PubMed Health⌕ Search

Biomedical subjects

F Debruyne

Publications and source records attributed to F Debruyne.

At least 19 recordsLinked to original sources
PubMed2006

Levothyroxine replacement therapy after thyroid surgery.

INTRODUCTION AND AIM: New entities, such as 'subclinical' over- and undersubstitution, are easily diagnosed after thyroid surgery due to improved testing methods, and the incidence of thyroidectomy with lifelong hormone substitution is increasing. Thus, there is a need to review conventional replacement therapy after thyroid surgery. We investigated the adequacy of our thyroid hormone replacement therapy for three months after total-, subtotal-, and hemithyroidectomy using an upper reference limit of thyrotropin (TSH) of 4.6 mU/L. MATERIALS AND METHODS: Eighty-seven patients undergoing thyroidectomy for benign thyroid pathology participated. Levothyroxine (L-T4) treatment began five days after surgery. Preoperatively euthyroid patients received 150 microg L-T4 daily following total thyroidectomy, 100 microg L-T4 after subtotal thyroidectomy, and 50 microg L-T4 after hemithyroidectomy. Preoperatively hyperthyroid patients received 100 microg L-T4 following total thyroidectomy and 50 microg L-T4 following subtotal thyroidectomy. An average of six weeks after surgery, thyrotropin (TSH) was measured (reference limits 0.15-4.60 mU/L), and necessary dose adjustments were made. RESULTS: Of the patients who were preoperatively euthyroid, 45% with total thyroidectomy, 42% with subtotal thyroidectomy, and 17% with hemithyroidectomy required L-T4 dose adjustments. Of the patients who were preoperatively hyperthyroid, 60% of those with total thyroidectomy and all of those with subtotal thyroidectomy required L-T4 dose adjustments. CONCLUSIONS: To avoid over- and undersubstitution after thyroidectomy, an optimal replacement therapy dose is necessary. A small majority of our preoperatively euthyroid patients received adequate therapy. Endocrinological follow-up six weeks after surgery revealed the need for L-T4 dose adjustments, especially in preoperatively hyperthyroid patients. When the extent of resection was similar for hyperthyroid and euthyroid patients, the same initial dose of L-T4 was justified.

Adult↗
PubMed2005

Completion thyroidectomy after the unexpected diagnosis of thyroid cancer.

The optimal surgical management of well-differentiated thyroid cancer (DTC) remains a controversial topic. Preoperative and peroperative investigations quite frequently fail to detect thyroid cancer in cold nodules, and only postoperative histological examination reveals malignancy. In these cases many physicians perform a completion thyroidectomy. Others recommend a conservative approach with close follow-up because of the increased risk of complications after re-operation. In our department, routine management includes completion thyroidectomy once the histopathological report concludes that there is carcinoma, except in cases of papillary carcinoma measuring less than 1 cm. The aim of our study was to determine the incidence of contralateral malignancy and of complications after completion thyroidectomy. We reviewed the records of 29 patients--25 women and 4 men-- who all underwent completion thyroidectomy because of an unexpected diagnosis of DTC. Residual malignancy was found in 12 patients (41.4%) after completion thyroidectomy. In ten patients (34.5%) the malignancy was localised in the contralateral lobe and two patients (6.9%) had lymph node metastases. Postoperative transient hypocalcaemia (< 8.0 mg/dl) occurred in five patients (17.2%) and permanent hypocalcaemia (lasting longer than 6 months) was a feature in two patients. One patient suffered transient laryngeal nerve injury occurred in one patient and there were no permanent lesions. In conclusion, we found residual DTC in 41.4% of patients undergoing reintervention. Because of the rather low re-operation rate, we prefer to perform a completion thyroidectomy to remove potential occult malignancy and to allow for postoperative 131I-treatment in all patients with a diagnosis of malignancy in their thyroid lobectomy specimen, with the exception of papillary carcinoma < 1 cm.

Adenocarcinoma, Follicular↗
PubMed2005

Brown tumour: presenting symptom of primary hyperparathyroidism.

