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Biomedical subjects

B Carnaille

Publications and source records attributed to B Carnaille.

64 records · Page 4Linked to original sources
PubMed1990

[The parathyroid risk in thyroid surgery. Argument against the early postoperative prescription of vitamin D. Experience with 729 thyroidectomies in 1988].

729 consecutive patients underwent thyroidectomy in 1988 in the same institution, including 477 (68%) bilateral resections and 242 (33%) total thyroidectomies. An effort was made to see and save all 4 parathyroids and their blood supply. Early post-operative hypoparathyroidism was defined at day 5, by serum calcium less than 8 mg/dl. and serum phosphate less than 4 mg/dl or by serum calcium only if greater than 7.5 mg/dl. Patients afflicted with early hypoparathyroidism were given calcium tablets without any vit D for 1 year at most. Follow-up, checking serum Ca, P and i PIH was done on a 3 months basis during 1 year. Permanent hypoparathyroidism was defined by persistence of the above-mentioned criteria after 1 year, and eventually vit D was started. 27 patients (5.6% our of 477 bilateral thyroid resections) experienced early post-op hypoparathyroidism. Inciting factors were previous thyroid surgery (4), radioiodine treatment (2), modified neck dissection (2), sternal split with mediastinal node clearance (1), visualization of 1 parathyroid gland only (3 redo cases) and autotransplantation of more than 1 parathyroid (1 case). 1 patient was lost for follow-up. 25 others recovered a normal parathyroid function. 1 is permanently hypoparathyroid (1 redo case with other risk factors). Painstaking parathyroid dissection allows a 0% rate of permanent hypoparathyroidism after primary surgery, if vit D is not given in the early post-operative period. We suggest that avoidance of early vit D prescription in cases of early post-operative hypoparathyroidism, leading to mild sustained hypocalcemia, stimulates the spared parathyroid glands (including a possible 5th) and therefore allows full recovery of the parathyroid function.

Humans↗
PubMed1990

[Decision-making for lymph node excision in surgery of thyroid cancer. Extemporaneous examination of the external supraclavicular lymph nodes].

UNLABELLED: Modified neck dissection (MND) is not recommended for surgery of thyroid carcinoma (TC) in the absence of grossly involved nodes, except for medullary thyroid carcinoma, and clinical node recurrence in uncommon at follow-up (3% for us). But several authors report metastatic cancer in non-palpable nodes up to 70% on MND specimens. The fear of overlooking occult metastatic nodes prompted us to sample even normal appearing nodes and to rely on frozen sections (FS) to make a decision whether or not a MND should be done. PATIENTS AND METHODS: 130 among 300 consecutive patients operated for TC were submitted to supraclavicular node sampling with FS. All pathological varieties were covered. In 170 cases, sampling was not done purposely (lack of intraoperative diagnosis of carcinoma: 75) or for other reasons (absence of obvious nodes: 77; unavailable pathologist: 14; miscellaneous: 4). All specimens were reviewed by paraffin sections (PS). RESULTS: Among the 130 patients; 25 had gross metastatic node involvement, confirmed by FS+ and PS+; 1 had grossly equivocal nodes with FS- and PS+; 104 had grossly normal nodes. In 101 (97%) this was confirmed by FS- and PS-. In 3 (3%) FS was +, leading to MND, and PS confirmed metastatic involvement in 2. All 32 specimens of routine node sampling done in 1988 have been reviewed by serial cross sections, one each millimeter (331 sections). One only disclosed one occult metastatic invasion. CONCLUSION: No more than 3% of the grossly normal supraclavicular nodes are metastatic at the time of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma↗
PubMed1990

[Hyperparathyroidism in patients with chronic renal failure: subtotal parathyroidectomy or total parathyroidectomy with autotransplantation? Experience with 121 cases].

From 1973 to 1988 121 patients with chronic renal failure underwent parathyroidectomy (PTX) for secondary hyperparathyroidism. The surgical decision was made upon clinical and/or radiological signs and symptoms. Two kinds of operation were performed: Subtotal PTX 87 cases; Total PTX + parathyroid autograft 34 cases. Post-operative results are discussed. For all cases, the authors emphasize: the need of transcervical thymectomy (ectopic supernumerary gland = 17.3%); the need of routine cryopreservation. Subtotal PTX should be the routine operation. Total PTX with autograft is elicited when a combined thyroidectomy is performed, if parathyroid remnant's blood supply is questionable and in case of recurrent Secondary HPT.

Adolescent↗
PubMed1989

Exclusive use of calcium channel blockers in preoperative and intraoperative control of pheochromocytomas: hemodynamics and free catecholamine assays in ten consecutive patients.

