PubMed Health⌕ Search

Biomedical subjects

P Jallet

Publications and source records attributed to P Jallet.

At least 37 records · Page 2Linked to original sources

Introduction of the closed cranial window technique in gerbils and verification by observation of the effects of specific drugs.

The exact mechanisms of cerebral arterial hypoxia are not perfectly defined. Our purpose is to adapt and validate, with drugs well known in rats and rabbits, a closed cranial window technique in gerbils. The method was used with seventeen gerbils to measure diameter changes of the pial arterioles under normoxia (after the topical application of agonists and antagonists of ATP-sensitive and Ca2+-dependent potassium channels), as well as under hypoxia. In normoxia, aprikalim (10(-6) M), a direct activator of ATP-sensitive potassium channels, increases the diameter of pial arterioles by 10+/-2% (N = 17). This effect is inhibited by glibenclamide (10(-6) M), but not affected by iberiotoxin (10(-6) M), a specific inhibitor of Ca2+-dependent potassium channels. The adenosine-induced dilation by 19+/-5% (N = 17) is reduced by 59+/-16% with iberiotoxin, by 33+/-23% with glibenclamide and inhibited by theophylline (10(-5) M). In hypoxia (15% O2), pial arteriole diameters are increased by 24+/-5% (N = 17) and partially decreased by the application of glibenclamide and iberiotoxin to 59+/-11% and 54+/-5%, respectively. These data are similar to those obtained in other species and validate the closed cranial window technique on gerbils. They indicate that, as for rats and rabbits, both ATP-sensitive and Ca2+-dependent potassium channels are present in gerbil pial vessels and play a role in hypoxia.

Adenosine↗

[MRI quantification of regional variations of left ventricular parietal stress in normal subjects].

The object of this study was to analyse regional variations in end systolic left ventricular wall stress in normal subjects using three-dimensional magnetic resonance imaging (MRI) with excellent spatial resolution. Eight to 12 contiguous short axis sections of the left ventricle were acquired from the apex to the base in apnoea with a rapid echo-gradient sequence in 15 healthy volunteers. The end systolic wall stress was calculated by three methods: Grossman's formula (CR) using the wall thickness and radius of curvature, Janz's formula (CS) using the surfaces, and a three-dimensional approach (C3D) providing a precise calculation of the radius of curvature. The values of wall stress obtained by CS and CR were lower (p < 0.001) at the apex (3.2 and 3.3 10(3) newton/m2 respectively) than at the base (6.9 and 7.1 10(3) newton/m2). There was no difference between the base and apex with the C3D method (8.0 and 9.0 10(3) newton/m2 respectively, NS). The same results were observed at the inferior, lateral, anterior and septal segments with an increase at the base using the CS and CR formulae, the C3D remaining homogeneous in the left ventricle except for the interventricular septum. The lateral wall stress was significantly lower with respect to the interventricular septum in all sections from the apex to the base, irrespective of the method of calculation used. The differences in regional wall stress from the base to the apex reported in healthy subjects seem to be related to an underestimation of left ventricular wall thickness and an underestimation of the radius of curvature rather than to a physiological phenomenon.

Adult↗

[Myocardial viability. Study of viability by myocardial scintigraphy].

