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Biomedical subjects

J P Chigot

Publications and source records attributed to J P Chigot.

At least 19 recordsLinked to original sources
PubMed1995

Should primary hyperparathyroidism be treated surgically in elderly patients older than 75 years?

BACKGROUND: Diagnosis of primary hyperparathyroidism (PHPT) is increasingly suspected in elderly patients after the discovery of hypercalcemia by routine measurement of serum calcium levels. Surgery is commonly accepted as the optimal treatment of PHPT. We wanted to assess risk and results of neck exploration in elderly patients with PHPT. METHODS: We performed a retrospective study of the charts of 78 patients older than 75 years (mean age, 79.1 years) with PHPT who underwent neck exploration during a 15-year period. RESULTS: The most common presenting symptoms were neurologic and psychiatric disorders (47 patients). Preoperative localization investigations, performed in 72 patients, were successful in 42 of them (sensivity, 58%). Single adenoma, double adenomas, and hyperplasia were found in 74 patients (95%), three patients, and one patient, respectively. Overall postoperative mortality was 3.8% (three patients) with no death since 1984. Significant complications occurred in three patients (4%): one myocardial infarction, one pulmonary embolism, and one cerebral hemorrhage. Average length of postoperative hospital stay was 4 days. Among patients who could be followed up (65 cases with a mean follow-up of 3 years), 94% reported an improvement in their symptoms. This was especially marked for fatigue and intellectual function. CONCLUSIONS: These data support a liberal approach regarding surgical treatment in elderly patients with PHPT.

Adenoma↗
PubMed1994

[Flow cytometry of thyroid tumors. Study of fresh tissue in 50 patients].

OBJECTIVES: A measurement of cell DNA content would be highly useful in determining the malignant nature of thyroid tumours in cases without distinctive features such as metastases, capsule invasion or emboli. Abnormal cell ploidy can be recognized with flow cytometry, but it is not known whether such results have diagnostic value. We therefore compared--in a double blind prospective study--the results of flow cytometry and pathologic diagnosis in fresh tumoural and non-tumoural thyroid cells. METHODS: Fifty unselected cold thyroid nodules were obtained from 50 consecutive patients (40 women, 10 men; age 18-80 years; mean 46) who underwent surgery within a 6 month period. Surrounding non-tumoural tissue was also obtained in 46 of them. Cell ploidy and the percentage of cells in each cell phase was determined with flow cytometry for both tumoural and nontumoural tissues. Two pathologists, unaware of the flow cytometric results, independently established the histologic diagnosis according to the WHO classification. RESULTS: The pathologic diagnosis was carcinoma in 7 cases (papillary carcinoma 6, vesicular carcinoma 1) and benign adenomas in 43 (29 macrovesicular, 11 microvesicular, 3 oncocytal). All the non-tumoural tissue samples were diploid. All 7 carcinomas were diploid and 10 of the 43 benign adenomas were aneuploid (4 near-diploid, 3 hyperploid, 1 near-tetraploid, 2 multiploid). The mean proliferation index was increased in 5 diploid tumours. CONCLUSION: These findings confirm that cell ploidy measured by flow cytometry is of no diagnostic value in the thyroid gland. It was also revealed that aneuploidy in adenomas may be related to tissue rearrangements of undetermined prognostic significance.

Adenoma↗
PubMed1993

Severe blunt trauma of the liver: study of mortality factors.

One hundred three victims of blunt trauma of the liver with serious hepatic lesions (classes III through V of Moore's classification) were seen over a period of 18 years, the total duration of this retrospective study being divided in two: 1973-1981 and 1982-1990. During the first period, indications for hepatic resection were extensive (56% of all surgical procedures), and overall perioperative mortality was 24%. Preference was shown for conservative treatment during the second period (71% of patients) and there was an increase in perioperative mortality to 34%. This increase was not attributable to the decrease in the number of excisions but rather to an increase in the severity of hepatic lesions between the two periods (the rate of class V lesions rising from 17% to 26% of cases) and the rate of multiple trauma (rising from 41% to 95%), with mortality linked to the presence of extra-abdominal lesions rising from 20% to 50% of all deaths. These results may bring into question the validity of conservative treatment for liver trauma at the present time.

Adolescent↗
PubMed1993

[Unusual association of somatostatin-secreting thyroid cancer and a calcitonin-secreting duodenal endocrine tumor. Is it an entity?].

We report a patient with a vesicular thyroid carcinoma secreting somatostatin and associated to an endocrine duodenal calcitonin secreting tumour. Increase of plasm somatostatin level induced an endocrine syndrome which completely resolved after thyroidectomy. By contrast, the digestive tumour remained asymptomatic. Six months after surgery, the course was marked by a relapse of the thyroid tumour along with pulmonary metastasis. At that time, pathological analysis showed only indifferentiated tumoural tissue.

Aged↗
PubMed1991

Hepatic trauma: experience with 135 consecutive liver injuries (1982-1989) and arguments for conservative surgery.

Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Thyroid abcess. Apropos of 5 cases].

Thyroid abcess and acute suppurative thyroiditis are uncommon, representing 0.1 to 0.7% of surgically treated thyroid pathologies. More common in children than in adults, this rarity is associated with poorly indicative clinical symptoms, thus making diagnosis difficult. Five cases reports are presented, 4 of them in adults, illustrating the diagnostic difficulties and the various etiopathological mechanism, thereby explaining the wide diversity of pathogenic agents responsible. Treatment includes surgery (drainage or (partial) thyroidectomy, depending upon the presence or not of an underlying thyroid pathology) and intravenous antibiotics. It is absolutely necessary to eliminate the source of the infection, often a piriform sinus fistula whose total resection effectively prevents a relapse (1 case in this series).

Abscess↗