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A Denizot

Publications and source records attributed to A Denizot.

31 records · Page 2Linked to original sources
PubMed1992

[Current surgical aspect of primary hyperparathyroidism (100 years after F. D. Von Recklinghausen)].

The "Association Française de Chirurgie" asked to authors an update on primary hyperparathyroidism based on a retrospective multicentric study on 4883 patients operated on by 79 surgeons. Aim of this study was an update on clinical and biological aspects, localizing studies, and therapeutic aspects with their results. There were 3418 females (70%) and 1465 males (30%) mean age 53 years (9 to 91 years): 3702 solitary adenomas (75.8%), 720 multi-glandular lesions (14.7%) 92 multiple endocrine neoplasias (1.9%) and 86 carcinomas (1.8%). None lesions was found in 283 cases (5.8%). To day, diagnosis is most often made on fortuitous hypercalcemia. Localising studies showed sensibility less than 50%. Surgery was successful in 92.7%. Mortality occurred in 0.6% hypoparathyroidism in 3.8%, laryngeal palsy in 1.5% and hematomas in 0.45%. In conclusion this study shows the changes regarding the diagnosis, the uselessness of localizing studies before first cervicotomy, and the good results of surgery. Autotransplantation and cryopreservation allow reducing of hypoparathyroidism.

Adenoma↗
PubMed1992

[Primary hyperparathyroidism. Results of a French multicenter study].

The "Association française de Chirurgie" asked to authors an update on primary hyperparathyroidism based on a retrospective multicentric study on 4883 patients operated on by 79 surgeons. Aim of this study was an update on clinic and biologic aspects, localizing studies, and therapeutic aspects with their results. There were 3418 females (70%) and 1465 males (30%) mean age 53 years (9 to 91 years): 3702 solitary adenomas (75.8%), 720 multiglandular lesions (14.7%) 92 multiple endocrine neoplasias (1.9%) and 86 carcinomas (1.8%). None lesion was found in 283 cases (5.8%). To day, diagnosis is most often made on fortuitous hypercalcemia. Localising studies showed sensibility less than 50%. Surgery was successful in 92.7%. Mortality occurred in 0.6%, hypoparathyroidism in 3.8%, laryngeal palsy in 1.5% and hematomas in 0.45%. In conclusion this study shows the changes regarding the diagnosis, the uselessness of localizing studies before first cervicotomy, and the good results of surgery. Autotransplantation and cryopreservation allow reducing of hypoparathyroidism.

Adolescent↗
PubMed1990

[Bone density after iatrogenic subclinical long-term thyrotoxicosis. Measurement by dual photon absorptiometry].

Thyrotoxicosis may be held responsible for osteoporosis. The question is whether a very slight subclinical hyperthyroidism, as is desirable in the post-operative treatment of differentiated thyroid carcinoma, can in the long run be detrimental to bone tissue. In a series of 37 patients, aged 50.9 +/- 11.1 years, presenting with the features of subclinical hyperthyroidism of 8.0 +/- 4.8 years duration, the authors have been unable to find any change in paraclinical parameters of bone and calcium-phosphate metabolism. Thirty-six of these 37 patients showed no abnormal decrease of vertebral bone density measured by dual photon absorptiometry.

Absorptiometry, Photon↗
PubMed1990

Endosonography in the localization of parathyroid tumors: a preliminary study.

A preoperative transesophageal exploration of the parathyroids by endosonography was performed on 23 patients with primary hyperparathyroidism. The system used was a 7.5 MHz transducer mounted on the tip of an endoscope with an external diameter of 13 mm. The field of visualization was 360 degrees. A retrograde exploration was done moving up from the aortic arch to the upper esophageal sphincter. All patients underwent surgery afterward, and adenomas were found. In 12 cases the adenoma was visualized. All 12 adenomas were posteriorly located on the right side (four cases) and left side (eight cases) of the esophagus. Nine of these 12 tumors were on the posterior face of the thyroid lobes, with six tumors in the middle one third of the thyroid lobe and three in the lower one third of the thyroid lobe. The other three tumors were located below the lower pole of the thyroid lobes in the upper posterior mediastinum. Mean tumor weight was 1165 mg. Of the 11 tumors that could not be visualized, eight tumors were anteriorly located; three of these tumors were on the anterior and lateral surface of the lower pole of the thyroid, and five were in the thyrothymic tracts. The remaining three tumors were located on the back of the thyroid lobes; two of these tumors were at the upper esophageal sphincter, and one was on the side of the pharynx. Mean tumor size was 1334 mg. Localization of parathyroid tumors by endosonography appears possible but only if lesions are located posteriorly, close to the esophagus. Endosonography is not indicated before routine cervical exploration for primary or secondary hyperparathyroidism. As in other such studies, endosonography could be useful in cases of persistent or recurrent hyperparathyroidism.

Adenoma↗
PubMed1990

[Obligatory parathyroid autotransplantation in thyroid surgery].

