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Biomedical subjects

J F Henry

Publications and source records attributed to J F Henry.

At least 37 records · Page 2Linked to original sources
PubMed2001

Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group.

Because of the rarity of adrenocortical carcinoma, survival rates and the prognosis for patients who have undergone operation are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors over an 18-year period. A trend study was associated to assess changes in the clinical and biochemical presentations as well as the surgical evolution. A total of 253 patients (158 women, 95 men) with a mean age of 47 years were included. Cushing syndrome was the main clinical presentation (30%), and hormonal studies revealed secreting tumors in 66% of the cases. Altogether, 72% (n = 182) of patients underwent resection for cure, and 41.5% (n = 105) of them had an extensive resection because of metastatic cancer. A lymphadenectomy was performed in 32.5% (n = 89) of the cases. The operative mortality was 5.5% (n = 14). Patients were given mitotane as adjuvant therapy in 53.8% of the cases (n = 135). The results of staging were stage I in 16 patients (6.3%), stage II (local disease) in 126 patients (49.8%), stage III (locoregional disease) in 57 patients (22.5%), and stage IV (metastases) in 54 patients (21.3%). Neither tumor staging nor the rate of curative surgery changed during the study period. More subcostal incisions were performed, and the use of mitotane increased significantly. The 5-year actuarial survival rates were 38% overall, 50% in the curative group, 66% for stage I, 58% for stage II, 24% for stage III, and 0% for stage IV. Multivariate analysis showed that mitotane benefited only the group of patients not operated on for cure. A better prognosis was found in patients operated on after 1988 (p = 0.04), in those with precursor-secreting tumors (p = 0.005), and in those at local stages of the disease (p = 0.0003). Thus mitotane benefited only patients not operated on for cure. Curative resection, precursor secretion, recent diagnosis, and local stage were favorably associated with survival.

Adolescent↗
PubMed2001

Video-assisted parathyroidectomy via the lateral approach vs conventional surgery in the treatment of sporadic primary hyperparathyroidism: results of a case-control study.

BACKGROUND: We previously demonstrated that minimally invasive video-assisted parathyroidectomy (VAP) can be performed via a lateral approach on the line of the sternocleidomastoid muscle. The aim of this study was to compare the results of this technique with those of conventional parathyroidectomy (CP) in a case-control study. METHODS: Over a 2-year period, 80 VAP were attempted. The selection criteria were as follows: sporadic primary hyperparathyroidism, no history of previous neck surgery, no thyroid disease, suggestion of a single adenoma on preoperative imaging. A rapid intraoperative parathyroid hormone (PTH) assay was performed. The procedure was completed successfully in 68 patients. A case-control study of 68 patients who underwent CP for a single adenoma was performed. The controls were matched for age and sex. RESULTS: All of the patients were normocalcemic at follow-up. No statistically significant differences between the VAP and the control groups were found for age, sex, pre- and postoperative calcemia and PTH, adenoma weight, operating time, complication rate, or postoperative stay. One VAP patient developed recurrent laryngeal nerve palsy. Patients who underwent VAP required less analgesics (p < 0.0001) and were more satisfied with the cosmetic results (p < 0.0001). CONCLUSIONS: This study suggests that VAP by the lateral approach has some advantages over CP in terms of postoperative pain and cosmetic results.

Case-Control Studies↗
PubMed2001

Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism.

BACKGROUND: Thirty percent of patients who undergo successful parathyroidectomy for primary hyperparathyroidism show unexplained elevated postoperative serum parathyroid hormone (PTH) levels despite normocalcemia. METHODS: PTH levels were measured monthly in 97 patients for 6 months after parathyroidectomy. Renal function, 25-OH-vitamin D levels, serum alkaline phosphatase levels, osteocalcin, and bone densitometry were evaluated before and 6 months after surgery. PTH reactivity to calcium loading was tested at the sixth month. RESULTS: Thirty patients had elevated PTH levels despite normocalcemia after parathyroidectomy. Before surgery, these 30 patients had higher PTH and creatinine levels, lower vitamin D levels, and more extensive bone involvement than those with normal postoperative PTH levels. In patients with normal renal function and normal vitamin D levels, postoperative PTH values correlated with preoperative PTH levels but not with bone disease. CONCLUSION: In most cases, elevated PTH levels after surgery is an adaptive reaction to renal dysfunction or vitamin D deficiency. If no adaptive cause can be found, persistent hyperparathyroidism must be suspected.

