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Biomedical subjects

E Sarfati

Publications and source records attributed to E Sarfati.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Neuroendocrine carcinoma of the esophagus].

Small cell neuroendocrine carcinomas are frequent in the bronchial tree, but are very are in the gastrointestinal tract. A 51-year-old woman underwent total esophagectomy for an ulcerated tumor of the lower third of esophagus. Pathologic examination showed an infiltrating small cell carcinoma, and immunohistochemical analysis proved it to be neuroendocrine. The patient died 2 months later from respiratory failure related to pleuritic metastases. Review of the 162 previously published cases showed a mean survival of 6.2 months, and rapid dissemination of metastatic disease, as in our case. As for small cell bronchial carcinoma, systemic chemotherapy should be considered for neuroendocrine carcinoma of the esophagus.

Carcinoma, Small Cell↗
PubMed1990

[Hyperparathyroidism with severe hypercalcemia. Treatment and results].

From 1960 to 1988, we successfully treated 1,200 primary hyperparathyroid patients. The serum calcium level was higher than 3.75 mmol/l (150 mg/l) in 75 patients. Sixty-five patients had acute primary hyperparathyroidism and 10 had asymptomatic severe hypercalcemia. Before admission to our department, most of the patients were given medication to lower their serum calcium levels. Analysis of our diagnostic and therapeutic experience leads us to insist upon the importance of prompt medical treatment and rapid surgical intervention. Only surgery can adequately treat severe hyperparathyroidism.

Acute Disease↗
PubMed1990

[Hyalinizing trabecular adenoma of the thyroid gland. Histologic and immunohistochemical study. Report of 2 cases].

Hyalinizing trabecular adenoma of the thyroid gland is an uncommon neoplasm that was recently described by Carney et al. (1987). It is important to recognize this tumor, considered benign, as it may mimic papillary carcinoma, medullary carcinoma or paraganglioma. We present two cases with histological and immunohistochemical criteria and discuss the diagnostic problems. Grossly, this small tumor is yellow tan and well circumscribed. The epithelial cells, polygonal or elongated and sharply outlined, have an eosinophilic or clear cytoplasm. The nuclei are oval or elongated, with often non-visible nucleoli. Grooved nuclei are quite frequent. Mitotic figures are very uncommon. The cells are arranged in clusters or trabeculae or pseudofollicles containing colloid material. Characteristically the cells, arranged shoulder to shoulder, can show a palisade pattern. The fibrovascular stroma appears hyaline, pseudoamyloid (Congo red staining is negative). The tumor cells show intense staining for thyroglobulin and no staining for thyrocalcitonin. Immunoreactivity for cytokeratin, vimentin, protein S100, NSE is positive but staining is negative for EMA and desmin. In one case, the tumor cells show little positivity for chromogranin A. The variable patterns of this tumor can lead to diagnostic problems. We can exclude the diagnosis of papillary carcinoma as this tumor lacks any true papillary architecture. We reject the diagnosis of medullary carcinoma because of its thyroglobulin and calcitonin immunoreactivity. Paraganglioma never shows immunoreactivity for thyroglobulin. Very often the surrounding thyroid tissue shows focal thyroiditis. The association of the tumor with Hashimoto's thyroiditis can be explained by an autoimmune process.

Adenoma↗
PubMed1990

[Use of the colon for esophageal substitution. Mortality and morbidity. Report of 105 cases].

One hundred and five colonic interpositions were performed in 102 patients. The indications for operation were caustic stenosis in 57 cases (Group A) and esophageal cancer in 45 patients (Group B). The right colon was used in 97 cases and isoperistaltic transverse colon in 8 cases. Eighty-nine transplants were anastomosed to the cervical esophagus and 16 to the pharynx. The distal anastomosis was to the antrum in 67 cases, to the second duodenum in 37 cases, and to the jejunum in 1 case. The overall mortality rate was 8.6 percent (9 cases), 5.3 percent (3 cases) in group A and 13.6 percent (6 cases) in group B (p less than 0.05). The morbidity rate was significantly higher in group B than in group A (77.3 percent vs 53.7 percent, p less than 0.05). Ischemic necrosis (3 cases) and chronic ischemia of the transplant (7 cases) were the major complications. Strictures occurred at the proximal anastomosis significantly more often in group B (63 percent) than in group A (40 percent) (p less than 0.05). Seven failures occurred in 93 survivors, i.e. oral feeding was impossible. In conclusion, mortality and morbidity rates of coloplasty are high. The use of colon as an esophageal substitute is justified only in case of caustic stenosis with unavailable stomach.

