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Biomedical subjects

E Hamoir

Publications and source records attributed to E Hamoir.

At least 19 recordsLinked to original sources
PubMed2003

Evaluation of the ultrasonic dissector in thyroid surgery. A prospective randomised study.

BACKGROUND: The use of ultrasonic dissectors in endoscopic surgery has proved to be of value, particularly for the prevention of bleeding and the reduction of electrical internal burns. This prospective randomised study was performed in order to evaluate the efficacy, security and cost of using the ultrasonic hook in thyroid surgery. METHODS: Thirty-four consecutive euthyroid patients with multinodular goitre for whom a total thyroidectomy was indicated, were randomly assigned either to group I, Ultracision or to group II, conventional hemostasis. Pre-, peri-, and postoperative biochemical, clinical, surgical and economical variables were compared between both groups. RESULTS: The use of the ultrasonic hook resulted in a significant reduction in operating time, blood loss, and maybe in "transitory hypoparathyroidism"; postoperative analgesic consumption was also reduced in this group. Considering the cost, the ultrasonic hook was no more expensive than conventional hemostasis, as long as a minimum of 15 patients shared the initial unit cost of the device. CONCLUSION: Even if the use of the ultrasonic dissector is not of major interest in terms of patient management or cost-saving in the context of total thyroidectomy, essential advantages reside in significant reductions of operating time, blood loss and organ injury, (particularly parathyroid). The reduced operating time undoubtedly represents a positive feature of the ultrasonic dissection technique.

Goiter, Nodular↗
PubMed2003

Breast cancer and serum organochlorine residues.

BACKGROUND: Controversy still exists about the breast carcinogenic properties in humans of environmental xenoestrogens (organochlorines), justifying new investigations. AIMS: To compare the blood levels of total dichlorodiphenyltrichloroethane (DDT) and hexachlorobenzene (HCB) in samples collected at the time of breast cancer discovery, in order to avoid the potential consequences of body weight change (after chemotherapy or radiotherapy) on the pesticide residue levels. METHODS: Blood levels of HCB and total DDT (we calculated total DDT concentrations by adding all DDT and DDE isomers) were compared in 159 women with breast cancer and 250 presumably healthy controls. Risk of breast cancer associated with organochlorine concentration was evaluated. RESULTS: Mean levels of total DDT and HCB were significantly higher for breast cancer patients than for controls. No differences in serum levels of total DDT or HCB were found between oestrogen receptor positive and oestrogen receptor negative patients with breast cancer. CONCLUSIONS: These results add to the growing evidence that certain persistent pollutants may occur in higher concentrations in blood samples from breast cancer patients than controls.

Breast Neoplasms↗
PubMed2003

[Medullary thyroid cancer: how tumor markers and genetics determine preventive measures].

Medullary thyroid cancer (MTC) arises from parafollicular C cells secreting calcitonin. MTC occurs both as sporadic tumors and as part of specific inherited autosomal dominant syndromes in which point mutations within a discrete set of RET codons were described. Total thyroidectomy and aggressive neck dissection represents the only chance for cure in the affected patients. Therefore, all patients with thyroid nodular disease should undergo measurement of calcitonin plasma levels to allow preclinical diagnosis of the disease and early appropriate surgery ("secondary prevention"). In case of proband patient for inherited disease, all the family members should be genetically screened to detect the disease gene carriers. Patients with germline mutation would benefit either from earlier surgery at the stage of C-cell hyperplasia or microcarcinoma or prophylactic surgery (total thyroidectomy without neck dissection) (primary prevention) before the onset of any C-cells pathology. The ideal age for performance of such prophylactic surgery is determined by the genotypic features of the disease.

Biomarkers, Tumor↗
PubMed2002

[Discordance between actual and radiologically estimated size of an incidentaloma. Delay in questions regarding operative decision-making criteria].

AIM OF THE STUDY: The accurate assessment of tumour size is an important consideration during preoperative evaluation of adrenal tumors, particularly incidentaloma; however the "size criteria" is still a controversial topic in some respects: size is a bad indicator of malignancy, there is still a confusion in the "grey zone" for tumors between 3 and 6 cm, and no universal consensus on the exact cut-off value for resection has been agreed. Nowadays it is clearly accepted that the "size criteria" alone is extremely limited in the assessment of adrenal tumor, moreover some studies suggested the relative inaccuracy of conventional CT in evaluating the size: radiological examination underestimated consistently adrenal tumor size. The aim of this study was to confirm those suggested data. PATIENTS AND METHODS: Our study compared the radiological estimated size and the histological size of 26 incidentaloma operated on with a laparoscopic approach. RESULTS: Our data confirm the inaccuracy of CT and MRI in predicting the size of incidentaloma particularly for tumor measuring less than 3 cm. CT and MRI significantly underestimated size of adrenal tumors, 108% for MRI and 101% for CT-scan. CONCLUSION: The decision to operate, even with the advent and safety of laparoscopic adrenalectomy, cannot only rely on the "size criteria". Radiologists have to perform multiple 1 mm cuts until the very superior and inferior tip of this tumor in order to provide a better estimation of the size.

