with normal kidney function. Modification of the initial dosage regimens is therefore probably not required.

Intestinal lymphatic absorption of cyclosporin A following oral administration in an olive oil solution in rats

The intestinal lymphatic absorption of cyclosporin A (CyA) following oral administration of 6.5 +/- 0.6 and 25.2 +/- 1.4 mg kg-1 doses of the drug dissolved in an olive oil solution was studied using a thoracic duct-cannulated rat model. Cumulative lymph samples were collected for up to 114 h post-dosing and assayed by liquid scintillation counting. In this study, the estimated amount of lymphatically absorbed CyA was 0.35 +/- 0.13 and 0.47 +/- 0.29 per cent of the respective doses. In terms of the overall oral bioavailability of CyA (Fpo) by all absorptive mechanisms, the intestinal lymphatics accounted for the absorption of approximately 2 per cent of the total amount of absorbed drug. Fpo was 21.3 +/- 2.5 per cent. The results of this study suggested that lipophilicity alone was not the only factor governing intestinal lymphatic drug absorption. An explanation for the low level of lymphatic CyA absorption is presented. In addition, some reasons for the low overall oral bioavailability of CyA are discussed.

[Vertebral osteonecrosis. Apropos of 4 cases with slow spinal cord compression in 1 case]

The authors report on four cases of aseptic osteonecrosis of the vertebral body in adults (VON). Among these, one patient, in whom histological data were available, presented with a slow spinal cord compression syndrome (SSCCS). This complication is uncommon since only one other similar case has been reported so far (4). VON thus remains an underestimated etiology of SSCCS by non-tumoral compression fracture of the vertebral body. Diagnosis is based on the roentgenograms which evidence osteocondensation with "gaseous dissection" of the vertebral body, the latter being considered as pathognomonic of this disease. The etiopathogeny is still unknown. Treatment is purely symptomatic and the course has always been favorable.

Lymphocyte chromosome aberrations in patients undergoing radiation therapy for mammary carcinoma

Patients undergoing radiation therapy for mammary carcinoma have been cytologically examined for the presence of polycentric chromosomes in their peripheral blood lymphocytes. The mean values of the observed yields can be fitted to a quadratic function. Due probably to a lower number of lymphocytes exposed the curve now obtained gives a smaller aberration yield than the dose effect curves published earlier for patients given telecobalt therapy.

Pharmacokinetic evaluation of the blood-to-lymph transfer of cyclosporin A in rats

The blood-to-lymph transfer kinetics of cyclosporin A (CyA) were investigated in thoracic duct cannulated rats after a 3 mg kg-1 i.v. bolus injection of tritium-labelled drug. Blood CyA concentrations declined bi-exponentially with a terminal half-life of 13.1 +/- 1.8 h. The appearance rate of CyA in the lymph was also bi-phasic, initially rising and then declining in parallel with the concentrations of CyA in the blood. A pharmacokinetic model describing the blood-to-lymph transfer kinetics of CyA is presented. From the slopes of graphs relating the appearance rate of CyA in the lymph to the corresponding midpoint blood drug concentration, the estimated blood-to-lymph clearance rate of CyA (ClL)b was 0.262 +/- 0.132 ml h-1. (ClL)b was positively correlated with the average lymph flow rate (QL) but was significantly less than QL. On the other hand, the plasma-to-lymph clearance rate of CyA (ClL)p of 0.393 +/- 0.198 ml h-1 was positively correlated and similar to QL. Lymph concentrations of CyA were approximately 40-60 per cent of the corresponding blood concentrations. The results of this investigation showed the existence of an intervening compartment between the blood and lymph fluids which would be consistent with the presence of lymph nodes. It was shown that the blood-to-lymph transfer of CyA was dependent on the flow rate of the lymph and that CyA appeared to be cleared from the plasma (or serum) fraction of the blood.

Role of lipoproteins and erythrocytes in the in vitro binding and distribution of cyclosporin A in the blood

The distribution of cyclosporin A between plasma, leucocytes and erythrocytes was studied in vitro by means of sedimentation in Ficoll-Paque and dextran. The uptake by erythrocytes was found to be about 50% and the fraction of cyclosporin A bound to leucocytes amounted to 15%. Fractionation of plasma by ultracentrifugation also showed that two thirds of the drug were associated with lipoproteins whereas binding studies with isolated lipoproteins and plasma also indicated that lipoproteins were the major complexing constituents for cyclosporin A in plasma. The binding of cyclosporin A to erythrocytes and lipoproteins seems to be a linear process. The binding to the leucocytes may be a saturable process, however it is of minor importance in terms of the overall binding capacity in the blood.

The binding characteristics of some adrenergic beta-receptor antagonists to human serum proteins

Binding of pindolol and 8 related compounds was studied in vitro by equilibrium dialysis. The overall binding in serum was compared with the binding to the main, isolated, serum proteins. Most substances show both saturable and non-saturable binding in serum. The saturable and main binding is to alpha 1-AGP, the low non-saturable binding corresponds to albumin and lipoprotein binding. The binding to alpha 1-AGP is characterized by approximately one binding site and association constants K ranging from 10(4) to 10(6) M-1. The binding of pindolol to alpha 1-AGP is strongly inhibited by propranolol, lidocaine, erythromycin, imipramine and TBEP. Significant correlations were found between log NK and log partition coefficient octanol-phosphate buffer suggesting that the protein binding of the 9 adrenergic beta-receptor antagonists to all serum proteins, including alpha 1-AGP, is predominantly hydrophobic in nature.

