[Primary hyperparathyroidism. Diagnostic and therapeutic problems].
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Biomedical subjects
Publications and source records attributed to A Spivach.
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Parathyroid surgery needs an appropriate diagnosis and a preoperative localization. We conducted a prospective study to compare the efficacy of 4 different imaging modalities in 17 patients: thallium-technetium subtraction scintigraphy, ultrasonography, computed tomography and arteriography. The sensitivity was: scintigraphy 58%, echotomography 86%, Tc 92% and arteriography only 33%. Neck exploration confirmed the imaging results. We found 15 cases of adenomas (2 cases of double adenoma) and 1 case of hyperplasia; in 1 patient, no lesions were found. We conclude that the association of such techniques appears to be the optimal strategy in about 100% of the patients.
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The Authors report a case of spontaneous rupture of the esophagus in a 66-year-old alcoholic. The symptomatology was characterized essentially by epigastralgie and vomiting culminating in violent retrosternal pain radiating to the back and by shock. X-rays taken an hour after hospitalization showed an increase of pulmonary hypodiaphania with presence of pleural effusion at the left base, cervicothoracic subcutaneous emphysema. Emergency surgery was performed by thoracotomy associated with suture of the esophageal opening with drainage of the supradiaphragmatic and pleural region. However, the patient died on the 10th day of broncopulmonary complications. The Authors therefore believe that the triad pain, shock and mediastinal thoracico-cervical emphysema should be considered pathognomonical of Boerhaave's syndrome and thus be kept in mind by the surgeon employed in a Division of Emergency Surgery and First Aid.
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Common and uncommon diseases whose symptom picture includes signs that may lead to an incorrect diagnosis are examined. Questions of this kind are obviously important in both medicine and emergency surgery, since incorrect diagnosis may involve either delay in the commencement of suitable treatment or the taking of what may even be dangerous therapeutic measures. Instances of heart and lung disease frequetly marked by abdominal symptomatologies are presented: bronchopulmonitis of various aetiologies, myocardial infarct, rhythm disturbances. In addition to the more atypical signs, such as epigastric pain in infarct and right hypochondriac pain in right basal bronchopulmonitis, manifestations such as vomiting, diarrhoea, diffuse abdominal pains and intestinal occlusion must be borne in mnd in establishing the correct diagnosis.
Primary giant-cell carcinoma of the lung is an infrequent observation. It is distinguished clinically solely its fairly rapid development but otherwise it does not seem to have any predilection for localization, age or sex. Histologically, differential diagnosis with othe tumours such as angiosarcoma, rhabdomyosarcoma, chorioepithelioma and others is of interest. Three cases of primary giant-cell carcinoma of the lung are reported and the various clinical and anatomopathological aspects discussed.
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