Adolescent↗
PubMed1989

Acute primary hyperparathyroidism: experience of 59 cases.

Acute primary hyperparathyroidism is a rare disease with a high mortality rate in some series. Between 1960 and 1986, 1000 patients were treated for primary hyperparathyroidism, among them 59 patients with acute hyperparathyroidism. All these patients were successfully operated on; none of them died before surgery. This study reveals the importance of resuscitation and urgent surgery. It is necessary to rehydrate, to correct electrolyte disorders and to lower serum calcium levels, but it is not necessary to obtain normal serum calcium levels before surgery.

Acute Disease↗
PubMed1989

[Preoperative localization of parathyroid adenoma with technetium and thallium double-labeling scintigraphy. Difficulties related to associated thyroid lesions].

Technetium and thallium double-labeling scintigraphy with image subtraction was carried out on 63 patients suspected of having primary hyperparathyroidism, with or without thyroid involvement. Forty-four patients had a normal thyroid image with technetium. The positive foci located by double-labeling in patients who were to undergo surgery always coincided with parathyroid adenoma. In the 16 cases where the initial diagnosis of hyperparathyroidism was not substantiated, the double-labeling test was normal. Thus for these 44 patients, scintigraphy sensitivity was 75% and specificity was 100%. Nineteen patients had an abnormal thyroid image with technetium. In 7 cases, image subtraction following double-labeling yielded uninterpretable data. In 12 other patients, the positive foci located outside the thyroid by double-labeling coincided with a parathyroid adenoma, whereas this was true for only one patient whose positive foci were located inside the thyroid; a parathyroid adenoma was not detected preoperatively in 4 patients. This double-labeling test is thus useful in locating parathyroid adenomas when technetium scintigraphy of the thyroid is normal; when it is abnormal, double-labeling is advantageous only in cases of extra-thyroid foci.

Adenoma↗
PubMed1989

[Immediate oesojejunal anastomosis after total gastrectomy in caustic necrosis].

Eight patients underwent total gastrectomy for caustic ingestion. Oesophago-jejunostomy was performed in the same surgical session. One patient died from hemorrhage. Only one of the 7 survivors had a benign anastomotic fistula. Five healed without any sequelae, 2 underwent colonoplasty 3 months later, because of a secondary oesophageal stenosis. We conclude that it is feasible, in certain unusual cases, to restore gastrointestinal continuity after total gastrectomy for caustic necrosis: moderate oesophageal lesions (stage I or II) and ingestion of a caustic product that cause few oesophageal damage (acids, liquid chlorine bleach, ...).

Adolescent↗
PubMed1989

[Role of surgery in burns of the upper digestive tract in adults. Apropos of 679 cases].

Surgery is mandatory in severe caustic burns of the upper digestive tract, either as an emergency, or later because of secondary complications. Then, the patients who develop oesophageal stenosis require oesophagoplasty or oesophagopharyngoplasty. The first clinical survey must be performed in a surgery department with an intensive case unit. All patients undergo an oesophageal examination with a fiberoptic endoscope when admitted. Some of them need a fiberoptic bronchoscopy. The authors describe their experience over the 18 years up to now. Over 700 patients were admitted in the same department. The different surgical procedures are given, as well as guidelines for management.

Adult↗
PubMed1987

[Esogastric lesions caused by ingestion of liquid chlorine bleach in adults].

A retrospective study of 193 adult patients who ingested liquid chlorine bleach is reported. This figure represents 37 p. 100 of caustic product ingestions treated in the authors' hospital unit, these being attempted suicides in 85 p. 100 of the cases. All patients had oesophagogastric fibroscopy on the day of the ingestion: serious, grade 2 or 3 lesions were present in 38 p. 100 of the cases. Emergency surgery was necessary in 10 patients for a complication that occurred within the first 3 weeks, and after 2 months in 6 patients to treat a digestive tract stenosis. Compared with the other caustic products, liquid chlorine bleach predominantly creates gastric lesions and may produce digestive tract perforations by secondary necrosis which occurs after a free interval ranging from 2 to 26 days.

Adolescent↗