Thyroid influence on the growth of hepatoma HW-165 in Wistar rats

The development of a fast-growing hepatoma (HW-165) in normal euthyroid Wistar rats, was shown to be stimulated by daily injection of a dose of triiodo-L-thyronine (T3) as low as 1.5 microgram/100 g body weight. Administered to thyroidectomized rats, T3 completely restored the frequency of tumor initiation and accelerated the growth of the hepatoma, which had been considerably slowed down in hypothyroid rats. Contrary to other investigators, working on fast-growing Morris hepatomas, we did not observe any significant increase in the T3 level in the serum of hepatoma HW-165-bearing rats. Similarly, the tetra-iodo-L-thyronine (T4) levels were of the same order of magnitude in the blood of both normal and tumor host animals. The mitotic activity was reduced in hepatomas transplanted in hypothyroid rats and increased in tumors of T3-treated animals. These results support the assertion of Short (20) suggesting a relationship between the mitogenic effects of iodothyronines on the normal hepatocyte and on transplanted tumors of hepatic origin.

On the altered nucleocytoplasmic transport "in vitro" of rapidly labelled RNA, in the presence of cytosol or serum from tumor-bearing rats

Enhanced nucleocytoplasmic RNA transport has been demonstrated by incubating normal rat liver nuclei in presence of cytosols originating from the poorly differentiated, fast-growing hepatoma HW-165, in the linear phase of tumor growth. The effect of hepatoma HW-165 cytosol was reduced or suppressed in presence of small amounts of normal liver cytosol: on the other hand, several polypeptides of molecular weight 20,000 to 40,000 daltons were hardly detectable in hepatoma HW-165 cytosol, both arguments indicating that potentially regulatory proteins should be absent or present in reduced concentration in hepatoma HW-165 cytosol. No modification of RNA release was observed in presence of cytosols originating from the thymus of RNA virus (BL/F)-infected rats, whatever be the time after inoculation. Attempts were made to use the nuclear restriction assay, supplemented with plasma or serum of various origins, as a biochemical marker of neoplasia. In a first series of assays, including 80 cancer patients and 12 healthy controls, the RNA transport activity was stimulated by the serum of patients bearing various tumors (lung cancer, cancer of the respiratory tract, uterine cervix...), except in a few cases of mammary carcinoma, where values equivalent to or lower than the controls were obtained.

[Femoro-patellar joint. Advantages of axial projection in external rotation of the knee (author'r transl)]

The classical technic for radiological examination of femoro-patellar joint cannot visualize a lot of real chondromalacia. Their diagnosis, and, therefore, their treatment, usually surgical, rely on doubtful results of clinical examination. Axial projections combined with external rotation of the knee is not perfect, but it is a good improvement. It reveals many femoro-patellar syndroms without any radiological expression until this time.

Comparison of plasma extraction techniques in preparation of samples for endotoxin testing by the Limulus amoebocyte lysate test

Due to the presence of inhibitory and possible mimicking substances in plasma difficulties have occurred in the use of the Limulus amoebocyte lysate test. Currently, there are a variety of extraction techniques discussed in the literature which are used to remove these interfering substances, but there is little information comparing these techniques. Five such procedures were compared in their ability to provide an extracted plasma sample in which low levels of endotoxin could be detected by the Limulus amoebocyte lysate test. Results indicated that some procedures adversely affected endotoxin detection. The dilution + heating extraction method was found to be as effective as the widely used chloroform extraction method. Comparison of Limulus amoebocyte lysate test results from healthy human plasma samples extracted by these two methods indicated that lysate type and not extraction procedure was associated with previously reported questionable positive tests. Thus, ambiguities associated with Limulus amoebocyte lysate tests of plasma samples may be due not only to extraction method but also the lysate type employed.

[Aseptic inflammatory reaction in surgery of the knee (author's transl)]

The author reports 15 cases which show the clinical and laboratory characteristics and treatment of the aseptic inflammatory reaction observed after operation on the knee. It should be carefully distinguished from pyogenic arthritis; the clinical signs and the appearance of the synovial fluid are identical. Only laboratory examination permits ones to distinguish them, by the presence or absence of bacteria. This is a benign complication which becomes cured within a few days by common medical anti-inflammatory treatment. The danger is confusion with septic arthritis and the choice of inappropriate treatment, which often causes severe sequelae of even secondary infection. The true cause of this complication which in every way resembles acute inflammatory rheumatism, remains unknown.

Survey for positive Limulus amoebocyte lysate test in plasma from humans and common research animals

A survey for positive Limulus amoebocyte lysate tests was conducted on apparently healthy humans, mongrel dogs, rats, mice, rabbits, and squirrel monkeys. Only mongrel dog (45.8%) and human (32.8%) plasma samples gave positive tests. In dogs, a significant correlation between positive Limulus amoebocyte lysate tests and the presence of intestinal parasites was found. Positives found in human plasma samples were thought to be due to the presence of background levels of endotoxin or some possible mimicker substance found in the plasma after chloroform extraction. It was concluded that there was a need to distinguish between these positive Limulus tests and those which represent significant endotoxemia.

[Chronic knee instability. Technics and results of ligament plasty in sports injuries]

Chronic laxity of the knee in sportsmen is limited in practice, owing to the mechanisms of blockage of rotation, to lesions of the medial and anterior cruciate ligaments, associated or not with tears of the meniscus. Full assessment is essential to draw up a full therapeutic plan. It is very difficult, even when clinical examination is completed by excellent XRays. The great technical facility of operations of musculo-aponeurotic transposition, has led surgeons to discard plastic operations on the ligaments. They do, however, give the best chance of return to sporting activity. Two techniques are discussed, one a plastic of the medial ligament, the other designed to palliate rupture of the anterior cruciate ligament. These operations are strong and precise straightaway but the prognosis depends mainly on the number of structures affected.