[Basedow disease following metastatic thyroid cancer]

OBJECTIVES

Metastatic thyroid carcinoma rarely provokes hyperthyroidism. We describe here the main characteristics of this association observed in a 48-year-old woman.

CASE REPORT

The patient had presented signs of hyperthyroidism for one year. Clinical examination revealed severe Graves' disease with nodular goiter. Presurgery investigations demonstrated thyroid carcinoma and lung metastasis. Thyroid stimulating immunoglobulins were elevated. After total thyroidectomy, hyperthyroidism persisted, indicating the functional nature of the lung metastases.

DISCUSSION

The effect of thyroid stimulating immunoglobulins on the clinical course of thyroid carcinoma and distant metastases remains unknown.

Comparison of SPECT lung perfusion with transbronchial lung biopsy after lung transplantation

The objective of this study was to evaluate the potential role for single photon-emission computed tomography (SPECT) using technetium 99m-macroaggregated albumin for diagnosing rejection in lung transplant patients. SPECT results were compared with those obtained from transbronchial biopsy (TBB) in patients undergoing bronchoscopy during routine surveillance and in cases of clinical, radiographic, or physiologic suspicion of lung rejection. This prospective, nonrandomized study was conducted by the Marseille Lung Transplant Group, Marseille University Hospitals South. It included 26 lung transplant recipients (19 double-lung, four single-lung, and three heart-lung). For each patient, SPECT lung perfusion was performed before TBB as part of routine surveillance protocol and when clinically indicated. Routine surveillance included TBB at 1, 3, 6, 9, and 12 months and every 6 months thereafter. SPECT was always performed within the 24 h preceding TBB. Whenever the SPECT was abnormal, biopsies were obtained from an area corresponding to a region of hypoperfusion. Results of the study were based on 79 paired SPECT and TBB obtained from 26 patients. Concordance between SPECT and biopsy occurred in 71 instances (89.9%). Among 25 cases of normal SPECT, TBB was normal in 24 and revealed subclinical lung rejection in one. Among 54 cases of abnormal SPECT, TBB was also abnormal in 47 (87.0%), with lung rejection being the abnormality in 23 (46%). For pairs performed as part of the routine surveillance protocol (61 pairs), clinically silent lung rejection was diagnosed in 16 (26.2%). SPECT was abnormal in 15 of 16 instances and normal in only one; this patient had minimal rejection that resolved without treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pulmonary perfusion tomoscintigraphy in pulmonary embolism. Preliminary study]

Tomoscintigraphy, a method developed over 10 years ago, is little used nowadays for the evaluation of suspected pulmonary embolism. The authors report the results of a preliminary study of 10 patients hospitalised for this condition. Tomoscintigraphy was normal in 2 cases and abnormal in 8 cases. Seven of these 8 patients underwent pulmonary angiography which confirmed the diagnosis of pulmonary embolism in 6 cases. The small number of patients, however, did not allow measurement of the sensitivity and specificity. Tomoscintigraphy, repeated at the 8th day and at the first month, provides an assessment of therapeutic efficacy. Some improvement is observed in all cases from the first control but the amount varies from one subject to another. At one month, 3 of the 6 patients undergoing control tomoscintigraphy had hypoperfusion sequellae. The simplicity of pulmonary tomoscintigraphy makes it a useful investigation for emergency diagnosis and follow-up pulmonary embolism.

Value of MRI and MIBG-I123 scintigraphy in the diagnosis of spinal bone marrow involvement in neuroblastoma in children

The results of MRI and MIBG scintigraphy performed on the spine of 14 children with neuroblastoma are reported. In 6 cases of diffuse spinal bone marrow tumor infiltration, diagnosis is easier with MIBG scintigraphy than with MRI. In 5 cases, MRI detected hyposignal of the vertebral body without any spinal abnormality on MIBG scintigraphy. A discussion of the reasons for negative MIBG scintigraphy is presented and in these 5 cases, it is suggested that a lateral view of MIBG scintigraphy and HMDP-Tc99m scintigraphy may be performed, even vertebral body biopsy in order to assess bone marrow tumoral infiltration.

Diagnosis of medullary carcinoma of the thyroid (MCT) by calcitonin assay using monoclonal antibodies: criteria for the pentagastrin stimulation test in hereditary MCT

A new calcitonin (CT) immunoradiometric assay, using anti-11-7 and anti-24-32 CT fragment monoclonal antibodies was evaluated and compared to classical RIA. The sensitivity was 2.5 ng/L, the normal basal level (n = 83) was lower than 10 ng/L, the response to pentagastrin stimulation in control subjects was absent in nine and between 10-30 ng/L in nine others. (mean, 15.4). In patients with renal failure the basal level was increased between 10-52 ng/L. In patients with medullary thyroid carcinoma (MTC; n = 28), the basal level was between 189-28,900 ng/L. A pentagastrin test was performed as screening for familial MTC in eight patients with confirmed MTC at subsequent surgery; the calcitonin peak was equal or greater than 38 ng/L. Large differences exist between CT levels measured by RIA and immunoradiometric assay. The latter method provides a greater sensitivity to pentagastrin test and allows a better identification of microcarcinoma in hereditary cases of MTC.

[Dynamic bone scintigraphy in osteoarticular pathology]

Three-phase radionuclide bone scanning was performed in patients with algodystrophy or osteonecrosis. This method is used to improve the specificity of ordinary bone scan. It explores vascularization and blood pool, then bone uptake in two symmetrical articulations. Non-focal hyperaemia and late diffuse uptake are in favour of algodystrophy, whereas a distinct focal hypervascularization and late uptake predominant in the femoral condyle area seem to be in favour of pre-radiological osteonecrosis.

[Comparative study of scintigraphy, x-ray computed tomography and magnetic resonance imaging in the diagnosis of osteonecrosis of the hip and algodystrophy]

Effectiveness of modern imaging techniques were compared when used for diagnosis of the painful hip in adults, particularly the distinction between aseptic osteonecrosis and decalcifying osteodystrophy. Although a small number of patients were studied (5 cases of osteonecrosis and 5 of decalcification) the series was homogeneous (same investigator for each technique and identical equipment for each patient), and the different methods of investigation (conventional radiology, scintigraphy computed scanography CE 10,000 and 0.15 resistive NMR imaging) could be validly compared. NMR images were recorded in only 5 patients but evaluation involved findings during use of this method of hip investigation over a period of 8 months. Results of comparison of the different imaging methods in osteonecrosis and osteodystrophy of hip showed conventional radiology to be much less effective for diagnosis. Conventional bone scintigraphy appeared to provide a good diagnostic approach, while C.T. images appeared to be as effective or even more specific than scintigraphy for differential diagnosis of the two affections. The only uncertainty is based on the radiologic latency in early stage disease, probably able to be filled by a densitometry. The use of NMR imaging appears to be promising, since it provides data as early as scintigraphy and as specific as scanography, particularly in view of apparent discrimination between osteonecrosis and osteodystrophy of the hip with respect to measurement of relaxation parameters.