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C Proye

Publications and source records attributed to C Proye.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Prospective study of early predictive factors of permanent hypocalcemia after bilateral thyroidectomy].

AIM OF THE STUDY: The aim of this prospective cohort study was to identify the early criteria potentially predictive for outcome of permanent hypocalcemia after thyroidectomy. PATIENTS AND METHODS: Serum calcium (Ca) et phosphorus (Ph) were measured daily until discharge in 2035 consecutive patients undergoing bilateral thyroidectomy. In all patients experiencing postoperative hypocalcemia, defined as a Ca < 8.0 mg/dl on two consecutive days, parathyroid hormone was measured prior initiation of calcium therapy et discharge (early PTH), et blood sample was also obtained 7 to 14 days after discharge for Ca et Ph measurements (delayed Ca et Ph). These patients were then followed up until complete resolution of hypocalcemia or at least one year. Those still needing substitutive therapy to maintain normocalcemia one year after surgery were considered to have permanent hypocalcemia. Correlation of outcome with clinical characteristics, postoperative Ca et Ph levels, early PTH, et delayed Ca et Ph were examined with univariate analysis et multivariate logistic regression. RESULTS: Postoperative hypocalcemia occurred in 153 patients (7.5%) and spontaneously recovered in all but 7 patients (0.3%). Delayed Ca, and delayed Ph were found to be predictive for outcome of hypocalcemia by univariate analysis (p < 0.01). Relative risk to develop permanent hypocalcemia was 15 for patients with early PTH < 12 pg/ml, 52 when delayed Ph was > 4.0 mg/dl, and 121 when delayed Ca was < 8.0 mg/dl. None of the 113 patients with delayed Ca > or = 8.0 mg/dl and delayed Ph < or = 4.0 mg/dl developed permanent hypocalcemia, in contrast to 1 out of 31 patients (3%) with delayed Ca > 8.0 mg/dl or delayed Ph > 4.0 mg/dl, and 6 out of 9 patients (66%) with delayed Ca < 8.0 mg/dl and delayed Ph > 4.0 mg/dl. Both delayed Ca and delayed Ph appeared as independent factors predicting outcome of hypocalcemia at one year with multivariate logistic regression analysis. CONCLUSION: Delayed serum calcium and phosphorus levels, when measured one week after starting calcium therapy but prior to administration of any vitamin D analogs, accurately predict outcome of hypocalcemia after thyroidectomy. Patients with delayed Ca under 8.0 mg/dl and/or delayed Ph above 4.0 mg/dl are at high risk to develop permanent hypocalcemia.

Adult↗
PubMed2002

[Multiple endocrine neoplasia type I or Werner syndrome. What is important to know about surgery of a rate disease].

Multiple endocrine neoplasia type 1 (MEN1) is a rare but misleading disease. The diagnosis is evocated when two main lesions are present (parathyroid, endocrine pancreas, pituary gland) but also when a family tree shows recurrent lesions. Other lesions must be taken into account (adrenal glands, neuroendocrine thymic or bronchic lesions, cutaneous lesions, lipomas, nervous central system tumors). Any surgical cure without knowing the MEN1 background leads to failure. Specific treatment of each lesion is reviewed. Genetic diagnosis is possible but the mutation is not found in all cases. Nevertheless, when the mutation is known in a family, a negative genetic test allows to exclude the disease. Prognosis is related to hepatic metastases and to thymic neuroendocrine tumors which are rare (2.1%) but aggressive. As a general rule, any apparently isolated endocrine lesion such hyperparathyroidism must prompt the surgeon to look for another endocrine lesion and to look for an abnormal family tree with recurent monoglandular or pluriglandular lesions.

Diagnosis, Differential↗
PubMed2002

[Radioguided surgery for primary hyperparathyroidism: 100 cases].

