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Biomedical subjects

C Proye

Publications and source records attributed to C Proye.

At least 109 records · Page 6Linked to original sources
PubMed1995

The value of lymph node dissection in hereditary medullary thyroid carcinoma: a retrospective, European, multicentre study.

Clinical data of 139 patients with hereditary medullary thyroid carcinoma (HMTC) from nine european centres surgically treated from 1980 to 1991 were reviewed retrospectively to analyse the value of systematic versus selective lymphadenectomy (LA). Biochemical cure rate was significantly higher in patients who underwent LA compared to patients who did not. In nodal-positive HMTC, systematic LA compared to selective LA improved biochemical cure in small but not large tumours. In nodal-negative HMTC, systematic LA compared to selective LA could not improve biochemical cure in either small or large primary tumours. To prevent local recurrences with the risk of increased surgical and tumour-related morbidity, systematic LA should be performed in all HMTC patients regardless of the primary tumour stage. However, an improvement of biochemical cure by systematic LA seems to be possible only in nodal-positive small primary tumours without distant metastases.

Adult↗
PubMed1995

Primary hyperparathyroidism in multiple endocrine neoplasia type 2A.

The rarity of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasia type 2A (MEN 2A) led us to study clinical findings, surgical therapy and outcome in 67 patients in order to evaluate our therapeutic strategy. The retrospective study was based on cases registered by the EUROMEN study group (nine participating centres) from 1972 to 1993. Characteristics of PHPT in 67 patients (41 females, 26 males) with MEN 2A were reviewed. All patients underwent exploratory neck surgery; PHPT was confirmed histologically and/or biochemically. The median age at diagnosis of PHPT was 38 years. In 75% of the patients, PHPT and medullary thyroid carcinoma were diagnosed synchronously, while in 4%. PHT was diagnosed earlier. In 18% of the patients, PHPT was diagnosed after thyroidectomy, and in 3%, after discovery of pheochromocytoma. Primary hyperparathyroidism was asymptomatic in 84% of the patients; 15% suffered from renal stones. Serum calcium was slightly elevated in 69% (2.9 +/- 0.2 mmol-1) and normal in 16% of subjects. A single adenomectomy was performed in 42% of the patients, subtotal parathyroidectomy in 31% and total parathyroidectomy with autotransplantation in 16%. Independent from the extent of resection, cure was achieved in 94% of the patients, including 13% with hypoparathyroidism; hypercalcaemia persisted in 3% and no information was available in 3%. In an 8-year follow-up, hypercalcaemia recurred in 12% of the patients, although half had undergone parathyroidectomy totally or subtotally. CONCLUSION. MEN 2A-related PHPT is characterized by a mild hypercalcemia which is mostly asymptomatic and can be cured by simple resection of an enlarged parathyroid gland in most cases.

Adolescent↗
PubMed1994

[Results of unilateral adrenalectomy for primary hyperaldosteronism].

From 1970 to 1992, 57 patients underwent unilateral adrenalectomy for primary hyperaldosteronism. All were hypertensive and the biochemical profile was diagnosed in all cases but two. 44 out of 57 were operated on using to the posterior Young Mayor approach. The present series included 44 macroadenomas > or = 1 cm in diameter (21 > 2 cm; 23 < or = 2 cm), 7 microadenomas (< 1 cm), 3 associations of macro and microadenomas and 3 cases of unilateral hyperplasia. All were biochemically cured. 4/57 patients remained hypertensive postoperatively (3/44 macroadenomas and 1/3 unilateral hyperplasia). There were two late recurrences, which were both clinical and biochemical (2 macroadenomas < or = 2 cm), and one of these was reoperated on for contralateral multiple "adenomas". Pathological background was defined by preoperative imaging studies with a sensitivity of 100% for MRI (23 cases), 96% for CT-scan (52 cases), 73% for NP 59 scanning (15 cases), 38% for sonography (16 cases) and 85% for venous sampling (7 cases). Cure of hyperaldosteronism or hypertension after unilateral adrenalectomy was therefore not predictable by the pathological background. If a firm diagnosis of primary hyperaldosteronism has been made and the unilaterality of the disease has been established, the patient should be operated. Even adrenalectomy for unilateral hyperplasia can lead to cure, and the syndrome can recur after removal of a solitary macroadenoma.

Adrenalectomy↗
PubMed1994

[Comparative secretory profiles of benign and malignant pheochromocytomas].

