Summary.The indication for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP) remains a controversial subject. The mortality rate of persistent thrombocytopenia is very low, except in severe cases. Conversely, the risks of splenectomy are significant (in the present series, morbidity: 4 . 1% mortality: 1 . 4%), with a success rate of only 60-75%. It is therefore useful to define a parameter able to predict the efficacy or failure of splenectomy.An analysis of 578 cases of chronic ITP, where the site of platelet destruction has been determined, is presented. 268 of these cases had been splenectomized. When platelet destruction was splenic, 96% of subjects aged 5-30 years and 91% of cases over the age of 30 years obtained a remission. Conversely, when platelet destruction was hepatic or diffuse, failure or incomplete results were observed in 92% of cases. The site of platelet destruction therefore constitutes a parameter which can help the clinician to make the decision to perform splenectomy.Keywords: thrombocytopenic purpura, platelet kinetics, site of platelet sequestration, splenectomy.We have previously reported a correlation between the site of platelet destruction and the efficacy of splenectomy in 222 cases of idiopathic thrombocytopenic purpura (ITP), 103 of whom underwent splenectomy (Najean et al, 1991). Our conclusions concerning children were criticized at that time, more because of the surgical indications (which were considered to be excessive) than for the actual isotope study (Reid, 1992). Only one similar study has since been published, confirming the predictive value of the method in 51 cases (Lamy et al, 1993). In a recent retrospective study (George et al, 1996), which proposed a practice guideline for diagnosis and treatment of ITP, isotopic assessment was only briefly considered as a measurement of platelet life-span for diagnostic purposes, but not for determination of the site of destruction as an aid to therapeutic decisions.At the time of writing, 578 cases of chronic ITP have undergone a kinetic study of autologous platelets labelled with 111 Indium-oxinate, 268 of whom have been splenectomized. PATIENTS AND METHODSAll of the cases studied (103 children aged 5-15 years, 146 adolescents or young adults aged 15-30 years, and 329 cases over the age of 30 years) had clinically documented thrombocytopenic purpura which could be considered to be idiopathic (systemic lupus erythematosus, viral infection, especially by HIV, lymphoma, and, in the elderly, myelodysplasia, were eliminated). Cases of genetic chronic thrombocytopenia due to a production defect were excluded. These cases of ITP were chronic, and had symptoms present for at least 6 months. We did not investigate pregnant women or very young children. The sex ratio in each age-group showed the same female predominance (M=F ¼ 0 : 6).Almost all patients had been previously treated (corticosteroids, immunoglobulins, danazol, and, in rare cases, azathioprine or vincristine). At the time of the isotope study, one half of the c...

BACKGROUND. Dog prostate cancer is usually considered to be highly relevant to human prostate cancer. We report the isolation of a new canine prostate cancer epithelial cell line designated DPC-1. METHODS. Primary cultures were established from a canine poorly differentiated prostatic adenocarcinoma. Population doubling time was determined by counting nuclei after cell lysis. Tumorigenicity was assessed in nude mice and in one adult immunode®cient dog. Immunoscintigraphy was performed in both models using a monoclonal antibody (mAb) raised against the [44±62] sequence of human PSMA. RESULTS. DPC-1 cells have a rapid growth in vitro (doubling time, 27 hr) which is not stimulated by androgens. In addition, DPC-1 displays immunoreactivity to human PSA and PSMA. DPC-1 was found to be highly tumorigenic not only in nude mice but also for the ®rst time after orthotopic seeding in an immunode®cient dog. This allograft mimicked, in a compressed form, the aggressive biological behavior of spontaneous dog prostate adenocarcinoma. Immunoscintigraphy using a 131 Iodine-labeled PSMA mAb clearly visualized induced tumors in nude mice and in the dog allograft. CONCLUSIONS. This study suggests that DPC-1 may constitute a powerful model for assessing new diagnostic and/or therapeutic tools in the management of prostate cancer.

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Objective: Because of major technical improvements and conscious care about cost effectiveness, limiting the inadequate use of thyroid biological tests appears to be a major issue. Design: To (i) estimate the ordering prevalence of each thyroid test, (ii) assess the prevalence of relevant thyroid tests, and (iii) evaluate the impact of expressing justification for tests during a 2-month intervention period on these prevalences. Methods: During a prospective 2-month survey (June-July 1997), all the request forms were divided into four groups of prescription: (1) investigation of thyroid function, (2) taking drugs affecting the thyroid, (3) monitoring of nodule and cancer, and (4) investigation of thyroid autoimmunity. Their appropriateness was thus determined according to consensus in our hospital and previously published recommendations. Results were compared with those of retrospective similar 2-month periods in 1996 and 1998. Combinations of thyroid function tests and thyroid antibodies were analyzed during the 1996, 1997 and 1998 periods. Results: The overall estimated rate of appropriate ordering between 1996 and 1997 increased from 42.5% to 72.4% (P < 10 -4 ), with a significant improvement in each group of main diagnosis referral, except in group 3 where suitability was always over 85%. However, in group 4, appropriateness remained low (36%). Combinations of thyroid tests revealed an increase in single TSH order forms and single autoantibodies to thyroperoxidase (TPOAb) ones, while TSH + free thyroxine + free tri-iodothyronine and TPOAb + autoantibodies to thyroglobulin ones decreased significantly. Interestingly, all these changes were maintained 1 year later (June-July 1998) even though physicians were not aware of this new study. Conclusions: Persistent change in medical practice was thus assessed.

Scintigraphy of the salivary glands with technetium-sodium pertechnetate (99mTc) was undertaken on 320 patients with oral dryness or connective tissue disease using a computer assisted method that gave quantitative results about the major salivary gland function. Compared with clinical and histological data, scintigraphy provides a sensitive method, even though it is not specific, for detecting minimal injuries to salivary glands in patients suspected of having Sjögen's syndrome. Moreover, it might differentiate between the Sjögen-like syndrome and the sequelae of radiotherapy in patients with bone marrow graft. Scintigraphy of the major salivary glands could therefore form part of the routine investigation of patients with Sjögen's syndrome.