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Biomedical subjects

C Proye

Publications and source records attributed to C Proye.

At least 37 records · Page 2Linked to original sources
PubMed1989

Current concepts in primary hyperparathyroidism.

622 patients were operated on between 1966 and 1988. Urolithiasis was the most common presenting symptom (26%) but routine measurements of serum calcium led to detect 50% cases. At present, the disease is three times more frequent in women than in men. Estrogenic deprivation, neck irradiation (3.4%) and lithium therapy favor the occurrence of hyperparathyroidism (HPT); frequent association with goiter (19.8%), diabetes (8.3%) and multiple endocrine neoplasia (3.5%) has been noticed. Bone Gla protein concentrations correlate with calcium and HPT blood concentrations but do not reflect the severity of bone damage. Dual photon absorptiometry is now available for quantification and follow-up of bone demineralization, especially in asymptomatic forms of HPT.

Humans↗
PubMed1989

Exclusive use of calcium channel blockers in preoperative and intraoperative control of pheochromocytomas: hemodynamics and free catecholamine assays in ten consecutive patients.

This study investigates the role of nicardipine hydrochloride in preoperative and intraoperative blood pressure control and intraoperative catecholamines (norepinephrine and epinephrine) release in 10 patients undergoing pheochromocytoma resection. Nicardipine was used orally in the preoperative period for either 1 or 8 days (60 to 120 mg/24 hr) and then was infused during anesthesia until tumor removal, continuously at a rate of 2.5 to 7.5 micrograms/kg/min, depending on systolic arterial pressure level. All patients were successfully operated on. No severe hypertensive crisis occurred during tumor manipulation, although several patients had a 3- to 85-fold (norepinephrine) and 3- to 40-fold (epinephrine) increase of catecholamines from baseline levels. Hemodynamics data suggest that nicardipine caused significant inhibition of vascular smooth muscle contraction (42% decrease in systemic vascular resistance); calcium-dependent catecholamines release was not inhibited by nicardipine infused as mentioned. Use of nicardipine may be recommended for perioperative and intraoperative control of pheochromocytomas and might substitute for routine alpha-adrenergic blockade.

Adrenal Gland Neoplasms↗
PubMed1989

[Pheochromocytoma revealed by pulmonary edema].

We report the case of a young patient of 37 presenting with two attacks of pulmonary oedema which revealed an underlying pheochromocytoma. The diagnosis was suggested by the raised level of vanyl-mandelic acid in the urine and the abdominal CT scan. After an adrenalectomy the outcome was satisfactory. Pheochromocytoma should be considered in the differential diagnosis of the acute respiratory distress syndrome in the adult linked to the action of the circulating catecholamines on the pulmonary capillaries.

Adrenal Gland Neoplasms↗
PubMed1989

[Immunoscintigraphy or intraoperative isotopic detection of colorectal neoplastic lesions using labelled monoclonal antibodies. Preliminary study. 20 cases].

20 patients submitted to surgery for colo-rectal malignancies, had I.V. injection of 500 microcuries of 125 I F (ab')2 anti CEA, 3 to 5 days preoperatively, after previous thyroid blockade by iodine. At the time of laparotomy, any obvious neoplastic growth or suspicious area was checked by "intra-operative scintigraphy" according to the technique already developed in thyroid surgery by Sten Lennquist. Result was considered as positive when the uptake ratio suspicious tissue/normal tissue was greater normal tissue than 1.5. 18 out of 19 pathologically proven carcinomas, 1 out of 3 liver metastasis, 3 out of 3 extra-hepatic deposits, and 3 out of 9 metastatic nodes only were positive at scintigraphy. These results are not correlated with preoperative plasma level of CEA. Perhaps some colo-rectal carcinomas might be able to secrete CEA but not to excrete it. Improvement of intraoperative decision-making by this method needs further experience to be appreciated. It was helpful in 2 of our 20 cases.

Adult↗
PubMed1989

[Pheochromocytoma. Experience of 60 operations].

Between 1971 and 1987, 60 patients presenting 68 pheochromocytomas were operated on in the University Teaching Hospital of Lille. Diagnosis has been transformed by the use of CT scan, which for the last 10 years has enabled the lesion to be more reliably localized than by MIBG scintigraphic scanning. Combination of the two investigations enables the diagnosis to be confirmed in 100% of cases. The following topics are covered: preparation for surgery with the indications for alpha and beta blockers, route of approach--preferably median laparotomy--and operative sequelae as a function of the benign or malignant nature of the tumor.

Adrenal Gland Neoplasms↗
PubMed1989

[Thyroid cancer and pregnancy].

