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Baud G, Chereau N, De Ponthaud C, Santucci N, Sebag F, Goudet P. Scope of prophylactic lymph node dissection in the surgical treatment of differentiated thyroid cancer. Recommendations of the AFCE (Association francophone de chirurgie endocrinienne) with the SFE (Société française d'endocrinologie) and the SFMN (Société française de médecine nucléaire). J Visc Surg 2023:S1878-7886(23)00068-1. [PMID: 37127470 DOI: 10.1016/j.jviscsurg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Prophylactic lymph node dissection is considered only for papillary cancers. It is not indicated for vesicular cancers or oncocytic cancers, nor should it entail a secondary surgical intervention in the event of an incidental discovery of papillary cancer on a thyroidectomy specimen. Prophylactic lymph node dissection means a cervical lymph node dissection in the absence of any pre- or intraoperative evidence (biological, cytological, histological, clinical or ultrasound) of lymph node metastases. There is currently no evidence in the literature that prophylactic central dissection improves overall survival, which is similar for N0 and NX patients. Yet although prophylactic lymph node dissection is not justified by overall survival, it does seem to reduce the risk of locoregional recurrence in the case of micro-N1, and it allows occult metastases to be detected and a tumour to be reclassified. This enables patients at risk of recurrence to be more surely identified and therapeutic strategy and follow-up adapted accordingly. Prophylactic homolateral central lymph node dissection is warranted for papillary cancers with largest ultrasound diameter 4cm and above and/or with intraoperative macroscopic evidence of perithyroid tissue invasion. The benefits and risks of lymph node dissection must be assessed and discussed on a case-by-case basis. Only a central lymph node dissection homolateral to the tumour is recommended, except for bilateral or isthmic cancers, for which a prophylactic bilateral central lymph node dissection may be considered. This bilateral lymph node dissection incurs an increased risk of complications (parathyroids, recurrent laryngeal nerve). Prophylactic lateral lymph node dissection is not recommended.
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Affiliation(s)
- Grégory Baud
- General and Endocrine Surgery Department, University Hospital Center of Lille, Lille, France.
| | - Nathalie Chereau
- Digestive and Endocrine Surgery Department, University Hospital Center Pitié Salpêtrière, Paris, France
| | - Charles De Ponthaud
- Digestive and Endocrine Surgery Department, University Hospital Center Pitié Salpêtrière, Paris, France
| | - Nicolas Santucci
- Department of Endocrine and Metabolic Surgery, University Hospital Center of Dijon Bourgogne, Dijon, France
| | - Fréderic Sebag
- Endocrine and Metabolic General Surgery Department, University Hospital of Marseille Conception, Marseille, France
| | - Pierre Goudet
- Department of Endocrine and Metabolic Surgery, University Hospital Center of Dijon Bourgogne, Dijon, France
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Benali K, Barre V, Hermida A, Milhem A, Philibert S, Boveda S, Bars C, Anselme F, Maille B, André C, Behaghel A, Moubarak G, Clémenty N, Da Costa A, Arnaud M, Venier S, Sebag F, Jesel L, Macle L, Martins R. Atrial fibrillation recurrences despite durable pulmonary vein isolation: Characteristics, management and outcomes, the PARTY-PVI study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Goren S, Paladino NC, Laks S, Cuny T, Vaillant-Lombard J, Mennetrey C, Assaf D, Hindié E, Guerin C, Fargette C, Taïeb D, Sebag F. Diagnostic Rechallenge with 18F-FCH PET/CT Often Allows Minimally Invasive Parathyroidectomy While Maintaining Exceptional Cure Rates. World J Surg 2022; 46:2409-2415. [PMID: 35763102 DOI: 10.1007/s00268-022-06629-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive parathyroidectomy (MIP) has gained acceptance as the preferred surgical procedure for management of primary hyperparathyroidism (pHPT). Appropriate selection of patients for a MIP is a crucial step in its utilization. The aim of the study was to evaluate the role of 18F-FCH PET/CT as second-line imaging for accurately directing MIP. METHODS This is a retrospective single-center study. Seventy-two patients with biochemical evidence of pHPT and a non-conclusive or negative first-line imaging (ultrasound and dual isotope subtraction scintigraphy) received 18F-FCH PET/CT between January 2018 and February 2020. All imaging studies were performed at our institution. Assessment of therapeutic changes and outcomes was performed. RESULTS of the 72 patients imaged with 18F-FCH PET/CT, 54 subsequently underwent parathyroidectomy. When considering the ability of 18F-FCH PET/CT alone to predict a uniglandular disease, the sensitivity, specificity, PPV and NPV were 92.7% (95%CI: 80.1-98.5), 46.2% (19.2-74.9), PPV 87.3% (80.5-92) and NPV 61.2% (31.4-84.5), respectively. When we combined the data provided by 18F-FCH PET/CT with the data already collected from 1st line imaging we were able to complete a minimally invasive surgery in 38 of the 41 (92%) patients with a uniglandular disease. Thirteen patients (24%) had a multiglandular disease, all of them except one underwent bilateral neck exploration based on the data collected by all imaging modalities combined. Overall, cure was achieved in 53 (98%) patients. CONCLUSION 18F-FCH PET/CT, interpreted along with first-line imaging results in selected patients, can better facilitate utilization of MIS while maintaining exceptional cure rates.
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Affiliation(s)
- Shani Goren
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France
- Department of General and Oncological Surgery-Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France
| | - Shachar Laks
- Department of General and Oncological Surgery-Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Thomas Cuny
- Department of Endocrinology, Conception University Hospital, APHM, Aix Marseille University, Marseille, France
| | - Josiane Vaillant-Lombard
- Department of Radiology, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Clément Mennetrey
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264, rue Saint-Pierre, 13385, Marseille, France
| | - Dan Assaf
- Department of General and Oncological Surgery-Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Elif Hindié
- Department of Nuclear Medicine, University Hospital of Bordeaux, Bordeaux, France
| | - Carole Guerin
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France
| | - Christelle Fargette
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264, rue Saint-Pierre, 13385, Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264, rue Saint-Pierre, 13385, Marseille, France.
| | - Fréderic Sebag
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France
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Mahmoudi K, Galea R, Elhadad S, Rezine LZ, Sebag F, Landolff Q, Raber L, Amabile N. Left atrial appendage remodeling following percutaneous closure with WATCHMAN 2.5 and FLX: insights from the WATCH-DUAL registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Percutaneous left atrial appendage closure (LAAC) has emerged as a valid option for prevention of thromboembolic events in patients with non-valvular atrial fibrillation and contraindications for oral anticoagulation. The most recent devices have been created to improve the intervention efficiency and to allow the procedure in a wider range of anatomies. The new-generation Watchman FLX (WMFLX) features a new design but its in vivo performances have not been compared to the previous WATCHMAN 2.5 (WM2.5) prosthesis. Hence, the data regarding conformability, compression and device-related LAA remodeling are scarce.
Purpose
To compare the anatomical results of WM2.5 and WMFLX implantation and impact on LAA dimensions.
