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J Leclere

Publications and source records attributed to J Leclere.

At least 19 recordsLinked to original sources
PubMed1995

[Hyperprolactinemic amenorrhea:treatment with cabergoline versus bromocriptine. Results of a national multicenter randomized double-blind study].

OBJECTIVES: Cabergoline is a new, long-acting D2 agonist, highly effective in suppressing prolactin and restoring gonadal function in hyperprolactinaemic amenorrhoea. This study compares its efficacity and safety with that of the reference compound, bromocriptine. METHODS: A prospective study involved 21 French Centres and 120 women, with hyperprolactinaemic amenorrhoea, randomized to either cabergoline (CAB 0.5-1 mg twice weekly) or bromocriptine (BRC 2.5-5 mg twice daily). Treatment is given under double-blind conditions for the first 8 weeks, and subsequently in open conditions in further 16 weeks with dose adjustments according to response. Patients were assessed for biochemical and clinical efficacy and drug safety (adverse symptoms and biology). RESULTS: Normoprolactinaemia was achieved in 56/60 (93.3%) taking CAB and 27/58 (48.2%) taking BRC (p < 0.0001). Ovulatory cycles or pregnancy were recorded in 71.6% and 48.2% of patients (p = 0.001). Prolactin suppression to below 50% of the baseline value was observed in 1.6% and 15.5% (p = 0.007). Adverse symptoms were recorded in 31/60 (51.6%) and 40/58 (69.2%) patients respectively in the double-blind period, and 53.3% versus 65.5% for the full course of the study. There were significantly fewer gastro-intestinal symptoms in the CAB group, 36.6% versus 84.5% (p < 0.0001). CONCLUSION: Cabergoline is a new prolactin-lowering drug, more effective and better tolerated with fewer gastrointestinal symptoms than the reference compound, bromocriptine.

Adolescent↗
PubMed1995

Comparative effects of atenolol and clonidine on polygraphically recorded sleep in hypertensive men: a randomized, double-blind, crossover study.

The effects on sleep of atenolol and clonidine were compared in 8 hypertensive men (mean age 46.9 years, range 16-56 years) without prior history of sleep disturbances. Polygraphic sleep recordings were performed at baseline (NO) and after a single oral dose of atenolol (100 mg) or clonidine (0.15 mg) at 6:00 pm at a 48-hour interval in a double-blind randomized crossover protocol. Both medications lowered arterial pressure to a similar extent. The subjective quality of sleep was judged satisfactory after both medications, the number of patients reporting dreams decreased from 5 (NO) to 1 after each treatment night. Total sleep time decreased slightly but not significantly after atenolol (440 +/- 63 min vs 474 +/- 47 min at baseline). Sleep latency was not affected after atenolol but significantly decreased after clonidine (16.9 +/- 21.6 vs 28.6 +/- 16.6 at baseline, p < 0.02). Although rapid-eye movement (REM) sleep time decreased after atenolol (71 +/- 30 min vs 95 +/- 30 min at baseline, p < 0.05), the percentage of REM sleep was unchanged (22 +/- 7% vs 23 +/- 5%). In contrast, clonidine strikingly reduced both REM sleep time (54 +/- 28 min vs 95 +/- 30 min at baseline, p < 0.002) and percentage of REM sleep (14 +/- 6% vs 23 +/- 5%, p < 0.0005). Thus atenolol tends to decrease total sleep time but does not affect the normal architecture of sleep, clonidine has a marked hypnotic effect, similar to that of some sedative medications and significantly reduces REM sleep.

Adolescent↗
PubMed1994

Serum parathormone profile during surgical treatment of hyperfunctioning parathyroid adenoma: a multicompartmental model.