In a series of 301 bilateral thyroidectomies carried out over a 6 month period, immediate parathyroid autotransplantation was performed in 44 patients, i.e. 14.6%. Hypoparathyroidism was transient in 14 patients, i.e. 4.7% but was permanent in 4 patients, i.e. 1.3%. We attempted to determine the conditions justifying parathyroid autotransplantation during thyroidectomies. In our opinion parathyroid autotransplantation should be performed only to save a parathyroid gland accidentally removed or devascularized. It should not be used simply as a means of avoiding dissection no matter how long or tedious.

Humans↗
PubMed1989

[Surgery of the adrenal glands in Sipple's syndrome. Apropos of 8 cases].

In a series of 82 pheochromocytomas operated on, the authors report 8 cases of Sipple's syndrome, currently classified by Steiner among the type II multiple endocrine neoplasia (MEN II). Six patients were operated on, the mean follow up being 4 years. These patients all underwent total thyroidectomy and 4 of them total bilateral adrenalectomy. Gluco and mineralocorticoid and thyroid hormone replacement therapy was instituted. No clinical or biological recurrence has been noted. The ideal therapeutic schema is difficult to define given the rarity of MEN II.

Adrenal Gland Neoplasms↗
PubMed1988

The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side.

In 6307 cervicotomies for thyroid and parathyroid excision, 33 cases of nonrecurrent inferior laryngeal nerve were identified (0.52%). The anomaly was observed in 31 cases from 4921 dissections on the right side (0.63%) and in two cases from 4673 dissections on the left side (0.04%). Of the 31 patients who were initially seen with this anomaly on the right side, no innominate (brachiocephalic) artery was found; the right common carotid artery was arising directly from the aortic arch. The aberrant subclavian artery could always be felt against the vertebral column behind the esophagus. The two patients with the anomaly on the left side had a right aortic arch associated with situs inversus viscerum. In one case of invasive thyroid carcinoma, the nerve had to be sacrificed. In all of the other patients, postoperative laryngoscopic findings were normal. The nervous anomaly was of vascular anomaly origin in all cases. Predisposing factors for its onset during aortic arch development are discussed. Before surgical treatment, the diagnosis may only be made if vascular anomaly is suspected. Impairment of swallowing is the only clinical symptom to be looked for. The retroesophageal subclavian artery may be detected on chest x-ray films (20%) or by the compression and distortion of the esophagus shown during barium swallow tests (97%). Although rare on the right side and exceptional on the left, an aberrant nonrecurrent pathway for the inferior laryngeal nerve represents a major surgical risk. This is an additional argument in favor of systematic dissection of the inferior laryngeal nerve during thyroid or parathyroid excision.

Angiography↗
PubMedDate not supplied

Thyroperoxidase immunodetection for the diagnosis of malignancy on fine-needle aspiration of thyroid nodules.

We have previously demonstrated that in 95.6% of malignant thyroid tumors the enzyme thyroid peroxidase (TPO) presents antigenic changes detectable by a monoclonal antibody termed MoAb47. The aim of this study was to investigate the interest of TPO immunodetection for the diagnosis of malignancy on fine-needle aspiration biopsy (FNAB) of thyroid nodules. The study was performed on 300 patients. Slides of FNAB aspirate were air-dried and stained by anti-TPO-MoAb47. According to the percentage of TPO-positive epithelial cells, patients were divided into two groups: benign (> 80%) and malignant (< 80%). In 279 cases additional slides were available for Giemsa stain and standard cytology. All the patients were operated on, and the final diagnosis was recorded as benign in 248 cases (183 macrofollicular nodules, 23 microfollicular adenomas, 18 atypical adenomas, 11 oncocytomas, 11 thyroiditis, 2 Graves' disease) and malignant in 52 cases (44 papillary carcinomas and 8 follicular carcinomas). Samples from 215 of 248 benign nodules yielded 80% to 100% TPO-positive cells, whereas samples from all malignant tumors yielded less than 80% positive cells. The sensitivity of TPO staining for diagnosis of malignancy was thus 100%, its specificity 86.7%, and its overall accuracy 89%. With conventional cytology, sensitivity, specificity, and accuracy were 91.6%, 79.2%, and 81.0%, respectively. We conclude from this study that TPO staining with MoAb47 should become an essential adjunct in the preoperative cytologic diagnosis of thyroid nodules.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients.