Methods
This study included LAAC patients from the WATCH-DUAL registry who benefited from a pre- and post-intervention CT scan. The WATCH-DUAL study was a dual center observational study including all the LAAC procedures prospectively collected in local registries from two high-volume centres between November 2017 and December 2020. The LAA and device dimensions were measured in a centralized core lab by 3D CT scan reconstruction methods, focusing on the device landing zone (LZ/defined as the cross section of the appendage that was perpendicular to its axis and connected the circumflex artery to a point 1 to 2 cm inside the LAA).
Results
This analysis included n=107 patients (n=58 WMFLX, n=49 WM2.5). The patients clinical profiles didn't differ, except for a higher proportion of coronary artery disease in WM2.5 group. The LAA dimensions were comparable between groups. There was a significantly higher proportion of chickenwing shapes in the WMFLX patients. The mean device baseline diameter was in the WMFLX compared to the WM2.5 patients (28.8±0.5 vs. 25.7±0.4 mm, p<0.001).
The median delay for CT control was 48 (43–62) days. The LZ area (451 (363–521) vs. 366 (260–459) mm2, p<0.001) and minimal diameter (23.0 (20.7–24.8) vs. 18.7 (15.9–21.8) mm, p<0.001) significantly increased after implantation among patients. The LZ area increase absolute value and percentage were 101 (18–151) mm2 and 28 (4–54) % respectively. The LZ dimensions increase was more pronounced in the WMFLX group: these patients exhibited post LAAC larger LZ area and dimensions compared to the WM2.5 cases. The LAA eccentricity was reduced after implantation: the ratio LZ maximal/LZ minimal diameter significantly decreased for all patients (r=1.28 (1.18–1.40) vs. 1.06 (1.05–1.09), p<0.001). Comparable results were observed in WMFLX and WM2.5 patients.
A multivariable regression analysis demonstrated that baseline LAA length, baseline LZ eccentricity and WM FLX use were independent predictors of LAA remodeling/dimensions increase.
Conclusion
LAA dimensions increased over time at the site of WM prosthesis implantation suggesting a local positive appendage remodeling after procedure. This phenomenon appears to be more pronounced with the WMFLX device.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mahmoudi
- Institut Mutualiste Montsouris, Paris, France
| | - R Galea
- Inselspital - University of Bern, Bern, Switzerland
| | - S Elhadad
- JOSSIGNY SITE OF GHEF MARNE LA VALLEE, Jossigny, France
| | - L Z Rezine
- JOSSIGNY SITE OF GHEF MARNE LA VALLEE, Jossigny, France
| | - F Sebag
- Institut Mutualiste Montsouris, Paris, France
| | - Q Landolff
- Institut Mutualiste Montsouris, Paris, France
| | - L Raber
- Inselspital - University of Bern, Bern, Switzerland
| | - N Amabile
- Institut Mutualiste Montsouris, Paris, France
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Salgues B, Guerin C, Amodru V, Pattou F, Brunaud L, Lifante JC, Mirallié E, Sahakian N, Castinetti F, Loundou A, Baumstarck K, Sebag F, Taïeb D. Risk stratification of adrenal masses by [ 18 F]FDG PET/CT: Changing tactics. Clin Endocrinol (Oxf) 2021; 94:133-140. [PMID: 32978795 DOI: 10.1111/cen.14338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT [18 F]FDG PET/CT improves adrenal tumour characterization. However, there is still no consensus regarding the optimal imaging biomarkers of malignancy. OBJECTIVES To assess the performance of Tumour standardized uptake value (SUV)max :Liver SUVmax for malignancy-risk and to build and evaluate a prediction model. DESIGN/METHODS The cohort consisted of consecutive patients with adrenal masses evaluated by [18 F]FDG PET/CT. The gold standard for malignancy was based on histology or a multidisciplinary consensus in nonoperated cases. The performance of the previously reported cut-off for Tumour SUVmax :Liver SUVmax (>1.5) was evaluated in this independent cohort. Additionally, a predictive model of malignancy was built from the training cohort (previous study) and evaluated in the validation cohort (current study). RESULTS Sixty-four patients were evaluated; 28% of them had a Cushing's syndrome. Fifty-four adrenal masses were classified as benign and 10 as malignant (including 7 adrenocortical carcinomas). Compared to benign masses, malignant lesions were larger in size, had higher unenhanced densities and higher [18 F]FDG uptake. CT-derived anthropometric parameters did not differ between benign and malignant masses. A tumour SUVmax :Liver SUVmax > 1.5 showed a good diagnostic performance: Se = 90.0%/Sp = 92.6%/PPV = 69.2%/NPV = 98.0% and accuracy = 92.2%. A predictive model based on tumour size and tumour-to-liver uptake SUVmax ratio for malignancy-risk was validated and provides a complementary approach to the ratio. CONCLUSIONS Tumour SUVmax :Liver SUVmax uptake ratio is a useful biomarker for diagnosis of adrenal masses. Another tactic would be to calculate with the model an individual risk of malignancy and integrate this information into a shared decision-making process.
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Affiliation(s)
- Betty Salgues
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, Marseille, France
| | - Carole Guerin
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - Vincent Amodru
- Service d'Enodrinologie, Centre hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - François Pattou
- Service de Chirurgie Endocrinienne, Centre Hospitalier Régional Universitaire de Lille, Lille, France
- Université Lille nord de France, INSERM, Lille, France
| | - Laurent Brunaud
- Université de Lorraine, Service de Chirurgie et unité multidisciplinaire de Chirurgie Endocrinienne, Métabolique et Thyroïdienne, Centre hospitalo-universitaire Nancy Brabois, Nancy, France
| | | | - Eric Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, CHU Nantes, Nantes, France
| | - Nicolas Sahakian
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, Marseille, France
| | - Frédéric Castinetti
- Service d'Enodrinologie, Centre hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - Anderson Loundou
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, Marseille, France
| | - Karine Baumstarck
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, Marseille, France
| | - Fréderic Sebag
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - David Taïeb
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, Marseille, France
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Lepillier A, Solimene F, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Stabile G. Reproducibility of pulmonary vein isolation guided by the ablation index: One-year outcome of the AIR registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pasteur-Rousseau A, Sebag F. [Cardiac CT-Scan: Utility for the management of chest pain, cardiovascular screening and before atrial fibrillation ablation procedure]. Ann Cardiol Angeiol (Paris) 2020; 69:276-288. [PMID: 33071021 DOI: 10.1016/j.ancard.2020.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 01/22/2023]
Abstract
Cardiac CT-scan is recommended for sorting patients presenting with stable or acute chest pain with low to intermediate risk of coronary artery disease (CAD). Recent studies have shown its reliability for diagnosing CAD in high-risk patients, notably those with acute coronary syndrome (ACS) without ST-elevation. Coronary CT-scan also represents a great opportunity for the screening of atherosclerosis in patients at risk and allows a better prevention of coronary artery disease by introduction of preventive treatments in patients with abnormal coronary CT-scan, especially statins. It is useful for the follow-up of patients who underwent a coronary arteries revascularization with either stents or bypasses. Coronary arteries calcium scoring appears to be an independent predictive factor of cardiovascular and total mortality and its use is recommended for stratifying the cardiovascular risk. However, its interpretation remains unobvious and the patient management is poorly improved by the results. Anyway, if the score is above zero, atherosclerosis is present and therefore a lipid lowering treatment should be discussed. Cardiac CT-scan has become the Gold Standard exam before an aortic valve replacement, for the measurement of the aortic root notably, allowing the best prothesis selection. Before atrial fibrillation ablation procedure by pulmonary vein isolation, the cardiac CT-scan allows a 3-D visualization of the two atria, especially the left atrium, and rules out any suspicion of cardiac thrombus. It allows the research of an anomalous pulmonary venous connection. The 3-D support will also enable the operator to navigate in the heart during the ablation procedure.
