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Biomedical subjects

J Barbier

Publications and source records attributed to J Barbier.

At least 55 records · Page 3Linked to original sources
PubMed1993

Airway complications in thyroid surgery.

Perioperative and postoperative morbidity and mortality were studied in a series of 3,008 thyroidectomies. Compressive symptoms, frequent in substernal and cancerous goiters, were present in 11.0% of the patients, although a low rate of dyspnea (2.7%) was observed. In large goiters, some orotracheal intubations were difficult. In such cases, the transtracheal approach can also be difficult, so failure should be anticipated. Postoperative causes of respiratory obstruction included local hemorrhages, bilateral recurrent nerve palsies, and laryngeal edema. A tracheal collapse was not observed. These respiratory obstructions led to repeat surgery in 11 patients, tracheostomy in 3, and temporary reintubation with steroid therapy in 1. The recurrent laryngeal nerve, which may have been affected preoperatively, was found to be damaged postoperatively in 0.5% of the patients with benign goiters, compared to 10.6% of the patients with thyroid cancer. In this last group a bilateral palsy was observed in 3 cases with prolonged or extensive surgery. After these short-term orotracheal intubations (114 minutes on average), injuries of the airway caused by the endotracheal tube were found in 4.6% of the patients.

Airway Obstruction↗
PubMed1993

[Contribution of peroperative ultrasonography].

Ultrasonography, the most reliable examination for the morphological analysis of the thyroid gland, does nonetheless produce some false negative findings. This results in residual nodules after surgery, which will cause real recurrence. Such recurrence can best be avoided by systematic palpation of the entire thyroid gland with two fingers by the surgeon. The authors wanted to assess the merits of intraoperative ultrasonography relative to preoperative ultrasonography and to intraoperative palpation in a randomized prospective study, the results of which are presented in this paper. Intraoperative ultrasonography is most useful for doubtful preoperative ultrasonographic findings in which lesions are described as "heterogeneous parenchyma" or "hypoechogenic areas". Like preoperative ultrasonography, intraoperative ultrasonography allows clearly visualizing the thickness and amount of parenchyma remaining within a multinodular goiter. Performing this intraoperative exploration, either with palpation or ultrasound, or both, seems to be the best way to avoid residual nodules.

Adolescent↗
PubMed1993

[Comments on the prevention of recurrence with thyroid hormone therapy].

Hemithyroidectomy is the basic operation for isolate thyroid nodules or unilateral multinodular goiters. However, surgeons must check the absence of contralateral nodules by palpation, in order to avoid residual nodules that are not readily amenable to hormone therapy. In a review of 1456 goiters operated between 1968 and 1983, the authors identify only the multinodular nature as a significant risk factor of recurrence. In view of the prevention of residual nodules, they note only 2.5% recurrence. Although some studies demonstrate an increase in the TSH level after hemithyroidectomy, these results do not allow recommending systematic postoperative hormone therapy. This seems to be justified only in a population at risks, namely patients with multinodular goiter, increased postoperative TSH levels, thyroiditis or a family history.

Humans↗
PubMed1993

Analysis and prevention of recurrent goiter.

The current study was done to analyze our experience with recurrent goiter. Prevention must be stressed because reoperations of the thyroid gland present technical difficulties and are associated with an increased risk of hypoparathyroidism and permanent hoarseness. Nodular recurrences occurred in 36 of 1,456 patients (2.5 percent) who underwent thyroidectomy between 1968 and 1983. All patients had the initial operation at Jean Bernard Hospital, Poitiers, France, and had follow-up evaluation from five to 20 years. Multinodular goiter accounted for 70 percent of the recurrences. Sixty percent of the recurrences were in patients with multinodular goiters. Recurrent goiter was usually first detected about eight years after thyroidectomy. Thirty patients with recurrence had reoperations. Two patients had paralysis of the vocal cord and one patient had permanent hypoparathyroidism. Recurrent goiter may occur because of the development of new nodules (true recurrence) or because of the growth of "residual" or persistent macroscopic or microscopic nodules left at the previous thyroid operation. Intraoperative digital palpation of the entire thyroid gland is essential for detecting residual macroscopic thyroid nodules, and all enlarged nodules should be removed. Thyroid-stimulating hormone (TSH) suppressive therapy is recommended by some authorities to prevent "true" recurrences, although its efficacy is debated. Since recurrence is uncommon in the current series, perhaps TSH suppressive therapy should only be used in high-risk patients. In the current experience, only the multinodular character of the nodules in euthyroid patients has a significant correlation with subsequent development of recurrent goiter (p < 0.01), and one must consider patients with multinodular goiter at risk for recurrence. Once TSH treatment is begun, it will logically be continued for life. Total thyroidectomy has been recommended by some endocrine surgeons for treating patients with multinodular goiter. We prefer subtotal thyroidectomy and reserve total thyroidectomy for patients when no normal thyroid tissue can be preserved because only 2.5 percent of the patients in the current study had recurrent goiter. Prevention of residual nodules is probably best assured by systematic palpation during operation of the two thyroid lobes. This considerably lessens the risk of recurrence. Since nodular recurrences occurred in only 2.5 percent of the patients in the current study, although multinodular goiter must be considered at risk for recurrence, we do not recommend systematic total thyroidectomy in multinodular goiter.

