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Biomedical subjects

G Turpin

Publications and source records attributed to G Turpin.

At least 55 records · Page 3Linked to original sources
PubMed1999

Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules.

Although ultrasound (US)-guided fine needle aspiration biopsy (FNAB) is widely prescribed in nonpalpable thyroid nodules, the goal of this study was to define precisely the indications and limits of US-FNAB in a series of 450 nonpalpable nodules. Among 94 surgically controlled cases, 20 (8 infracentimetric and 12 centimetric or supracentimetric) carcinomas were diagnosed. The diagnosis of malignancy was successfully made by US-FNAB in 16 of 20 carcinomas, 3 were missed because of insufficient cytological material, and 1 was misdiagnosed. US-FNAB sensitivity and specificity were 94% and 63%, respectively. A logistic model indicated that nodule size (P < 0.6) was not associated with histological diagnosis, but that solid hypoechoic features were more likely to be malignant (P < 0.0003), with US sensitivity and specificity for malignancy of 80% and 70%, respectively. Logistic regression indicated that adequate cytological material significantly increased with nodule size (P < 0.0001). This result outlined the limits of US-FNAB in small nodules. Hence, indication of US-FNAB appears judicious in centimetric or supracentimetric nodules or in solid and hypoechoic ones. Such a management would allow the discovery of 15 of 20 carcinomas and would avoid 16% of unnecessary biopsies.

Adolescent↗
PubMed1999

Effects of stimulus intensity, risetime, and duration on autonomic and behavioral responding: implications for the differentiation of orienting, startle, and defense responses.

The effects of stimulus intensity, duration, and risetime on the autonomic and behavioral components of orienting, startle, and defense responses were investigated. Six groups of 10 students were presented with 15 white noise stimuli at either 60 or 100 dB, with controlled risetimes of either 5 or 200 ms, and at stimulus durations of 1 or 5 s (1 s only in the case of the 60-dB groups). A dishabituation stimulus consisting of a 1000 Hz tone was also presented. Measures consisted of skin conductance and heart rate, together with ratings of facial expressions and upper torso movement obtained using video recording. Increased intensity resulted in greater amplitudes and frequencies of electrodermal and behavioral responses, and a change from cardiac deceleration to acceleration. Faster risetimes elicited larger electrodermal responses, greater frequencies of eye-blinks, head and body movements, and larger cardiac accelerations. The effects of duration for the 100-dB stimuli were less clear-cut. Overall, the results are discussed in relation to the differentiation of orienting, startle, and defense responses.

Acoustic Stimulation↗
PubMed1999

[Prognostic factors in the surgical management of acromegaly].

To determine the prognostic factors of surgical cure of growth hormone secreting pituitary adenomas, we have studied 48 patients operated between 1982 and 1992. We compared the features of the cured group (n = 18) with the non cured group (n = 30). We found that the factors of poor prognostic were: young age, growth hormone level before surgery over 50 ng/ml, invasive adenomas, monohormonal status in immunocytochemistry, and lack of decrease in postoperative growth hormone level during the glucose tolerance test.

Acromegaly↗
PubMed1999

Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases.

BACKGROUND: The goal of this study was to evaluate the complication rate of secondary thyroidectomy in patients with prior thyroid surgery for benign disease. METHODS: Over an 8-year period, 203 thyroid reoperations were performed on 202 patients. All information relating to operative procedures, pathology, and complications was recorded prospectively. RESULTS: There were 24 men and 178 women with a mean age of 52 years. Prior surgery was unilateral in 136 cases (67%) and bilateral in 67 cases (33%), and 14 patients (6.9%) had more than 1 previous thyroid operation. For euthyroid or pretoxic recurrent nodular goiter, 190 reoperations were performed and 13 reoperations were performed for recurrent thyrotoxicosis. Twenty-three cancers were found in a specimen (11.4%). Completion thyroidectomy was done in 143 patients. Postoperative complications occurred in 21 patients (10.4%): recurrent laryngeal nerve palsy (7 patients), hypocalcemia (8 patients), hematoma requiring surgical evacuation (5 patients), and wound infection (1 patient). Complications remained permanent in 4 patients (2%). CONCLUSIONS: The permanent complication rate is higher in thyroid reoperations than in primary thyroid operations. However, we believe that this 2% rate is low enough to allow reoperation whenever it is necessary, provided precise operative rules are respected.

Adult↗
PubMed1999

[Familial hypercholesterolemia].