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Affiliation(s)
- A Pasteur-Rousseau
- Institut Cœur Paris Centre, clinique Turin, Clinique internationale du Parc Monceau, clinique Floréal, 31, rue du Petit-Musc, 75004 Paris, France.
| | - F Sebag
- Institut mutualiste Montsouris, Clinique Turin, Paris, France.
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Porterfield C, Wystrach A, Rossi P, Rillo M, Sebag F, Dorszewski A, Gora P, Nilsson K. P1023Comparison of gap identification using three technologies for confirmation of pulmonary vein isolation. Europace 2020. [DOI: 10.1093/europace/euaa162.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Tools and techniques used for confirmation of PVI vary greatly, and it is unclear whether the use of any particular combination of tools and techniques provides greater sensitivity for identifying gaps periprocedurally. A high-density mapping catheter enabling simultaneous recording of adjacent bipolar EGMs in two directions is now available in multiple geographies, and it has been suggested that this technology may provide improved sensitivity for gap identification.
Purpose
To identify trends in the incidence of gaps identified in de novo PVI lines using three diagnostic catheter technologies, which may be suggestive of improved sensitivity for gap identification.
Methods
Self-reported procedural data was prospectively collected in de novo atrial fibrillation ablation cases utilizing one of three technologies to confirm PVI: 10-pole circular mapping catheter (CMC10), 20-pole circular mapping catheter (CMC20), and Advisor HD Grid catheter (HD Grid). Techniques for PVI confirmation were analyzed for each group, and the incidence and location of gaps identified by each technology was quantified.
Results
Data was collected in 99 cases across 11 centers in Europe and the United States. PVI was confirmed via entrance and/or exit block in all cases. CMC10 was utilized in 30 cases, CMC20 in 36, and HD Grid in 33. Use of adenosine varied across groups (CMC10: 6.7%; CMC20: 86.1%; HD Grid: 41.7%), as did application of a waiting period (CMC10: 96.7%; CMC20: 2.8%; HD Grid: 11.1%). Gaps were identified in in 36.7%, 38.9%, and 81.8% of cases using CMC10, CMC20, and HD Grid, respectively. HD Grid identified significantly more gaps than the other two technologies (p = 0.015), identifying an average of 49.0% and 139.1% more gaps per patient than CMC20 and CMC10, respectively (HD Grid: 2.15/patient; CMC20: 1.44/patient; CMC10: 0.9/patient). The location and incidence of gaps identified by each technology is shown in Figure 1.
Conclusions
Significantly more gaps were identified by the Advisor HD Grid catheter, as compared to a 10-pole or 20-pole circular mapping catheter. While this does not represent a direct comparison of the sensitivity for identification of gaps across these three technologies, and results could be impacted by other factors (e.g., operator, ablation technique, PVI confirmation technique, etc.), the strong trend toward an increased number of gaps identified with the HD Grid is striking. This may warrant further study including direct comparison of gap identification across technologies, and the resulting impact on long-term clinical outcomes when these additional gaps are ablated during the index procedure.
Abstract Figure.
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Affiliation(s)
- C Porterfield
- French Hospital, San Luis Obispo, CA, United States of America
| | - A Wystrach
- Sozialstiftung Klinikum Bamberg, Bamberg, Germany
| | - P Rossi
- S. Giovanni Calibita FateBeneFratelli – Isola Tiberina, Rome, Italy
| | - M Rillo
- Casa di Cura Villa Verde, Taranto, Italy
| | - F Sebag
- Institut Mutualiste Montsouris, Departement de Cardiologie, Paris, France
| | - A Dorszewski
- Evangelisches Krankenhaus Dinslaken, Dinslaken, Germany
| | - P Gora
- Abbott, Minneapolis, United States of America
| | - K Nilsson
- Piedmont Athens Regional Medical Center, Athens, GA, United States of America
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Baud G, Brunaud L, Lifante JC, Tresallet C, Sebag F, Bizard JP, Mathonnet M, Menegaux F, Caiazzo R, Mirallié E, Pattou F. Endocrine surgery during and after the COVID-19 epidemic: Expert guidelines from AFCE. J Visc Surg 2020; 157:S43-S49. [PMID: 32448761 PMCID: PMC7190473 DOI: 10.1016/j.jviscsurg.2020.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic commands a major reorganisation of the entire French healthcare system. In France, general rules have been issued nationally and implemented by each healthcare centre, both public and private, throughout France. Guidelines drafted by an expert group led by the French-speaking Association of Endocrine Surgery (AFCE) propose specific surgical management principles for thyroid, parathyroid, endocrine pancreas and adrenal surgery during and after the COVID-19 epidemic.
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Affiliation(s)
- G Baud
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - L Brunaud
- Chirurgie viscérale, métabolique et cancérologique (CVMC), CHRU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - J-C Lifante
- Chirurgie digestive, oncologique et endocrinienne, CHU de Lyon, 69310 Pierre-Bénite, France
| | - C Tresallet
- Chirurgie viscérale et digestive, AP-HP, hôpital Avicenne, 93000 Bobigny, France
| | - F Sebag
- Chirurgie générale et endocrinienne, AP-HM, La Conception, 13005 Marseille, France
| | - J-P Bizard
- Chirurgie endocrinienne et viscérale, hôpital privé Arras-les-Bonnettes, 62000 Arras, France
| | - M Mathonnet
- Chirurgie digestive et endocrinienne, CHU de Limoges, 87000 Limoges, France
| | - F Menegaux
- Chirurgie générale digestive et endocrinienne, AP-HP, hôpital Pitié-Salpêtrière, Sorbonne université, 75013 Paris, France
| | - R Caiazzo
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - E Mirallié
- Chirurgie cancérologique, digestive et endocrinienne (CCDE), CHU de Nantes, 44093 Nantes, France
| | - F Pattou
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France.
