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Biomedical subjects

Y Fulla

Publications and source records attributed to Y Fulla.

34 records · Page 2Linked to original sources
PubMed1994

[Surgery of primary hyperparathyroidism by unilateral approach under local anesthesia and intraoperative determination of PTH 1-84].

Between July 89 and June 92, 70 patients with primary hyperparathyroidism underwent adenomectomy by unilateral incision under local anesthesia (Ul/LA), without exploration of the remaining glands. The procedure was carried out with intraoperative monitoring of urinary cyclic AMP (n = 35), Calcemia was measured 6-monthly for one year in every patient. 62 (88.6%) patients were cured after Ul/LA, whereas 5 patients required conversion to bilateral cervicotomy under general anesthesia because of abnormal hormonal levels, thus giving an overall success rate of 97% (67/70). The reasons for treatment failure of Ul/LA included misleading conclusions of cervical ultrasonography (n = 5), agitation of the patient (n = 1) and deep localization of the adenoma (n = 1). When cervical ultrasonography is suggestive of a parathyroid adenoma in expert hands, the probability of a second localization or associated hyperplasia is very low, so that adenomectomy by Ul/LA can be attempted safely, provided that the serum level of intact parathyroid hormone returns to normal values within one hour following resection. In our experience, parathyroidectomy by Ul/LA should not be considered in case of non conclusive ultrasonography, familial history pf hyperparathyroidism of MEN-I, ultrasonic evidence of several enlarged glands or associated thyroid nodule requiring simultaneous treatment.

Adult↗
PubMed1991

[Excision under local anesthesia of parathyroid adenomas. Criteria of selection and control of effectiveness. 35 cases].

Primary hyperparathyroidism caused by an adenoma that has been identified and localized by ultrasonography can be treated through a limited approach route, under local anaesthesia, provided the effect of excision is controlled by a perioperative assay of urinary cAMP or, preferably, of plasma parathormone level, and provided the contra-indications of this method are respected. Thirty-three out of 35 patients have been successfully operated upon by this method. In case of failure confirmed by laboratory tests, local anaesthesia was only a prelude to cervicotomy under general anaesthesia.

Adenoma↗
PubMed1991

[Study of antibody-dependent cell mediated cytotoxicity and thyroid growth blocking antibodies in congenital hypothyroidism].

Antibody-dependent cell mediated cytotoxicity (ADCC) and thyroid growth immunoglobulin blocking (TGI block) which have been found in autoimmune thyroiditis in adults, as well as TSH receptors binding inhibitory antibodies (TBI ab) and antimicrosomal (Mc ab) and antithyroglobulin (Tg ab) antibodies were search in 42 mothers-infants pairs called at hospital after a positive screening for congenital hypothyroidism. The etiologic diagnoses were: 12 athyreosis, 12 ectopies, 7 anatomically normal glands and 11 transients. Tg ab and Mc ab were measured by commercial hemagglutination tests, TBI ab were determined using a radio ligand assay. ADCC in a 51Cr release assay by human thyroid cells in culture and TGI block by incorporation of 3H-thymidine using the same cells. Results were 38% for TBI ab in infants mainly in patients with dysgenesis without any concordance between mothers and infants. ADCC were found in 24% and TGI block in 24% with respectively mothers-infants concordance of 90% and 84%. Five mothers had autoimmune diseases (2 thyroiditis, 2 Graves' diseases and 1 insulin-dependent diabetes). Beside these rare cases of maternal diseases, the significantly high number of antibodies without any expression in the mothers suggests that autoimmunity plays a role in the etiology of congenital hypothyroidism.

Antibody-Dependent Cell Cytotoxicity↗
PubMed1989

[Ultra-sensitive TSH and the TRH test in the follow-up of thyroid and pituitary diseases].

Basal TSH values measured by an ultra-sensitive method (TSH-US) were compared with the response of TSH under TRH (delta TSH) in 178 patients. In all thyroid pathologies and in patients without thyroid or hypophyseal pathology, results are in good agreement, i.e., delta TSH is proportional to basal TSH-US (r = 0.93). In 92 patients with hypophyseal diseases, no correlation between delta TSH and basal TSH-US could be found.

Humans↗
PubMed1987

[Surgery of primary hyperparathyroidism. Contribution of the peroperative assay of urinary cyclic AMP].