Adolescent↗
PubMed1992

Effect of bromolevamisole and other imidazo [2,1-b] thiazole derivatives on adenylate cyclase activity.

We studied the effect of bromolevamisole (BL) and other imidazo [2,1-b] thiazole derivatives--bromodexamisole (BD) and levamisole (LV)--on adenylate cyclase (AC) activity. BL and BD both inhibited forskolin-activated human thyroid AC, while LV had no effect. This inhibition was non-stereospecific and the IC50 values, as measured with 1 mM ATP and 40 microM forskolin, were 0.95 and 0.80 mM for BL and BD, respectively. In contrast, human thyroid alkaline phosphatase (ALP) inhibition was stereospecific, with IC50 values of 0.0012 mM for BL and 0.9 mM for BD. LV was a 10-fold weaker inhibitor of ALP than BL. These results show that ALP inhibition is not correlated with forskolin-activated AC inhibition. Furthermore, in the presence of a competitive inhibitor of GTP (0.1 mM guanosine 5'-O-(2-thiodiphosphate), BL retained its antagonizing effect on forskolin-activated AC which suggests a direct action on the catalytic subunit. The inhibition was of the mixed type, indicating a complex interaction between BL and AC. Glucagon-activated AC activity in rat liver membranes was also inhibited by BL, although to a slightly lesser degree than thyroid stimulating hormone (TSH)-activated AC from human thyroid for a given BL concentration. In cultured human thyroid cells, BL (0.25 mM) induced a potent decrease in cAMP accumulation after 2 hr of stimulation by TSH. Taken together, these results show that BL inhibits AC and that this inhibition is not organ-specific.

Adenylyl Cyclase Inhibitors↗
PubMed1992

The evolution of carotid and coronary artery disease after operation for carotid stenosis.

We followed 278 consecutive patients undergoing carotid artery surgery between January 1985 and December 1989 using a computerized surveillance program file with automatic carotid and coronary artery follow-up investigations every six months. Combined postoperative neurologic mortality and morbidity was 1.7%. During the mean follow-up period of 30 months, 10 patients died, four due to myocardial infarction. Actuarial rates of survival and freedom from cerebral vascular accidents at 36 months were 94% and 95.8%, respectively. No fatalities due to cerebral vascular accidents occurred during follow-up. Eleven patients had myocardial infarction, an actuarial rate of 6% at 36 months; 18 patients experienced angina pectoris, while seven sustained silent electrical myocardial ischemia. Findings on myocardial angioscintiscans and coronary artery arteriograms led to four aortocoronary bypasses and seven percutaneous coronary artery dilatations. Duplex scanning documented three asymptomatic carotid restenoses of > or = 80%, which were operated upon, and 32 contralateral carotid artery stenoses ranging between 80% and 99%, 24 of which were asymptomatic. Twenty-eight patients underwent secondary contralateral carotid artery revascularization. No one with contralateral carotid artery stenosis < 80% experienced a carotid artery ischemic event. These results clearly show the value of cardiac and neurologic surveillance of patients operated on for carotid artery stenosis.

Actuarial Analysis↗
PubMed1992

Optimal central trapping (OPCETRA) vena caval filter: results of experimental studies.

