Antithyroid drugs and Graves' disease — prospective randomized assessment of long-term treatment

OBJECTIVE: Although antithyroid drugs (ATD) are widely used in the treatment of Graves' disease, management protocols, especially treatment duration, remain a subject of debate. The rate of relapse after short-term regimens of less than 6 months with ATD at decreasing doses is higher than after longer treatments from 12 to 24 months. As no prospective study has provided data on even longer protocols exceeding 2 years, we conducted a prospective trial to determine potential benefits of a 42-month treatment compared with an 18-month treatment. DESIGN, PATIENTS AND MEASUREMENTS: The aim of this prospective randomized trial was to compare relapse rates achieved two years after treatment withdrawal in patients who received carbimazole at decreasing doses for 18 months (n = 62) vs 42 months (n = 72). In addition to clinical relapse rate, the percentage of patients who normalized antithyroperoxidase (TPO) antibody and anti-TSH receptor stimulating antibody (TSAb) levels and early iodine uptake at the end of treatment were assessed as outcome criteria. RESULTS: The relapse rate two years after discontinuation of treatment did not differ significantly in patients treated for 18 months from those treated for 42 months (36% vs 29%, NS). At the end of treatment, there was no significant difference between the two groups in the percentage of anti-TPO positive patients (53% vs 46%, NS) or early iodine uptake (27% vs 21%, NS). Although the percentage of patients with TSAb was significantly lower in the 42-month treatment group (18% vs 42%, P = 0.004) at treatment withdrawal, the percentage of TSAb-positive patients did not significantly decrease between 18 and 42 months in this group (27% vs 18%, NS). CONCLUSION: Treatment duration greater than 18 months did not improve remission rate determined 2 years after treatment withdrawal or immunological variables or early iodine uptake measured at the time of discontinuation of treatment. These findings would indicate that, when a defined duration treatment is planned, prolonging treatment beyond 18 months does not provide any additional benefit.     

An automated microscopy system MECOS-Ts2 and its trial use for blood and bone-marrow smear analysis

Disadvantages of conventional procedures for testing of medical automated microscopy systems are considered. A testing procedure based on step-by-step testing of the system units is suggested. The procedure makes use of remote data analysis through communication lines. The structure of MECOS-Ts2 automated microscopy system and the procedure for its testing are considered.     

Deletion of the 5'ABL region in Philadelphia chromosome positive chronic myeloid leukemia: frequency,origin and prognosis

The use of new nuclei probes in fluorescent in situ hybridization (FISH) at diagnosis and during follow up has recently allowed the detection of a deletion of the 5'abl region on the derivative chromosome 9 among some CML patients. This deletion seems to be a powerful and independent prognostic factor. The aim of our study was not only to estimate the frequency of the deletion of the 5'abl region among chronic myeloid leukemia (CML) patients with bcr-abl fusion gene, but also, to assess whether this deletion is concomitant with the formation of the Philadelphia (Ph) chromosome or represents a sign for progression of the disease, and finally to evaluate the prognostic implications of this abnormality. One hundred and twelve patients were analysed using FISH with LSI bcr-abl dual ES color probes, at the moment of the diagnosis when possible or, if not, on a sample with a strong rate of Ph+ metaphases evaluated by conventional cytogenetics. When the deletion was highlighted in a patient, we performed an hybridization on all the samples available during the follow-up. The deletion of the 5' region of the gene abl was detected among 9 patients. When the deletion was found in a patient, it was present in all the Ph+ metaphases and nuclei and in all the samples studied at diagnosis and during follow up. In these patients, we never identified cells carrying the Ph chromosome translocation without the deletion. None of the patients with the deletion had a major cytogenetic response to treatment with interferon. The deletion of the 5'abl region on der(9), present in approximately 9% of the CML, takes place at the same time as the formation of the Ph chromosome translocation and seems of worse prognosis. The detection of this deletion could thus constitute an argument to start STI treatment in first intent for these patients.     

Psychometric Properties of the Life Events Checklist-Korean Version

Objective

The Life Events Checklist is a brief screening instrument that is used for potentially traumatic events such as accidents, disasters, sexual or physical assaults, or combat-related exposures. The original English version was recently tested for reliability and validity and it showed good psychometric properties, and so its use is recommended for the assessment of trauma.