Patterns of intact parathyroid hormone (iPTH) elimination and subsequent recovery of parathyroid function were studied in seven patients undergoing surgical removal of solitary hyperfunctioning parathyroid adenoma. Using a sensitive two-site immunoradiometric assay, iPTH levels were measured pre, peri-, and postoperatively. Blood samples were taken at very early and at late stages, including 3, 6, 9, and 15 minutes and 48, 72, and 96 h after adenomectomy. A biexponential formula was calculated to fit the decreasing values of iPTH in all patients. The PTH half-life in the early phase was 1.4 +/- 1.1 minutes (95% confidence limits). The PTH half-life in the second phase was 64.45 +/- 32.19 minutes (95% confidence limits). A third phase is represented by a slow, linear increase in plasma iPTH values as a result of the recovery of healthy suppressed parathyroid glands. The extrapolation to baseline of the later phase shows that the recovery of normal parathyroid function begins as soon as 240 minutes after adenomectomy and is independent of the decrease in PTH of adenomatous origin. All individual results were consistent with this model. Five patients had iPTH values below 5 pg/ml, one had 15 pg/ml, and the last had 27 pg/ml 5 h after parathyroid adenomectomy. The recovery of the hormonal activity of the remaining glands occurred rapidly. By the postoperative hour 24 the mean serum iPTH concentration was 12.28 +/- 8.07 pg/ml. The intraoperative serum iPTH concentration offers a model to assess both recovery of hormonal secretion from functionally suppressed parathyroid glands and disappearance of parathyroid hormone.

Adenoma↗
PubMed1994

A phase II study of high-dose cisplatin, vinblastine, bleomycin, and etoposide (PVeBV regimen) in malignant nondysgerminomatous germ-cell tumors of the ovary.

Fourteen patients with malignant nondysgerminomatous germ-cell tumors of the ovary were treated with a combination of high-dose cisplatin, vinblastine, bleomycin, and etoposide (PVeBV regimen). Nine patients received PVeBV as primary postoperative therapy, of whom four had no residual disease. Four patients received PVeBV for recurrent disease. One patient underwent PVeBV therapy as second-line treatment. Three patients with initial poor prognostic features were treated with early high-dose chemotherapy with autologous bone marrow rescue as consolidation therapy after two cycles of PVeBV. Ten of 14 patients (71%) are progression-free with a median follow-up of 6 year. Equal efficacy and less toxicity favor the combination of bleomycin, etoposide, and cisplatin (BEP) as standard treatment of ovarian germ-cell tumors in the 1990s.

Adolescent↗
PubMed1994

Screening for adrenal medullary disease in patients with medullary thyroid carcinoma.

Adrenal medullary disease (AMD) is clinically silent in most patients with medullary thyroid carcinoma (MTC). It was screened yearly by urinary measurements of catecholamines and derivates, and by abdominal ultrasonography (US) in a series of 174 patients with MTC. In cases with suspicion of AMD, abdominal computerized tomography and scintigraphy with meta-iodobenzylguanidine were also performed. AMD was discovered in 10 patients (one adrenal medullary hyperplasia and 9 pheochromocytomas). Three patients were already known to belong to a type II multiple endocrine neoplasia (MEN-2a) family and two had a MEN-2b syndrome. In 5 patients previously considered as having either a sporadic (4 cases) or a familial type of isolated MTC (one case), the occurrence of AMD led to diagnose a MEN-2a syndrome. The diagnostic values of the tests were evaluated by a case-control study. Urinary metanephrine plus normetanephrine (MN+N) had an acceptable sensitivity (0.8) and specificity (0.8). The other urinary tests had a high specificity (range: 0.8 to 1) but a poor sensitivity (range: 0.1 to 0.5). US had a high sensitivity (0.8) and a specificity of one. MN+N and US performed yearly constitute a simple and efficient strategy to screen for AMD in patients with MTC.

Adolescent↗
PubMed1994

[Treatment of Basedow disease with synthetic antithyroid drugs. Evaluation of the dose on the efficacy of the long term treatment].

A direct immunosuppressive action of antithyroid drugs (ATD) has been suggested by the progressive decrease of thyroid antibodies during treatment. High doses of ATD were then proposed to improve the level of remissions of Graves' disease but the results of such high doses remain a matter of controversies. The french Group of Research on Thyroid (GRT) underwent a multicenter study comparing the efficacy of 60 mg/d of carbimazole with the minimal dose required to obtain euthyroidism in 197 randomly and equally distributed patients. After 18 months of therapy and a 2-year follow-up the remissions are 70.9% with high and 53% with low doses (p = 0.03). After the third year of follow-up, this difference was not significative (p = 0.06). Moreover after a 3-year follow-up the remission rate of high dose (60.3%) is not different from which is obtained with intermediate one (20 to 30 mg/d) associated with a permanent decrease of TSH by thyroid hormone.