The skeletal lesions of primary hyperparathyroidism, including brown tumour, are rare nowadays, with the practice of checking serum calcium levels leading to an earlier diagnosis of hyperparathyroidism. Clinical, laboratory, radiographic and histological investigations can lead to a correct diagnosis. Treatment of brown tumour focuses on the hyperparathyroidism, and is usually followed by a regression of the brown tumour. The diagnosis of hyperparathyroidism and brown tumour should be considered in patients with hypercalcaemia and an osteolytic expansive bone lesion. We present a patient where a brown tumour of the mandible was the presenting symptom of primary hyperparathyroidism.

Adenoma↗
PubMed2004

Handling and reporting of biopsy and surgical specimens of testicular cancer.

This paper is the result of a meeting of the European Association of Pathologists, Uropathology Division in Florence 2003. The aims of this meeting were to establish: guidelines for specimen handling by urologists and minimum requirements for data accompanying testicular specimens submitted to pathologists; a consensus on techniques for processing specimens by pathologists; the essential information required from pathology reports; areas where our standard practice is traditional rather than evidence based and where further studies are required. The general aims of histopathology are to give or confirm a diagnosis; assess established prognostic markers; identify changes associated with treatment; provide information for audit (i.e. imaging, urology and pathology) and maintain a permanent record (slides/blocks).

Biopsy↗
PubMed2004

The effect of ventilation tubes on otoacoustic emissions. A study of 106 ears in 62 children.

The aim of this investigation was to study the presence and the characteristics of transient evoked otoacoustic emissions (TEOAE) in ears with ventilation tubes. Theoretically the small mass and the opening of the tube could influence the OAE. We studied a population of children between the age of 3 and 9 years with functional ventilation tubes and a normal hearing on pure tone audiometry (Fletcher index < 25 dB). A total of 110 ears from 62 children were included. According to the criterion of 70% wave reproducibility, TEOAE were present in 86.7% of the ears. Looking at the reproducibility in the different frequency bands of the response, it was found that the TEOAE were strongest in the 2 kHz frequency band. It is concluded that the measurement of TEOAE can be used as a useful hearing test in young children with ventilation tubes, maybe even when pure tone audiometry is not yet possible. However, false negative results were found in about one tenth of the ears.

Acoustic Stimulation↗
PubMed2001

[The future of urology in Europe: a perspective from the European Urology Association].

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSIONS: An action plan is proposed to confront these changes without losing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.

Europe↗
PubMed2001

The future of urology in Europe: an overview from the European association of urology.

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSION: An action plan is proposed to confront these changes without loosing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.

Europe↗
PubMed2001

Voice similarity in identical twins.

If people are asked to discriminate visually the two individuals of a monozygotic twin (MT), they mostly get into trouble. Does this problem also exist when listening to twin voices? Twenty female and 10 male MT voices were randomly assembled with one "strange" voice to get voice trios. The listeners (10 female students in Speech and Language Pathology) were asked to label the twins (voices 1-2, 1-3 or 2-3) in two conditions: two standard sentences read aloud and a 2.5-second midsection of a sustained /a/. The proportion correctly labelled twins was for female voices 82% and 63% and for male voices 74% and 52% for the sentences and the sustained /a/ respectively, both being significantly greater than chance (33%). The acoustic analysis revealed a high intra-twin correlation for the speaking fundamental frequency (SFF) of the sentences and the fundamental frequency (F0) of the sustained /a/. So the voice pitch could have been a useful characteristic in the perceptual identification of the twins. We conclude that there is a greater perceptual resemblance between the voices of identical twins than between voices without genetic relationship. The identification however is not perfect. The voice pitch possibly contributes to the correct twin identifications.

Adolescent↗
PubMed2001

Pre- and intra-operative findings in primary hyperparathyroidism.

