Search

Objectives: To determine the distribution of orders for hormonal tests assessing thyroid function in a hospital setting. To collect the opinion of physicians specialized in endocrinology concerning free triodothyronine (FT3) assessment., Methods: Using a cross-sectional survey numbers of free thyroxine (FT4), total T4 (TT4), FT3, total T3 (TT3), and TSH tests were collected from the heads of laboratory assessing thyroid function in June 95 at the Assistance Publique-Hôpitaux de Paris (AP-HP). Cost for these tests was estimated. The physicians of the AP-HP specialized in endocrinology were asked through a questionnaire for circumstances justifying FT3 test ordering., Results: Twenty-eight laboratories (93%) responded: 28455 measurements (TSH: 43%, FT4: 33%, TT4: 2%, FT3: 20%, TT3: 2%) were performed and were valued at 3.4 million French Francs. Proportions of T4 (36%) and T3 (20%) tests were lower in hospitals with an inpatient department of endocrinology than in hospitals with an outpatient clinic with specialists in endocrinology (T4: 36%; T3: 27%) or with no endocrinology unit (T4: 33%, T3: 27%); proportion of TSH tests was higher in hospitals with an inpatient endocrinology unit (respectively 44%, 40%, 32%). Forty-two endocrinologists (76%) from 21 departments answered. Follow-up of treatment with amiodarone and euthyroid sick syndrome were considered the only conditions justifying FT3 test ordering., Conclusion: Though the opinion of physicians specialized in endocrinology was not uniform regarding recommendations for TT3 or FT3 tests as a first-line measurement, the cost of these tests has been estimated at 650 thousand Francs for a month at the AP-HP.

It has been traditionally held that developmental anomalies in language acquisition are more frequent in neonatologically at-risk subjects. There is some suggestion that proficiency in phonology is correlated with motor control development. The purpose of this paper was to compare the patterns of acquisition of the control of the acoustic-phonetic cues for voicing in the speech of premature infants and controls. The measure studied was initial stop consonant voice onset time (VOT), which is known to be the most reliable acoustic cue for the distinction between voiced and voiceless stops. The total population of the study consisted of 7 infants born at less than 37 weeks gestation and a control group of 7 infants born full-term at normal weight; 7 adults, aged 24-26 years, also participated. Each child was recorded under standard recording conditions saying words contrasting labial, dental and velar voiced and voiceless initial stops. Elicited word productions were collected monthly from infants, at different age levels, ranging from 18 to 21 months. The results show that the subjects are more advanced in the acquisition of the appropriate VOT values for the voiceless than for the voiced consonants. This difficulty may be related to the increased neuromuscular control and more complex muscle activity necessary for maintaining voicing during the closure, especially for velar stops. It is important to recognize the possibility that increased variability in preterm children may be related to some neuromuscular immaturity.

Expression of the IL-13 gene in malignant tissues from 26 human B-cell lymphoid malignancies was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). A positive signal was detected in 16 cases, which included high grade B lymphomas, follicular lymphomas and B-cell chronic lymphocytic leukemias. IL-13 mRNA was also detected in the 9 malignant B cell lines and in the 6 lymphoblastoid cell lines tested, as well as in freshly isolated malignant B cells from 2 patients with a Burkitt's lymphoma. Two of 8 T-cell lymphomas and 2 of 4 T-cell lines expressed the IL-13 gene. In contrast, IL-13 gene expression was not detected in any of the 5 non-lymphoid cell lines tested. No specific binding of radiolabeled IL-13 was detected on B cell lines, suggesting an absence of IL-13 receptors on such cells. This conclusion was also supported by the inability of IL-13 or anti-IL-13 antibodies to affect the growth of malignant B cells. Taken together, these results show that both malignant and EBV-transformed B lymphocytes, either freshly isolated or maintained as cell lines, express the IL-13 gene. This raises the question of the role of B lymphocyte-derived IL-13, a B lymphocyte stimulating cytokine, on the in vivo function of normal B lymphocytes as well as on the in vivo behaviour of B lymphoid malignancies.

