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N Pras-Jude

Publications and source records attributed to N Pras-Jude.

11 recordsLinked to original sources
PubMed1996

Role and operative risk of bilateral adrenalectomy in hypercortisolism.

Transsphenoidal pituitary surgery has radically modified the management of pituitary-dependent hypercortisolism (Cushing's disease). Bilateral adrenalectomy may, however, represent the ultimate treatment in some cases of hypercortisolism. In the present study we report our experience of bilateral adrenalectomy in 82 patients operated on during the last 15 years. The causes of hypercortisolism were Cushing's disease (n = 78), ectopic ACTH syndrome (n = 3), and primary adrenocortical nodular dysplasia (Carney-Meador syndrome) (n = 1). Before operation 37% of the patients had severe symptoms of hypercortisolism. A bilateral posterior approach was undertaken in 58 patients, whereas 18 patients had an anterior transabdominal approach and 6 patients a laparoscopic approach. There were two operative deaths (2.4%). Postoperative complications occurred mostly in cases of advanced disease and were observed in 14 patients (17%), among whom 4 had severe complications. At long-term follow-up, one recurrence of hypercortisolism and 12 Nelson syndromes (15%) were observed. In conclusion, bilateral adrenalectomy carries an acceptable operative risk, and we recommend bilateral adrenalectomy rather than long-term suppressive therapy in patients requiring prompt and definitive control of their hypercortisolism or after pituitary surgery failure.

ACTH Syndrome, Ectopic↗
PubMed1992

[Adrenal gland pheochromocytomas. Apropos of 35 operated patients].

Thirty-five patients (20 female and 15 male, mean age = 47 years) operated on for an adrenal pheochromocytoma were reviewed. Catecholamine excessive production was symptomatic in 33 patients (94%). Urinary excretion of vanyl-mandelic acid, catecholamines and metanephrine was abnormal in 84%, 75% and 90% of cases, respectively. Tumor was presumed benign (no metastasis) in 31 cases. Sensitivity of CT scan (n = 35) and magnetic resonance imaging (n = 13) was 100%. Meta-iodo-benzylguanidine scan (n = 19) always recognized the main tumor, but did not visualize 1 second tumor in 1 patient and 1 metastasis in 1 other patient. An anterior intraperitoneal approach was performed in all cases. Operative mortality rate was 5.7%. In the last 15 patients, systematic preoperative treatment by prazosine did not lead to fall in rates of peroperative arrythmia and hemodynamic disorders. Twenty-two of 25 (88%) hypertensive patients remained normotensive without medication postoperatively. The risk of undiagnosed pheochromocytoma and problems in resection of large right-sided tumors are discussed.

Adolescent↗
PubMed1988

One liver for two: an experimental study in primates.

The need for liver grafts is critical in countries where brain death is not accepted as a legal criterion for organ retrieval. This experimental study was conducted with nonhuman primates in order to evaluate the feasibility of liver transplantation using a living donor. An original technique was employed to remove the left part of the liver from the donor: transection of the parenchyma was done while the blood flow was kept to the left part of the liver. In the recipients, the graft was placed heterotopically. No blood transfusions were administered to donors or recipients. In spite of a few failures, due to consequences of intraoperative bleeding, several donor operations using this original technique were successful, in the immediate postoperative period as well as several months later. Among the recipients, the large number of early failures suggests that the heterotopic position is probably not the appropriate one and that orthotopic transplantation should be preferred.

Animals↗