Distant metastases are the only clue for diagnosis of malignancy in pheochromocytoma patients. This study was designed to define a secretory profile possibly suggestive of malignancy. Among 79 pheochromocytomas (55 benign, 24 malignant), dopamine-secretion, either exclusive or blended with other catecholamines was found in 34.5% of benign and in 75% of malignant tumors. Dopamine secretion, although if more frequent and more abundant in cases of malignant pheochromocytomas, is therefore not actually diagnostic, but only suggestive of malignancy. It demands life-long follow-up as metachronous metastases may supervene extremely late in the course of the disease.

Adrenal Gland Neoplasms↗
PubMed1994

[Hyperparathyroidism and intrathyroid parathyroid gland. 43 cases].

The rate of occurrence of intrathyroidal parathyroid glands in patients treated surgically for hyperparathyroidism (HPT) varies across studies. Among 1200 consecutive patients who underwent surgery for HPT at the Lille Hospital, France, between December 1965 and July 1992, 43 (3.6%) had 47 histologically-proven intrathyroidal parathyroid glands, including 44 lower and three upper parathyroid glands. Fifteen patients had a thyroid gland abnormality. Of the 14 patients who had a preoperative ultrasound study, eight exhibited an abnormal image. Thirty-four of the 47 intrathyroidal parathyroid glands were visible at the surface of the thyroid gland, five were felt on palpation, and eight were discovered upon examination of a lobectomy specimen. A normal or abnormal parathyroid gland can be completely concealed within the thyroid gland, even in the absence of concomitant thyroid gland disease. In most cases, the ectopia affects one or both lower parathyroid glands, although in some instances the two glands on the same side are intrathyroidal. There is no fail-proof means for detecting intrathyroidal parathyroid glands preoperatively. An apparently missing fourth parathyroid gland or a fifth gland should be looked for in the thyroid gland when the cause of HPT is not found during a first cervicotomy procedure. Pre- or intra-operative ultrasonography may be the most informative imaging method for detecting intrathyroidal parathyroid glands and should be performed routinely when a repeat procedure for persistent HPT is being considered.

Adolescent↗
PubMed1994

Pheochromocytoma as the first manifestation of von Hippel-Lindau disease.

BACKGROUND: von Hippel-Lindau disease is an autosomal dominant disorder characterized by the development of hemangioblastomas in the cerebellum, spinal cord, and retina, renal cell carcinoma and cysts, pancreatic cysts, and pheochromocytoma. METHODS: We have studied a series of 36 French patients affected with von Hippel-Lindau disease pheochromocytoma. Thirty (83%) of them were diagnosed as having von Hippel-Lindau disease because the disease occurred in a familial von Hippel-Lindau disease setting; six (17%) were diagnosed as having von Hippel-Lindau disease because they displayed another characteristic manifestation of that disease. RESULTS: The mean age at pheochromocytoma diagnosis was 29 +/- 14 years (5 to 62 years). Bilateral tumors were documented in 15 (42%) cases, paraganglioma was associated with adrenal pheochromocytoma in four cases, and malignant pheochromocytoma occurred in three cases. Prevalence of pheochromocytoma revealing von Hippel-Lindau disease was 20 (53%) out of 36. In six cases pheochromocytoma was the only manifestation of the disease. CONCLUSIONS: In the interest of the patients themselves and of family members who are at risk, search for von Hippel-Lindau disease must be systematic in the presence of pheochromocytoma. Basic checkup may be completed with familial inquiry, ophthalmoscopy, cerebral magnetic resonance imaging, abdominal ultrasonography, and computed tomography-scan for detection of latent lesions. In the future, after characterization of von Hippel-Lindau disease gene mutations, molecular diagnosis is going to be possible in individual patients.

Adolescent↗
PubMed1994

Scintiscans and carcinoid tumors.

BACKGROUND: The presence of somatostatin receptors on carcinoid tumors mediates imaging of tumor extent and inhibition of tumor growth and marker secretion. This prospective study aimed to evaluate radiolabeled somatostatin analog scans in the therapeutic workup of carcinoids. METHODS: Twenty-one patients with carcinoids underwent 26 scans with iodine octreotide or indium pentetreotide. The results for tumor and metastases imaging were analyzed and compared with those of a short inhibition test of marker secretion and with those of metaiodobenzylguanidine scan. RESULTS: The sensitivity for obtaining images of the overall 43 tumor sites was 72%. We had no false-positive results. Unknown tumor sites were discovered in three patients. The results were slightly better with indium pentetreotide and metastases imaging. A positive scan did not always preclude responsiveness to the functional effect of octreotide. Results of somatostatin analog scans were better than those with metaidobenzylguanidine. The two techniques were complementary in one patient. CONCLUSIONS: The choice of treatment for patients with carcinoid tumors should benefit from functional inhibition test with octreotide and from indium pentetreotide and metaidobenzylguanidine scans.