Interferon-gamma (IFN-gamma) has been shown to inhibit human immunodeficiency virus (HIV) replication in macrophages. However, the site of its effect on the HIV infectious cycle is unknown. We show here that IFN-gamma inhibits the transactivation of HIV long terminal repeat (LTR) during viral infection and that it antagonizes tat effect in HT4LacZ-1 cells. HT4LacZ-1 is an indicator CD4+ HeLa cell line for HIV infectivity, because it harbors a HIV LTR-LacZ gene susceptible to transactivation by tat. It was used in combination with a computer-assisted image analyzer to quantify: (i) the number of transactivated foci following HIV infection, (ii) their individual level of transactivation, and (iii) the fusion potency of infected cells. IFN-gamma induced a 75% decrease of the number of transactivated foci following infection of HT4LacZ-1 cells by HIV. The remaining 25% foci still susceptible to transactivation were transactivated at a lower level than in control cultures, and the fusion potency of infected cells was strongly decreased. IFN-gamma acted after HIV entry into the cell and independently of reverse transcription. IFN-gamma antagonized tat-induced LTR transactivation: it inhibited transactivation of HT4LacZ-1 cells when tat was provided either from a SV40-based expression vector of tat or by polyethylene glycol-induced cell fusion with HeLa-tat-III cells. These results suggest that IFN-gamma affects the expression or the activity of cellular factors interacting with tat and that the high level of IFN-gamma production associated with HIV infection plays a role in the establishment of HIV latency.

The clinical and pathological features of a patient with giant cell arteritis of the uterus and ovaries are described. A 61 year old woman had fever and weight loss over a period of eight months. A hysterectomy with bilateral salpingo-oophorectomy was performed for a large cystic ovarian mass. Histological examination showed a benign ovarian cyst and unexpected giant cell arteritis affecting numerous small to medium sized arteries in the ovaries and myometrium. The diagnosis of temporal arteritis was confirmed by a random temporal artery biopsy, despite the absence of symptoms of temporal arteritis. This observation is compared with previously reported cases and the relation between granulomatous arteritis of the genital tract and temporal arteritis is discussed. The main differential diagnosis in this localisation was represented by Wegener's granulomatosis and periarteritis nodosa.

The data to be discussed in this paper are drawn from a study of three groups of infants: small (low birth weight less than 10 centile for gestational age), preterm (gestational age less than 37 weeks) and full term. The total population of this study consisted of 12 children (4 subjects for each group). The purpose of the study was to examine phonetic and lexical development in these three populations to determine both normal and delayed patterns of this development over the second year of life. The time sampled for early behaviors were 18, 19, 20, and 21 months, based on chronological age. The spontaneous verbal productions of the subjects were tape-recorded and transcribed using phonetic symbols (IPA). Comparison were made between preterm and full term infants based on both chronological and gestational age. The data resulting from the comparison of our subjects on these parameters provide us with evidence that there can be early indicators of later speech and lexical development of the group of preterm infants.

A report on the late outcome of reposition performed for septal dislocation present at birth. 42 cases have been examined 13 to 16 years after the intervention and it has been found that in the majority of patients (69%) the final esthetic and functional results have been satisfactory. Conversely, those cases (31%) where uni- or bilateral obstruction was still present at the time of late control had experienced a markedly increased incidence of upper respiratory infections. The different situations present at birth are indicated and it is stated that cases which tend to recur after repositioning requiring a second intervention and--possibly--unilateral packing are more likely to have an unsatisfactory late outcome.

A group of very low birthweight and/or preterm newborns has been studied and compared with a control group of healthy at term newborns, in order to evaluate hearing maturation processes by means of ABR. The wave-latencies have been found significantly higher in the study group, while no difference could be found in inter-peak latencies (IPL). Further, the study group has been split up in order to analyze the possible influence of variables like birthweight, cranial circumference, APGAR score and modality of delivery on ABR latencies. Basing upon these evaluations, it appears difficult to present clear cut conclusions, since ABR latencies' behaviour seems to be related to individual maturative variables and fails to produce an unequivocal model of maturation.

Aggressive non Hodgkin lymphoma (NHL) occurs frequently in the elderly and because of drug related toxicity treatment remains controversial. Seventy-two patients over 65 years (68-83 y, median 73 y) with intermediate and high grade NHL were retrospectively studied. We found 22 cases of high grade NHL and diffuse large cell the most frequent type encountered (54%). Seven patients had stage I, 8 stage II, 14 stage III, and 43 stage IV disease. Treatment for localized disease was radiotherapy or chlorambucil, and disseminated stage patients were treated by three different chemotherapy regimens, group I: classic dose chemotherapy without Adriamycin (15 pts), group II: same type of regimen with Adriamycin (45 mg/m2) (42 pts), group III: high dose chemotherapy with Adriamycin (75 mg/m2) (8 pts). Overall complete response (CR) rate was 53% without significant differences between treatment groups. Median duration of survival was 38 months and estimated 5 year survival at 40%. Following complete remission, 15 patients (40%) relapsed. Thirty-seven patients have died, 6 from toxic deaths (5 toxic deaths in group II and III), 28 from NHL, and 3 from other diseases. Toxicity was greater among patients treated with Adriamycin. In a multivariate analysis, the attainment of complete remission was the only factor influencing survival. Our data shows that classical dose chemotherapy leads to the same CR rate and survival as more intensive regimens.