Thyroid cancer is very rare during pregnancy, but a thyroid nodule is more likely to be cancerous if discovered during pregnancy (43 p. cent versus 15 p. cent). The diagnosis is more difficult. Tests using radioactive substances are contraindicated during pregnancy. Ultrasonography does not permit to specify the nature of the nodule and aspiration biopsy with cytological examination becomes the examination of choice. One should not hesitate to operate on these nodules, during pregnancy, if the diagnosis is made. It is difficult to assert that the prognosis is aggravated by pregnancy since there are so few cases, but several authors report a few cases with an abnormally fast progression during pregnancy. Forms which are properly treated and occurred before the age of 40, are not a contraindication to subsequent pregnancies, if they are not anaplastic or metastatic forms. However, a reasonable delay of the surgery is advised in order to stabilize the hormonal treatment and the calcium-phosphorus balance.

Adult↗
PubMed1989

[Multi-glandular lesions in primary hyperparathyroidism. Late outcome of 86 consecutive patients treated with conservative surgery].

Multiple gland enlargement (M.G.E.) in primary hyperparathyroidism (H.P.T.) is the presence of 2 or more enlarged glands weighing more than 50 mg. Conservative surgery (C.S.) consists of resecting the grossly enlarged glands without biopsying the normal glands. Some authors have suggested that C.S. might overlook minute hyperplasia, hence leading to late recurrences of H.P.T., or conversely result in the unnecessary resection of grossly enlarged, but not hyperfunctioning glands. 379 patients have been operated upon for H.P.T. 86 (22.7%) had M.G.E. including 13 (15.2%) M.E.N. cases, 8 (9.3%) familial cases and 65 (75.6%) seemingly sporadic cases (S.S.C.). 2, 3 or 4 glands (or more) were involved in 39.5%, 35% and 25.5% of cases respectively. 1 patient died post-operatively and 3--all S.S.C. with hyperplasia--had to be reoperated upon within 1 year for persistent hypercalcemia. Pathological diagnosis was: double adenomas in 5.8%, hyperplasia in 36%, adenoma associated with hyperplasia in 46.5% and a normal second gland, on light microscopy findings in 11.7%. None of 13 deaths occurring during follow-up was related to H.P.T. 78 patients (90.7%) are available for follow-up (av. 85.3 months). 85.9% are normocalcemic (2.2 less than Ca less than 2.6 mmol/l), 5.1% hypocalcemic and 9% hypercalcemic. 61 had late i. P.T.H. assay; i. P.T.H. was appropriate to serum calcium in 78.7% and appropriate to normal serum calcium levels in 90.6% of 53 normocalcemic cases.

Adolescent↗
PubMed1989

[Functional and motor study of retrosternal esophageal plasties].

The stomach may be used for esophageal reconstruction after resection of esophageal cancers. The aim of this study was to assess the motility of retrosternal esophagoplasty (RO) following the Akiyama procedure in 6 men (mean age: 56.7 years), at least two months after surgery by means of two techniques: a) manometry of the transplant with a multilumen perfused catheter in 50 and 40 cm from the incisor teeth including spontaneous (5 min) and poststimulation recordings, b) an isotopic method for assessing the gastric emptying of a meal labelled with 111In for the liquid phase and with 99mTc for the solid phase, compared to 12 volunteers as controls. Baseline pressure was 11.2 +/- 2.4 H2O cm without spontaneous activity. After dry and wet deglutition (5 ml of water), 6 patients showed synchronous rise in pressure, having mean amplitude of 12.7 +/- 2.3 cm H2O and lasting 4.3 +/- 1.2 s. Liquids T1/2 was 16.2 +/- 7.8 min in controls (p less than 0.01) and solids T1/2 was 17.7 +/- 6.4 min vs 61.7 +/- 16.5 min (p less than 0.001). The lack of propagated activity associated with rapid emptying of the meal through the plasty with no discrimination between solids and liquids suggests that RO does not participate actively in digestion.

Deglutition↗
PubMed1988

[The new clinical picture of primary hyperparathyroidism. Diagnostic circumstances and current symptomatic characteristics. Results of a multicenter study].

Primary hyperparathyroidism (PHP) is particularly interesting at this time because of the modifications of its traditional symptoms, which have renewed the conditions of its diagnosis. This is the result of a better knowledge and consequently an increased frequency of the simple forms, mild or clearly atypical, usually expressing the initial stages of the disease which are now better detected. The relative part of the classical manifestations of the disease is therefore reduced as well. In order to verify this fact, the authors have initiated a retrospective study of 535 recent cases of PHP, over 12 years, comparing them with 322 older cases, examined and operated upon between 1954 and 1976 by P.L. Chigot. Analysis of the differences that were noted, was the subject of a statistical evaluation. The first result of this investigation is that PHP remains a disease affecting predominantly women, especially between the ages of 40 and 60 years, and beyond that age to a lesser degree. In comparing the data obtained from analyzing the circumstances of discovery of the disease and its symptoms, the most striking modification consisted in a real drop in the frequency of bony lesions. These modifications are much more rare, only exceptionally presenting their classical characteristic X-ray appearance and they only represent a factor of contingency in the clinical picture of PHP. This is probably the result of a much earlier discovery of the disease. The incidence of renal insufficiency is also remarkably low, probably for the same reason. In return, asthenia and urinary lithiasis are now the major symptoms of PHP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