Calcium↗
PubMed2001

[Immunodetection of thyroid peroxidase in the diagnosis of follicular variants of thyroid papillary cancer].

STUDY AIM: The aim of this retrospective study was to assess the role of thyroid peroxidase immunodetection in the cytological diagnosis of follicular variants of thyroid papillary cancer (FVTPC) which are difficult to identify by standard cytology. PATIENTS AND METHODS: Between 1991 and 1998, 3,505 thyroid fine needle aspiration biopsies were performed by thyroid peroxidase immunocytochemistry and 1,576 patients were operated on. Out of a total of 227 thyroid papillary cancers (TPC), 42 (18.5%) were diagnosed as FVTPC. The results of standard cytology and thyroid peroxidase immunodetection were compared with the histological findings. RESULTS: The rate of false negatives for TPC in standard cytology was 11% (25/227 cases), with 40% of these false negatives being FVTPC; ten out of 42 (23.8%) cases of FVTPC were not identified by standard cytology. However, cytology with thyroid peroxidase immunodetection diagnosed 224 out of the 227 TPC (99%), and all the FVTPC were correctly identified (100%). CONCLUSION: FVTCP are the most frequent source of false negatives in standard cytology. Thyroid peroxidase immunodetection allows most of these errors to be avoided, and correctly identifies 99% of TPC including FVTPC.

Biopsy, Needle↗
PubMed2001

[Hyperparathyroidism induced by lithium. A new case].

INTRODUCTION: Lithium salts, used for the first time in 1949, had proved to be a highly effective preventive measure in bipolar illness. The first report of lithium-induced hyperparathyroidism was suggested by Garfinkel et al. in 1973. About 40 cases have been reported since, suggesting an enhancement of occurrence of hyperparathyroidism in patients cured by lithium carbonate. We report here a new case discovered by a systematic measurement of calcemia after a surgical intervention for a hip joint prosthesis. EXEGESIS: Unusual metabolic features associated with this case of hyperparathyroidism include low urinary calcium excretion, normal cyclic AMP excretion and lack of calcic nephrolithiasis. The mechanism probably results from lithium linking with the calcium receptor on the parathyroid and then stimulating PTH secretion. In the same way it could enhance the tubular reabsorption of urinary calcium. Lithium withdrawal is often inefficient in clinical and laboratory test abnormalities and surgery is usually required. CONCLUSION: It is very important to recognise this particular secondary effect of lithium therapy because clinical symptoms of hypercalcemia can simulate a worsening of the bipolar illness.

Adult↗
PubMed2001

Minimally invasive adrenal surgery.

The adrenals can be approached endoscopically using either transperitoneal or retroperitoneal access, most surgeons favouring the transperitoneal flank approach with the patient in the lateral decubitus position. Endoscopic retroperitoneal adrenalectomy can be performed via either a posterior or a lateral approach. The main advantage of the retroperitoneal approach in the prone position is that it allows bilateral adrenalectomy without repositioning the patient. Although technically more demanding, endoscopic adrenalectomy provides clear advantages over open procedures for tumours less than 5-6 cm in diameter. The small working space provided by the retroperitoneal approach is a contra-indication for the dissection of tumours over 5-6 cm in diameter. Peritoneal adhesions caused by previous abdominal surgery or a large right lobe of the liver may contra-indicate transperitoneal access. For small benign tumours, the transperitoneal and retroperitoneal routes are safe and effective, and there is no clear advantage of one procedure over the other. Invasive adrenal carcinoma is an absolute contra-indication for endoscopic adrenalectomy. Whether large (>5-6 cm) and potentially malignant tumours should be removed laparoscopically remains debatable.