The increase of nephrogenic cyclic AMP is an excellent index of parathyroid hypersecretion. A successful treatment of primary hyperparathyroidism results in a rapid fall in nephrogenic cAMP. In a series of 24 patients with proven primary hyperparathyroidism (hyperplasia 3, adenoma 21) and 2 patients with suspected hyperparathyroidism, the success of surgical excision was evaluated by measuring the urinary cAMP/urinary creatinine ratio (R), which in the absence of renal impairment, is proportional to the level of nephrogenic cAMP. Sequential assays of urinary cAMP and creatinine were performed during surgery; laboratory results were available within less than one hour. Among 22 patients with elevated baseline value or R, R became normal in 18 and decreased by more than 50% in 3; these findings suggested that the operation would be successful. In 1 case, R was not measured as the patient had impaired renal function. In another patient with normal baseline value of R, R did not significantly decrease after excision. Surgery failed in 1 patient, although the high value of R at the end of the operation should have prompted us to continue. Finally, in 2 patients the diagnosis was erroneous since R was lower than 0.5 as in controls. Surgeons, therefore, now have a reliable biochemical method at their disposal, but its use will be limited by its cost and complexity.

Aged↗
PubMed1985

Free thyroxine measurement by one-step method in the plasma of treated and untreated hypothyroid infants.

The one-step radioimmunoassay of free thyroxine (f-T4) using a gamma-coated kit was used in this study. In controls the mean plasma levels (pmol/l) were 20.8 (range 13.5-37) during the first days of life, 17.4 (11.5-27) from 1 week to 1 year, and 17.0 (10-24.5) after 1 year. In preterm newborns it was correlated with the length of gestation. Among 23 untreated hypothyroid infants aged 15-22 days, f-T4 was undetectable in those with athyreosis, while in cases with dysgenetic thyroid it was variable, correlated to the width of the gland (r = 0.77, p less than 0.01). In 44 hypothyroid patients treated with l-T4, a highly significant positive correlation was found after the 1st month of treatment between plasma f-T4 and the daily l-T4 dose (r = 0.46, p less than 0.01), and a negative one between f-T4 and plasma TSH (r = -0.59, p less than 0.001). It is concluded that measurement of f-T4 offers a valuable means for control of diagnosis and treatment in congenital hypothyroidism, especially useful for avoiding both under- and overtreatment. Its correlations suggest that it is the most reliable hormonal measurement in the follow-up of thyroid children.

Dose-Response Relationship, Drug↗
PubMed1984

[Direct assay of free thyroxine in children. Application to the monitoring of the treatment of hypothyroidism].

A direct measurement of free thyroxine (FT4) by a radio-immunologic method using an analogue of thyroxine as tracer allowed to establish the normal values in 341 children from birth to puberty. These values were used as reference for the determination of free T4 in the diagnosis and management of treatment for congenital hypothyroidism. In 44 treated hypothyroid children, there was a positive correlation between the serum concentration of free T4 and the amount of levothyroxine given daily (r = 0.46, p less than 0.01). There was also a negative correlation between free T4 and serum TSH (r = 0.59, p less than 0.001). Thus, the measurement of free thyroxine seems to be a more reliable, more accurate and more sensitive parameter than that of total thyroxine or TSH for controlling the treatment of congenital hypothyroidism.

Adolescent↗
PubMed1980

[Management of primary hypothyroidism in childhood treated with thyroid extract (author's transl)].

In a group of 19 children with primary hypothyroidism who were treated with thyroid extract, linear relationships were found between blood thyroxine and triiodothyronine levels and the dose of thyroid extract adjusted for surface area. Thus it is likely that the composition of thyroid extract is homogeneous and that the metabolism of thyroid hormones in the patients is similar. Thyroxine (T4) was the most reliable parameter for monitoring treatment as T3 levels were elevated in patients who were otherwise euthyroid. T3 uptake was rather insensitive but the free thyroxine index agreed well with the T4 level. A negative linear semilogarithmic correlation was demonstrated between TSH and T4 but not with T3. In some cases TSH was still raised although the T4 had returned to normal. It is postulated that this could be due to thyrotropic cells hyperplasia. TRH tests did not provide any further information. The recommended dose of thyroid extract which is needed to raise the T4 above the lower limit of normal for age (-2 SD) can be calculated from the regression of T4 and dose of thyroid extract. The mean value was 8.49 +/- 0.86 cg/m2.

Adolescent↗
PubMedDate not supplied

Parathyroid adenomectomy under local anesthesia with intra-operative monitoring of UcAMP and/or 1-84 PTH.

Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra-operative monitoring of urinary cAMP (UcAMP) and 1-84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non-cooperative, were excluded from this procedure. UcAMP and 1-84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty-two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow-up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMedDate not supplied

[Surgery of primary hyperparathyroidism by unilateral approach under local anesthesia and peroperative assay of 1-84 parathyroid hormone].

By combining echography and per-operative hormone assay, surgery for primary hyperparathyroidism due to a single adenoma can be performed via a limited unilateral access route with local anaesthesia. In a recent series of 204 patients, this technique was not contraindicated in 88 (43%). The operation was successful in 81 of these (92%). In 8 cases, the operation had to be converted into bilateral cervicotomy under general anaesthesia. Six of them were successful. The overall cure rate was 98%. Peroperative assay of 1-84 parathyroid hormone is an essential element in this technique.

Adult↗