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Baud G, Brunaud L, Lifante JC, Tresallet C, Sebag F, Bizard JP, Mathonnet M, Menegaux F, Caiazzo R, Mirallié É, Pattou F. [Endocrine surgery during and after the COVID-19 epidemic: Guidelines from AFCE]. ACTA ACUST UNITED AC 2020; 157:S44-S51. [PMID: 32355510 PMCID: PMC7190492 DOI: 10.1016/j.jchirv.2020.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
La pandémie de COVID-19 impose une réorganisation majeure de l’ensemble de notre système de soins. En France, des règles générales ont été diffusées au niveau national et sont déclinées par chaque établissement, public comme privé, sur l’ensemble du territoire. Ces recommandations, rédigées par un groupe d’experts sous l’égide de l’Association francophone de chirurgie endocrinienne (AFCE), ont pour objectif de proposer des principes spécifiques de prise en charge chirurgicale au cours et au décours de l’épidémie de COVID- 19, pour les pathologies chirurgicales de la thyroïde, des parathyroïdes, du pancréas endocrine, et des surrénales.
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Affiliation(s)
- G Baud
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - L Brunaud
- Chirurgie viscérale, métabolique et cancérologique (CVMC), CHRU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - J C Lifante
- Chirurgie digestive, oncologique et endocrinienne, CHU de Lyon, 69310 Pierre-Bénite, France
| | - C Tresallet
- Chirurgie digestive, bariatrique et endocrinienne, AP-HP, Hôpital Avicenne, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - F Sebag
- Chirurgie générale et endocrinienne, AP-HM, La Conception, 13005 Marseille, France
| | - J P Bizard
- Chirurgie endocrinienne et viscérale, hôpital privé Arras-lès-Bonnettes, 62000 Arras, France
| | - M Mathonnet
- Chirurgie digestive et endocrinienne, CHU de Limoges, 87000 Limoges, France
| | - F Menegaux
- Chirurgie générale digestive et endocrinienne, Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - R Caiazzo
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - É Mirallié
- Chirurgie cancérologique, digestive et endocrinienne (CCDE), CHU de Nantes, 44093 Nantes, France
| | - F Pattou
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
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11
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Castinetti F, Barlier A, Sebag F, Taieb D. Diagnostic des phéochromocytomes et paragangliomes. ONCOLOGIE 2020. [DOI: 10.3166/onco-2019-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les phéochromocytomes et les paragangliomes sont des tumeurs rares responsables d’une surmorbidité et d’une surmortalité. Au cours de ces 20 dernières années, de nombreuses avancées ont permis de mieux les caractériser sur le plan phénotypique (via l’imagerie métabolique) et génotypique (avec la mise en évidence de nombreux gènes de prédisposition). La prise en charge d’un phéochromocytome ou d’un paragangliome nécessite désormais le recours à un centre expert dès la phase diagnostique. L’objectif de cette revue est de souligner les principales caractéristiques de ces tumeurs, et ce, afin de sensibiliser le clinicien aux différentes étapes permettant d’aboutir à une prise en charge optimale.
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12
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Amabile N, Bagdadi I, Armero S, Elhadad S, Sebag F, Saby L, Mammhoudi K, Mechulan A, Landolff Q, Caussin C, Boulanger CM. P3725Impact of left atrial appendage closure on circulating microvesicles levels: the MICROPLUG study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Percutaneous left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation therapy for the prevention of systemic embolism in patients with non-valvular atrial fibrillation (AF). Microvesicles (MVs) are shed-membrane particles generated during various cellular types activation/ apoptosis that carry out diverse biological effects, including procoagulant effects. Left atrial appendage has been suspected to be a potential source of MVs during AF, but the effects of LAAO on MVs production and circulating levels are unknown.The aim of this work study was to assess the variations of circulating MVs levels following LAAO.
Methods
The study includedn=25 LAAO patients and n=25 control patients who underwent coronary angiography. LAAO and control patients were treated by clopidogrel+ aspirin loading doses before procedures. Blood samples were drawn before antiplatelets therapy & 2 days after for all. A third sample was collected 6 weeks after procedure in LAAO patients. In N=10 extra patients, blood samples were collected from right atrium, left appendage and pulmonary vein during LAAO procedure. Circulating procoagulant (AnnV+), endothelial (CD62e+), platelets (CD41+), red blood cells/RBC (CD235+), leukocytes (CD11+) derived-MVs were measured using flow cytometry methods.
Results
Control and LAAO groups baseline characteristics were comparable, except for the higher age & incidence of previous stroke and lower incidence of coronary artery disease in LAAO patients. Baseline levels of the different microvesicles were comparable in both groups. In the LAAO group, we observed a significant increase of AnnV+ MVs (4355 [1712–8478] vs. 1798 [1006–2759] ev/μL, p=0.001), platelets (1615 [833–4772] vs. 802 [358–1376] ev/, p=0.005), RBC (207 [85–708] vs. 35 [5–84] ev/μL, p<0.001), and leukocytes MVs (1368 [783–2319] vs. 1067 [827–1564] ev/μL, p=0.02) following intervention, whereas only AnnV+ MVs levels significantly rose in controls (3701 [2043–7017] vs. 1506 [1033–4899] ev/μL, p=0.03). The 6-w analysis showed that RBC-MVs (55 [8–182 ev/μL]and AnnV+ MVs levels (2468 [1813–5576 ev/μL]were still significantly increased compared to baseline values in LAAO patients (p<0.05). The in-site analysis revealed that leukocyte MVs and CD62e+ endothelial-MVs were significantly higher in left atrial appendage compared to pulmonary vein (respectively 430 [26–700 vs. 161 [0–426] and 344 [22–723] vs. 200 [120–326] ev/μL, p<0.05), suggesting a local increased production. No major adverse ischemic or bleeding event was observed in any patient post procedural course.
Conclusions
LAAO impact circulating MVs and could create mild pro-coagulant status, inflammation and potential erythrocytes activation due to device presence during the first 6 weeks following intervention. These results suggest that careful attention should be paid in the anti-platelet/anti-coagulant therapy in the post procedural course.