One hundred patients with primary hyperparathyroidism underwent radioguided surgery within 90 to 180 minutes following IV injection of a diagnostic dose of MIBI and after parathyroid scanning with planar and oblique views. Exclusion criteria were thyroid pathology requiring surgery and suspicion of multiple endocrine neoplasia. A>20% step-up between the background noise and tissue uptake was the diagnostic threshold for parathyroid hyperfunctionning tissue, and this was observed in only 15% of cases overall all cured, but two. This method of detection is technically demanding and various angles of application of the probe can result in significant discrepancies of recorded uptake for the same spot. Our results demonstrate a physiological step-up between the ipsilateral unaffected upper and lower quadrants of the neck (range: - 34% to - 5%), seemingly because of the proximity of supra-aortic vessels (upper neck-upper mediastinal gradient: - 57% to - 21%). Therefore, significant ratios are meaningful only between either the symmetrical left and right controlateral quadrants, 8% of pre-operative scannings were non-contributory, and probe detection was contributory in 3/8 cases only. Benefit of the technique is limited in routine, but it can be helpful in redo cases if the offending gland is not located in close surroundings of tissues physiologically taking up the radio pharmaceutical (salivary glands, great vessels and heart).

Humans↗
PubMed2002

Vitamin D deficiency and severe hyperparathyroidism.

The typical manifestations of severe hypercalcemia with osteitis fibrosa cystica have become exceedingly rare. We describe the case of a woman hospitalized for a tibial tumor with functional impotence, leading to a diagnosis of primary hyperparathyroidism (HPT I) associated with profound vitamin D deficiency. This 31-year-old woman was admitted, after two pregnancies complicated by the HELLP syndrome. Preoperative laboratory values were as follows: calcemia 4.05 mmol/l (2.2-2.6); urinary calcium 30 mmol/24 h (1.25-7.5); parathormone (PTH) 1 195 pg/ml (10-60); and 25 OH-vitamin D 13 nmol/l (22-120). Specific MIBI uptake by the tibial lesion oriented the diagnosis towards a brown tumor. After surgical excision of a parathyroid adenoma and the brown tumor (associated with tibial fracture), calcemia fell to 1.55 mmol/l and normalized after three months. Urinary calcium fell to 0.1 mmol/24 h and remained low during the 2 years following surgery. Vitamin D levels rapidly normalized on supplementation (87 nmol/l). PTH levels fell markedly after surgery but remained higher than normal till 2 years after surgery despite normalization of calcemia three months after. Bone repair, estimated by means of bone densitometry, improved from preoperative Z-score values of - 6.54, - 5.20 and - 3.50 in the left femoral neck, right femoral neck and lumbar spine, respectively, to - 0.20, - 1.55 and - 0.28, respectively, one year after surgery. In conclusion, this case illustrates: 1) the severe osseous expression of HPT probably related to vitamin D deficiency; 2) specific MIBI uptake by the bone lesion, orientating the diagnosis towards a brown tumor; 3) the consequences of vitamin D deficiency on postoperative outcome, with transient severe initial hypocalcemia related to bone calcium avidity; 4) a possible link between HPT and the HELLP syndrome.

Adult↗
PubMed2001

Clinical evaluation of a new sensitive calcitonin assay: study of specificity.

BACKGROUND: Calcitonin (CT) is the most sensitive marker available for medullary thyroid carcinoma, but it lacks specificity. Procalcitonin is the precursor protein of calcitonin. Infections are known to be associated with elevations of procalcitonin. The aim of this study was to evaluate a new sensitive calcitonin assay in a large population and to study the assay specificity in two particular populations: patients with renal failure and patients hospitalized in intensive care units with a high procalcitonin level. METHODS: Using two immunometric assays (A and B) to detect only mature calcitonin, we evaluated the calcitonin level in 488 sera (46 stimulation tests) from 340 subjects. RESULTS: The clinical evaluation showed that the calcitonin concentrations obtained with the two assays were similar for all patients except those with high procalcitonin levels. Among the patients, 12% (n=13) had basal calcitonin concentrations greater than 10 pg/ml with method A and 25.7% (n=25) with kit B. No correlation was found between calcitonin and procalcitonin concentrations. CONCLUSION: The new sensitive calcitonin assay tested is very efficient especially for the low concentrations. The cross-reaction for high procalcitonin levels exists and is variable according to the kits used. The procalcitonin evaluation can help the interpretation of ambiguous calcitonin levels.

Adolescent↗
PubMed2001

Natural history of liver metastasis of gastroenteropancreatic neuroendocrine tumors: place for chemoembolization.