Adrenal Gland Neoplasms↗
PubMed2002

New challenges in the treatment of early breast cancer or surgery for early breast cancer ... can less be more?

Breast cancer is a major public health problem of great interest and importance to physicians in a variety of specialities. The incidence of the disease has increased dramatically, heightening concern among physicians and women in general. In addition, long-term results are now available from clinical trials initiated in the 1970s and 1980s to evaluate the usefulness of early detection with mammography and physical examination, breast-conserving treatment with limited breast surgery and irradiation, and adjuvant systemic therapy with hormonal therapy and chemotherapy. Furthermore, in the light of newly gained knowledge, new strategies for addressing this problems have been proposed. In this review, we will summarize the evidence evaluating the strategies for diagnosis and therapy initiated in the 1970s and 1980s, and will describe the prospects for prevention and for more specific treatments bases on evolving biologic knowledge. Our review will only focus on early breast cancer, discussing the following topics: Breast Cancer screening: Who should be screened and how often?; New technologies in Breast Cancer Diagnosis; Selection of patients for Breast-conserving therapy; Management of the axilla in primary breast cancer or "Is sentinel lymph node biopsy useful?"; Expanded use of adjuvant systemic therapy; Genetic predisposition for Breast Cancer; Clinical options for Women at high-risk for Breast Cancer.

Breast Neoplasms↗
PubMed2001

Right hepatic lobectomy as a liver graft-saving procedure.

Retransplantation is common after liver transplantation (LT). However, in the present era of organ shortages, every attempt to save the liver graft should be performed before considering retransplantation. We report our experience with right hepatic lobectomy (RHL) for liver graft salvage. In a retrospective series of 180 adult LTs, 4 patients underwent RHL (Couinaud's segments V, VI, VII, VIII) in the post-LT period. In all cases, the procedure was performed without Pringle's maneuver or mobilization of the left liver lobe to preserve its vascularization. Three liver graft recipients developed intrahepatic biliary strictures, mainly localized to the right lobe of the graft, and RHL was performed 14, 75, and 78 months after LT. These patients were alive at last follow-up without further episodes of cholangitis or retransplantation (mean follow-up, 38 months). The fourth patient developed early post-LT right liver necrosis with a functioning hepatic artery and underwent right lobectomy 48 hours after LT. He later developed cholangitis secondary to late hepatic artery thrombosis, requiring retransplantation after 18 months. We conclude that RHL can be considered a graft-saving option in selected liver transplant recipients with localized biliary strictures, with excellent patient and graft survival.

Bile Ducts↗
PubMed2001

[Update on pancreatic transplantation].

Pancreas transplantation significantly improves the quality of life as well as the survival of the diabetic patient. It is also associated with stabilization and reversal of secondary diabetic complications. Improvements in organ preservation, surgical techniques and immunosuppression have achieved one-year graft survival of more than 90% for combined kidney-pancreas transplant and 80% for isolated pancreas transplantation. Recipient evaluation must weigh the benefits of the procedure with the risk associated with surgery and chronic immunosuppression. Combined kidney-pancreas transplantation appears today as the best treatment for the diabetic patient with end stage renal disease. Isolated pancreas transplantation is reserved to non-uremic patients with severe diabetic complications or with brittle glycaemic control and severe impairment of quality of life.

Humans↗
PubMed2001

[Acute cardiac failure revealing a paraganglioma].

Therapy of cardiomyopathy is usually symptomatic. So, the etiology is often only superficially investigated. However, because of their curability, rare causes must be sought for. We report a case of acute cardiac failure in a young female patient with severe hypertension of recent onset. Urinary catecholamines analysis and medical imaging demonstrated a paraaortic paraganglioma. After coelioscopic resection, cardiac function recovered.

Acute Disease↗
PubMed2000

Iatrogenic thyrotoxicosis: causal circumstances, pathophysiology, and principles of treatment-review of the literature.

Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. In most instances thyrotoxicosis is due to hyperthyroidism, a term reserved for disorders characterized by overproduction of thyroid hormones by the thyroid gland. Nevertheless, thyrotoxicosis may also result from a variety of conditions other than thyroid hyperfunction. The present report focuses on the etiologies, pathophysiology, and treatment of iatrogenic thyrotoxicosis. Iatrogenic thyrotoxicosis may be caused by (1) subacute thyroiditis (a result of lymphocytic infiltration, cellular injury, trauma, irradiation) with release of preformed hormones into circulation; (2) excessive ingestion of thyroid hormones ("thyrotoxicosis factitia"); (3) iodine-induced hyperthyroidism (radiologic contrast agents, topical antiseptics, other medications). Among these causes of iatrogenic thyrotoxicosis, that induced by the iodine overload and cytotoxicity associated with amiodarone represents a significant challenge. Successful management of amiodarone-induced thyrotoxicosis requires close cooperation between endocrinologists and endocrine surgeons. Surgical treatment may have a leading yet often underestimated role in view of the potential life-threatening severity of this disease, whereas others kinds of iatrogenic thyrotoxicosis are usually treated conservatively.

Amiodarone↗
PubMed2000

[Evaluation of the Ultracision ultrasonic dissector in thyroid surgery. Prospective randomized study].

STUDY OBJECTIVE: This prospective randomized study was designed to evaluate the efficacy, safety and cost of the ultrasonic hook in thyroid surgery, in comparison with conventional hemostasis. METHODS: Thirty-four consecutive euthyroid patients with multinodular goiter undergoing total thyroidectomy were randomly assigned to either group I, Ultracision or group II, conventional hemostasis. Preoperative, intraoperative and postoperative biochemical, clinical, surgical and economic variables were compared in each group. RESULTS: Use of the ultrasonic hook resulted in a significant reduction in operating time (70.7 +/- 18.3 versus 96.5 +/- 28.9 minutes), blood loss (74.5 +/- 50.9 g versus 134.6 +/- 108.42 g), and postoperative analgesic consumption (paracetamol (mg): 700 +/- 722 versus 1888 +/- 978), and may also reduce the incidence of transient hypoparathyroidism (5.8% versus 23.5%). The ultrasonic hook was no more expensive than conventional hemostasis, as long as a minimum of 15 patients shared the initial unit cost of the device. CONCLUSION: Although the use of the ultrasonic dissector does not allow a major cost-saving in total thyroidectomy, the essential advantages were a significant reduction of intraoperative blood loss, length of operating time and postoperative analgesic consumption.

Adult↗
PubMed2000

[[Hypnosedation, a new method of anesthesia for cervical endocrine surgery. Prospective randomized study].

UNLABELLED: Retrospective studies have confirmed the feasibility and safety of thyroid and parathyroid procedures performed under hypnoanesthesia (hypnosis, local anesthesia and minimal conscious sedation) as sole method of anesthesia. This very effective technique seems to provide physiological, psychological and economic benefits for the patient. STUDY AIM: To assess, by means of a prospective randomized study, the advantages of hypnosedation as an alternative to general anesthesia in terms of clinical and laboratory parameters. PATIENTS AND METHODS: Twenty patients operated under hypnoanesthesia were compared to 20 patients operated under conventional anesthesia. The two groups were compared in terms of inflammatory, neuroendocrine, hemodynamic and immunologic parameters and postoperative course (pain, fatigue, muscle strength and stress). RESULTS: No clinical or demographic differences were observed between the two groups. Operative times, bleeding, weight of specimens, and surgical comfort were similar. Significant differences in terms of inflammatory response and hemodynamic parameters were observed in favor of hypnoanesthesia. Neuroendocrine and immunological parameters were similar. Patients of the hypnoanesthesia group had significantly less postoperative pain. Postoperative fatigue syndrome and convalescence were significantly improved in these patients. CONCLUSION: This study confirms that, in our hands, hypnosedation presents real advantages over general anesthesia, in patients undergoing thyroid surgery.

Adult↗
PubMed1999

Asymptomatic adrenal tumours: criteria for endoscopic removal.