Adrenal Gland Neoplasms↗
PubMed2001

The pattern of intestinal substrate oxidation is altered by protein restriction in pigs.

BACKGROUND & AIMS: Previous studies indicate that amino acids and glucose are the major oxidative substrates for intestinal energy generation. We hypothesized that low protein feeding would lower the contribution of amino acids to energy metabolism, thereby increasing the contribution of glucose. METHODS: Piglets, implanted with portal, arterial, and duodenal catheters and a portal flow probe, were fed isocaloric diets of either a high protein (0.9 g/[kg/h] protein, 1.8 g/[kg/h] carbohydrate, and 0.4 g/[kg/h] lipid) or a low protein (0.4 g/[kg/h] protein, 2.2 g/[kg/h] carbohydrate, and 0.5 g/[kg/h] lipid) content. They received enteral or intravenous infusions of [1-13C]leucine (n = 17), [U-13C]glucose (n = 15), or enteral [U-13C]glutamate (n = 8). RESULTS: CO2 production by the splanchnic bed was not affected by the diet. The oxidation of leucine, glutamate, and glucose accounted for 82% of the total CO2 production in high protein-fed pigs. Visceral amino acid oxidation was substantially suppressed during a low protein intake. Although glucose oxidation increased to 50% of the total visceral CO2 production during a low protein diet, this increase did not compensate entirely for the fall in amino acid oxidation. CONCLUSIONS: Although low protein feeding increases the contribution of enteral glucose oxidation to total CO2 production, this adaptation is insufficient. To compensate for the fall in amino acid oxidation, other substrates become increasingly important to intestinal energy generation.

Animals↗
PubMed2001

Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism.

BACKGROUND: Different minimally invasive techniques of parathyroidectomy have been described. We performed a retrospective study to evaluate the indications and results of video-assisted parathyroidectomy by lateral approach (VAPLA) in the management of our patients with primary hyperparathyroidism (PHPT). METHODS: From December 1997 to December 2000, we operated on 293 patients with PHPT. VAPLA was proposed for patients with sporadic PHPT in whom a single adenoma was localized by means of sonography or sestamibi scanning, or both. VAPLA was performed on the anterior border of the sternocleidomastoid muscle. A quick parathormone (PTH) assay was used during the surgical procedures. RESULTS: Of the 293 patients, 127 (43.3%) were not eligible for VAPLA: ipsilateral previous neck surgery (28 cases), associated nodular goiter (59 cases), suspicion of multiglandular disease (15 cases), no preoperative localization (17 cases), and miscellaneous causes (8 cases). VAPLA was performed in 166 patients (56.7%). Conversion to conventional parathyroidectomy was required in 26 patients (15.6%). Morbidity included 2 local hematomas, 1 definitive recurrent nerve palsy, and 4 capsular fractures. All of the 166 patients were normocalcemic, with follow-up ranging from 3 to 33 months. CONCLUSIONS: VAPLA is safe and effective. It should be reserved for patients with sporadic PHPT, with a small single adenoma clearly localized preoperatively.

Adult↗
PubMed2001

Lactase synthesis is pretranslationally regulated in protein-deficient pigs fed a protein-sufficient diet.