UNLABELLED: FUNDAMENTAL PRINCIPLES: Myocardial scintigraphy is a metabolic approach to myocardial viability visualizing the localization, the extent and to some degree the quantity of non-functional yet viable myocardial tissue. Potential for functional recovery cannot be ascertained directly from the scintigram but can be inferred from commonly observed behavior after blood flow has been restored. Myocardial scintigraphy is thus fundamentally different from other functional exploration methods such as echocardiography or nuclear magnetic resonance imaging which can detect residual contractile capacity unmasked by inotropic stimulation. It must be remembered however that such 'forced' contractility may not necessarily be expresses spontaneously after revascularization and that, however detected, truly viable myocardium may not recover normal contractility after reperfusion when associated with non-transmural infarction or diffuse fibrosis. PET AND THALLIUM 201 SCANS: Positron emission tomography (PET) is the gold standard. Accomplished after administration of an isotope labeled substance (18-fluoro-deoxyglucose, FDG), the PET scan visualizes metabolic activity in viable myocardium. Special equipment is however required and facilities are limited, particularly in France. Thallium 201 scans can be acquired with conventional gamma cameras and protocols have been widely developed with nearly equivalent performance in certain situations of doubtful residual viability after post-infarction thrombolysis or angioplasty. It must be noted however that in such cases, search for homolateral or contralateral ischemia may be the main objective rather than the detection of residual viability. A 3-step thallium 201 scintigraphy protocol with stress, 4-hr redistribution then imaging after reinjection is usually sufficient to document ischemia or viability warranting revascularization. The problem is quite different for patients with major myocardial dysfunction and histological remodeling due to hypokinetic dilated cardiomyopathy. In such types of myocardium, chances of recovering inotropic capacity are quite limited and detecting viable tissue would be technically difficult; however with a proper protocol (without stress, resting images late after injection), thallium 201 scintigraphy can be helpful. PERFORMANCE: Data in the literature shows that isotopic techniques lack specificity by overestimating the extent of viable tissue capable of recovering contractility. Actually this could be seen as an advantage since the consequences of missing even a small chance for revascularization warrant risking an ineffective procedure for a patient whose only alternative is heart transplantation. This situation explains why 18-FDG PET exploration should be performed even if the thallium scintigram leaves very little room for hope of recovering viable myocardium in patients with terminal disease. PERSPECTIVES: Isotopic exploration of the myocardium is a moving field and routine practice can expect to benefit from research conducted in pioneer centers. The future offers two main perspectives: the development of metabolic tracers giving more precision than thallium 201 (for example isotope-labeled fatty acids); and technical advances in conventional gamma cameras more adapted to the physical characteristics of 18 FDG used for PET scans. Scintigraphy is an indispensible tool for metabolic exploration of the myocardium. Only nuclear magnetic resonance spectroscopy may provide comparable results.

Fluorodeoxyglucose F18↗

NMR investigation of experimental chemical induced brain tumors in rats, potential of a superparamagnetic contrast agent (MD3) to improve diagnosis.

The different steps of development of chemically induced brain tumors were investigated in rats by MRI using a superparamagnetic contrast agent, magnetite-dextran nanoparticles (MD3). Sprague Dawley strain pregnant female rats were injected intravenously with ethylnitrosourea solution at the end of pregnancy. Offspring whelped by the inoculated mother were followed. MRI examinations were performed at 0.5 T. MD3 nanoparticles were injected intravenously at a dose of 5 mg Fe kg(-1) body weight 30 min before rat sacrifice. After sacrifice, histological slices were stained with hematoxylin-eosin. Relaxation times were measured at 40 MHz and 37 degrees C. MD3 nanoparticles act differently according to the step of the tumor development. Before tumor appearance, at a step characterized by the presence of abnormal cell clusters, relaxation time T2 increased significantly. The T2-weighted image showed a small increase in signal intensity in the lesion. Image contrast was improved by MD3 nanoparticles injection because of the decrease in healthy tissue signal intensity. The T1-weighted image did not provide any additional information. In presence of a minute tumor, relaxation times decreased in tumor but increased in surrounding tissue. The T1-weighted image showed a hypersignal on the border of an hyposignal. T2-weighted image showed a hypersignal in the same area. Signal intensity was not modified after MD3 nanoparticles injection. When new vascular capillaries developed in the tumor, MD3 nanoparticles cross into the cerebral parenchyma. Transmission electron microscopy showed magnetite crystals in this specific area on cytoplasm vesicles of glial cells and in tumor-specific membrane arrangements. On T2-weighted image, the hypersignal consisted of a well defined part and a second more fuzzy part, its signal being extinguished after MD3 nanoparticles injection. Necrotic areas and edema can be discriminated. The use of such a superparamagnetic contrast agent would be helpful in early detection of tumor development and in improving distinction of tumor mass from its vascular environment in patients.

Animals↗

Glial tumoral proliferation induces changes in the state and physical properties of water during ENU-induction of brain tumors in rats.

Modifications of water state were analyzed during ethylnitrosourea-induction of brain tumor in rats. Four different steps were identified in the cancerization process according to NMR and histological findings. Two analogies were observed in the pattern of bound' water at decreasing temperatures: first the pattern was similar in tumor area and white matter, second the pattern was similar in the same area of normal brain tissue and cortical gray matter. This phenomenon, which corroborates previous reports on liver cancerization, points out that pathological proliferation of glial cells, and their progressive organization into multiple layers, is accompanied by a transformation of water properties at the cellular level.

Animals↗

[Measurement of the left ventricular mass using MRI with automatic determination of the endocardial and epicardial contours].

