Biomedical subjects

Didier Mellière

Publications and source records attributed to Didier Mellière.

5 recordsLinked to original sources

PubMed2003

Functioning pulmonary metastases of thyroid cancer: does radioiodine influence the prognosis?

Functioning pulmonary metastases are the most common distant lesions of differentiated thyroid cancer. About 50% of patients with such metastases die within 10 years. The impact of iodine-131 therapy is controversial. In this study we examined: (1) the early diagnostic value of post-surgery (131)I ablation for lung invasion and (2) the survival of patients receiving periodic (131)I therapy. Between January 1970 and December 1995 we provided initial treatment for 509 patients with thyroid cancer. Most of them (74%) underwent total thyroidectomy and (131)I ablation. Functioning pulmonary metastases occurred in 20 patients. All these patients received periodic (131)I therapy for as long as (131)I uptake persisted. Additional therapy consisted of lung surgery in three patients and local treatment of bone lesions in four patients. Follow-up data were recorded up to December 2001. Functioning pulmonary metastases occurred late in one patient, and were visible on the post-surgery (131)I therapy scan in the other 19 patients. At diagnosis of lung invasion, 11 patients had negative chest X-ray findings, and serum thyroglobulin levels were not suggestive of metastatic disease in 56% of these cases. One of the 11 patients with negative chest X-ray findings died with a neck recurrence, two have persistent pulmonary (131)I uptake, and the other eight are in apparent remission after receiving an average cumulative (131)I activity of 338 mCi (12.51 GBq). The nine patients with positive chest X-ray findings received an average of 939 mCi (34.74 GBq); two of them died, five are continuing to receive therapy and two are in apparent remission. Overall survival at 10 years is 84%. The average follow-up of the 17 survivors is 12.7 years. These results suggest that patients with functioning pulmonary metastases, even in advanced stages, may survive for many years on (131)I therapy. Early diagnosis, during post-surgery (131)I scanning, of radiologically inapparent metastases is associated with a better prognosis.

Adolescent↗

PubMed2002

Parathyroid gland radionuclide scanning--methods and indications.

The usefulness of preoperative radionuclide scanning of the parathyroid glands in patients with primary or secondary hyperparathyroidism was long controversial because available techniques were of limited diagnostic efficacy. Technetium-99m-labeled sestamibi (99Tc-sestamibi) is a new radiopharmaceutical agent easily detected by gamma cameras. The first parathyroid imaging studies done with 99Tc-sestamibi about 10 years ago used a double-phase technique to separate thyroid and parathyroid tissue. Although promising, this method was less than ideal, particularly in multiple gland primary hyperparathyroidism and in secondary hyperparathyroidism. For several years, we have been using subtraction between two images acquired simultaneously, one with 99Tc-sestamibi, which binds to thyroid and parathyroid tissue, and the other with 123-iodine, which binds only to thyroid tissue. The remarkable efficacy of this technique in both primary and secondary hyperparathyroidism invites a reappraisal of the place of radionuclide imaging as a preoperative localization procedure done to reduce the need for repeat surgery. The usefulness of this technique in selecting candidates for unilateral surgery among patients with primary hyperparathyroidism is discussed.

Humans↗

PubMed2002

[Progress, checks and errors in arterial surgery during the last two decades].

The Advancement of Vascular Surgery since the eighties. During the last two decades, Vascular Surgery became a specialty, vascular technics and materials were greatly improving and surgical indications have been rationalized. Results greatly improved. However they currently came up against an incompressible rate of complications. It explains the increasing place of endovascular therapies and sporadic experiments of laparoscopic surgery. As all procedures remain associated with early and late risks, vascular surgeons should systematically monitor their results in order to maintain them at the best level.

Humans↗

PubMed2002

[Annual self-assessment of perioperative complications and early success: the best way to improve the medical results in the Vascular Surgery Department].

In spite of many recent advances, vascular surgery is still weighed down with serious complications which occur in 1 to 5% of open surgery cases and 0 to 2% of endovascular cases. Some of them are due to the specific characteristics of atherosclerotic and aneurysmal diseases; others are associated with the technics of arterial reconstructions; but others are surgeon-dependant as their rate vary from on center to another. Quality of results depend on the experience of one surgeon and his team. This experience is based on an unquantified analysis of past success and failures. However currently, it is necessary to take in account the scientific guidelines as well as the personal results of the surgical team. The latter are known only when they are periodically checked in a systematic process. We report a 23 years experience of annual self assessment of the perioperative complications covering all the arterial reconstructions performed during the previous year. These evaluation had five effects: they linked the physicians and nurses in the quest of optimal efficacy; they focused all the team on the cares and results which needed to be improved; complications and success rates were a guide for the therapeutic choices; reliable results rates allowed a precise information of patients, hospital-managers and lawyers when necessary; they were one of the most important factors of continuing medical education. No other mean can replace these self-assessment procedures: retrospective studies are focused on limited areas; mortality-mobidity conferences are devoted to the recent complications without statistical analysis; the PMSI is directed towards cost-containment rather than quality of results. When a team do not know which results are poor, it is unlikely that they will be improved. We hope that the hospital accreditation which has been introduced in France in 1996, will make mandatory the practice of mortality-morbidity conferences, annual evaluation of perioperative complications and periodic studies of long term results. For medical and economical reasons, the population may require that we systematically monitor our results and take them in account before deciding a treatment. Physicians who are unaware of there own results cannot inspire confidence.

France↗

PubMedDate not supplied

Extensive unilateral iliofemoral occlusions: durability of four techniques of arterial reconstructions.

In patients with long unilateral iliofemoral occlusive disease unfit for percutaneous transluminal angioplasty (PTA), most surgeons would choose some type of prosthetic bypass (aortounifemoral, iliofemoral or cross over). All these bypasses would provide excellent early results, but some may not be sufficient in patients with a good life expectancy who also need durable patency. The purpose of the study was to compare the long-term results of four types of arterial reconstructions. Over 20 years, 468 unilateral iliofemoral occlusions were treated primarily by one of the following techniques: aortounifemoral bypass (group 1, n = 108), iliofemoral bypass (group 2, n = 144), crossover bypass (group 3, n = 108), and iliofemoral endarterectomy (group 4, n = 108). Patients in group 3 presented with more severe comorbidities, and patients in group 4 had more superficial femoral artery occlusions. All data were prospectively registered after discharge and during the survey. Patency was assessed with duplex ultrasonography on a yearly basis. Perioperative complications and death rates were similar in all groups. The standard error was less than 10% for a period of over 10 years in all groups, except for group 3, in which it was more than 10% after 8 years. At 8 years, primary patency rates in groups 1, 2, 3, and 4 were 79%, 66%, 74%, and 89%, respectively. The difference was significant between group 4 and group 2 (p < .02) and group 3 (p < .01). Secondary patency and limb salvage rates were not significantly different. In this study, for an equal perioperative risk, the primary patency rates of iliac endarterectomies were superior to those of the other techniques, suggesting that these procedures should be the first choice in patients in good physical condition. Iliofemoral bypasses and crossover bypasses needed much more redo surgery. A crossover bypass should be reserved for patients who are unfit for an abdominal approach or who have a short life expectancy.

Arterial Occlusive Diseases↗