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Biomedical subjects

Y Chapuis

Publications and source records attributed to Y Chapuis.

214 records · Page 12Linked to original sources
PubMedDate not supplied

Parathyroid adenomectomy under local anesthesia with intra-operative monitoring of UcAMP and/or 1-84 PTH.

Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra-operative monitoring of urinary cAMP (UcAMP) and 1-84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non-cooperative, were excluded from this procedure. UcAMP and 1-84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty-two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow-up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMedDate not supplied

Survival rates and prognostic factors in adrenocortical carcinoma.

In the last 12 years, 41 patients with adrenocortical carcinoma were operated on at Cochin Hospital. There were 29 females and 12 males having an average age of 42 +/- 17 years. Seven of them underwent repeat operation for local recurrence after an average interval of 22 months. Eighty per cent of the tumors had secretory activity while 20% did not. Adrenalectomy and lymphadenectomy were performed on all patients. Thirteen (32%) patients underwent extensive resection because of invasive cancer. The same procedure was performed on 7 patients undergoing re-operation. Operative mortality was 4% (2 of 48 patients). Twenty-four patients died of cancer with an average survival time of 22 months (range 2-86 months) and 15 (37%) patients were still alive, 4 of them with metastases, with an average survival time of 51 months. Curative resection for the 31 patients with local (n = 21) or regional disease (n = 10) allowed a 5 year actuarial survival rate of 45%. The 5 year actuarial survival rate for patients undergoing repeat surgery was 33%. Only 1 of the 10 patients with metastases, and who had an impressive response to OP'DDD, was alive 2 years after the operation. The other 9 patients died within 3-4 months after operation. We found that neither patient characteristics or tumor characteristics were of significant prognostic value. There was no overall prolongation of survival in patients receiving OP'DDD. However 4 patients with metastases occurring in the course of their disease experienced an impressive response with OP'DDD and a relatively long survival.

Adolescent↗
PubMedDate not supplied

[Migrating and recurrent superficial phlebitis and Takayasu's disease (apropos of a case)].

This case of recurrent migratory superficial phlebitis is reported because of the highly unusual nature of the lesion observed. The picture was dominated by periphlebitis with inflammatory granuloma, giant cells and elastophagia. When the condition had been present for sixteen months, an aortic arch syndrome developed in an inflammatory context. In this light, various auto-immunological etiologies were considered, among them Takayashu's arteritis of which, in the author's opinion, this would be the first case to be combined with venopathy.

Adult↗
PubMedDate not supplied

[Evaluation of the number of patients likely to require surgical treatment of hepatic metastases. Based on a series of 180 colorectal cancers].

The spontaneous prognosis of patients with hepatic metastases from colo-rectal cancer is poor in the short term: less than 10 p. cent will be alive after 2 years. Over recent years, several teams have obtained encouraging results after surgical resection of hepatic metastases. The aim of the present study was to evaluate the number of patients likely to require resection of hepatic metastases in a serie of 180 cases of colo-rectal cancer. 57 patients (30 p. cent) already had hepatic metastases at the time of the gastro-intestinal resection and only 3 underwent a simultaneous metastasectomy. In the other cases, the extent of the disease or the general condition of the patients contra-indicated a 2-stage resection. Among the 126 patients free of metastases at the time of the operation, 40 p. cent would have been excluded from hepatic resection in the event of secondary development of metastases because of the general clinical state. 75 patients were suitable for post-operative surveillance of hepatic metastases. We calculated that 20 of them might develop a hepatic metastasis without local recurrence of the colo-rectal cancer in the 2 years following the colonic resection, although of course we were unable to predict the type of metastasis or its accessibility to surgery. These figures may be useful as a guide to the development of a surveillance strategy.

Aged↗
PubMedDate not supplied

[Surgery of primary hyperparathyroidism by unilateral approach under local anesthesia and peroperative assay of 1-84 parathyroid hormone].

By combining echography and per-operative hormone assay, surgery for primary hyperparathyroidism due to a single adenoma can be performed via a limited unilateral access route with local anaesthesia. In a recent series of 204 patients, this technique was not contraindicated in 88 (43%). The operation was successful in 81 of these (92%). In 8 cases, the operation had to be converted into bilateral cervicotomy under general anaesthesia. Six of them were successful. The overall cure rate was 98%. Peroperative assay of 1-84 parathyroid hormone is an essential element in this technique.

Adult↗
PubMedDate not supplied

[Riedel's thyroiditis and lymphoma. Diagnostic difficulties].

Two cases of Riedel's thyroiditis demonstrated the difficulties encountered in diagnosis. In the first case, subtotal thyroidectomy was performed due to compressive goiter. The intraoperative macroscopic aspect suggested Riedel's thyroiditis. The pathology report also discussed the diagnosis, despite a major lymphoid component, as dense fibrosis had multilated the thyroid parenchyma. Subsequent clinical course led to the diagnosis of lymphoma. The clinical presentation in the second case was classical with rapid increase in size of a hard thyroid gland. Histology was however atypical showing calcifications and liquid cysts within the fibrous thyroid tissue. The initial signs of Riedel's thyroiditis, a very rare disease, usually suggest neoplasia: ligneous compressive goiter with deep adherences. Histologically, there is invasive fibrous thyroiditis with highly suggestive occlusive phlebitis in certain cases. The origin of the disease remains obscure. The differential diagnosis between a sclerosing form and lymphoma is particularly important for therapeutic management.

Aged↗