This study describes a method of automatic border detection of the left ventricular endocardium and epicardium associating three methods of segmentation (increase of region, border detection and adaptive threshold), applicable to the evaluation of ventricular mass and volume by magnetic resonance imaging. Despite slight underestimation, the spin-echo sequence used in 9 small pigs provided a value of left ventricular mass close to that observed ex vivo (r = 0.97, SEE = 6.05 g). Clinical validation using a rapid gradient-echo sequence was undertaken and compared with manual border detection carried out by three independent, trained operators. The study population included healthy subjects and patients with global or segmental left ventricular dysfunction with or without ventricular deformation. The correlations between automatic and manual detection were satisfactory both for calculation of left ventricular mass (r = 0.93, SEE = 13 g) and measurement of surfaces (r = 0.91, SEE = 1.4 cm2). The concordance of the two methods was confirmed by the Bland and Altman test. Cardiac magnetic resonance imaging may provide accurate and reproducible measurements of left ventricular mass within acceptable acquisition and image processing times for routine use. Although the clinical value of such a method is accepted both for establishing the prognosis and guiding management, studies of the cost/efficacy ratio should be undertaken to situate magnetic resonance imaging with respect to other non-invasive techniques of investigation of left ventricular function.

Adult↗

[Renovascular hypertension due to renal artery thrombosis].

The authors report the case of a 74 year old woman admitted to hospital for severe hypertension with unilateral renal artery thrombosis. Recanalisation of the renal artery was obtained by transluminal angioplasty leading to rapid control of the hypertension. Dynamic renal scintigraphy with MAG 3 confirmed the viability of the kidney distal to the thrombosis and, secondarily, the functional recovery of the affected kidney.

Aged↗

Investigation of blood-brain barrier permeability to magnetite-dextran nanoparticles (MD3) after osmotic disruption in rats.

The permeability of experimentally disrupted blood-brain barrier (BBB) to superparamagnetic nanoparticles (MD3) was studied in rats. BBB opening was induced by intracarotid injection of mannitol. One hundred eighty rats were used for the study. Rats were examined at two time points, 30 minutes and 12 hours after intracarotid mannitol injection. Different preparations intravenously injected 30 minutes before rat sacrifice were used for characterization of BBB disruption. BBB integrity was determined with 99mTc-diethylenetriamine pentaacetic acid (DTPA) and 99mTc-albumin. Iron oxide-glucose particles (12-nm mean diameter), 99mTc-labeled lecithin-cholesterol liposomes of three different sizes (50, 100, and 200 nm), and polyethylene glycol (PEG)-coated 99mTc liposomes (50 nm) were used for investigations of the dependence of BBB permeability on particle system size or surface. Magnetite-dextran nanoparticles (MD3) were evaluated as superparamagnetic contrast agent to monitor with magnetic resonance imaging (MRI) the BBB breakdown. In vitro T1 and T2 relaxation times of the brain tissue were measured at 40 MHz and 37 degrees C, and T2-weighted MR images were acquired at 0.5 T. After intracarotid mannitol infusion, as expected, the BBB breakdown was immediate and temporary as judged by soluble molecule diffusion. MD3 nanoparticles crossed the BBB 12 hours after intravenous mannitol injection, at a time when brain permeability for molecules or small particles returns to normal. Magnetite crystals were found in cytoplasmic vesicles of glial cells. On MRI, signal intensity decreased after injection of MD3, even 12 hours after mannitol injection. This particularity could be useful in the study of focal pathological lesions accompanied by BBB permeability modifications. In such conditions, superparamagnetic particle contrast agents could be caught by the BBB, allowing the observation of impaired BBB areas without detectable cellular lesions.

Animals↗

[Value of MRI with injection of gadolinium in the diagnosis of mitral ring abscess. Apropos of a case].

Transoesophageal echocardiography is the investigation of choice for the diagnosis of valvular vegetations in infectious endocarditis but the diagnosis of an associated ring abscess is sometimes difficult especially in patients with valvular prostheses or calcifications which are in important source of artefacts. The authors report a case of mitral annular abscess confirmed at surgery and comment on the diagnostic and prognostic value of cardiac MRI. MRI showed an abnormal cavity directly related to the mitral annulus and separated from the left ventricle by a low intensity signal which increased after injection of gadolinium suggesting an inflammatory origin and therefore arising from the abscess. The cavity was heterogeneous in T1 associating zones of low intensity with high intensity signals increasing in T2 on the second echo (thrombus and necrosis). Cine-MRI showed non communication between the abscess cavity and the left ventricle or atrium.