Antithyroid Agents↗
PubMed1994

[Contributions and limitations of transcutaneous ultrasonography in the preoperative evaluation for hepatic resections].

From October 1990 to January 1992, 36 patients were operated in order to perform an hepatectomy for hepatic metastases (n = 33) or primary malignant tumors (= 3). The authors evaluated the reliability of preoperative ultrasonography (US) by comparing US data to intraoperative findings without consideration of others preoperative examinations. Preoperative US detected 65 out the 78 nodules founded intra-operatively; 13 nodules (4 to 30 mm) and a micronodular dissemination were not detected (sensitivity 82% for the whole lesions). Probable causes of false negative cases (size, location and echogenicity of the nodules) are discussed. Sixty three out of the 65 nodules detected were correctly located in the hepatic segmentation by preoperative US. Hepatectomy was performed in 30 of the 36 patients (84%). The resection previously planned by preoperative US was realized in 24 patients, 5 hepatic resections (14%) had to be enlarged and one completed by a lymphadenectomy; in 6 cases (16.5%) the hepatectomy was not possible because of intraoperative findings of lesions previously not detected by preoperative examinations including US (3 with not removable hepatic nodules, 3 with lymph nodes metastases). This study confirms the reliability of US for anatomical location of hepatic lesions. US sensitivity for the detection is satisfactory. However the number of nodules was underestimated in one third of the patients. The hepatic resection previously planned was effectively realized in only 67% of the cases, in one case out of 6, the resection had to be enlarged and in one case out of 6, the resection was not possible.

Adult↗
PubMed1993

Osteogenic anaplastic carcinoma of the thyroid.

An unusual osteogenic anaplastic carcinoma of the thyroid developed in a 68-year-old man and showed follicular and osteosarcomatous components. Seven months after surgery and 70 mCi 131I treatment, a local tumor recurrence was found and showed an intense uptake of 99mTc-MDP on the bone scan. After a second operation, pathologic and immunostaining analysis revealed no more thyroid carcinoma but only osteosarcomatous cells. Chemotherapy was ineffective and the patient died with diffuse pulmonary metastases 26 months after the diagnosis. The importance of osteogenic sarcomatous differentiation is proven by the bone scan. Osteosarcoma of the thyroid is a rare but well known tumor. Usually these tumors do not contain any cells originating from the thyroid epithelium and only comprise sarcomatous components. Ten cases of undifferentiated carcinoma of thyroid origin with osteogenic component have been reported. These tumors have been recently included in undifferentiated carcinomas in the second edition of the WHO classification. The evolution and pathologic findings favor the hypothesis of a transdifferentiation of the thyroid cell into osteogenic cells.

Aged↗
PubMed1993

[Epidemiology].

Explore the source record for details and available documents.

Adolescent↗
PubMed1993

[Management of the thyroid nodule. Preliminary results of a practice survey of 685 general practitioners and specialists].

The authors present the preliminary results of a mailed survey of policies for the management of thyroid nodules (TN). This survey involved 685 general practitioners and specialists and was carried out at the initiative of APNET (National Educational Association for Training in Therapeutics) with the aid of ANDEM (National Agency for the Development of Medical Evaluation). Twelve percent of responders (13.1% among GPs) declare that they do not manage TNs. Those have been excluded from the analysis. The answers taken into account come from general practitioners (n = 179), endocrinologists (n = 233), specialist surgeons (n = 64), ENT practitioners (n = 93) and nuclear medicine practitioners (n = 26). The average number of patients with TN seen in a year varies according to the specialty: 6 a year for GPs, 30 in ENT, 89 for endocrinologists, 105 for surgeons. This survey reveals a number of common position: 1) the therapeutic attitude must be customized according to clinical findings and to complementary tests; 2) prescriptions are homogeneous as regards radionuclide scanning (technetium or iodine), TSH assays, ultrasonography and T4 assays; 3) ultrasonography is used in first intention; 4) ultrasonography has limitations, and is regarded by a majority or responders as unable to provide information about benignancy or malignancy. Conversely, responses are much more variable about a number of points: 1) the use of fine needle aspiration cytology which is mainly used by endocrinologists and nuclear medicine practitioners; 2) the management of nodules discovered on ultrasonography: the attitude is different from that adopted with palpable nodules for endocrinologists, surgeons and nuclear medicine practitioners, and identical for most general and ENT practitioners; 3) the usefulness of a suppressing treatment with thyroid hormones. Both general practitioners (47%) and, even more so, specialists (84%) are aware of these differences in practices. Faced to this situation, 69% of specialists are in favor of establishing consistent practices, but a minority (42%) only think that it is possible. Thus recommendations about practices may be useful only if they are adapted to the type of practice and to the conditions of access to complementary tests, and they should be aimed at rationalizing management rather than making it consistent.

