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Biomedical subjects

L Hooghe

Publications and source records attributed to L Hooghe.

At least 19 recordsLinked to original sources
PubMed1997

Presurgical localization of abnormal parathyroid glands using a single injection of technetium-99m methoxyisobutylisonitrile: comparison of different techniques including factor analysis of dynamic structures.

Single-tracer methoxyisobutylisonitrile (MIBI) imaging is considered to be a sensitive method for the localization of abnormal parathyroid glands. The aims of this study were to determine which of the analytical techniques described for this method - visual comparison of early (15-min) and late (120-min) images, use of time-activity curves (TACs) generated on regions of interest and factor analysis of dynamic structures (FADS) - corresponds best with surgical findings, and to ascertain the potential overall contribution of presurgical scintigraphy. Fifty-five patients were studied, 34 of whom presented with primary hyperparathyroidism (HPT) and 21 with secondary HPT. After a 925 MBq injection of technetium-99m MIBI, a 40-min dynamic acquisition was performed and static images were acquired at 5, 20, 40 and 120 min using a gamma camera equipped with a pinhole collimator. The dynamic series were submitted to FADS, an attractive non-operator-dependent technique, and TACs were generated on regions of interest after the visual comparison of early and 120-minute images (15'-120'). The presumed localizations of abnormal glands were compared with a sketch drawn by the surgeon. Sensitivity was defined as the percentage of true-positive localizations and was 84.4%, 74% and 65% in adenoma and 76%, 66.6% and 45% in hyperplasia for 15'-120', FADS and TACs, respectively. Surgical accuracy, i.e. the percentage of patients accurately and completely described, was 72%, 56% and 59% in adenoma and 53%, 30% and 22% in hyperplasia for 15'-120', FADS and TACs, respectively. The visual comparison method scored best in all cases. FADS was found to be sensitive in cases of adenoma but was handicapped by more false-positive localizations. TACs were particular inefficient in hyperplasia. With respect to the detection of adenomas, we found a relationship between the gland weight and scintigraphic positivity. This dependence on gland weight was not found in hyperplasia. The poorer results obtained with all techniques for surgical accuracy can be explained by the need for a complete scintigraphic description of all pathological glands found by the surgeon in a patient. This study demonstrates that the 15'-120' visual comparison method is more efficient and less cumbersome than TAC or the attractive FADS technique. However, it was less efficient than neck exploration by an experienced surgeon. Therefore, in our institution, scintigraphic studies are now only requested in selected cases of HPT, usually primary HPT and cases undergoing re-operation.

Adenoma↗
PubMed1997

Impact of growth hormone treatment on a Belgian population of short children with renal allografts.

We retrospectively analyzed the effects of recombinant human growth hormone (rhGH) in a Belgian population of 36 short children with renal allografts. Seven children were dropped from the growth study: 1 had skeletal dysplasia and in 6 cases rhGH was given for less than 1 yr (1 died, 1 developed genu valgum, 2 were non-compliant and 2 grafts deteriorated). Final height was reached in 17 patients, and 12 children were still growing at the end of the study. Median height standard deviation score (SDS) in the 29 patients was -2.3 at the time of transplantation, and -2.7 when rhGH therapy was initiated. During rhGH therapy (median duration 3.2 yr, range 0.6-7.7 yr), height SDS increased by a mean of 0.4 per year, and bone maturation was not accelerated. Final height reached was 162.7 (149.0-169.5) cm (median SDS -1.8) in males and 151.0 (130.5-169.5) cm (median SDS -1.9) in females. Final height is significantly greater in males than females compared with a historical control group of untreated patients. Final height is within the parental target height range in 6 out of the 17 patients. The increase in height SDS in patients who were at an advanced stage of puberty (Tanner stages 4-5) when rhGH therapy was initiated exceeded our expectations (mean height gain 14.2 cm in boys and 10 cm in girls). In the cohort of 36 children, 4 patients developed an acute allograft rejection, all of whom had an underlying chronic rejection. This resulted in 3 graft losses within 5 yr. Our results indicate that rhGH treatment has a positive effect in short children with renal allografts, even if it is started in late puberty. In the presence of underlying chronic rejection, rhGH treatment needs careful monitoring to minimize the risk of graft loss.

Adolescent↗
PubMed1993

[Reoperations in parathyroid surgery].

In a continuous series of 439 parathyroidectomies for primary or secondary hyperparathyroidism, 36 cases were reoperations. The initial operation had been a prior parathyroid exploration (PTx) in 17 cases, a thyroidectomy (Tx) in 17 cases, both operations in two cases. The incidence of parathyroid glands discovered at exploration was lower in both types of reoperations (67% after Tx, 72% after PTx) than in patients who were explored for the first time (94%). Anatomical variations and parathyroid pathologies were comparable in patients reoperated after Tx and in those explored for the first time. In patients reoperated after PTx, anatomical abnormalities (46% of glands in ectopic locations, 12% of supernumeray glands) and multiglandular pathologies (56% of hyperplasias) were much more frequently encountered. Long term results were satisfactory in patients explored for the first time (98% cures) and in reoperations after Tx (94% cures), but were less favourable in reoperations after PTx (78% cures).