The authors present the in vitro and in vivo results of use of a new vena caval filter, the optimal central trapping (OPCETRA) filter. The in vitro study was designed to compare the clot-trapping effectiveness of three filters: the OPCETRA, the stainless steel Greenfield, and the original Vena Tech-LGM. Standardized 3-mm, 5-mm, and 7-mm clots were captured in 66%, 100%, and 100% of cases, respectively, with the OPCETRA filter; in 34%, 82%, and 100% of cases with the Greenfield filter; and in 50%, 100%, and 100% of cases with the LGM filter. When filters were tilted 15 degrees, 100% of the 5-mm clots were trapped with the OPCETRA filter versus 50% with the Greenfield (P < 1.04 x 10(-9)) and 70% with the LGM (P < 1.78 x 10(-5)) filters. The in vivo animal study was designed to confirm ease of placement, tolerance, and effectiveness of the OPCETRA filter in sheep. Animals were separated into two groups: Group 1 underwent embolization through the femoral vein 40 days after filter implantation and were killed immediately; group 2 underwent embolization at 90 days and were killed 8 days later. In all cases pathologic analysis on the vena cava wall was performed after resection. The in vivo study demonstrated no tilting or migration with the OPCETRA filter. These encouraging results can be explained by the filter's hourglass shape, the number of arms, and the slow release of the filter at insertion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[Hepatobiliary complications of total parenteral nutrition].

Total parenteral nutrition has showed his efficacy in severe digestive diseases. However, infections, metabolic and hepato biliary complications can appear. Aim of this study is to report hepato biliary complications in 200 adult patients, mean age 53 years, treated between 1979 and 1988. Three types of hepato biliary complications occurred in 138 patients initially free of hepato biliary disorders: 1) biochemical hepatic disorders (cholestasis and/or cytolysis) occurred in 58 patients (42%) with mean time of 27 days. In 40% these disorders disappeared after modifications or stop of parenteral nutrition. 2) Jaundice occurred in 9 patients (7%) with mean time of 73 days. Regression of Jaundice is possible only if enteral nutrition is reestablished. Sludge or cholelithiasis occurred in 34 patients (25%) with mean time of 43 days. In five of these patients cholecystectomy must be performed. Literature confirms high frequency of hepato biliary complications in total parenteral nutrition. Occurrence of these complications seems to be related to duration of total parenteral nutrition and to type of nutrition. Most complications decrease when we can stop total parenteral nutrition. Use of lipids in separated perfusion decreases significantly (p < 0.05) biochemical hepatic disorders occurrence. In conclusion, 1) biochemical hepatic disorders are very common, requiring biochemical hepatic tests weekly. 2) Jaundice is rare but serious, requiring stop of parenteral nutrition, and sometimes surgery to reestablish an enteral nutrition. 3) high frequency of cholelithiasis justifies ultrasonographic follow-up, and perhaps preventive cholecystectomy in operation leading total parenteral nutrition.

Adolescent↗
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

[Prognostic incidence of blood transfusion in 753 patients operated for colorectal adenocarcinoma].

Do transfusions have a deleterious effect on the survival after surgery for colorectal carcinoma (CRC)? Among 1,221 patients operated on for a CRC between 1969 and 1988, 753 patients having undergone a curative surgical procedure with a follow-up of at least six months were evaluated retrospectively. 134 patients (17.2%) did not receive any transfusion; the others 619 (82.80%) received transfusions including 150 with packed red blood cells only. Transfused and non transfused patients were compared. Among the classical indicators for disease free survival, the only valuable parameter was the pathological classification, but it was not discriminant between transfused and non transfused patients. Prognostic value of transfusions were evaluated with regard of the components and the quantity of transfused items, the time of transfusions (either per- or perioperative), the surgical procedures and the tumor location on colon and rectum. The 5 years survival of transfused patients was less than for non transfused patients (56.3% versus 61.7%, p > 0.05 NS), but only the transfusions of more than 5 packed red blood cells worsened significantly the prognostic. (5 years chi 2 = 5.7; p < 0.02). Adjustments with pathologic analysis and time evolutive indications for transfusions did not alter those results. These results point the fact that transfusions could influence survival after surgery for CRC and stress us to limit reasonably transfusions.

Adenocarcinoma↗
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↗
PubMed1992

Bilateral symptomatic adrenal myelolipoma.

Adrenal myelolipomas are rare, nonfunctioning benign tumors that consist of mature fat and bone-marrow elements. In the first half of this century, most adrenal myelolipomas were found incidentally at autopsy. These tumors are usually unilateral and asymptomatic. Today they are detected by ultrasonography, computerized tomography, or magnetic resonance imaging scan, done for other reasons. Adrenal myelolipomas can be diagnosed because of their characteristic images. Thus they are classified as "incidentalomas." We report the case of a 50-year-old man who had bilateral adrenal myelolipomas and whose right-side tumor was symptomatic. To our knowledge it is the third operated case reported in the literature. A right adrenalectomy was performed, keeping the asymptomatic left adrenal myelolipoma to preserve adrenal function.

Adrenal Gland Neoplasms↗