This study investigates the role of nicardipine hydrochloride in preoperative and intraoperative blood pressure control and intraoperative catecholamines (norepinephrine and epinephrine) release in 10 patients undergoing pheochromocytoma resection. Nicardipine was used orally in the preoperative period for either 1 or 8 days (60 to 120 mg/24 hr) and then was infused during anesthesia until tumor removal, continuously at a rate of 2.5 to 7.5 micrograms/kg/min, depending on systolic arterial pressure level. All patients were successfully operated on. No severe hypertensive crisis occurred during tumor manipulation, although several patients had a 3- to 85-fold (norepinephrine) and 3- to 40-fold (epinephrine) increase of catecholamines from baseline levels. Hemodynamics data suggest that nicardipine caused significant inhibition of vascular smooth muscle contraction (42% decrease in systemic vascular resistance); calcium-dependent catecholamines release was not inhibited by nicardipine infused as mentioned. Use of nicardipine may be recommended for perioperative and intraoperative control of pheochromocytomas and might substitute for routine alpha-adrenergic blockade.

Adrenal Gland Neoplasms↗
PubMed1989

[Immunoscintigraphy or intraoperative isotopic detection of colorectal neoplastic lesions using labelled monoclonal antibodies. Preliminary study. 20 cases].

20 patients submitted to surgery for colo-rectal malignancies, had I.V. injection of 500 microcuries of 125 I F (ab')2 anti CEA, 3 to 5 days preoperatively, after previous thyroid blockade by iodine. At the time of laparotomy, any obvious neoplastic growth or suspicious area was checked by "intra-operative scintigraphy" according to the technique already developed in thyroid surgery by Sten Lennquist. Result was considered as positive when the uptake ratio suspicious tissue/normal tissue was greater normal tissue than 1.5. 18 out of 19 pathologically proven carcinomas, 1 out of 3 liver metastasis, 3 out of 3 extra-hepatic deposits, and 3 out of 9 metastatic nodes only were positive at scintigraphy. These results are not correlated with preoperative plasma level of CEA. Perhaps some colo-rectal carcinomas might be able to secrete CEA but not to excrete it. Improvement of intraoperative decision-making by this method needs further experience to be appreciated. It was helpful in 2 of our 20 cases.

Adult↗
PubMed1989

[Multi-glandular lesions in primary hyperparathyroidism. Late outcome of 86 consecutive patients treated with conservative surgery].

Multiple gland enlargement (M.G.E.) in primary hyperparathyroidism (H.P.T.) is the presence of 2 or more enlarged glands weighing more than 50 mg. Conservative surgery (C.S.) consists of resecting the grossly enlarged glands without biopsying the normal glands. Some authors have suggested that C.S. might overlook minute hyperplasia, hence leading to late recurrences of H.P.T., or conversely result in the unnecessary resection of grossly enlarged, but not hyperfunctioning glands. 379 patients have been operated upon for H.P.T. 86 (22.7%) had M.G.E. including 13 (15.2%) M.E.N. cases, 8 (9.3%) familial cases and 65 (75.6%) seemingly sporadic cases (S.S.C.). 2, 3 or 4 glands (or more) were involved in 39.5%, 35% and 25.5% of cases respectively. 1 patient died post-operatively and 3--all S.S.C. with hyperplasia--had to be reoperated upon within 1 year for persistent hypercalcemia. Pathological diagnosis was: double adenomas in 5.8%, hyperplasia in 36%, adenoma associated with hyperplasia in 46.5% and a normal second gland, on light microscopy findings in 11.7%. None of 13 deaths occurring during follow-up was related to H.P.T. 78 patients (90.7%) are available for follow-up (av. 85.3 months). 85.9% are normocalcemic (2.2 less than Ca less than 2.6 mmol/l), 5.1% hypocalcemic and 9% hypercalcemic. 61 had late i. P.T.H. assay; i. P.T.H. was appropriate to serum calcium in 78.7% and appropriate to normal serum calcium levels in 90.6% of 53 normocalcemic cases.

Adolescent↗
PubMed1988

[Mortality in a general surgery department of a University Hospital Center. A study during 1985: 1409 surgically treated cases, 45 postoperative deaths].

In 1985, 1409 consecutive patients underwent surgery in one surgical Professorial Unit of Lille (France). 45 (3.2%) died post-operatively: 28 (62%) were more than 70 years of age, 23 (50%) died after emergency procedure and 18 (40%) died in sepsis. Nothwerthy in retrospect, 20 (44%) died after surgical indication or procedure of questionable legitimacy. Preoperative appraisal of the surgical risk is still challenging nowadays but conclusions drawn from those charts should avoid identical outcome in similar patients.

Adult↗
PubMedDate not supplied

[Usefulness and limits of intraoperative hormone measurements in surgery of endocrine duodeno-pancreatic tumors: experience of 72 cases].

Intraoperative hormonal measurement has been successfully used to guide the surgical treatment of various endocrine diseases. In this study, we report the results of intraoperative insulin measurement in patients with organic hypoglycemia (n = 52 operations in 51 patients) and the results of intraoperative gastrin measurement in patients with gastrinoma (n = 20). Measurements were done in the systemic and portal blood at the beginning of the operation, and 20 min after removal of the lesion(s), with intra-operative secretin stimulation test for gastrinoma in some cases. Results accurately predicted cure (insulinomas) or non-cure (half of gastrinomas) of the disease. Limitations of the method are the possibility of normal hormone base line levels at the time of surgery and the importance of secretion of pro-insulin products by insulinomas not taken in account by the assay with monoclonal antibodies.

Biomarkers, Tumor↗