Acknowledgement/Funding
This work was funded by a research grant from the French Society of Cardiology and a research grant from St Jude/Abbott
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Affiliation(s)
- N Amabile
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - I Bagdadi
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - S Armero
- Hôpital Européen Marseille, Marseille, France
| | - S Elhadad
- CH Marne la Vallée, Jossigny, France
| | - F Sebag
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - L Saby
- Hôpital Européen Marseille, Marseille, France
| | - K Mammhoudi
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - A Mechulan
- CHP Clairval, Department of Cardiology, Marseille, France
| | - Q Landolff
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiology, Paris, France
| | - C M Boulanger
- Paris Cardiovascular Research Center (PARCC), Paris, France
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13
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Meunier E, Payet C, Peix JL, Kraimps JL, Menegaux F, Pattou F, Sebag F, Lifante JC, Duclos A. Influence of Daily Variations in Individual Surgeon's Operative Time on Patient Outcomes. World J Surg 2019; 43:2720-2727. [PMID: 31312949 DOI: 10.1007/s00268-019-05081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence is lacking regarding the potential association between daily variation in individual surgeon's operative time, procedure after procedure, and risk of patient complication. We assumed that surgeon deviation from the expected procedure duration may be harmful for patient. METHOD All patients who underwent a thyroidectomy undertaken in five hospitals during a 1-year period were included prospectively. For each thyroidectomy, we estimated the expected operative time from a multilevel linear regression considering the attending surgeon who performed the operation, the patient preoperative risk, and the procedure complexity. Three groups of thyroidectomies were identified according to whether the observed duration is: slower than expected, as expected, or faster than expected. Rates of permanent recurrent laryngeal nerve palsy and hypoparathyroidism at 6 months were then compared between these groups. RESULTS A total of 3102 patients who underwent a thyroidectomy undertaken by 22 surgeons were considered. Risk of laryngeal nerve palsy was higher in the "slow" group than in the "normal" group (OR = 4.63, 95% confidence interval 2.21-9.70), as was that of hypoparathyroidism (OR = 2.43, 95% confidence interval 1.21-4.88). There was no significant difference between "fast" and "normal" groups for either complication. Deviation from expected procedure duration was more frequent at the end than at the beginning of the daily operation schedule (29.4% vs. 18.3%, respectively, P < .001). CONCLUSION Patients had a greater risk of complication when the surgeon performed thyroidectomy slower than expected. Surgeons avoiding excessive deviations from their expected procedures durations reflect safer practice.
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Affiliation(s)
- Etienne Meunier
- Health Data Centre, Public Health Department, Hospices Civils de Lyon, Lyon, France.
| | - Cécile Payet
- Health Data Centre, Public Health Department, Hospices Civils de Lyon, Lyon, France.,Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Louis Peix
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, Lyon, France
| | - Jean-Louis Kraimps
- Department of Endocrine Surgery, Jean Bernard Hospital, Poitiers University, Poitiers, France
| | - Fabrice Menegaux
- Service de Chirurgie Générale, Viscérale et Endocrinienne, Hôpital la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Pattou
- Chirurgie Générale et Endocrinienne, Centre Hospitalier Régional Universitaire de Lille, Lille, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Université Lille Nord de France, Lille, France
| | - Fréderic Sebag
- Chirurgie Générale, Endocrinienne et Métabolique, Centre Hospitalier Universitaire la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean Christophe Lifante
- Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France.,Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, Lyon, France
| | - Antoine Duclos
- Health Data Centre, Public Health Department, Hospices Civils de Lyon, Lyon, France.,Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France
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14
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Blanchard C, Bannani S, Pattou F, Brunaud L, Hamy A, Christou N, Mathonnet M, Dahan M, Prades J, Landecy G, Dernis H, Sebag F, Babin E, Bizon A, Lifante J, Jegoux F, Volteau C, Caillard C, Riche V, Mirallié É. Impact of body mass index on post‐thyroidectomy morbidity. Head Neck 2019; 41:2952-2959. [DOI: 10.1002/hed.25773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Claire Blanchard
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
| | - Sahar Bannani
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
| | - François Pattou
- CHU LilleUniversité de Lille, Chirurgie Générale et Endocrinienne Lille France
| | - Laurent Brunaud
- CHU Nancy ‐ Hôpital de BraboisService de Chirurgie Digestive, Hépato‐Biliaire, et Endocrinienne Nancy France
| | - Antoine Hamy
- CHU AngersChirurgie Digestive et Endocrinienne Angers Cedex 09 France
| | - Niki Christou
- CHU de Limoges ‐ Hôpital DupuytrenChirurgie Digestive, Générale et Endocrinienne Limoges Cedex France
| | - Muriel Mathonnet
- CHU de Limoges ‐ Hôpital DupuytrenChirurgie Digestive, Générale et Endocrinienne Limoges Cedex France
| | - Marcel Dahan
- CHU de Toulouse ‐ Hôpital LarreyChirurgie Thoracique, Pôle Voies Respiratoires Toulouse Cedex 9 France
| | - Jean‐Michel Prades
- CHU Saint‐Etienne ‐ Hôpital NordORL et Chirurgie cervico‐faciale et plastique Saint‐Etienne Cedex 2 France
| | - Gérard Landecy
- CHU de Besançon ‐ Hôpital Jean MinjozChirurgie digestive Besançon Cedex France
| | - Henri‐Pierre Dernis
- Centre Hospitalier du MansService ORL et chirurgie cervico‐faciale Le Mans Cedex 9 France
| | - Fréderic Sebag
- AP‐HM ‐ Hôpital de La TimoneChirurgie Générale Marseille France
| | - Emmanuel Babin
- CHU de CaenORL et chirurgie cervico‐faciale Caen Cedex 9 France
| | - Alain Bizon
- CHU d'AngersORL et chirurgie cervico‐faciale Angers Cedex 09 France
| | - Jean‐Christophe Lifante
- Centre Hospitalier Lyon‐SudChirurgie Générale, Endocrinienne, Digestive et Thoracique Pierre Bénite Cedex France
| | - Frank Jegoux
- CHU de Rennes ‐ Hôpital PontchaillouService ORL et chirurgie maxillo‐faciale Rennes Cedex 9 France
| | | | - Cécile Caillard
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
| | - Valery‐Pierre Riche
- Direction de Recherche cliniqueDépartement Partenariats et Innovation, cellule Innovation Nantes Cedex 1 France
| | - Éric Mirallié
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
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15
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Bannani S, Christou N, Guérin C, Hamy A, Sebag F, Mathonnet M, Guillot P, Caillard C, Blanchard C, Mirallié E. Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism. Br J Surg 2018; 105:223-229. [PMID: 29405278 DOI: 10.1002/bjs.10739] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/16/2017] [Accepted: 09/29/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Normocalcaemic primary hyperparathyroidism (NcPHPT) is a new clinical entity being diagnosed increasingly among patients with mild primary hyperparathyroidism (PHPT). The aim of this study was to evaluate quality of life and non-specific symptoms before and after parathyroidectomy in patients with NcPHPT compared with those with hypercalcaemic mild PHPT (Hc-m-PHPT). METHODS This was a prospective multicentre study of patients with mild PHPT from four university hospitals. Patients were evaluated before operation, and 3, 6 and 12 months after surgery for quality of life using the SF-36-v2® questionnaire, as well as for 25 non-specific symptoms. RESULTS Before operation, the only statistically significant difference between the NcPHPT and Hc-m-PHPT groups was in the mean(s.d.) blood calcium level (2·54 versus 2·73 mmol; P < 0·001). At 1 year after surgery, the blood calcium level had improved significantly in both groups, with no significant difference between them. Quality of life improved significantly in each group compared with its preoperative score, with regard to the physical component summary (P = 0·040 and P = 0·016 respectively), whereas the mental component summary improved significantly in the Hc-m-PHPT group only (P = 0·043). Only two non-specific symptoms improved significantly in the NcPHPT group compared with nine in the Hc-m-PHPT group. CONCLUSION Parathyroidectomy mildly improves quality of life and some non-specific symptoms in patients with NcPHPT.