Abscess↗

[Is the presence of right ventricular high intensity signals sufficient for the diagnosis of right ventricular dysplasia?].

The aim of this study was to assess "morphological" MRI data (spin-echo) compared with cine-MRI in 10 patients with documented right ventricular dysplasia and 10 normal controls. Data was acquired with a 0.5 Tesla superconductor magnet associating sequences of spin-echo and gradient echo (cine-MRI). An abnormal high intensity signal was observed in spin-echo in 9 out of the 10 patients. They were present on the anterior and sub-tricuspid walls of the right ventricle (8/10) and in the pulmonary infundibulum (8/10). A dyskinetic zone corresponding to the abnormal signals was detected in 8 patients. In the control group, only one subject had an abnormal high intensity signal and no dyskinesis could be detected. The association of high intensity signals and dyskinesis would seem to be very specific of right ventricular dysplasia. On the other hand, a high intensity signal alone may be observed in apparently normal subjects and would seem to be less specific.

Aged↗

Radionuclide angiography and magnetic resonance imaging: complementary non-invasive methods in the diagnosis of constrictive pericarditis.

Constrictive pericarditis presents with a suggestive clinical picture, and its diagnosis is based on a haemodynamic pattern revealing impaired ventricular filling. In this study of 15 patients with pure isolated constrictive pericarditis, we attempted to evaluate the diagnostic value of two non-invasive methods not usually employed in this indication: radionuclide angiography (RNA) and magnetic resonance imaging (MRI). Whilst RNA permits analysis of the functional pattern of the global and segmental left ventricular filling impairment, MRI allows measurement of the thickness of the pericardium. RNA revealed increased early diastolic filling as evidenced by a shorter one-third filling time (TF1/3; P<0.0001 with respect to a normal population), a higher peak filling rate (PFR; P<0.01) and its early occurrence (P<0.001), increased one-third and mid diastolic filling fractions (P<0.01), and the ratio of the PFR over the peak ejection rate (P<0.01). During late diastole, the atrial filling fraction decreased (NS). The patients with constrictive pericarditis also showed a decrease in the physiological filling asynchrony, as assessed by segmental evaluations. Seven patients underwent MRI. The pericardium was thickened in all the patients, varying from 6 to 14 mm (normal: 2.5+/-0.7 mm), without any systolo-diastolic variation. Pericardial thickening appeared as a dark low-intensity signal band, demonstrating the fibrocalcific nature of the pericardial contents. Sagittal and coronal cross-sections were particularly well-suited to show the non-uniformity of the pericardial thickening. These results indicate that RNA and MRI are complementary non-invasive methods, and can provide the functional and anatomical information required for the diagnosis of constrictive pericarditis.

Adult↗

Calciotropic hormones in elderly people with and without hip fracture.

The effects of age on calciotropic hormones are not completely understood. The presence of secondary hyperparathyroidism has previously been demonstrated, particularly in patients with hip fracture. The role of a disturbance of vitamin D metabolism, especially a defect in 1 alpha-hydroxylation, is debated. The aim of this study was to compare serum parathyroid hormone (PTH), osteocalcin and vitamin D metabolites (25(OH)D and 1,25(OH)2D) in osteoporotic elderly patients with hip fracture (HF) and in elderly controls. We studied 57 HF patients aged 83.9 +/- 5.9 years (mean +/- SD) and 68 controls aged 82.5 +/- 5 years recruited during two periods: 1 January and 30 April 1988 and 1989. Patients with chronic renal failure (serum creatinine above 150 mumol/l), cancer, or other metabolic bone disease were excluded. Thirty healthy young adults were studied in 1989 only for measurement of 1,25(OH)2D. (1,25(OH)2D was measured by different laboratories in 1988 and 1989 for technical reasons.) We also measured serum PTH, osteocalcin, total calcium and ionized calcium. 1,25(OH)2D levels were not statistically different between HF patients and controls for the two years, nor between HF patients and young healthy adults in 1989. 25(OH)D was decreased in HF patients (p < 0.003), as was ionized calcium. Serum PTH levels were higher in HF patients than in controls (p < 0.01). A positive correlation has been found between PTH and age in HF patients (r = 0.29; p < 0.03) and in the whole group of HF patients and controls. There was a significant decrease in osteocalcin in HF patients versus elderly controls (p < 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Direct effect of calcitriol on the regulation of parathyroid hormone secretion in a case of pseudo-hypoparathyroidism (a 24-month follow-up study).