The files were studied of 300 patients operated for primary hyperparathyroidism for the first time. Their median age was 60 years. The female/male ratio was 3/1, but in the younger patients males and females were about equally present. Preoperatively, one third was considered as asymptomatic with respect to hyperparathyroidism. In this subgroup the hypercalcemia was detected coincidentally and the mean parathyroid hormone level was lower than in the others. Another third of the patients had nephrolithiasis, they were on the average younger and there were more males. Finally one third showed other symptoms as gastrointestinal disease, bone disease or general malaise. Intraoperatively, we found a solitary adenoma in 90% of the cases, a double adenoma in 5% (on each side of the neck in half of the cases) and hyperplasia in 4%. The adenomas had a tendency to occur more often in the upper parathyroid glands, but the difference was not important enough to influence the surgical technique. Hyperplasia patients were, on the average, younger and double adenoma patients older. The female/male ratio was 1/1 for hyperplasia and 15/1 for double adenoma.

Adenoma↗
PubMed2001

Postoperative course of serum parathyroid hormone and calcium after surgery for primary hyperparathyroidism.

The aim of this study was to describe the course of parathyroid hormone (PTH) and serum calcium after surgery for primary hyperparathyroidism, and to evaluate the usefulness of daily measurement of these parameters. PTH and serum calcium were daily monitored during the early postoperative period in 45 patients where a parathyroid adenoma was removed. PTH showed a sharp drop to a very low level already on the first postoperative day, whereafter a rapid recovery began. Serum calcium decreased more slowly: on the average, the lowest calcium level was seen on the second day. A majority of the patients were temporarily hypocalcemic, apparently to various degrees. After two weeks 38 patients showed a normal calcemia, while six patients remained slightly hypocalcemic. It is concluded that after removal of a parathyroid adenoma an abrupt fall of PTH precedes the decrease of serum calcium. The first day's PTH level is a reliable indicator of the success of the intervention and it should be a major point in the postoperative biochemical follow-up. Repeated measurements of serum calcium are useful, in contrast with the daily dosage of PTH which can be omitted for economical reasons.

Adenoma↗
PubMed2001

Recent trends in the initial surgical treatment of primary hyperparathyroidism: a review.

INTRODUCTION: The standard treatment of primary hyperparathyroidism has long been, and for many surgeons still is, a cervicotomy with presentation of all parathyroid glands. The last two decades have been marked by a progress in localization and identification techniques, together with a general trend towards less invasive surgery. This evolution resulted in numerous and diverging new surgical strategies, all claiming to be as effective as the conventional neck exploration, but resulting in fewer complications and better cosmesis. We want to give an overview and a realistic positioning of these new techniques. METHODOLOGY: A literature search using PubMed from January 1980 to December 2000, combined with reference checking, identified the most important articles describing the new strategies. We present the evolution in the thinking, the data supplied, and our critical remarks. RESULTS AND CONCLUSION: The initial random unilateral exploration was followed by trials to achieve a more guided unilateral exploration. Different adjuncts developed can be classified as preoperative (isotope scanning, ultrasonography, computer tomographic scanning) and intraoperative (intraoperative intact parathyroid hormone measurement, intraoperative 99mTc sestamibi scanning). The surgical techniques using these adjuncts range from a classic collar type incision followed by a unilateral exploration, over external exploration (unilateral or bilateral) through a very small incision, to endoscopic neck exploration. Reported outcomes of these techniques are presented, and all aspects mentioned are labeled as T-1 (preoperative), T0 (intraoperative), or T + 1 (results and complications) features. The reported results seem to indicate there is a place for a less invasive approach, but should be interpreted with caution seeing the ever present selection bias in the described population.

Humans↗
PubMed2001

Parathyroid function in the early postoperative period after thyroidectomy.

Serum levels of parathyroid hormone (PTH) and calcium were studied in 132 patients, divided into three groups: unilateral thyroid-lobectomy, (sub)total thyroidectomy for non-toxic goitre and (sub)total thyroidectomy for hyperthyroidism. It was found that all types of thyroidectomy, even unilateral lobectomy, had a temporary influence on the PTH and calcium metabolism in the early postoperative period, albeit to different degrees. The effect was most pronounced after surgery for hyperthyroidism, which carries the greatest risk for postoperative hypocalcemia. The pathogenesis of transient postoperative hypocalcemia as well as the implications for the surgical management are discussed.