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Affiliation(s)
- S Bannani
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - N Christou
- Service de Chirurgie Digestive, Générale et Endocrinienne, CHU Limoges, Limoges, France
| | - C Guérin
- Service de Chirurgie Générale, Endocrinienne et Métabolique, CHU Marseille, Marseille, France
| | - A Hamy
- Service de Chirurgie Viscérale, CHU Angers, Angers, France
| | - F Sebag
- Service de Chirurgie Générale, Endocrinienne et Métabolique, CHU Marseille, Marseille, France
| | - M Mathonnet
- Service de Chirurgie Digestive, Générale et Endocrinienne, CHU Limoges, Limoges, France
| | - P Guillot
- Service de Rhumatologie, Hôtel Dieu, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - C Caillard
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - C Blanchard
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - E Mirallié
- Clinique de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
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16
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Abstract
Left atrial appendage occlusion (LAAO) is an alternative option to oral anticoagulation therapy in patients with non-valvular atrial fibrillation. According to French regulations, this procedure is currently reserved for patients with formal contraindications to VKA and direct thrombin inhibitors. LAAO procedures reduce ischemic and stroke risks compared to no treatment and also reduce bleeding events compared to VKA therapy in eligible patients. The peri-procedural complications risk has been reported to be limited in the different series published so far. Although elderly patients (>75 years) have either higher ischemic and bleeding risk than younger subjects, they hardly benefit from optimal anticoagulation. Thus, these subjects might greatly benefit from LAAO. Published studies reported excellent feasibility and efficiency of LAAO procedure in elderly patients. Yet there is a trend towards a higher incidence of peri-procedural complications (including tamponade), long-term safety is excellent and comparable to what is observed in patients<75 years. Therefore, interventional percutaneous LAAO is an attractive strategy in elderly patients with atrial fibrillation that should be incorporated in a multidisciplinary management.
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Affiliation(s)
- N Amabile
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France.
| | - S Elhadad
- Service de cardiologie, CH Marne la Vallée, 77600 Jossigny, France
| | - C Roig
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - F Sebag
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - P Charles
- Service de médecine interne, institut mutualiste Montsouris, 75014 Paris, France
| | - C Caussin
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
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17
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Vermalle M, Alessandrini M, Graillon T, Paladino NC, Baumstarck K, Sebag F, Dufour H, Brue T, Castinetti F. Lack of functional remission in Cushing's syndrome. Endocrine 2018; 61:518-525. [PMID: 30019306 DOI: 10.1007/s12020-018-1664-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hypercortisolism leads to severe clinical consequences persisting after the onset of remission. These physical sequelae of cortisol exposure are known to profoundly impact the patient's quality of life. As psychological factors may be correlated with this quality of life, our objective was to determine the specific weight of psychological determinants of quality of life in patients in remission from hypercortisolism. PATIENTS AND METHODS In an observational study, 63 patients with hypercortisolism in remission were asked to complete exhaustive self-administered questionnaires including quality of life (WHOQoL-BREF and Cushing QoL), depression, anxiety, self-esteem, body image, and coping scales. Multivariate analyses were performed. Psychological variables relevant to the model were: anxiety, depression, self-esteem, body image, and positive thinking dimension of the Brief-COPE. Cortisol deficiency was defined as a potential confounder. RESULTS The median time since remission was 3 years. Patients had significantly lower quality of life and body satisfaction score than the French population and patients with chronic diseases. Depression significantly impaired all WHOQoL and Cushing QoL domains. A low body satisfaction score significantly impaired social relationships quality of life score. In total, 42.9% of patients still needed working arrangements, 19% had disability or cessation of work. CONCLUSION Patients in biological remission of hypercortisolism can rarely be considered as functionally cured: this is evidenced by altered quality of life, working arrangements, and chronic depression. A multidisciplinary management of these patients is thus mandatory on a long-term basis.
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Affiliation(s)
- M Vermalle
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
- Department of Endocrinology, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille (AP-HM), Centre de Référence des Maladies Rares Hypophysaires HYPO 13005, Marseille, France
| | | | - T Graillon
- Department of endocrine surgery, La Conception Hospital, Marseille, France
| | - N C Paladino
- Department of Neurosurgery, La Timone Hospital, Marseille, France
| | | | - F Sebag
- Department of Neurosurgery, La Timone Hospital, Marseille, France
| | - H Dufour
- Department of endocrine surgery, La Conception Hospital, Marseille, France
| | - T Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
- Department of Endocrinology, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille (AP-HM), Centre de Référence des Maladies Rares Hypophysaires HYPO 13005, Marseille, France
| | - F Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France.
- Department of Endocrinology, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille (AP-HM), Centre de Référence des Maladies Rares Hypophysaires HYPO 13005, Marseille, France.
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18
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Taïeb D, Jha A, Guerin C, Pang Y, Adams KT, Chen CC, Romanet P, Roche P, Essamet W, Ling A, Quezado MM, Castinetti F, Sebag F, Pacak K. 18F-FDOPA PET/CT Imaging of MAX-Related Pheochromocytoma. J Clin Endocrinol Metab 2018; 103. [PMID: 29534198 PMCID: PMC6276705 DOI: 10.1210/jc.2017-02324] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT MYC-associated factor X (MAX) has been recently described as a new susceptibility pheochromocytoma (PHEO) gene with a total of ~40 reported cases. At present, no study has specifically described the functional imaging phenotype of MAX-related PHEO. OBJECTIVE, PATIENTS, AND DESIGN The objective of the present study was to present our experience with contrast-enhanced computed tomography (CT) and 18F-fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography (PET)/CT in six consecutive patients (four at the initial diagnosis and two at the follow-up evaluation) with rare, but clinically important, MAX-related PHEOs. In five patients, 18F-FDOPA was also compared with other radiopharmaceutical agents. RESULTS The patients had five different mutations in the MAX gene that caused disruption of Max/Myc interaction and/or abolished interaction with DNA based on in silico analyses. All but one patient developed bilateral PHEOs during their lifetime. In all cases, 18F-FDOPA PET/CT accurately visualized PHEOs that were often multiple within the same gland or bilaterally and detected more adrenal and extra-adrenal lesions than did CT (per-lesion sensitivity, 90.9% vs 52.4% for CT/magnetic resonance imaging). The two PHEOs missed on 18F-FDOPA PET/CT were <1 cm, corresponding to nodular adrenomedullary hyperplasia. 68Ga-DOTA,Tyr3-octreotate PET/CT detected fewer lesions than did 18F-FDOPA PET/CT in one of three patients, and 18F-fluorodeoxyglucose PET/CT was only faintly positive in two of four patients with underestimation of extra-adrenal lesions in one patient. CONCLUSIONS MAX-related PHEOs exhibit a marked 18F-FDOPA uptake, a finding that illustrates the common well-differentiated chromaffin pattern of PHEOs associated with activation of kinase signaling pathways. 18F-FDOPA PET/CT should be considered as the first-line functional imaging modality for diagnostic or follow-up evaluations for these patients.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, Centre Européen