Familial hypercholesterolemia is characterized by a high plasma LDL-cholesterol level. The low-density particles are the end-product of the triglyceride-rich particles, i.e. VLDL, synthetized by the liver. These triglyceride-rich particles are subsequently transformed into intermediate density lipoprotein by the lipoprotein lipase and LDL after further triglyceride hydrolysis by the hepatic lipase. The LDL particles are taken up in all cells by the mean of the LDL receptor. A large body of evidence (including experimental, clinical, epidemiological data as well as the results of large trial with lipid lowering drugs) has accumulated to establish that these particles are one of the major causative factor of atherosclerosis and its complications. Two different mechanisms may be at work in the familial hypercholesterolemia: a mutation in the LDL receptor or a single mutation in the apolipoprotein B100. Specific therapeutic intervention should be undertaken to decrease the risk to develop cardiovascular disease, mainly coronary heart disease. The therapeutic intervention includes both a diet low in saturated fatty acids and cholesterol and statins which are now the first line therapy. Fibrates are proposed to those who do not tolerate statins and LDL-apheresis is associated to statin in the rare homozygous familial hypercholesterolemia.

Anticholesteremic Agents↗
PubMed1999

Modifications of alpha-tocopherol and fatty acid concentrations in blood and adipose tissue of obese patients during a weight loss programme.

BACKGROUND AND AIM: The aim of the study was to describe qualitative and/or quantitative modifications of lipoproteins, including their fatty acid composition, in obese patients during a hypocaloric diet, and determine whether the variations observed paralleled modifications of alpha-tocopherol concentration in adipose tissue and blood. METHODS AND RESULTS: 15 healthy, obese volunteers (5 males, 10 females; age: 32-69 yr; BMI: 28.4-60.5 kg/m2) were given a 3-week hypocaloric diet (3.9 MJ (941 kcal)). Adipose tissue and blood samples were taken at the beginning and at the end of this period. At baseline and after 3 weeks measurements were made for alpha-tocopherol and fatty acids in total serum, lipoproteins and adipose tissue; thiobarbituric acid-reactive substances (TBARS) in serum. A significant drop in cholesterol-rich particles (LDL and HDL) was observed, in parallel to a significant enrichment of n-6 polyunsaturated fatty acids (PUFA) at the expense of both saturated and monounsaturated fatty acids in serum. A drop in alpha-tocopherol concentration (expressed as mumol alpha-tocopherol/g lipid) in serum and lipoprotein fractions paralleled the decrease in cholesterol-rich lipoproteins. CONCLUSIONS: Our results suggest that a hypocaloric diet not only decreases cholesterol-rich particle levels in serum, but also leads to a significant modification of fatty acid composition which may reflect improvement of insulin sensitivity. We did not observe any modification in adipose tissue after diet with regard to both alpha-tocopherol and fatty acid concentrations. Despite a drop in alpha-tocopherol concentration and an increase in n-6 PUFA content in serum, we did not find any enhancement of serum lipid peroxidation level evaluated by the thiobarbituric acid-reactive substance (TBARS) assay. If we assume that dietary intakes of alpha-tocopherol were not modified during this diet, it can be supposed that adipose tissue released alpha-tocopherol without any specific regulation, in parallel to the release of fatty acids.

Adipose Tissue↗
PubMed1999

[Myocardial infarction after a stress test. A case report].

The authors report a case of first myocardial infarction occuring after an asymptomatic stress test in a patient presenting several cardiovascular risk factors. Coronary angiography, performed before the 4th hour after onset of the symptoms in this patient, identified the mechanism of myocardial infarction to be occlusion of the left anterior descending artery by thrombus, very probably complicating rupture of an atherosclerotic plaque. The initial failure of thrombolytic therapy led to a mechanical revascularization procedure with primary success. The pathophysiological mechanisms possibly contributing to this type of accident are discussed.

Angioplasty, Balloon, Coronary↗
PubMed1998

[Lipids/hemostasis interactions. A new approach to cardiovascular risk factors].

NEW CARDIOVASCULAR RISK FACTORS: A causal link would appear to exist between hemostasis and cardiovascular disease. This is particularly true for fibrinogen which is an independent risk factor. MULTIPLE INTERACTIONS: There is an association between elevated triglyceride and FVIIc (pro-coagulant) levels and hypofibrinolytic PAI-1. In addition, an association exists between elevated cholesterol and FVIIc and platelet activation. LIPID LOWERING DRUGS AFFECT HEMOSTASIS: The hemostasis equilibrium is modulated by diet. In addition, fibrinogen levels are lowered by fibrates and platelet activation and thrombin generation are decreased by statins. These modifications have a potential clinical interest. Such observations remain to be confirmed by cardiovascular prevention studies with the specific objective of evaluating the effect of lipid lowering drugs on hemostasis parameters.

