Progrès dans le traitement chirurgical des adénomes parathyroïdiens primaires

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Intraoperative measurement of parathyroid hormone in minimally invasive surgery for parathyroid adenoma

INTRODUCTION: In the past bilateral neck exploration was the gold standard for successful surgical management of primary hyperparathyroidism. More restricted procedures have been introduced recently thanks to imaging techniques and intraoperative parathyroid hormone assay confirming eradication of hyperfunctioning tissue. METHODS: Thirty patients operated for parathyroid adenoma were submitted to intraoperative PTH determination with Quick Pack immunochemiluminescent assay (Nichols lab.) prior to excision and 5, 10 and 20 minutes after removal of the presumed hyperactive gland. Eleven patients were operated on by a minimally invasive procedure with videoassistance. RESULTS: Response to excision of the hyperfunctioning gland was evidenced by a significant decrease of PTH levels (50% of initial value) in 26 patients. Plasma PTH levels decreased by at least 80% of pre-excisional value after 20 minutes, 70% after 10 minutes and by 50% after 5 minutes. In 2 cases, significant decrease of PTH was obtained after 45 and 60 minutes respectively. In 2 other cases, the adenoma could not be found and there was no decrease of PTH even after extensive exploration of the neck. In the 11 patients who underwent minimal invasive surgery, 2 were converted to open neck surgery: in one case the adenoma was not accessible in the upper part of the neck, in the other case the hyperfunctioning gland remained undiscovered. CONCLUSION: intraoperative measurement of PTH should be considered a reliable and reproducible method for evaluation of the secreting activity of a parathyroid gland. The Quick Pack method has the advantage of confirming that the hyperactive gland has really been eradicated and consequently of considerably reducing operating time and avoiding extensive exploration of the neck.Journal Articleinfo:eu-repo/semantics/publishe

A Delayed Fatal Metastatic Hürthle Cell Carcinoma

Hürthle (oxyphilic or oncocytic) cell carcinoma is a variant of follicular cell carcinoma of thyroid. Although this entity of thyroid cancer is well known, its occurrence in young patients has scarcely been reported. We report a case of a 26 year-old male patient, at the time of diagnosis, of Turkish origin, who developed a tracheal, pulmonary and mediastinal metastatic Hürthle cell carcinoma with bilateral cervical and mediastinal lymphadenopathies. This case illustrates an aggressive and metastatic cancer at the time of diagnosis and resistant to all treatment options including surgery, chemotherapy and radioactive iodine

A study to determine the correlation between clinical, fiber-optic endoscopic evaluation of swallowing and videofluoroscopic evaluations of swallowing after prolonged intubation

Background: Clinical evaluation of swallowing disorders postextubation is often neglected. Videofluoroscopy is the gold standard with fiber-optic endoscopic evaluation of swallowing (FEES) having a high sensitivity. The aim of this study was to analyze the correlations between clinical, FEES, and videofluoroscopic evaluations in the intensive care unit. Methods: Twenty-one patients extubated after prolonged intubation were subjected to a clinical evaluation of swallowing and FEES within 24 hours. This was repeated at 48 hours with a videofluoroscopic evaluation with identical swallowing-namely, boluses of liquid and thickened water. The patients were scored from 0 (normal) to 3 (worst). Results: There was no correlation between the oral phase (bedside evaluation) and FEES. The correlation between pharyngeal phase (palatal and laryngeal elevation, pharyngeal rales, and gag reflex) before and after swallowing at 24 and 48 hours was statistically significant (liquid water P =.025 [24 hours] vs P <.001 [48 hours]; thickened water P <.001 [24 and 48 hours]). Clinical assessment, although not statistically significant, failed to detect silent aspiration (P =.58). There was a good correlation between FEES and videofluoroscopy as opposed to clinical assessment and videofluoroscopy (P <.001 vs P =.762). Conclusion: Cough is a reliable sign of swallowing disorder but does not exclude silent aspiration and contraindicates oral feeding. Cough induced by liquid water should lead to modification of diet in terms of consistency and viscosity with cough reassessment. © 2011 American Society for Parenteral and Enteral Nutrition.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Preoperative localization of parathyroid adenoma: A comparison between the information provided by traditional SPECT-radiological CT fusion and direct hybrid SPECT-CT fusion

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Progrès dans la mise au point préopératoire et la chirurgie des adénomes parathyroïdiens

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