de Recherche en Imagerie Médicale, Aix-Marseille University, Marseille, France
- Correspondence and Reprint Requests: David Taïeb, MD, PhD, Service de Médecine Nucléaire, Centre
Hospitalo-Universitaire de la Timone, Centre Européen de Recherche en Imagerie Médicale,
Université Aix-Marseille, 264 rue Saint-Pierre, Marseille 13385, France. E-mail:
; or Karel Pacak, MD, PhD, DSc, FACE, Section of
Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of
Child Health and Human Development, Warren Grant Magnuson Clinical Center, National
Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive, MSC-1109, Bethesda,
Maryland 20892-1109. E-mail:
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, Warren Grant Magnuson Clinical Center,
National Institutes of Health, Bethesda, Maryland
| | - Carole Guerin
- Department of Endocrine Surgery, Conception University Hospital, Aix-Marseille
University, Marseille, France
| | - Ying Pang
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, Warren Grant Magnuson Clinical Center,
National Institutes of Health, Bethesda, Maryland
| | - Karen T Adams
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, Warren Grant Magnuson Clinical Center,
National Institutes of Health, Bethesda, Maryland
| | - Clara C Chen
- Nuclear Medicine Division, Radiology and Imaging Sciences, Warren Grant
Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Pauline Romanet
- Laboratory of Molecular Biology, Conception Hospital and National Center for
Scientific Research, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille,
Unité Mixte de Recherche 7286, Aix-Marseille University, Marseille, France
| | - Philippe Roche
- Integrative Structural and Chemical Biology and INT-3D Molecular Modeling
Platform, Cancer Research Centre of Marseille, National Center for Scientific Research,
Unité Mixte de Recherche 7258, Marseille, France
| | - Wassim Essamet
- Department of Neuropathology, La Timone University Hospital, Centre Européen de
Recherche en Imagerie Médicale, Aix-Marseille University, Marseille, France
| | - Alexander Ling
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National
Institutes of Health, Bethesda, Maryland
| | - Martha M Quezado
- Labaratory of Pathology, Center for Cancer Research, National Cancer Institute,
Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda,
Maryland
| | - Frédéric Castinetti
- Department of Endocrinology, Conception University Hospital, Aix-Marseille
University, Marseille, France
| | - Fréderic Sebag
- Department of Endocrine Surgery, Conception University Hospital, Aix-Marseille
University, Marseille, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, Warren Grant Magnuson Clinical Center,
National Institutes of Health, Bethesda, Maryland
- Correspondence and Reprint Requests: David Taïeb, MD, PhD, Service de Médecine Nucléaire, Centre
Hospitalo-Universitaire de la Timone, Centre Européen de Recherche en Imagerie Médicale,
Université Aix-Marseille, 264 rue Saint-Pierre, Marseille 13385, France. E-mail:
; or Karel Pacak, MD, PhD, DSc, FACE, Section of
Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of
Child Health and Human Development, Warren Grant Magnuson Clinical Center, National
Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive, MSC-1109, Bethesda,
Maryland 20892-1109. E-mail:
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Romanet P, Guerin C, Pedini P, Essamet W, Castinetti F, Sebag F, Roche P, Cascon A, Tischler AS, Pacak K, Barlier A, Taïeb D. Pathological and Genetic Characterization of Bilateral Adrenomedullary Hyperplasia in a Patient with Germline MAX Mutation. Endocr Pathol 2017; 28:302-307. [PMID: 27838885 PMCID: PMC6287616 DOI: 10.1007/s12022-016-9460-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In recent years, familial pheochromocytoma (PHEO) with germline mutations in the MAX (MYC associated factor X) gene has been reported in a few cases. Here, we investigated a 25-year-old patient with multiple PHEOs associated with a non-sense germline MAX mutation. Preoperative 18F-FDOPA PET/CT revealed bilateral adrenal involvement with multiple tumors. In addition, both adrenal glands were found to have diffuse or nodular adrenal medullary hyperplasia (AMH), a histopathological feature previously described as a precursor of MEN2- and SDHB-related PHEOs but not MAX. After bilateral adrenalectomy, different paraffin-embedded and frozen samples were analyzed for allelic imbalances of the MAX gene using allelic quantification by pyrosequencing. The expression of the protein MAX was studied by immunohistochemistry. All PHEOs but also nodular AMH exhibited a loss of the normal allele. By contrast, the diffuse AMH did not show loss-of-heterozygosity. Nevertheless, immunohistochemistry demonstrated loss of protein MAX expression in all samples including diffuse hyperplasia, suggesting a causative role of MAX mutation for both PHEOs and AMH. The present case shows that both nodular and diffuse AMH belongs to the spectrum of MAX-related disease. These data support the possible continuum between nodular AMH and PHEO, expanding the qualification of micro-PHEO to nodular AMH.
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Affiliation(s)
- Pauline Romanet
- Laboratory of Molecular Biology, Aix Marseille University CNRS, CRN2M, Marseille, France & APHM Conception, 13385, Marseille, France
| | - Carole Guerin
- Department of Endocrine Surgery, Aix-Marseille University Marseille, France & APHM Conception, 13284, Marseille, France
| | - Pascal Pedini
- Laboratory of Molecular Biology, Aix Marseille University CNRS, CRN2M, Marseille, France & APHM Conception, 13385, Marseille, France
| | - Wassim Essamet
- APHM Timone Department of Neuropathology, Marseille, France
| | - Frédéric Castinetti
- Department of Endocrinology, Aix Marseille University, CNRS, CRN2M, Marseille, France & APHM Conception, Marseille, France
| | - Fréderic Sebag
- Department of Endocrine Surgery, Aix-Marseille University Marseille, France & APHM Conception, 13284, Marseille, France
| | - Philippe Roche
- Integrative Structural & Chemical Biology (iSCB) & INT-3D Molecular Modeling Platform, Cancer Research Centre of Marseille, CNRS UMR7258; INSERM U1068; Institut Paoli Calmettes; Aix-Marseille University, UM105, Marseille, France
| | - Alberto Cascon
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre and Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Arthur S Tischler
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, MD, 20892, USA
| | - Anne Barlier
- Laboratory of Molecular Biology, Aix Marseille University CNRS, CRN2M, Marseille, France & APHM Conception, 13385, Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital & CERIMED & Inserm UMR1068 Marseille Cancerology Research Center, Institut Paoli-Calmettes, Aix Marseille University, 264 Rue Saint-Pierre, 13385, Marseille, France.