Adult↗
PubMed1993

Total parathyroidectomy and presternal subcutaneous implantation of parathyroid tissue for renal hyperparathyroidism.

When hyperparathyroidism recurs in patients previously treated by total parathyroidectomy and intramuscular parathyroid autotransplantation, excision of the graft is not always technically easy and it is often necessary to resect the portion of the muscle containing the implants. During November 1986, we began a program to test the feasibility of presternal subcutaneous autotransplantation of parathyroid tissue. We hoped this technique would make removal of the grafts simpler. Thirty-six patients with renal hyperparathyroidism (RHPT) received subcutaneous parathyroid implants. Persistent or recurrent hyperparathyroidism was observed in three patients during the follow-up period. The presence of active parathyroid tissue was demonstrated after some time in all the patients. The parathyroid implants were easily excised in three instances (one persistent RHPT and two recurrences). Microscopic examination of the resected specimens did not show any sign of malignant transformation. We conclude that presternal subcutaneous implantation of parathyroid tissue after total parathyroidectomy is a quick, safe and efficient surgical procedure in the treatment of RHPT.

Adult↗
PubMed1992

Hypocalcemia after thyroidectomy.

Serum calcium, sodium, potassium, chloride, magnesium, phosphorus, osmolarity, total protein, albumin, parathyroid hormone, and calcitonin values were systematically surveyed in 135 patients who underwent thyroidectomy and in 104 control surgical patients. A transient and moderate hypocalcemia developed after operation in thyroidectomized and control patients. Concentrations of other electrolytes, osmolarity, proteins, and albumin followed the same pattern of evolution. After thyroidectomy, the degree and duration of hypocalcemia increased with the extent of thyroid resection. A profound hypocalcemia (less than 2.0 mmol/L) and a marked reduction of the parathyroid hormone concentration (below normal) were present in 12% and 8% of cases after subtotal thyroidectomy and in 22% after total thyroidectomy. Calcitonin values did not increase after thyroidectomy. A slight correlation was observed between the preoperative serum alkaline phosphatase level and the minimal postoperative serum calcium level. It is concluded that post-thyroidectomy hypocalcemia is a multifactorial phenomenon. It is due, at least in part, to hemodilution. A temporary parathyroid insufficiency after subtotal and total thyroidectomy, and an avidity of the skeleton for calcium in hyperthyroid patients, may aggravate the hypocalcemia.

Adolescent↗
PubMed1992

[Persistent and recurrent hyperparathyroidism following parathyroidectomy].

In a series of 416 parathyroidectomies for primary or secondary hyperparathyroidism, 19 were reoperations for persistence (17 cases) on recurrence (2 cases) of the disease. (1) Preoperative localisation studies were useless in half of the cases. (2) In re-explorations, 72% only of parathyroid glands were discovered, 46% of them in ectopic locations. In reoperations for primary hyperparathyroidism, 56% of cases had more than one pathological gland. (3) Long term results have been less satisfactory after re-explorations than after the first operations.

Adult↗
PubMed1988

[Postoperative pancreatitis, hyperamylasemia and amylase isoenzymes after parathyroidectomy for primary hyperparathyroidism].

Recent studies have cast doubt on the concept of causative association between parathyroidectomy for primary hyperparathyroidism and postoperative pancreatitis. The present study indicated that the relationship was real and that the development of acute pancreatitis after parathyroid surgery was not purely incidental. Acute pancreatitis was observed postoperatively in 3 p. 100 of cases after parathyroidectomy (6/196 cases), in 37 p. 100 after pancreatic surgery (19/51 cases), but never after thyroidectomy (100 cases) or other extra-abdominal operations (100 cases). During the first five postoperative days, the incidence of hyperamylasemia was 16 p. 100 after parathyroidectomy, 47 p. 100 after pancreatic surgery, 3 p. 100 after thyroidectomy, 2 p. 100 after other extra-abdominal operations. During the same period, the frequency of hyperlipasemia was similar: 20 p. 100 after parathyroidectomy, 54 p. 100 after pancreatic surgery, 1 p. 100 after thyroidectomy, 0 p. 100 after other extra-abdominal operations. In all cases with hyperamylasemia after parathyroidectomy, the pancreatic fractions of amylase isoenzymes were abnormally elevated.

Adolescent↗
PubMed1979

Cardiovascular effects of methyl methacrylate monomer.

Although cardiorespiratory human sensitivity to circulating methyl methacrylate monomer remains unknown, it is clear that the blood levels responsible for cardiocirculatory alterations in intact dogs are not obtained after insertion of acrylic cement in long bones in clinical practice. Circulating monomer considered as the sole causal factor for the hemodynamic changes described during orthopedic method is highly questionable.

Animals↗