Blood Coagulation Factors↗
PubMed1998

Characterization of two HDL subfractions and LpA-I, LpA-I:A-II distribution profiles and clinical characteristics of hyperalphalipoproteinemic subjects without cholesterol ester transfer protein deficiency.

The aims of the present study were (i) to characterize the HDL2, HDL3 and the LpA-I, LpA-I:A-II distribution, (ii) to investigate the prevalence of atherosclerotic lesions and (iii) to assess the activity of cholesteryl ester transfer protein (CETP) in 29 hyperalphalipoproteinemic (HALP) patients (HDL-C=90+/-11 mg/dl) with combined hypercholesterolemia (LDL-C=180+/-16 mg/dl). According to the HDL2/HDL3 and LpA-I/LpA-I:A-II ratios, two HALP profiles (A and B) were defined: in 22 patients (HALP profile A) these ratios were increased compared to the normolipidemic control subjects (1.19+/-0.11 versus 0.53+/-0.19, P < 0.001 and 1.01+/-0.2 versus 0.51+/-0.25, P < 0.001, respectively) and in seven patients (HALP profile B) these ratios were within the normal range (0.64+/-0.20 and 0.69+/-0.2, respectively). The atherosclerotic lesions were assessed by ultrasonography of the carotid arteries. Amongst patients with HALP profile A, 17 were free from lesions, five had intimal wall thickening and none displayed plaques, whereas for patients within the HALP profile B, only one was free from lesions, two had intimal wall thickening and four displayed plaques. CETP activities (348+/-116 versus 371+/-75%/ml/h) and CETP concentrations (2.4+/-0.5 versus 2.5+/-0.6 microg/ml) were similar in HALP profiles A and B, however these values were both higher than in control subjects (190+/-40%/ml/h, P < 0.001 and 1.8+/-0.3 microg/ml, P < 0.001, respectively). Hence the hyperalphalipoproteinemic profiles (A and B) described here were not related to CETP deficiency. In conclusion, the HALP profile A was characterized by both increased HDL2/HDL3 and LpA-I/LpA-I:A-II ratios and was associated with a low prevalence of atherosclerosis, whereas the HALP profile B, characterized by HDL2/HDL3 and LpA-I/LpA-I:A-II ratios within the normal range, was less cardioprotective.

Adult↗
PubMed1998

Hyperalphalipoproteinemia: characterization of a cardioprotective profile associating increased high-density lipoprotein2 levels and decreased hepatic lipase activity.

The aim of the present study was to investigate the high-density lipoprotein (HDL) structural characteristics and metabolism in hyperalphalipoproteinemic (HALP) patients (HDL-cholesterol [HDL-C], 92 +/- 14 mg/dL) with combined elevated low-density lipoprotein-cholesterol (LDL-C) levels (LDL-C, 181 +/- 33 mg/dL). Patients were subjected to a complete cardiovascular examination, including ultrasonographic investigation of carotid arteries. Two HALP profiles were identified according to the HDL2/HDL3 ratio. HALP profile A was characterized in 28 patients by increased HDL2/HDL3 ratio, HDL2b, and lipoprotein (Lp)A-I levels compared with normolipidemic subjects, and HALP profile B, including the 12 remaining patients, was characterized by a HDL2/HDL3 ratio within the normal range and by the increase of all HDL subclasses (HDL(2b,2a,3a,3b,3c)), LpA-I, and LpA-I:A-II levels. With regard to the exploration of carotid arteries, in HALP profile A, 20 patients were free from lesions and eight had only intimal wall thickening. In HALP profile B, only one patient was free from lesions, four had intimal wall thickening, and seven displayed plaques, but none had stenosis. Taking into account the number of patients with plaques within each group, HALP profile A was associated with a low prevalence of atherosclerotic lesions, whereas HALP profile B was less cardioprotective (odds ratio, 77.7 [95% confidence interval, 3.7 to 1,569.7]; P < .0001). For both HALP profiles, cholesteryl ester transfer protein (CETP) deficiency was discarded and activities of phospholipid transfer protein (PLTP) and lipoprotein lipase (LPL) were normal. However, hepatic lipase (HL) activity was significantly decreased in HALP profile A, but within the normal range for HALP profile B. In conclusion, an HALP profile A with a low prevalence of atherosclerosis was characterized by an increased HDL2/HDL3 ratio, HDL2b, and LpA-I levels associated with decreased HL activity.

Adult↗
PubMed1998

Sheehan's syndrome: differential diagnosis in the acute phase.