The in vivo effects of protein malnutrition and protein rehabilitation on lactase phlorizin hydrolase (LPH) synthesis were examined. Five-day-old pigs were fed isocaloric diets containing 10% (deficient, n = 12) or 24% (sufficient, n = 12) protein. After 4 wk, one-half of the animals in each dietary group were infused intravenously with [(13)C(1)]leucine for 6 h, and the jejunum was analyzed for enzyme activity, mRNA abundance, and LPH polypeptide isotopic enrichment. The remaining animals were fed the protein-sufficient diet for 1 wk, and the jejunum was analyzed. Jejunal mass and lactase enzyme activity per jejunum were significantly lower in protein-deficient vs. control animals but returned to normal with rehabilitation. Protein malnutrition did not affect LPH mRNA abundance relative to elongation factor-1alpha, but rehabilitation resulted in a significant increase in LPH mRNA relative abundance. Protein malnutrition significantly lowered the LPH fractional synthesis rate (FSR; %/day), whereas the FSR of LPH in rehabilitated and control animals was similar. These results suggest that protein malnutrition decreases LPH synthesis by altering posttranslational events, whereas the jejunum responds to rehabilitation by increasing LPH mRNA relative abundance, suggesting pretranslational regulation.

Amino Acids↗
PubMed2001

Pheochromocytoma in multiple endocrine neoplasia type 2: a prospective study.

OBJECTIVE: The aim of this prospective study is to update our knowledge of the chronology of pheochromocytoma occurrence in multiple endocrine neoplasia type 2 (MEN 2), and to better manage MEN 2 patients after the genetic diagnosis. DESIGN: Eighty-seven non-index gene carrier MEN 2 patients were included in this prospective study: 84 patients with MEN 2A (from 52 families) and 3 with MEN 2B (from 3 families). METHODS: Medullary thyroid carcinoma (MTC) was diagnosed by measuring plasma calcitonin in basal conditions or after pentagastrin stimulation. The search for pheochromocytoma consisted of clinical evaluation, 24 h determination of urinary catecholamines and adrenal imaging. The mean age at genetic diagnosis of MEN 2 was 14.0+/-7.0 years, the mean duration for the follow-up was 7.6+/-2.8 years. RESULTS: All 87 patients had a MTC detected at the same time as the genetic diagnosis was made. Urinary catecholamine measurements led to the diagnosis of pheochromocytoma and a combination of imaging techniques enabled the correct localization of both unilateral or bilateral adrenal involvement. Pheochromocytoma was detected simultaneously with MTC in only seven patients, and seven others were detected throughout the follow-up. Of the 14 patients with pheochromocytoma, 11 had bilateral involvement: nine were initially bilateral and two became so during follow-up. CONCLUSION: This study demonstrates that in MEN 2, MTC is the lesion which appears earliest. Pheochromocytoma develops later during the evolution of the disease, and necessitates regular clinical and biological monitoring throughout follow-up. Determination of urinary and/or plasma catecholamines and metanephrines should be performed to detect pheochromocytoma. Imaging techniques lead to the detection of both unilateral and bilateral pheochromocytoma, thus making video-assisted laparoscopic adrenalectomy possible.

Adolescent↗
PubMed2000

Adaptive regulation of intestinal lysine metabolism.

The metabolism of dietary essential amino acids by the gut has a direct effect on their systemic availability and potentially limits growth. We demonstrate that, in neonatal pigs bearing portal and arterial catheters and fed a diet containing 23% protein [high protein (HP) diet], more than half the intake of essential amino acids is metabolized by the portal-drained viscera (PDV). Intraduodenal or i.v. infusions of [U-(13)C]-lysine were used to measure the appearance across and the use of the tracer by the PDV. In HP-fed pigs, lysine use by the PDV was derived almost entirely from the arterial input. In these animals, the small amount of dietary lysine used in first pass was oxidized almost entirely. Even so, intestinal lysine oxidation (24 micromol/kg per h) accounted for one-third of whole-body lysine oxidation (77 micromol/kg per h). Total lysine use by the PDV was not affected by low protein (LP) feeding (HP, 213 micromol/kg per h; LP,186 micromol/kg per h). In LP-fed pigs, the use of lysine by the PDV accounted for more than 75% of its intake. In contrast to HP feeding, both dietary and arterial lysines were used by the PDV of LP-fed pigs in nearly equal amounts. Intestinal lysine oxidation was suppressed completely. We conclude that the PDV are key organs with respect to amino acid metabolism and that the intestines use a disproportionately large amount of the dietary supply of amino acids during protein restriction.