Hepatic metastases of gastroenteropancreatic tumors are observed in at least 10% of cases at presentation and in 85% of cases after 20 years of follow-up. They are slow-growing; and there is a 5-year life expectancy that varies between 13% and 60% depending of the degree of differentiation, with occasional survival of more than 20 years. Curative liver resection is the best treatment, with a 4-year survival rate of 73%, but this is possible in only 10% of cases. Chemoembolization is indicated for nonresectable multiple bilobar metastases: 87% of patients respond, half with tumor reduction and the other half with diminution of the symptoms of hypersecretion. The mean survival is 2 years; complete remission of more than 2 years is exceptional. The technique can be repeated but is not without risks, with a possible postembolization syndrome lasting up to 10 days and subsiding spontaneously, without indication for operation. Therefore one lobe only should be embolized at a session. It is not impossible that chemoembolization increases the occurrence of lung metastases. It is only a palliative method but with great functional benefit for patients with hypersecreting tumors.

Chemoembolization, Therapeutic↗
PubMed2001

Hyperparathyroidism in multiple endocrine neoplasia type I: surgical trends and results of a 256-patient series from Groupe D'etude des Néoplasies Endocriniennes Multiples Study Group.

The French and Belgian GENEM study group's multiple endocrine neoplasia type I (MEN-I) database was used to evaluate trends in clinical presentation, surgical treatment of primary hyperparathyroidism (pHPT) (n = 245), and prognostic factors for hypercalcemia correction among 256 MEN-I cases. The patients were retrieved through the GENEM network from various Belgian and French institutions with the help of genetics laboratories. Among the 245 pHPT patients (96%), 42% were men. The mean age at the time of diagnosis was 39.5 +/- 13.3 years. Trends were studied for three periods: before 1986, from 1986 to 1990, and thereafter. After 1990 MEN-I patients were more often diagnosed with isolated pHPT (8%, 11%, 28%, for the three periods, respectively; p = 0.002); it was seen more often in screened patients (31%, 28%, 53%; p = 0.001), more often among those in already known MEN-I families (64%, 45%, 72%; p = 0.005), and among those with lower preoperative calcemia (2.93, 2.87, 2.79 mmol/L; p = 0.001). The age at pHPT diagnosis remained constant throughout the study. The percentage of cervical explorations dropped during the entire study (87%, 87%, 53%; p < 0.0001). After 1985 the percentage of subtotal parathyroidectomies increased (25%, 59%, 51%; p = 0.0004). Pathology disclosed more hyperplasias (59%, 85%, 74%; p = 0.008). Postoperative hypercalcemia decreased (47%, 15%, 19%; p < 0.0001); and postoperative hypocalcemia increased nonsignificantly (5%, 15%, 15%; p = 0.1). Subtotal parathyroidectomy [odds ratio (OR) 13], no MEN-I family background (OR 3), and the most recent study period (> 1985) (OR 3) were significant predictive factors of hypercalcemia correction according to the multivariate analysis. This is the first multicentric study on the management of MEN-I-related pHPT. Immediate postoperative hHPT cure increased, but only 80% of the operated patients were cured after 1990. Fifteen percent were hypocalcemic. Because MEN-I-related hHPT cure remains difficult to achieve, we advocate that subtotal parathyroidectomies be performed in specialized centers.

Adult↗
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

[Endocrine tumors of the duodenum and pancreas: "prerequisites", imaging, and intraoperative detection].

Non-secreting pancreatic neuroendocrine tumors and diarrheogenic tumors are usually bulky and easy to recognize thanks to somatostatin-receptor scintigraphy and hormonal dosages. The real difficulty concerns insulinomas and particularly gastrinomas, which are found at the level of the duodenum and can be very small. Diagnosis is based on biological examinations, and the search for MEN I must be done systematically. Their localization is based on two essential and noninvasive exams: echoendoscopy and somatostatin-receptor imaging, though the surgeon's skill in the operative field, aided by an intraoperioperative echography, is indispensable. Surgical treatment of insulinomas gives excellent results. However, for sporadic gastrinomas, there was only a 34% recovery rate, and still less for MEN I gastrinomas.

Diagnosis, Differential↗
PubMed2001

[Outcome of non-operated adrenal masses in 126 patients observed from 1986 to 1999].