3-Iodobenzylguanidine↗
PubMed1994

Thoracoscopic excision of enlarged mediastinal parathyroid glands.

BACKGROUND: Most abnormal parathyroid glands can be removed through the neck, but those deep in the chest have required sternotomy or thoracotomy. To avoid the morbidity of these open procedures, ectopic parathyroid glands deep in the chest were removed with video-assisted thoracoscopy. METHODS: Two patients with persistent primary and two with persistent secondary hyperparathyroidism had technetium-thallium scintigraphy and computed tomography of the chest to localize their ectopic glands. Video-assisted thoracoscopy was used for operative removal of these glands in each patient. RESULTS: Parathyroid scans identified a mediastinal gland that was confirmed and localized precisely by the computed tomography scan. An enlarged ectopic gland weighing 1 to 2 gm was removed from each patient with normalization of serum calcium level. Glands were found by the main pulmonary artery, aortopulmonary window, ascending aorta, and aortic arch. One patient had recurrent disease 9 months later. CONCLUSIONS: Removal of parathyroid glands deep in the chest with video-assisted thoracoscopy is a safe and successful alternative to median sternotomy.

Adenoma↗
PubMed1994

[Recurrence of gastroesophageal reflux: role of the abdominal approach and the restoration of the antireflux device].

UNLABELLED: One to five percent of patients who have undergone antireflux operation will be reoperated on for severe persistent or recurrent symptoms. Most cases of failed operation are observed after Nissen fundoplication: partially or totally disrupted fundic wrap, slipping of the fundoplication, perigastric wrapping, gastric para-esophageal hernia. Preoperative functional tests, including manometry, can identify the factors responsible for failure of the initial operation and guide the choice for remedial surgery. A review of the literature shows that the results at reoperation are not as good as those at the primary procedure: mortality is 0 to 12%, morbidity 7 to 57%, good functional results 75 to 96%. IN CONCLUSION: remedial surgery is possible through a transabdominal approach at the first operation. Redo-fundoplication is recommended. Nissen or Collis-Nissen procedure is the most frequently performed. Results are directly related to the number of previous operations.

Abdomen↗
PubMed1994

Iodine-123-Tyr-3-octreotide uptake in pancreatic endocrine tumors and in carcinoids in relation to hormonal inhibition by octreotide.

UNLABELLED: Uptake of 123I-Tyr-3-octreotide (TOCT) by hormone-secreting abdominal tumors was studied to compare scintigraphic observations with the reduction in hormone levels brought about by a brief therapeutic test. METHODS: A prospective study was conducted on 17 patients, totalizing 46 proven lesions, with endocrine tumors of the pancreas (10 patients, 20 lesions) and/or carcinoid metastases (8 patients, 26 lesions). Tumor hormonal hypersecretion was inhibited by octreotide. RESULTS: There was good agreement between the results of these examinations. CONCLUSIONS: The detection of abdominal tumors using this radiotracer is strongly related to its functional characteristics. Variations in the scintigraphic and test results according to different tumor types were in agreement with published data on the density of somatostatin receptors measured by in vitro studies or scintigraphy and by the therapeutic effects of octreotide.

Adult↗
PubMed1993

[Management of isolated thyroid nodules. Conclusion].

From a functional point of view, the present management of solitary thyroid nodules should no longer include the first-intention assay of FT3 and FT4 but that of sensitive TSH only. From an oncological point of view, is should be aimed at leading to surgery all malignant solitary thyroid nodules and sparing it to as many benign nodules as possible, except when justified by cosmetic reasons or by pressure symptoms. The principle of systematic surgery for cold nodules with a low uptake should be given up. The clinical examination remains the key to the selection of candidates to surgery; F.N.A. should become almost systematic, as may the measurement of plasma calcitonin. According to the local facilities, ultrasonography or radionuclide scanning, especially with thallium, can be used to help to refine indications. Infraclinical "nodules", which are purely ultrasonographic images, can be ignored, at least in first intention.

France↗