Endocrinology↗
PubMed1992

[Pituitary adenoma revealed by Traquair's syndrome].

Junction scotoma is a classic field defect initially described by Traquair in 1917. Sparse cases have been reported until today. The authors report a silent pituitary adenoma in a 58 year-old female revealed by a junction scotoma. The field defects secondary to insult of chiasma from pituitary tumors besides usual bitemporal hemianopsia are reviewed by the authors. The possibility of minor ophthalmologic symptoms despite voluminous tumor has to be emphasized.

Adenoma↗
PubMed1991

Femoral infarction following intraarterial chemotherapy for osteosarcoma of the leg: a possible pitfall in magnetic resonance imaging.

Bone infarction of the distal femur is reported in two patients with osteosarcoma of the leg (1 tibia, 1 fibula) treated by preoperative chemotherapy including intraarterial chemotherapy (IAC) by Cis-platinum. Both patients were examined by magnetic resonance imaging before chemotherapy and again prior to limb salvage surgery. The location of these lesions in the distal femur must suggest bone infarction especially if the tumor has decreased in size under treatment.

Adult↗
PubMed1990

Scanning electron microscopy (SEM) of the human thyroid gland: a technical improvement for follicular cell observation.

SEM is a valuable tool for the examination of hollow organ free surfaces. It has been used in a few studies of human thyroid. The cell surface observation is usually limited by the presence of colloid in the follicular lumen. A technique of direct removal of the colloid has been previously proposed. It gives good morphological results. But this method needs preliminary fixation and critical point drying of thyroid samples. Antigenic properties of tissue blocks are then unsuitable for further staining. We describe a fast and easy technique for colloid removal by washing thyroid samples in a saline solution. Colloid is correctly removed from the tissue block surface prior to fixation. Apical cells are left undamaged. The exposure of thyroid blocks to ultrasound did not improve colloid removal. A post-fixative chemical drying in hexamethyldisilazane shortens processing time. We have studied the efficiency of this technique on 24 human thyroid samples obtained by surgery (normal tissue, Grave's disease, heteromultinodular goiter, toxic solitary adenoma). All specimens were observed by SEM and transmission electron microscopy in order to assess the good preservation of cell surface details. This easy technique could be used as a routine process.

Adenoma↗
PubMed1989

Decreased lymphocyte function-associated antigen-1 molecule expression on peripheral blood lymphocytes from patients with Graves' disease.

Humoral and cellular abnormalities have been described in autoimmune thyroid diseases, but a deficient cooperation between humoral and cellular systems has been poorly investigated in such diseases. Lymphocyte function-associated antigen-1 (LFA-1), a glycoprotein expressed on T- and B-lymphocytes, plays an important role in cell-cell interaction mechanisms and is involved in the homing phenomenon. The expression of this molecule was investigated on peripheral blood lymphocytes from patients suffering from various thyroid disorders. Decreased numbers of LFA-1-positive cells were observed in 30 patients with Graves' disease, while normal values were present in 8 patients with Hashimoto's thyroiditis and 37 subjects with nonautoimmune thyroid disorders. Treatment-induced improvement of Graves' disease was associated with an increase in LFA-1-positive cell number.

Adult↗