STUDY AIM: CT scan performed for non-adrenal related symptoms detects an adrenal mass or 'incidentaloma' in 0.4 to 4.3% of cases, and most authors advocate a non-operative policy, after minimal but careful work-up aimed at excluding pheochromocytoma and aldosteronoma. The breakthrough of laparoscopic adrenalectomy has led some to challenge this attitude. This retrospective study focused on the outcome of non-operated adrenal masses. PATIENTS AND METHOD: From 1986 through 1999, 126 patients (64 men and 62 women) presented with an incidental mass of the adrenal fossa, and a non-surgical attitude was elicited. Mean size was 36.5 mm in diameter. All patients underwent an in-depth clinical, biochemical and imaging work-up. They have been stratified into two groups: group I: no contraindication to surgery (n = 95); and group II: contraindication to surgery (frail patients, invasive adrenal or metastatic extra-adrenal cancer) (n = 31). RESULTS: With a mean follow-up of 4.3 years, 17 patients were lost to follow-up (13.5%), including 11/95 in group I; 36 were dead (28.5%), including 12/95 in group I (no adrenal-related death) and 24/31 in group II; 72 were alive and well without operation, including only one in group II; one patient was operated for a benign adrenal adenoma removed at the time of surgery for aortic aneurysm. CONCLUSION: Careful clinical, biochemical, imaging and nor-iodo-cholesterol scintigraphy with definite uptake by the adrenal mass, a strong indicator of benignancy, allows surgical indication to be postponed, and is likely to cancel it if, at one-year follow-up, imaging studies show no change in the mass.

Adenoma↗
PubMed2001

[Radioguided surgery for primary hyperparathyroidism. Experience in 75 cases].

STUDY AIM: To report feasibility and efficacy of radioguided mini invasive hyperparathyroidism surgery. PATIENTS AND METHOD: From November 1998 to August 2000, 75 patients with primary hyperparathyroidism have been operated on by radioguided surgery within 90 to 180 minutes following i.v. injection of a diagnostic dose of MIBI and after parathyroid scanning with planar and oblique views. Exclusion criteria were thyroid pathology requiring surgery and suspicion of multiple endocrine neoplasia. A 20% step-up between the background noise and tissue uptake was the diagnostic threshold for parathyroid hyperfunctioning tissue. RESULTS: A 20% step-up was observed in only 17% of cases overall; all cured, but two. Various angles of application of the probe can result in significant discrepancies of recorded uptake for the same spot. These results demonstrate a physiological step-up between the ipsilateral unaffected upper and lower quadrants of the neck (range: -17 to -8%), because of the proximity of supraortic vessels (upper neck-upper mediastinal gradient: -44 to -30%). Therefore, significant ratios are meaningful only between either the symmetrical left and right controlateral quadrants respectively, and not between the upper and the lower ipsilateral quadrants. Eleven per cent (8/75) of preoperative scannings were non-contributory, and probe detection was contributory in 3/8 cases only. CONCLUSION: Benefit of the technique is limited in routine, but it can be helpful in redo cases if the offending gland is not located in close surroundings of tissues physiologically taking up the radiopharmaceutical (salivary glands, great vessels and heart).

Adult↗
PubMed2001

[Coagulation activation with intraportal islets of Langerhans transplantation in swine].

STUDY AIM: Intraportal islet allograft appears to be one of the promising treatments for type I diabetes. However, many limiting factors persist. An activation of the coagulation cascade upon contact with islets, has been reported recently in vitro and could play a crucial role in a non specific inflammatory reaction and favour the specific immune reaction. The aim of this experimental study was to confirm in vivo this activation of the coagulation cascade. MATERIAL AND METHODS: An allogenic islets preparation or a material control (inert microbeads) was injected intraportally, in Large White pigs (n = 26), associated with or without an anticoagulant treatment (heparin). Systemic markers of haemostasis were measured in pigs for 72 hours following injection of the studied material. RESULTS: The thrombin-antithrombin complex increased and platelet count decreased in groups receiving preparation of islets, both indicators of an activation of the coagulation cascade. This activation was proportional to the injected volume and was partially attenuated by heparin. No activation was observed in pigs receiving the material control. CONCLUSION: The activation of the coagulation cascade and the non specific inflammatory reaction could be one of the obstacles to the success of the islet allografts. The use of anticoagulant and anti-inflammatory molecules could potentially allow an improvement of the present results of islet allograft.

Animals↗
PubMed2001

[Hemodynamic instability and paraplegia after thoracotomy for excision of a cardiac pheochromocytoma].