Adaptation, Physiological↗
PubMed2000

Complications of laparoscopic adrenalectomy: results of 169 consecutive procedures.

Laparoscopic adrenalectomy (LA) has become the gold standard for adrenalectomy. Review of the literature indicates that the rate of intra- and postoperative complications is not negligible. The aim of this study was to evaluate the complications observed in a series of 169 consecutive LAs performed at a same center for a variety of endocrine disorders. Between June 1994 and December 1998 a series of 169 LAs were performed in 159 patients: 149 unilateral LAs and 10 bilateral LAs. There were 98 women and 61 men with a mean age of 49. 7 years (range 22-76 years). There were patients with 61 Conn syndrome, 41 with Cushing syndrome, 1 androgen-producing tumor, 29 pheochromocytomas, and 37 nonfunctioning tumors. Mean tumor size was 32 mm (range 7-110 mm). LA was performed by a transperitoneal flank approach in the lateral decubitus position. Mean operating time was 129 minutes (range 48-300 minutes) for unilateral LA and 228 minutes (range 175-275 minutes) for bilateral LA. There was no mortality. Twelve patients had a significant complication (7.5%): three peritoneal hematomas requiring (in two cases) laparotomy and (in one case) transfusion; one parietal hematoma; three intraoperative bleeding episodes without need for transfusion; one partial infarction of the spleen; one pneumothorax; one capsular effraction of the tumor; and two deep venous thromboses. Eight tumors were malignant at final histology (4.7%), of which four were completely removed laparoscopically. Conversion to open surgery was required in eight cases (5%): for malignancy in four cases, difficulty of dissection in three cases, and pneumothorax in one case. With a mean follow-up of 26.58 months (range 6-60 months) all patients are disease-free. We conclude that LA is a safe procedure. With increasing experience the morbidity becomes minor. To avoid complications LA should be converted to open surgery if local invasion is suspected or if there is difficulty with the dissection.

Adrenal Glands↗
PubMed2000

[Insulinomas in multiple endocrine neoplasia type 1. Report of a series of 44 cases by the multiple endocrine neoplasia study group].

STUDY AIM: The aim of this retrospective study conducted by the "Groupe d'étude des néoplasies endocriniennes multiples type 1" (GENEM) was to report a series of insulinomas associated with multiple endocrine neoplasias type 1 (NEM 1) and to determine the most appropriate strategy for the topographical exploration and surgical management. PATIENTS AND METHODS: From 1960 to 1996, 44 patients were included, 16 men and 28 women (mean age: 36.4 +/- 13.9 years). This study concerned morphological investigations, tumoral features, modalities and results of the treatment. RESULTS: Insulinomas were associated with other functional islet tumors in 15 patients: ZE syndrome (n = 8), glucagonoma (n = 6), vipoma (n = 1). Malignant lesions were present in 6 patients: isolated insulinomas (n = 2), insulinomas associated with ZE syndrome (n = 2) and vipoma (n = 1). The sensitivity of the preoperative imaging procedures was less than 70%. Fourty-one patients were operated on: subtotal pancreatectomy (n = 26 including cephalic enucleations in 8), enucleations (n = 8), total pancreatectomy (n = 3), pancreaticoduodenectomy with caudal enucleations (n = 1), and for 3 patients, no details were available. There was no postoperative mortality. Hyperinsulinism disappeared in 27 patients (including 2 after reoperation) with a mean follow-up of 9 years. Among 6 patients with malignant lesions, 3 were alive with a 3, 4 and 10 year-follow-up. CONCLUSION: Subtotal pancreatectomy with splenic conservation and enucleation of cephalic lesions is suggested as the procedure of choice in this group of patients. This procedure allows simplification of preoperative imaging investigations because lesions of the pancreatic head have only to be detected. Preoperative endoscopic ultrasonography and intraoperative ultrasonography are the best investigations.