OBJECTIVE: Assessment of criteria for videoscopic removal of adrenal lesions discovered incidentally. DESIGN: Open prospective study. SUBJECTS: 63 patients operated on for 65 adrenal tumours. OUTCOME MEASURES: Relevance of proposed criteria: secreting adrenal lesion; diameter larger than 4 cm or increase in size at any re-evaluation; computed tomogram of intratumoral necrosis, haemorrhage, or irregular margins; high concentrations of dehydroepiandrosterone (DHEAS). RESULTS: Laparoscopic adrenalectomy was successful in 61 patients (97%). There were 4 minor complications. Criteria allowed us to identify correctly : phaeochromocytoma (n = 23), primary hyperaldosteronism (n = 18), Cushing's adenoma or disease (n = 7), single metastasis (n = 4), adenoma with DHEAS or cortisol hypersecretion (n = 3). 8 non-secreting incidental tumours (13%) were operated on. CONCLUSION: Simple criteria for videoscopic adrenalectomy for lesions discovered incidentally allowed us to reduce the number of doubtful indications (positive predictive value 87%).

Adolescent↗
PubMed1999

Hypnoanesthesia for endocrine cervical surgery: a statement of practice.

OBJECTIVES: To assess the feasibility of endocrine cervical surgery under hypnoanesthesia as a valuable, safe, efficient, and economic alternative to general anesthesia. METHODS: Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnoanesthesia (HYP) using Erikson's method. Operative data and postoperative course of this initial series were compared to a contemporary population of patients (n = 119) clinically similar except that they declined HYP or were judged unsuitable for it, and who were therefore operated on under general anesthesia (GA). RESULTS: The surgeons all reported better operating conditions for cervicotomy using HYP. Conversion from hypnosis to GA was needed in two cases (1%). All patients having HYP reported a pleasant experience and, keeping in mind that the GA group is not a randomly assigned control group, both had significantly less postoperative pain and analgesic use. Hospital stay was also significantly shorter, providing a substantial reduction in the costs of medical care. The postoperative convalescence was significantly improved after HYP and a full return to social or professional activity was significantly quicker. CONCLUSION: From this study, we conclude that HYP is an effective technique for providing relief of intraoperative and postoperative pain in endocrine cervical surgery. The technique results in high patient satisfaction and better surgical convalescence. This technique can therefore be used in most well-chosen patients and reduces the socioeconomic impact of hospitalization.

Adult↗
PubMed1999

Bilateral neck exploration under hypnosedation: a new standard of care in primary hyperparathyroidism?

OBJECTIVE: The authors review their experience with initial bilateral neck exploration under local anesthesia and hypnosedation for primary hyperparathyroidism. Efficacy, safety, and cost effectiveness of this new approach are examined. BACKGROUND: Standard bilateral parathyroid exploration under general anesthesia is associated with significant risk, especially in an elderly population. Image-guided unilateral approaches, although theoretically less invasive, expose patients to the potential risk of missing multiple adenomas or asymmetric hyperplasia. Initial bilateral neck exploration under hypnosedation may maximize the strengths of both approaches while minimizing their weaknesses. METHODS: In a consecutive series of 121 initial cervicotomies for primary hyperparathyroidism performed between 1995 and 1997, 31 patients were selected on the basis of their own request to undergo a conventional bilateral neck exploration under local anesthesia and hypnosedation. Neither preoperative testing of hypnotic susceptibility nor expensive localization studies were done. A hypnotic state (immobility, subjective well-being, and increased pain thresholds) was induced within 10 minutes; restoration of a fully conscious state was obtained within several seconds. Patient comfort and quiet surgical conditions were ensured by local anesthesia of the collar incision and minimal intravenous sedation titrated throughout surgery. Both peri- and postoperative records were examined to assess the safety and efficacy of this new approach. RESULTS: No conversion to general anesthesia was needed. No complications were observed. All the patients were cured with a mean follow-up of 18 +/- 12 months. Mean operating time was <1 hour. Four glands were identified in 84% of cases, three glands in 9.7%. Adenomas were found in 26 cases; among these, 6 were ectopic. Hyperplasia, requiring subtotal parathyroidectomy and transcervical thymectomy, was found in five cases (16.1%), all of which had gone undetected by localization studies when requested by the referring physicians. Concomitant thyroid lobectomy was performed in four cases. Patient comfort and recovery and surgical conditions were evaluated on visual analog scales as excellent. Postoperative analgesic consumption was minimal. Mean length of hospital stay was 1.5 +/- 0.5 days. CONCLUSIONS: Initial bilateral neck exploration for primary hyperparathyroidism can be performed safely, efficiently, and cost-effectively under hypnosedation, which may therefore be proposed as a new standard of care.

Adult↗
PubMed1999

Hypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient.

Acetaminophen↗