The diagnosis of pseudohypoparathyroidism with osteitis fibrosa was made in a 51-year-old woman on the basis of hypocalcaemia, elevated plasma PTH (1-84) and blunted cAMP response to hPTH infusion. Radiologically, widespread signs of hyperparathyroidism were observed and quantitative histomorphometry confirmed the increased bone cellular turnover. Treatment with calcitriol (1,25 dihydroxyvitamin D3) induced a dramatic improvement of bone lesions. During treatment PTH (1-84) normalized with high dosage of calcitriol in spite of low or subnormal levels of serum calcium, and subsequently increased for each reduction of calcitriol dosage despite normal calcium levels. Our observations support a major and direct effect of 1,25 dihydroxyvitamin D3 on the regulation of parathyroid secretion of parathyroids glands.

Biopsy↗

Contribution of parathyroid hormone-related peptide to the evaluation of hypercalcemia.

Hypercalcemia of malignancy is due either to local osteolysis at the site of bone metastases or to production by the malignancy of parathyroid hormone-related peptide, which shares some of the effects of parathyroid hormone. We used a radioimmunoassay (antiserum specific to the amino-terminus) to measure serum parathyroid hormone-related peptide levels in controls (n = 61), chronic renal failure patients (n = 10), patients with primary hyperparathyroidism (n = 19), cancer patients with (n = 35) or without (n = 57) hypercalcemia and/or bone metastases (n = 53 and n = 39, respectively), and patients with hematologic malignancies (n = 15). We set the upper limit of normal of the parathyroid hormone-related peptide assay at 2.7 pmol/L. The peptide was undetectable in two-thirds of healthy controls. Renal failure did not interfere with the assay. Eighteen of the 19 patients with primary hyperparathyroidism had normal levels. In contrast, 82% of patients with humoral hypercalcemia of malignancy (i.e., without detectable bone metastases) had increased levels; in this subgroup there was a significant inverse correlation between serum levels of the peptide and phosphorus. Elevation of parathyroid hormone-related peptide levels was less common among hypercalcemic patients with metastatic bone disease (38%). Four of the seven hypercalcemic patients with hematologic malignancies had elevated parathyroid hormone-related peptide levels. In our overall study population, serum calcium levels were weakly but significantly correlated with parathyroid hormone-related peptide levels. In conclusion, elevated parathyroid hormone-related peptide in a patient with hypercalcemia suggests a malignant disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Comparison of the analytical and clinical performances of three thyrotropin immunoassay kits.

We first compared the analytical performances in terms of precision of two different generation thyrotropin (TSH) assays: Amerlite TSH-60 Assay (K2-TSH) versus Berilux hTSH (B3-TSH) and Kodak Amerlite TSH-30 Ultrasensitive Assay (K3-TSH). Then, we compared the clinical performances in 69 thyrotropin-suppressed patients with thyroid cancer and in 17 other patients referred for newly diagnosed hyperthyroidism. All the patients were given 200 micrograms of Protirelin IV for TRH testing. At the analytical level, the functional detection limit (FDL) was 0.006, 0.017, and 0.04 mU/l for B3-, K3-, and K2-TSH, respectively. At the clinical level of the 17 hyperthyroid patients, 52.9% displayed a positive TRH test with B3, 5.9% with K3, and 11.8% with K2; besides, 29.4% had a basal TSH detectable value with B3, 5.9% with K3, and 11.8% with K2. Among the patients receiving suppressive therapy: 1) 95.6%, 49.3%, and 50.7% showed a detectable TSH response to TRH, with B3-TSH, K2-TSH, and K3-TSH, respectively, and 2) only 5.8% had undetectable basal TSH values with Berilux hTSH, versus 84% with K2 and 89.8% with K3. Considering our findings, we first conclude that third generation TSH assays (having a functional sensitivity limit between 0.01 and 0.02 mU/l) can be useful for monitoring patients on thyroxine suppressive therapy, so as to distinguish partial from more complete thyrotropin suppression. Secondly, even though K3 has a FDL consistent with a third generation TSH assay, it appears less clinically sensitive than B3. Yet, no current assay can thoroughly ascertain a state of overtreatment. Finally, it is important to routinely determine the FDL, which can vary from one kit to the other, within one generation of TSH assays. Indeed, B3 with a FDL at 0.006 mU/l is more useful for monitoring LT4-suppressed patients for thyroid cancer than K3 whose FDL is 0.017 mU/l.