Among 258 patients operated on for secondary hyperparathyroidism (HPT II) from 1971 to 1988, a total of 33 had one or more reoperations for persistent or recurrent HPT II. These reoperations did not induce any mortality or significant morbidity. After inadequate parathyroidectomy (25 cases), 15 patients were reoperated. Twelve of these had undergone initial surgery at another institution. Three patients died of causes unrelated to their HPT II. The other 12 patients are disease-free. After successful subtotal parathyroidectomy (79 cases), 2 patients (2.5%) had a recurrence 5 and 6 years later, respectively. Currently, the 2 patients remain disease-free. After total parathyroidectomy with autotransplantation (152 cases), 16 patients (10.5%) had reoperations on the grafts. The mean time before reoperation was 2 1/2 years. Hypertrophy of grafted fragments was observed in 4 cases (2.6%), but only 2 of these 4 patients were cured by removal of the grafts. Residual parathyroid tissue or a supernumerary gland in the neck or the mediastinum was suspected in 5 patients, but this could not be confirmed because one had already been reoperated on in the neck without success, another still refuses reoperation, and 3 died. In 6 other patients, the recurrence was debatable and HPT II was not confirmed. In the last 3 patients, the diagnosis was incorrect and aluminum intoxication was proved later. Results of reoperations for persistent or recurrent HPT II depend, first, on a correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Surgical treatment of secondary hyperparathyroidism in hemodialyzed patients with chronic renal failure. Results and choice of a technic].

Results are reported of surgical treatment of hyperparathyroidism secondary to chronic renal failure in 231 patients who had undergone 250 operations over 16 years: 152 total parathyroidectomies associated in 151 cases with an autotransplant, 58 subtotal parathyroidectomies, 9 incomplete parathyroidectomies, I white cervicotomy and 39 repeat operations for persistent or recurrent hyperparathyroidism. Results were evaluated clinically, biologically and radiologically after a mean follow up of 4 years, and were rated good in 71.4% of cases. The quality of the results was independent of the type of parathyroidectomy practised: 71% good results after total parathyroidectomy with autotransplantation and 69% after subtotal parathyroidectomy. No significant difference was demonstrated between the two techniques with respect to mortality, postoperative morbidity and late complications. The only divergence seen was in relation to recurrences: recovery surgery at the cervical level after subtotal parathyroidectomy leaving a clearly identified glandular stump associated with a better result than repeat operation on grafts at brachial level after total parathyroidectomy and autograft. These results led to the adoption of a surgical routine for hyperparathyroidism secondary to chronic renal failure using subtotal parathyroidectomy combined with bilateral thymectomy. The operation of total parathyroidectomy without immediate autotransplant is reserved for cervical recovery surgical procedures. Whatever the technique used, frozen storage of removed tissue is the indispensable complement of parathyroidectomy.

Follow-Up Studies↗
PubMedDate not supplied

[Intraoperative parathormone assay. The value of assessment of primary hyperparathyroidism in surgery].

Peroperative assay of intact parathormone has been proposed to improve the surgical results, either by confirming cure peroperatively or to indicate the need for further search in case of persistent pathological secretion. Between October 1992 and July 1994 parathormone was assay peroperatively during 136 operations for primary hyperparathyroidism in 135 patients. Seven samples were made for each patient in the operating theatre: at intubation, at skin incision (ti), at ablation of the pathological gland, then 15 (t15), 30 (t30) and 60 (t60) minutes later. All samples were assayed with the rapid technique and controlled the next day with the standard method. The correlation coefficient between the two methods was 0.97. Comparing the drop in intact parathormone levels between cured patients and those with persistent hyperparathyroidism after surgery showed statistically significant differences. We retained a dramatic drop in hormone level by 80% between t1 and t15 with persistent low levels between t15 and t30 (ratio t30 over t15 < 1) as the criteria of cure: the drop off between t1 and t15 is not sufficient to confirm cure. Peroperative assay of intact parathormone can be used to demonstrate the presence of remaining pathological parathyroid tissue, especially important in case of highly ectopic localizations. This assay technique is not particularly well adapted to routine parathyroid surgery for primary hyperthyroidism but has been reserved for cases planned for limited dissection (operations conducted under local anaesthesia and reoperations).

Adult↗
PubMedDate not supplied

Bone insufficiency fractures as an inaugural manifestation of primary hyperparathyroidism.

Primary hyperparathyroidism causes excessive bone resorption with a decrease in bone mineral density. Fractures of the vertebras and appendicular bones, however, seem uncommon, even in the long term. We report three patients who presented with bone insufficiency fractures as the inaugural symptom of primary hyperparathyroidism. The three patients were women, aged 62, 65 and 86 years, respectively, who presented with fractures of the medial tibial plateau, femoral neck of femoral neck and tarsus. Laboratory tests showed hypercalcemia, hypophosphatemia and elevated parathyroid hormone levels. Apart from confusion in the 86-year-old patient, there were no clinical manifestations. A bone biopsy obtained in one patient showed increased resorption parameters with no loss of bone trabecular volume; the two other patients underwent absorptiometry, which disclosed a marked decrease in bone mineral density at the spine and femoral neck. There were no risk factors for osteopenia apart from advanced age and female gender. A parathyroid adenoma was removed surgically in all three cases. Vitamin D deficiency was a concomitant abnormality that probably exacerbated the adverse effects of hyperparathyroidism on the skeleton.

Absorptiometry, Photon↗