The authors report their preliminary findings in a prospective study on the possible effects of different risk conditions present at birth on language acquisition and cognition. A multifactorial test was used to test normal children for normative values. This test was then administered to 186 at-risk babies and controls at 18 months of age. A noticeable difference in overall performance was observed only for preterm babies having an appropriate weight for their gestational age. However, significant results will only be available after evaluations are repeated when the children are 36 months old.

A number of pure-tone tests were presented to 8 groups of children of different ages who had no ear, nose, and throat pathology and a normal I.Q., in order to investigate the degree of maturation of their hearing abilities. The Luescher test (identification of difference limen or intensity) showed a significant relationship between increasing age and precise identification of gradually decreasing levels of intensity. Performance on this test was shown to be very reliable in children, and may be used as an indication of the degree of physiological maturation of hearing abilities.

Hearing screening with reactometry in the newborn is now being considered too expensive and fails to detect quite a number of deaf children. Conversely, experiences at the age of 8 months with BOEL-Test (a distraction test, which yields further information on visual and neurological deficiencies) have shown that it becomes possible to detect the majority of hearing defects. As this age level is quite adequate for diagnosis even of defects arising in the first year (progressive genetic deafness, deafness due to infections etc.) and considering that rehabilitation can start only after this term, the authors suggest to reserve neonatal screening only for risk cases and to retest all children with the BOEL-Test.

Different hearing defects have been attributed to prolonged use of oral contraceptives. The aim of the present investigation has been the evaluation by means of a number of audiological tests and of brain-stem evoked responses (BSER) of the possible incidence of subclinical pathology of the nervous hearing structures in these subjects. Twenty healthy subjects taking oral contraceptives from 9 to 30 months and 10 paired controls have been studied. No hearing loss was found but the study of BSER showed the presence of a significantly shorter latency of waves I and III which could be attributed to a functional alteration. Other, less significant, alterations are described and the conclusion is reached that prolonged oral contraception does not affect the hearing function, even if it is investigated with sophisticated techniques. However, the significant alterations of BSER responses and of the stapedial reflex might be considered as an initial non-organic sign of impairment of the central hearing pathways and therefore deserve further investigation.

The author discusses the different problems connected with ENT examination of infants. First of all, the general problems are reviewed (e. g. the consultation rooms in which the infants are examined, the need for close collaboration with paediatricians and immunologists, as well as the necessity of general anaesthesia for a number of examinations). This is followed by a discussion of the various problems connected with age, starting with malformations at birth and methods of examining loss of hearing up to the problems presented by the catarrhal child. Attention is given to the possibilities of endoscopy in childhood. Finally, the author considers the possibilities offered by screenings involving examination of hearing and speech as a means of prevention. From these data it becomes clear that comprehensive ENT examination and care during childhood may solve a number of problems in many patients and should therefore be considered to be important also from a social point of view.

We have evaluated from a clinical and functional point of view a total of 61 children (37 boys and 24 girls with a median age of 3 years, range 4 months to 6 years) who had been submitted before 1978 to insertion of tympanostomy tubes (in a total of 131 ears) for prophylaxis of recurrent purulent otitis media. Of these, 67.6% remained free from recurrencies after removal or extrusion of grommets, whereas in the remaining group discharge could be cured with local and/or general antibiotic treatment. Sixteen cases had tympanic calcifications, 6 an atrophic drum, and 10 a severe tympanic retraction, but only 8 out of these 32 cases had signs of conductive hearing loss (average loss 20 dB on frequencies from 500 to 2000 Hz). Further complications observed in this follow-up have been perforations (6 cases) and one case of migration of the tube into the tympanic cavity. No cholesteatoma has been observed in our series. A few considerations can be drawn from these observations: insertion of grommets, correctly performed in the anterior-inferior part of the drum appears to prevent a large percentage of recurrencies, and should therefore be considered, even in the long-term, an adequate prophylaxis for the otitis-prone child; complications as seen during a long follow-up period are relatively few, can be cured, and have a modest functional impact.