Adult↗

[Performances of two kits for parathyroid hormone-related peptide (PTHrP) assay in the additional study of malignant hypercalcemias].

Measurement of parathyroid hormone-related peptide (PTHrP) associated with that of parathyroid hormone, allows to establish, in most cases, diagnosis of hypercalcemia of malignancy and more exactly of patients with Malignancy Humoral Hypercalcemia (MHH). Because of the variety of molecular forms of PTHrP, linked to its catabolism, its immunoassay remains difficult. After a study evaluating the methodological reliability, we measured the contribution of PTHrP to the hypercalcemia by 2 assays: a N-terminal RIA and a 1-72 IRMA in samples from 47 control subjects, 10 patients with chronic renal failure (IRC), 13 patients with primary hyperparathyroidism (HPT), and 48 patients with solid tumors classified by their level of calcemia: 48 normocalcemia and 23 hypercalcemia. We noted a strong correlation (r = 0.92) between the two assays. They do not show increases in renal insufficiency; they have a good diagnostic discrimination between HPT, normal subjects and patients with MHH. Elevated levels of PTHrP are similar in both assays. However, IRMA appears to be more sensitive and more practical than RIA. Moreover, it shows the best correlation between serum calcium and phosphorus in patients with MHH.

Adult↗

In vitro study of the hemocompatibility of superparamagnetic contrast agent for magnetic resonance imaging.

Five different nanoparticles, potentially useful in magnetic resonance imaging (MRI) after venous administration, were studied for their hemocompatibility. The in vitro methodology evaluated these materials by several parameters: cytotoxicity towards cells cultured in vitro, aggregation ability of platelets, hemolysis inducibility, intrinsic and extrinsic coagulation pathway activation, and complement activation. With the proposed clinical dose, regardless of the cell type used (murine cell line or human endothelial cells) no toxicity was observed. The presence of the particles in blood did not produce any considerable damage: either hemolysis or platelet aggregation or blood coagulation were recorded. However, a slight decrease in aggregation ability of platelets was noticed as well as an increase in partial thromboplastin time. Because of the quick removal of the particles from the bloodstream, these phenomena must be short-lived, thus avoiding significant adverse clinical effects.

Animals↗

Pentagastrin stimulation test and early diagnosis of medullary thyroid carcinoma using an immunoradiometric assay of calcitonin: comparison with genetic screening in hereditary medullary thyroid carcinoma.

A pentagastrin stimulation test using a calcitonin (CT) immunoradiometric assay was performed in 38 healthy subjects and in the following 50 patients: 25 subjects from families with at least 2 known cases of medullary thyroid carcinoma (MTC), 11 subjects from families with apparently sporadic MTC, 2 pheochromocytoma carriers, 1 primary hyperparathyroidism, 8 patients with thyroid nodules, and 3 others with various diseases. In healthy volunteers, basal CT values were always less than 10 ng/L; the response to pentagastrin was below 30 ng/L for 36, and for the remaining 2, the peaks reached 30 for 1 subject and 48 ng/L for the other. The pentagastrin-stimulated CT peak was above 30 ng/L in each of the patients presented here, and all were thyroidectomized. In screening the 25 relatives of patients with familial MTC, a CT peak level over 30 ng/L was constantly associated with C-cell disease (23 cases of MTC and 2 of C-cell hyperplasia). A response to pentagastrin above 100 ng/L was observed in 15 patients among the 23 with MTC. In 8 of the 10 patients with a peak CT level between 30-100 ng/L, pathological examination showed a MTC; the other 2 had C-cell hyperplasia and a negative linkage study analysis. In the 25 other patients in the study without familial MTC, the pentagastrin-stimulated CT level was over 100 ng/L in 11 of the 14 subjects with MTC. The abnormal CT response to pentagastrin, which has been used as a criterion for surgical treatment, is currently determined by an immunoradiometric assay. Our study confirms that subjects with a peak CT level above 100 ng/L should undergo surgery whatever the reason for the test. In the context of inherited MTC, our results suggest that for patients with a CT peak level between 30-100 ng/L, surgery may actually be postponed when their probability of being gene carriers is low. Recent progress with the characterization of specific mutations in affected individuals will make familial screening much easier in the next few months.

Adolescent↗