Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra-operative monitoring of urinary cAMP (UcAMP) and 1-84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non-cooperative, were excluded from this procedure. UcAMP and 1-84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty-two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow-up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

PubMedDate not supplied

Survival rates and prognostic factors in adrenocortical carcinoma.

In the last 12 years, 41 patients with adrenocortical carcinoma were operated on at Cochin Hospital. There were 29 females and 12 males having an average age of 42 +/- 17 years. Seven of them underwent repeat operation for local recurrence after an average interval of 22 months. Eighty per cent of the tumors had secretory activity while 20% did not. Adrenalectomy and lymphadenectomy were performed on all patients. Thirteen (32%) patients underwent extensive resection because of invasive cancer. The same procedure was performed on 7 patients undergoing re-operation. Operative mortality was 4% (2 of 48 patients). Twenty-four patients died of cancer with an average survival time of 22 months (range 2-86 months) and 15 (37%) patients were still alive, 4 of them with metastases, with an average survival time of 51 months. Curative resection for the 31 patients with local (n = 21) or regional disease (n = 10) allowed a 5 year actuarial survival rate of 45%. The 5 year actuarial survival rate for patients undergoing repeat surgery was 33%. Only 1 of the 10 patients with metastases, and who had an impressive response to OP'DDD, was alive 2 years after the operation. The other 9 patients died within 3-4 months after operation. We found that neither patient characteristics or tumor characteristics were of significant prognostic value. There was no overall prolongation of survival in patients receiving OP'DDD. However 4 patients with metastases occurring in the course of their disease experienced an impressive response with OP'DDD and a relatively long survival.

Adolescent↗

PubMedDate not supplied

[Palilloma and papillary tumor of the gallbladder].

Frequently confused with adenomas or pseudopolyps of the gall bladder, papillomas are rare tumours defined as vegetations covered with an epithelium of gall bladder type in the centre of which is a thin connective tissue axis. They are usually recognised on lyon histological examination of the operative specimen. The uncertainty concerning their course makes them a potentially malignant lesion as shown by the two cases reported here including one personal case concerning a carcinoma situated close to a benign papillomatous lesion. The frequent coexistence with lithiasis which may induce their malignant transformation reinforces the indications for surgery for gall stones.

Adenocarcinoma, Papillary↗

PubMedDate not supplied

[Iodine 131 uptake by a bronchogenic cyst in a patient with differentiated carcinoma of the thyroid gland].

BACKGROUND: After thyroidectomy for differentiated thyroid carcinoma, extracervical uptake of iodine 131 is suggestive of metastasic dissemination. False positives can however occur. CASE REPORT: Differentiated thyroid carcinoma was found in a female patient with a non-functional nodule. Two years after subtotal thyroidectomy and an ablative dose of iodine 131, the whole body scan showed abdominal mediastinal uptake with low serum thyroglobulin level. Considering the possibility of tumor recurrence or lymph node metastasis, the mass was excised. The histology diagnosis was mediastinal bronchogenic cyst. DISCUSSION: To date, iodine uptake in a bronchogenic cyst has not been reported among other false-positives previously described. The pathophysiology of this iodine 131 uptake in a bronchogenic cyst is still unknown: the presence of NIS symporter or a protein which can organify iodine in the mucus cells of the cyst remains to be proven.

Adenocarcinoma↗

PubMedDate not supplied

[Tolerance and short-term results of the systematic laparotomy-chemotherapy-radiotherapy sequence in Hodgkin's disease in adults].

Twenty five cases of Hodgkin disease were treated by chemotherapy and radiotherapy after staging laparotomy. The safety and the utility of staging laparotomy are discussed. Staging laparotomy seems to be usefull in stage II with involvement of at least three lymphatic territories and in stage III.

Abdominal Neoplasms↗

PubMedDate not supplied

[Proliferative myositis with compression of the sciatic nerve].

A case of proliferative myositis, an unusual inflammatory pseudotumour of skeletal muscle, is reported. This case was particular in that the lesion was located in the popliteal fossa, developed over a long period and above all, was revealed by compression of the sciatic nerve. The diagnosis was confirmed by peripheral biopsy of the mass which showed normal muscular tissue associated with numerous fibroblasts and with characteristic basophilic giant cells. The clinical, histological and pathogenetic features of the disease are discussed with emphasis on the importance of a thorough pathological examination to exclude with certainty a possible sarcoma.

Aged↗

PubMedDate not supplied

[Gastrointestinal haemorrhage related to portal hypertension. The pathologist's viewpoint (author's transl)].

Study of as homogeneous series as possible of 72 cases of gastrointestinal haemorrhage in patients with portal hypertension showed that the major cause of bleeding, accounting for almost 70% of cases, was ulceration of oesophageal varices. The presence at autopsy of haemorrhagic or necrotic lesions of the gastric mucosa is not felt to be a definite argument in favour of a gastric origin of the bleeding. Ulceration of gastric varices is considered to be an uncommon possibility, by virtue of the absence of dystrophic changes in the overlying mucosa, in contrast to the state of affairs seen in the oesophagus. Finally, the authors noted the relatively common presence of an associated malignant tumour (more than 8% of cases). This should perhaps lead to more profound investigations in order to seek a malignant intra- or extrahepatic malignant tumour before any bypass procedure to correct portal hypertension is undertaken.

Esophageal and Gastric Varices↗

PubMedDate not supplied

Transpariental puncture biopsy of the liver. A review of 464 cases.

Explore the source record for details and available documents.

Biopsy, Needle↗