Many studies have been done in the later course of Sheehan's syndrome, but very few have documented the acute phase with clinical, endocrine and imaging data. We present the case of a young woman complaining of severe headache after delivery, who developed hypopituitarism. Magnetic resonance imaging (MRI) disclosed the presence of an enlarged non haemorrhagic pituitary gland. Follow-up MRI showed a spontaneous and rapid shrinkage of the pituitary, within 20 days, which appeared as an empty sella 3 months later. Sheehan's syndrome may initially closely mimic hypophysitis, or the necrosis of an adenoma. We discuss the differential diagnoses, important for the best therapeutic management.

Acute Disease↗
PubMed1998

Prevalence of lymphocytic infiltrate in 1400 pituitary adenomas.

To evaluate the prevalence of lymphocytic infiltrate in a large series of pituitary adenomas, we retrospectively studied tumor tissues from 1400 patients. Based on immunocytochemical data, tumors were classified as PRL (n=411), multihormonal (n=310), immunonegative (n=275), ACTH (n=166), GH (n=137), alpha subunit (n=44), FSH and/or LH, (n=42), and TSH (n=15) adenomas. The lymphocytic infiltrate was diagnosed on histological examination and investigated by immunostaining with anti LCA (human leucocyte common antigen), anti CD45RO (human T cell) and anti CD20 (human B cell) antibodies. Lymphocytic infiltrate was present in 40 adenomas (2.9%), 26 females and 14 males, aged 18 to 77 years (mean+/-SD, 37+/-14 years). The tumors were 19 PRL, 8 multihormonal, 4 GH, 4 alpha subunit, 3 ACTH, and 2 immunonegative adenomas. In PRL adenomas, the sex ratio (female/male) and the age were similar in patients with and without lymphocytic infiltrate (2.8 vs. 4.6 and 29+/-6 years vs. 32+/-11 years, respectively). The frequency of lymphocytic infiltrate was similar in PRL, GH, ACTH and multihormonal adenomas, but lymphocytic infiltrate was significantly more frequent in PRL adenoma than in immunonegative adenoma, and in alpha subunit adenoma than in immunonegative, ACTH and multihormonal adenomas. The lymphocytic cells were almost exclusively T cells. We conclude that lymphocytic infiltrates are rare in pituitary adenomas. Their frequency is not statistically different in major categories of secreting adenomas (PRL, GH, ACTH, multihormonal). Their pathophysiological significance remains to be established.

Adenoma↗
PubMed1998

Relationship between thyroid hormones and plasma D-dimer levels.

High serum levels of cholesterol and triglycerides are risk factors for coronary heart disease and are strongly related to several haemostatic parameters. Thyroid disorders are a frequent feature in hyperlipidemic patients and are also associated with a variety of haemostatic abnormalities. Therefore, we analysed the relationships between free T4 (fT4) levels and Factor VII and VIII activities (FVIIc and FVIIc), D-Dimers (DDI) and Plasminogen Activator Inhibitor type 1 (PAI-1), in a group of 472 healthy patients referred for hyperlipidemia. Fourty patients were found to have primary hypothyroidism. A negative correlation was found in the whole study population between fT4 and DDI (p = 0.0001, r = -0.21) and the same results were found after exclusion of the patients with fT4 below the normal range (p = 0.0007, r = -0.17). In a multivariate regression analysis, the relationship between DDI and fT4 was independent of age, Body Mass Index (BMI), gender and total cholesterol. Less impressive correlation coefficients were found with FVIIc (r = -0.10), FVIIIc (r = -0.09) and PAI-1 (r = -0.09). These results suggest that fT4 may play a physiological role in the regulation of the haemostatic equilibrium in hyperlipidemic patients and that low levels of fT4 are associated with a hypercoagulable state.

Adolescent↗
PubMed1998

[Management of atherogenic hyperlipidemia].

After defining the type of hyperlipoproteinaemia (the three main are IIa, IIb and IV), confirming its primary nature (i.e. after eliminating the various causes of secondary hyperlipoproteinaemia) and after defining the therapeutic objective (different according to the context of primary or secondary cardiovascular prevention), treatment must be prescribed. It always consists of diet, and very often a lipid-lowering drug. The remarkable results obtained with statins in studies of primary prevention, secondary prevention and regression of atherosclerosis does not mean that they can be prescribed blindly. Therapeutic indications depend on the type of hyperlipidaemia. By limiting the discussion to the three main types of atherogenic hyperlipoproteinaemia, treatment consists of: in pure type IIa hypercholesterolaemia: a first-line statin (or fibrate or resin in the case of adverse effects); in pure type IV hypertriglyceridaemia: a fibrate and possibly omega-3 fatty acids; in combined or mixed type IIb hyperlipidaemia: a statin in the case of type IIb with predominant hypercholesterolaemia, a fibrate in the case of type IIb with predominant hypertriglyce-ridaemia, failure to comply with these rules can lead to poor laboratory results.