Adult↗
PubMed2000

[Supernumerary ectopic hyperfunctioning parathyroid gland: a potential pitfall in surgery for sporadic primary hyperthyroidism].

STUDY AIM: The aim of this retrospective study was to report a series of nine patients with a sporadic primary hyperparathyroidism, operated on for an ectopic supernumerary hyperfunctioning parathyroid gland. PATIENTS AND METHOD: From 1973 to 1998, among a total of 1,307 patients operated on for a primary hyperparathyroidism, 9 (0.69%) had an ectopic supernumerary hyperfunctioning gland. There were six women and three men (mean age: 63 years) with a sporadic hyperparathyroidism. Initial cervicotomy was performed in our institution in 6 cases. The nine patients underwent 19 operations including one through sternotomy. The ectopic parathyroid gland was localized in the eight patients who had preoperative localization studies. RESULTS: The supernumerary gland was located in the anterior mediastinum (n = 6), in the carotid sheath (n = 2) and within the vagus nerve (n = 1). In three patients, it was found during the initial cervicotomy. In the 6 other patients, it was found in the course of a reoperation. With a mean follow-up of five years, all the patients were biochemically cured. One patient had a permanent recurrent nerve palsy and a definitive hypoparathyroidism. CONCLUSIONS: The low incidence of an ectopic supernumerary hyperfunctioning parathyroid gland in sporadic hyperparathyroidism does not justify the routine use of preoperative localization studies and intra-operative quick parathormon assay. During an initial conventional cervicotomy the search for a 5th gland is highly recommended when 4 normal glands have been found in the neck. This research should also be performed in case of multi-glandular disease.

Aged↗
PubMed2000

[Intravagal parathyroid ectopia].

AIM OF THE STUDY: The presence of an ectopic parathyroid gland is the commonest cause of persistent hyperparathyroidism (HPT). High cervical ectopic glands represent 0.21 to 9% of these cases. Only 3 cases of high intravagal sites have been described. The authors report two new cases of persistent HPT caused by an intravagal parathyroid gland. PATIENTS AND METHOD: In a series of 1,712 cases of HPT operated over the last 25 years (1,307 primary HPT and 405 secondary or tertiary HPT), two cases (0.12%) of persistent HPT were caused by a high intravagal parathyroid gland. One case corresponded to primary HPT and the other case corresponded to tertiary HPT. One patient underwent three operations and the other patient underwent four operations. CONCLUSION: Intravagal thyroid tissue may cause HPT. This very rare site must be considered among the other high cervical ectopic sites in the pre- and intraoperative assessment of hyperparathyroidism, particularly in cases of persistent or recurrent hyperparathyroidism.

Choristoma↗
PubMed2000

The "false" nonrecurrent inferior laryngeal nerve.

BACKGROUND: Communicating branches between the cervical sympathetic system and the inferior laryngeal nerve (ILN) have been described. They usually originate from the middle cervical sympathetic ganglion (MCSG). These branches (sympathetic-inferior laryngeal anastomotic branch [SILAB]), usually thin, sometimes have the same diameter as the ILN. In this study we prospectively evaluated the frequency of this condition and its implications during surgical neck exploration. METHODS: From November 1998 to October 1999, 791 patients underwent surgical neck exploration, and 1253 ILNs were dissected: 656 on the right side (52.3%) and 597 on the left side (47.7%). RESULTS: On the right side, a nonrecurrent ILN was found in 3 cases (0.46%), and a large SILAB was found in 10 cases (1.5%). The SILAB originated from the superior cervical sympathetic ganglion in 2 cases and directly from the sympathetic trunk above the MCSG in 8 cases. No anomalous branch was found on the left side. CONCLUSIONS: The SILAB may originate not only from the MCSG but also from the superior cervical sympathetic ganglion or directly from the sympathetic trunk. When the SILAB is as large as the ILN, it could be mistaken for a nonrecurrent ILN. The awareness of this anatomic condition during neck dissection may help to avoid injuries of the genuine ILN running in the usual pathway.

Adolescent↗