Adult↗
PubMed2001

Historical note: the beginning of parathyroidectomy.

The paper describes briefly the major historical steps towards the development of the surgical treatment of hyperparathyroidism. The first parathyroidectomies were carried out in 1925, in Europe and in the United States, independently from each other. The first surgeon in Vienna, F. Mandle, has received a rightly deserved place in the history of medicine, while in Boston the first patient is reminded mostly.

Austria↗
PubMed2000

Errors in histological grading by prostatic needle biopsy specimens: frequency and predisposing factors.

Sampling error is an inherent problem of prostate biopsy. Consequently, there are problems in determining whether a given carcinoma is clinically significant on the basis of biopsy results. This study assesses the factors that predispose to errors in biopsy grading, as well as the dimensions of sampling error due to these factors. Among 187 cases, biopsy grading error was retrospectively related to grade heterogeneity in the prostate and to biopsy-related factors. Clinically relevant biopsy grading errors occurred in a quarter of the cases. Of all grading errors, at least 17% resulted from misinterpretation by the pathologist only. Overall, prostates with grade heterogeneity revealed grading errors twice as frequently as specimens without grade heterogeneity. In most cases, however, grading error resulted from multiple factors, such as the number and length of cores obtained (p<0.05). This was an important finding because the mean core length was only 9.4 mm, whereas the biopsy needle is designed to obtain cores of 15 mm. Moreover, clinically relevant biopsy grading error had occurred in almost half of the cases when the Gleason score was based on a tumour deposit measvring less than 0.5 mm (p<0.05). The clinical consequences of these findings are important. Clinicians should try to obtain at least six biopsies, each 15 mm in length, to minimize grading error. Pathologists should be cautious in reporting Gleason scores based on tumour lesions smaller than 400x total magnification field. Interpretation could be refined, when necessary, by warning the urologist of the Limitations of the biopsy report.

Aged↗
PubMed2000

Weight characteristics of the parathyroid glands in renal hyperparathyroidism.

BACKGROUND: Although the mean weight of normal parathyroid glands is known, reports concerning the weight of hyperplastic glands in renal hyperparathyroidism are rare. The aim was to collect data about the weight of such glands and also to study the intraindividual distribution. METHODS: Statistical results are presented about the weight of 60 parathyroid glands that were removed in 20 patients with renal hyperparathyroidism (the fourth gland was subtotally removed and therefore not included in the study). RESULTS: The median weight was 1.005 g, with a range from 0.10 to 7.15 g. All removed glands were enlarged, but the most salient finding was the wide distribution of weights. Also, the intra-individual variation was great. The largest gland of each patient weighed, on average, three to four times more than the smallest gland of the same subject. CONCLUSION: The weight of the superior glands tended to be somewhat greater in comparison with the inferior glands.

Adult↗
PubMed2000

Longitudinal voice changes: facts and interpretation.

To study intraindividual vocal changes over time, a longitudinal research design is preferred. However, this procedure reveals many restrictions concerning methodology and interpretation, especially in cases of (semi)retrospective studies. This is illustrated by an investigation of the voices of 20 male Dutch-speaking reporters of the Belgian Radio Broadcasting service. These men read the same text they did 30 years previously for a digital registration. After having copied the high-quality archival recordings digitally, the results of the acoustical analysis of both recordings (recent and archival) were compared. This was done to search for the contribution of aging. In this article we report on the results of the speaking fundamental frequency (SFF) and the standard deviation of the SFF (SFFsd) as a measure of intraindividual variability, and the voice onset time (VOT). Results indicate that, in connected speech, SFF decreased, SFFsd became more restricted, and the VOT increased strongly. The interpretation of the results compels us to conclude that it is extremely difficult to define the specific effect of aging alone, since it is only one element among many others, including methodological concerns.

Adult↗