Arteriosclerosis↗
PubMed1997

[Rhabdomyolysis in patients with preexisting myopathy, treated with antilipemic agents].

BACKGROUND: Lipid lowering drugs (fibrates and statins) are generally well tolerated and side effects, mainly hepatic and muscular disorders are rare. However, when they occur, muscular disorders may be severe, leading to rhabdomyolysis. We report here four cases of rhabdomyolysis in patients given lipid lowering drugs and who had pre-existing myopathy. CASE REPORTS: The four patients complained of muscle pain after treatment with niacin, HMGCoA inhibitors, as well as fibrates. The myopathy was not recognized at the time of prescription in three cases. Myopathy resolved rapidly upon discontinuation of the drugs and none of the patients developed renal failure. DISCUSSION: This is the first report of rhabdyomyosis induced by lipid lowering drugs in patients with pre-existing myopathy. Drug induced myopathy is a known complication of lipid lowering drugs either alone or in patients with other conditions such as renal failure, immunosuppressive therapy for cardiac transplantation, or in case of combination regimens. Such a side effect without concomitant disease has not been reported previously in patients with congenital myopathy. Cholestyramine is the drug of choice for these patients. Our observations suggest that the rhabdomyolysis provoked by lipid lowering drugs may be favored by pre-existing myopathy.

Adult↗
PubMed1997

Direct isolation of labeled low density lipoproteins for the determination of cholesteryl ester transfer protein activity.

The measurement of the activity of cholesteryl ester transfer protein (CETP), is of high clinical interest and this study reports the use of a direct LDL isolation (d-LDL) technique to determine in one step the amount of radiolabeled cholesteryls esters ([3H]-CE) transferred from exogenous HDL3 to LDL, avoiding the conveniences of the usually used ultracentrifugation or precipitation of apo-B containing lipoproteins in the CETP methodologies. The d-LDL technique providing a specific immunoprecipitation of VLDL, IDL and HDL allowed to directly determine the [3H]-CE transferred on LDL (d-[3H]-CE-LDL). Two methodologies were assayed for the CETP activity using either exogenous or endogenous lipoproteins, and the results with the d-LDL technique were compared with those obtained using the ultracentrifugation (u-[3H]-CE-LDL) considered as the reference method. The intra- and inter-assays were similar in both techniques for the two CETP activity assays. Strong positive correlations were established between values obtained with d-[3H]-CE-LDL and u-[3H]-CE-LDL isolation procedures for CETP activities with exogenous or endogenous lipoproteins (r = 0.972; p = 0.0001 and r = 0.965; p = 0.0001 respectively). In conclusion, the d-LDL technique represents an easy and accurate procedure to measure directly, in normotriglyceridemic plasmas, the amount of [3H]-CE transferred from HDL to LDL by the CETP.

Carrier Proteins↗
PubMed1997

The replacement of arginine by cysteine at residue 151 in apolipoprotein A-I produces a phenotype similar to that of apolipoprotein A-IMilano.

Rare nonsynonymous mutations in the apolipoprotein A-I (apo A-I) gene are associated with low HDL-cholesterol levels. Despite the inverse correlation of high density lipoprotein (HDL)-cholesterol levels with the risk of coronary heart disease (CHD) in the population, reduced circulating concentrations of HDL do not necessarily predispose to premature CHD. One apo A-I defect was even reported to cause longevity. We describe a French patient who presented with very low serum HDL-cholesterol levels (10 mg/dl). Sequence analysis of the apo A-I gene identified a heterozygous mutation in the apo A-I gene which causes a cysteine for arginine replacement at residue 151. Family members with the mutation displayed 50% lower levels of plasma HDL-cholesterol and of apo A-I than unaffected members. Plasma activity of lecithin:cholesterol acyl transferase (LCAT) was significantly lower in apo A-I(R151C) heterozygotes than in controls. Furthermore, we found that as for apo A-IMilano (R173C), apo A-I(R151C) forms heterodimers with apo A-II. Moreover, HDL particles were abnormal in both lipid composition and size distribution. Despite these quantitative and qualitative differences in HDL, neither the history of the family over three generations nor the examination of the patient, gave any indication of premature occurrence of atherosclerosis or CHD. We conclude that apo A-I(R151C) causes a phenocopy of apo A-IMilano (R173C), an apo A-I variant which is assumed to cause longevity and which is considered as a potentially anti-atherogenic agent.

Adult↗