Biomedical subjects
Publications and source records attributed to G Vallée.
Authors have selected 1928 measurements of thyroglobulin and studied their value in the thyroid pathology. They show that elevated values of thyroglobulin, the only one response in this pathology, can, even if isolated, be the mode of revelation of thyroid illness. They insist, in order to explain this fact, on the presence of a "sixth factor" which depends upon the quality of the thyroid tissue.
A systematic study of antibodies directed against thyroglobulin on one side, and against microsomes on the other side, was made during two consecutive years on a hospital population of out patients supposed to suffer from a thyroid affection: about one fourth of the serums is positive for at least one of the two antibodies; the benefit of searching antimicrosomal antibodies is capital, but the simultaneous research of thyroglobulin antibodies is necessary. The consequences of this screening are developed in three main pathologic fields: hypothyroidism (real frequency of Hashimoto's disease in spontaneous myxodema); hyperthyroidism (prognostic implications of antibodies presence); normothyroid subjects (screening of clinical thyroid abnormalities).
We have investigated the frequency of discordant results between the TRH test and classic dynamic tests of thyroid function (thyroid suppression and TSH stimulation tests) for patients presenting a diagnostic problem for hyperthyroidism. 12 patients in group I posed the problem of having a relapse of Graves' disease previously treated: a discrepancy between TRH and T3 suppression test results was observed in 17% of the cases. 10 patients in group II demonstrated the ophtalmopathy of Graves' disease without hyperthyroidism: discordance between tests results in this group was present for 20%. Finally, 25 patients in group III had a "hot" thyroid nodul apparent at thyroid scan: in 40% of the cases, the response to TRH did not lead to the same diagnosis that was suggested by the classical dynamic tests of thyroid regulation. The discrepancies observed in this work, between the results of the TRH test and those of classic dynamic tests, demonstrate that this two types of tests are not completely interchangeable, because they do not reflect exactly the same function.
Frozen section histological study of all cold nodules requiring total extracapsular lobectomy is absolutely essential during surgery. Whilst total thyroidectomy for intracapsular carcinomas is most often proposed in extracapsular carcinomas, the authors deliberately leave a small part of the gland in contact with the parathyroids. The need for recurrent laryngeal lymph node dissection is accepted, as is the principle of jugulo-carotid dissection.
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Considering recent progress which permits routine direct estimation of circulating iodinated hormones, classical investigations based on plasma iodine fractions (PBI 127, BEI 127, 127 IH) must be considered out of date for the routine diagnosis of hyperthyroidism. The best possible approach for the detection of hyperthyroidism by radio-isotope tests in vitro consists of associating a determination of the free thyroxine index and tri-iodothyronine. Certain types of hyperthyroidism, mainly in the goup of toxic adenomas, escape this detection in vitro, and justify the use of conventional in vivo tests whenever this diagnosis is suspected.
This report analyses quantitative data collected during spontaneous examination in normal subjects and in hypothyroid subjects, attempting to determine what figures obtained in this way can provide in the diagnosis of this disease. 125I tests in vitro today play a very important role and suffice der detection provided radio-immunoassay is carried out, whether the latter concerns iodine hormones or the thyreotropic pituitary hormone and provided the diagnosis is not confirmed by one single examination. The 131I kinetic test helps in classification of the hypothyroidism. Naturally, only further tests will permit us to determine certain causes (thyroid scan, Querido's test, TRF test, anionic competition, immunological study, etc.). Chemical estimations of stable iodine (127I) no longer have any place in this routine assessment, except that the total iodine is essential to interpret the kinetics in vivo.
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The metabolism of HBs Antigen had been studied in three human volunteers. One had chronic hepatitis and two were "silent carriers". The HBs Antigen had been isolated and purified from the plasma of each of the three subjects and, after iodination, reinjected to the same donor. The parameters of plasma kinetics of 131I HBsAg have been analyzed according to a two compartmental model on the basis of the radioactivity of TCA precipitate (TP) and immunoprecipitate (IP). The fast initial volume of distribution was approximately equal in the three subjects (46.6 ml/kg). The metabolic clearance rate (MCR) of IP was the very same in two subjects but is four times higher in one of the silent carrier. The total renewal time (TRT) was about 3.3 days. Assuming that the HBs Antigen extraction was of the order of 65% the plasma HBs Antigen concentration per liter of plasma would be 12 and 53 mg/liter fot two silent carriers and 61 mg/liter for the patient with chronic hepatitis. The radioactive efflux from the model (calculated as IP.MCR multiplied by HBs Antigen concentration) was identical for the two silent carriers adn 50% higher in the patient with chronic hepatitis. This increase possibly reflects an increased synthesis of HBs Antigen in the patient with chronic hepatitis. The cumulative urinary radioactivity when added to the whole body counting demonstrated that radioactivity was excreted solely in the urine. The ratio of organ counting to precordium counting did not vary significantly with time in all subjects.
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The characteristics of the disappearance of radioiodinated synthetic human calcitonin from plasma have been studied in man. After single injection the disappearance curve was multiexponential. The number of exponentials of the theoretical curve fitting the best with the experimental data varied individually. Metabolic clearance rate was determined both from single injection and constant infusion studies, and fast initial distribution volume from the former. Metabolic clearance rate values in normal man calculated from constant infusion studies were 82.3 +/-3.4 ml/min per m(2). Values derived from single injection studies were similar, 77.0 +/-4.7 ml/min per m(2). These results were compared to those obtained in end stage, renal failure patients. Metabolic clearance rate was considerably lower and volume of fast initial distribution slightly larger in that group. This fact emphasizes the important role of kidneys in the utilization and/or the degradation of human calcitonin.
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