Methods

This study investigated the reliability and validity of a Life Events Checklist-Korean version in 157 consecutive psychiatric outpatients at a university-affiliated teaching hospital. The questionnaire also included the Impact of Events Scale-Revised (IES-R), the Beck Depression Inventory (BDI), and the State and Trait Anxiety Inventory (STAI). Correlation and principal component analyses were conducted.

Results

The four week test-retest reliability was good and the internal consistency was acceptable. In addition, the number of traumatic events was significantly correlated with the posttraumatic depressive and anxiety symptoms, which demonstrated the convergent validity of the scale. Additionally, exploratory factor analysis identified a six-factor structure that explained 57.2% of the total variance.

Conclusion

These findings support the reliability and validity of the Life Events Checklist-Korean version.     

Dramatic effect of sirolimus on renal angiomyolipomas in a patient with tuberous sclerosis complex

Angiomyolipomas are very common in patients with tuberous sclerosis complex (TSC) and cause substantial morbidity. Until now, arterial embolization has been the recommended treatment for symptomatic patients. We report the case of a woman with TSC and giant angiolipomas in whom sirolimus induced a dramatic reduction in bilateral renal tumors.     

Effect of a 188 Re-SSS lipiodol/131I-lipiodol mixture, 188 Re-SSS lipiodol alone or 131I-lipiodol alone on the survival of rats with hepatocellular carcinoma

BACKGROUND AND AIM: It has been shown that the use of a cocktail of isotopes of different ranges of action leads to an increase in the effectiveness of metabolic radiotherapy. The purpose of the present study was to compare with a control group the effectiveness of three different treatments in rats bearing hepatocellular carcinoma (HCC), using (1) a mixture of lipiodol labelled with both I and Re, (2) lipiodol labelled with I alone and (3) lipiodol labelled with Re alone. MATERIAL AND METHODS: Four groups were made up, each containing 14 rats with the N1-S1 tumour cell line. Group 1 received a mixture composed of 22 MBq of Re-SSS lipiodol and 7 MBq I-lipiodol. Group 2 received 14 MBq I-lipiodol. Group 3 received 44 MBq of Re-SSS lipiodol and group 4 acted as the control. The survival of the various groups was compared by a non-parametric test of log-rank, after a follow-up of 60, 180 and 273 days. RESULTS: Compared with the controls, the rats treated with a mixture of Re-SSS lipiodol and I-lipiodol show an increase in survival, but only from day 60 onwards (P=0.05 at day 60 and 0.13 at days 180 and 273). For the rats treated with I-lipiodol, there was a highly significant increase in survival compared with the controls at day 60, day 180 and day 273 (P=0.03, 0.04 and 0.04, respectively). There is no significant increase in survival for the rats treated with Re-SSS lipiodol, irrespective of the follow-up duration (P=0.53 at day 60, 0.48 at day 180, and 0.59 at day 273). CONCLUSIONS: In this study, I-lipiodol is the most effective treatment in HCC-bearing rats, because this is the only method that leads to a prolonged improvement of survival. These results cannot necessarily be extrapolated to humans because of the relatively small size and unifocal nature of the lesions in this study. It appears necessary to carry out a study in humans with larger tumours in order to compare these three treatments, particularly with a view to replacing I-labelled lipiodol by Re-labelled lipiodol. However, this study clearly demonstrated that, for small tumours, as in an adjuvant setting for example, I-labelled lipiodol should be a better option than Re-labelled lipiodol.     

Spontaneous coronary artery dissection causing myocardial infarction in an 18-year-old man: A case report

Spontaneous coronary artery dissection (SCAD), an uncommon cause of myocardial infarction, typically affects a younger, otherwise healthy population. There are currently no known direct causes of this condition, although some correlations have been noted. Commonly found in women, the asymptomatic presentation in men is very rare. Herein, we report the case of an 18-year-old man who presented to our institution with asymptomatic myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. Until now, there is no specific guideline for SCAD. Choice of treatment should be tailored to the clinical condition of each individual patient.