Biomedical subjects
Publications and source records attributed to Y Lecharpentier.
Two cases of cardiac surgery under cardiopulmonary bypass in previously pneumonectomized patients are reported. In one case a postoperative tension pneumothorax required an emergency drainage. No other complications occurred. The authors describe their technique and underline the value of an adequate pre-operative respiratory preparation and a systematic drainage of the pleural cavity.
A prospective randomized study was carried out to assess two protocols of antibiotic prophylaxis in patients undergoing cardiac surgery with cardiopulmonary by-pass. Each patient of the first group received four intravenous injections of 1 g cefazolin over a period of 12 h, whilst in the second group each one received twelve doses over a period of 36 h. Between May 1983 and April 1984, 159 patients scheduled for cardiac surgery entered the study. Those who underwent emergency surgery, or weighed less than 20 kg, or received antibiotics in the week before surgery, or had a previous history of anaphylaxis to cephalosporins were not included in the study. Both groups were similar in their distribution of age, weight, height, sex, past history of infectious disease, surgery and iatrogenic factors. There were no significant differences between the two groups in the number of minor infections and bacterial floral changes. There were no major infections either (septicaemia, mediastinitis, endocarditis). Temperature charts were the same on the first four days. The length of stay at hospital was the same in both groups. Since the efficacy of the two protocols in preventing major infections was the same, the authors recommend the short prophylaxis with cephazolin for cardiac surgery patients.
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The aim of our study was to evaluate the function and growth of parathyroid tissue autografted into the forearm of hemodialysis patients using several presently available methods. In a dynamic study, the secretory function of autografted tissue was evaluated in seven patients using either zero calcium dialysate or calcium infusion. In an additional prospective study, seven patients had repeated determinations of plasma immunoreactive parathyroid hormone (iPTH) concentration on samples from both forearms, a radionuclide evaluation of autograft function using thallium-201 chloride, and real time ultrasonography. Light microscopy analysis was performed in two patients. The dynamic study demonstrated that induction of hypocalcemia was followed by an increase, and induction of hypercalcemia by a decrease, in circulating iPTH in both forearms using three different radioimmunoassays, similar to what has been reported for normal parathyroid tissue. A significant gradient (ie, greater than 2.0) of plasma iPTH concentration in samples from both forearms was observed in only three out of the seven patients of the prospective study. Two of these patients disclosed an increased uptake of 201TI chloride at the site of autografted tissue and had an echographically detectable mass. In both, hyperplastic parathyroid tissue was removed. At present, the remaining third patient does not have other features of recurrent hyperparathyroidism. In conclusion, autotransplanted parathyroid tissue of hemodialysis patients shows an adequate response to physiologic stimuli such as hypo- and hypercalcemia. Dynamic tests, therefore, appear to be a useful tool in the assessment of its function. In addition, radionuclide and echographic studies may be reliable adjuncts in the detection of marked parathyroid autograft hyperplasia.
Severe secondary hyperparathyroidism is still observed at present in 5-10% of haemodialysis patients. It requires surgical correction. Fifty-eight haemodialysis patients had neck surgery and their 222 parathyroid glands analysed. The individual gland weight was comprised between 22 and 3880 mg (mean +/- SEM, 689 +/- 62 mg). Mean total parathyroid gland weight per patient was comprised between 2 and 3 g. Schematically, 4 types of gland architecture could be distinguished: diffuse hyperplasia alone; diffuse hyperplasia associated with incipient nodule formation; hyperplasia with pronounced nodule formation; and nodule formations alone. Total gland weight was significantly higher for the latter two histological forms than for the former suggesting transformation with time of pure hyperplasia to nodular hyperplasia. Patients with chronic pyelonephritis had a mean gland weight higher than that of patients with chronic glomerulonephritis (3308 +/- 498 mg versus 1824 +/- 358 mg, p less than 0.01). No relation was found between total gland weight and plasma calcium, phosphate or alkaline phosphatases. However, a weak relation existed between total gland weight and plasma immunoreactive parathyroid hormone. In addition, a negative relation was observed between highest prior plasma aluminium and gland weight when considering only patients with a gland weight less than 2000 mg. Parathyroid gland aluminium content was significantly higher in haemodialysis patients than in nonuraemic patients with primary hyperparathyroidism. A direct relation was found between parathyroid gland and bone aluminium. In conclusion, in haemodialysis patients with evolving hyperparathyroidism initially diffuse gland hyperplasia appears to be associated progressively with nodule formation. Circulating immunoreactive parathyroid hormone is positively related to total gland weight.(ABSTRACT TRUNCATED AT 250 WORDS)
Fifty-eight patients on intermittent haemodialysis underwent parathyroidectomy because of severe secondary hyperparathyroidism. Mean individual parathyroid gland weight was 689 +/- 62 (SEM) mg. Mean total gland weight per patient was between two and three grams. Increasing nodule formation within hyperplastic glands appeared to develop with increasing time of duration of hyperparathyroidism. Patients with chronic pyelonephritis had a higher gland weight than those with chronic glomerulonephritis. A direct relationship was found between gland weight and circulating immunoreactive parathyroid hormone, but an inverse relationship between gland weight and plasma aluminium concentration. The higher the parathyroid gland aluminium, the higher was the bone aluminium concentration.
Africa, and in particular North Africa, is a site of high prevalence of carcinoma of the nasopharynx in the young subject. There is a marked male predominance and a clear peak of incidence between 15 and 25 years. The presenting feature is usually rapidly growing cervical lymphadenopathy. The diagnosis is based upon histological examination of these nodes. It is a squamous carcinoma, usually highly undifferentiated and difficult to identify. However, for the experienced observer, the special appearance of tumour proliferation makes it possible to localise the primary tumour in the epi-pharyngeal region. Current work is aimed at research into a possible genetic predisposition and the relationship which the carcinoma may have with the Epstein-Barr virus.
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The authors report two cases of periarteritis nodosa associated with carcinoma. The first case was a man with an anaplastic bronchial carcinoma, the second was a woman with a rectal adenocarcinoma. Study of the association of certain collagen diseases with carcinoma was made to emphasize the great rareness of this association.
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