We report the occurrence of a sustained hypotension (vasoplegia) following thoracic phaeochromocytoma surgery. Diagnosis of spinal cord injury was done by magnetic nuclear resonance (MNR) showing surgical "Horsley wax" inside the vertebral canal and ischaemic signal inside the anterior part of the spine cord. Removal of "Horsley wax" dramatically improved arterial blood pressure but did not correct all neurologic disorders. Haemodynamic disorders related to spinal cord injury are rare after thoracotomy, and may have been enhanced by the haemodynamic instability typically associated with phaeochromocytoma surgery. Early diagnosis has to be done by MNR.

Heart Neoplasms↗
PubMed2001

Why do frozen sections have limited value in encapsulated or minimally invasive follicular carcinoma of the thyroid?

The diagnosis of encapsulated or minimally invasive follicular carcinoma of the thyroid requires the proof of vascular or capsular invasion. The aim of the present study was to evaluate the relationship between intraoperative diagnosis (benign, suggestive of carcinoma, or malignant) and the final histopathologic criteria for encapsulated or minimally invasive follicular carcinoma (tumor size, capsular invasion, vascular invasion, and differentiation). This was a retrospective study of 63 cases of encapsulated or minimally invasive carcinomas, with the final histopathologic diagnosis taken as the "gold standard." The sensitivity of frozen sections for the diagnosis of malignant neoplasm was 17%. The median number of vascular invasions was 1, identified with a mean number of 9 paraffin-blocks of the tumor. In most cases, intraoperative frozen sections are unable to establish the proof of malignant neoplasm. Intraoperative study of tumor differentiation is useful to select follicular tumors that require a rapid definitive diagnosis and a completion thyroidectomy within 48 to 72 hours (73% of the cases in our study).

Adenocarcinoma, Follicular↗
PubMed2001

Indications for adrenalectomy in the laparoscopic era.

The tilt from open to laparoscopic surgery seems to be definite in most adrenal disorders. The aim of this study is to evaluate the current indications for laparoscopy and the persistent indications for open adrenalectomy, as seen in our experience and in the literature data. Between January 1985 and December 1999, 486 patients were operated on for adrenalectomy. Since January 1994, 91 laparoscopic adrenalectomies were performed in 84 patients. The Authors retrospectively evaluated the indications for laparoscopy in 55 patients (45.9%) and for open adrenalectomy in 65 others (54.1%) operated on in the last three years. Exclusion criteria for the laparoscopic approach included clinical suspicion of malignancy and tumour size greater than 6 cm, in the 38.5% and in the 23.0% of cases respectively. In Authors experience the laparoscopic adrenalectomy is the procedure of the choice for the surgical removal of non-malignant, unilateral or bilateral tumours under 6 or 7 cm. The laparoscopy is not a radical operation for cancer. Open surgery is always indicated for large and malignant tumours. The fascinating feature of laparoscopy has not to change the indications and the surgeon must plan the appropriate approach for every single patient.

Adolescent↗
PubMed2001

Chromogranin A assay and (131)I-MIBG scintigraphy for diagnosis and follow-up of pheochromocytoma.

UNLABELLED: We assessed the performance of a new serum chromogranin A (CgA) assay in combination with the results of (131)I-metaiodobenzylguanidine (MIBG) scintigraphy for diagnosis and follow-up in 89 patients with clinical findings suggestive of pheochromocytoma. METHODS: The study population consisted of 41 patients with proven pheochromocytoma and 48 patients with refuted pheochromocytoma. Eighty-seven scintigraphy examinations were performed, 52 in patients with proven pheochromocytoma (39 before surgery and 13 after surgery) and 35 in patients with refuted pheochromocytoma. RESULTS: The sensitivity of the CgA level was 90.2%, and the specificity was 99.0% and 92.3% in the control and refuted pheochromocytoma groups, respectively. A significant relationship was seen between serum levels of CgA and tumor mass (r = 0.70; P < 10(-5)). The postoperative CgA level was an early and accurate predictor of curative surgery or relapse. The concordance between CgA levels and scintigraphic data was 90.8%. CONCLUSION: Serum CgA level is an effective marker of pheochromocytoma. Increased levels strongly correlate with tumor mass; therefore, small tumors may go undetected. The concordance between CgA level and the results of (131)I-MIBG scintigraphy is high. A CgA level in the reference range is highly predictive of normal scintigraphy findings.

3-Iodobenzylguanidine↗