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20
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McVeigh TP, Mulligan RJ, McVeigh UM, Owens PW, Miller N, Bell M, Sebag F, Guerin C, Quill DS, Weidhaas JB, Kerin MJ, Lowery AJ. Investigating the association of rs2910164 with cancer predisposition in an Irish cohort. Endocr Connect 2017; 6:614-624. [PMID: 28899898 PMCID: PMC5640569 DOI: 10.1530/ec-17-0196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/12/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION MicroRNAs (miRNAs) are small noncoding RNA molecules that exert post-transcriptional effects on gene expression by binding with cis-regulatory regions in target messenger RNA (mRNA). Polymorphisms in genes encoding miRNAs or in miRNA-mRNA binding sites confer deleterious epigenetic effects on cancer risk. miR-146a has a role in inflammation and may have a role as a tumour suppressor. The polymorphism rs2910164 in the MIR146A gene encoding pre-miR-146a has been implicated in several inflammatory pathologies, including cancers of the breast and thyroid, although evidence for the associations has been conflicting in different populations. We aimed to further investigate the association of this variant with these two cancers in an Irish cohort. METHODS The study group comprised patients with breast cancer (BC), patients with differentiated thyroid cancer (DTC) and unaffected controls. Germline DNA was extracted from blood or from saliva collected using the DNA Genotek Oragene 575 collection kit, using crystallisation precipitation, and genotyped using TaqMan-based PCR. Data were analysed using SPSS, v22. RESULTS The total study group included 1516 participants. This comprised 1386 Irish participants; 724 unaffected individuals (controls), 523 patients with breast cancer (BC), 136 patients with differentiated thyroid cancer (DTC) and three patients with dual primary breast and thyroid cancer. An additional cohort of 130 patients with DTC from the South of France was also genotyped for the variant. The variant was detected with a minor allele frequency (MAF) of 0.19 in controls, 0.22 in BC and 0.27 and 0.26 in DTC cases from Ireland and France, respectively. The variant was not significantly associated with BC (per allele odds ratio = 1.20 (0.98-1.46), P = 0.07), but was associated with DTC in Irish patients (per allele OR = 1.59 (1.18-2.14), P = 0.002). CONCLUSION The rs2910164 variant in MIR146A is significantly associated with DTC, but is not significantly associated with BC in this cohort.
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Affiliation(s)
- T P McVeigh
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
| | - R J Mulligan
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
| | - U M McVeigh
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
| | - P W Owens
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
| | - N Miller
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
| | - M Bell
- Department of EndocrinologySchool of Medicine, NUI Galway, Galway, Ireland
| | - F Sebag
- Department of Endocrine Surgery Centre hospitalo-universitaire de La ConceptionAssistance Publique Hôpitaux de Marseille, Marseille, France
- Aix-Marseille UniversitéFaculté de Médecine, Marseille, France
| | - C Guerin
- Department of Endocrine Surgery Centre hospitalo-universitaire de La ConceptionAssistance Publique Hôpitaux de Marseille, Marseille, France
- Aix-Marseille UniversitéFaculté de Médecine, Marseille, France
| | - D S Quill
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
| | - J B Weidhaas
- David Geffen School of MedicineUniversity of California, Los Angeles, USA
| | - M J Kerin
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
| | - A J Lowery
- Discipline of SurgeryLambe Institute for Translational Research, School of Medicine, NUI Galway, Galway, Ireland
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Zerdoud S, Leboulleux S, Clerc J, Leenhardt L, Bournaud C, Al Ghuzlan A, Keller I, Bardet S, Giraudet AL, Groussin L, Sebag F, Garrel R, Lamy PJ, Toubert ME, Mirallié É, Hindié E, Taïeb D. Traitement par iode 131 des cancers thyroïdiens différenciés : recommandations 2017 des sociétés françaises SFMN/SFE/SFP/SFBC/AFCE/SFORL. Médecine Nucléaire 2017. [DOI: 10.1016/j.mednuc.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Claridge S, Sebag F, Behar J, Porter B, Jackson T, Sieniewicz B, Gould J, Webb J, Chen Z, O'Neill M, Gill J, Leclercq C, Rinaldi C. 96Cost effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators at the time of generator change. Europace 2017. [DOI: 10.1093/europace/eux283.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Guerin C, Pattou F, Brunaud L, Lifante JC, Mirallié E, Haissaguerre M, Huglo D, Olivier P, Houzard C, Ansquer C, Hindié E, Loundou A, Archange C, Tabarin A, Sebag F, Baumstarck K, Taïeb D. Performance of 18F-FDG PET/CT in the Characterization of Adrenal Masses in Noncancer Patients: A Prospective Study. J Clin Endocrinol Metab 2017; 102:2465-2472. [PMID: 28431167 DOI: 10.1210/jc.2017-00254] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
CONTEXT Few prospective studies have evaluated the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the characterization of adrenal masses. OBJECTIVE To assess the performance of 18F-FDG PET/CT in the malignancy diagnosis of adrenal masses in noncancer patients. DESIGN Prospective multicenter study. MATERIAL AND METHODS The study population consisted of 87 patients (87 adrenal masses) referred to endocrine surgeons: 56 with mass diameter ≥40 mm and 31 with a diameter <40 mm and of indeterminate nature based on unenhanced and washout CT attenuation densities. Fourteen patients had hypercortisolism. Adrenal masses were characterized by 18F-FDG PET/CT. Histology was the gold standard for the diagnosis of malignancy. In the absence of pathological proof (n = 23), the nature of the lesion was based on the 12-month imaging follow-up. RESULTS Fifteen adrenal masses were classified as malignant (including 11 adrenocortical carcinomas) and 72 as benign. Compared with benign lesions, malignant lesions were larger in size (P = 0.003), had higher unenhanced densities (P = 0.002), lower relative washout values (P = 0.007), and higher 18F-FDG uptake parameters (P < 10-3). The optimal threshold value of (Tumor SUVmax:Liver SUVmax) the ratio for malignancy was >1.5 with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 86.7%, 86.1%, 56.5%, 96.9%, and 86.2%, respectively. CONCLUSIONS Our results show that 18F-FDG PET/CT complements adrenal washout CT in the evaluation of adrenal masses and should be recommended in the evaluation of large and/or indeterminate adrenal masses.
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Affiliation(s)
- Carole Guerin
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, 13005 Marseille, France
| | - François Pattou
- Service de Chirurgie Endocrinienne, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille, France; Université Lille Nord de France, INSERM, Lille, France
| | - Laurent Brunaud
- Université de Lorraine, Service de Chirurgie Digestive, Hépatobiliaire et Endocrinienne, Centre Hospitalo-Universitaire Nancy Brabois, 54511 Nancy, France
| | - Jean-Christophe Lifante
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Lyon Sud, Pierre Bénite, 69495 Lyon, France
| | - Eric Mirallié
- Clinique de Chirurgie Digestive et Endocrinienne, Hôtel Dieu, CHU Nantes, 44000 Nantes, France
| | - Magalie Haissaguerre
- Service d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut-Lévêque Pessac, 33600 Pessac, France
| | - Damien Huglo
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Lille, OncoTHAI, INSERM U 1189, Univ, 59037 Lille, France
| | - Pierre Olivier
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire Nancy Brabois, 54511 Nancy, France
| | - Claire Houzard
- Service de Médecine Nucléaire, Centre Hospitalier Lyon Sud, Pierre-Bénite, 69495 Lyon, France
| | - Catherine Ansquer
- Service de Médecine Nucléaire, Hôtel Dieu, CHU Nantes, 44000 Nantes, France
| | - Elif Hindié
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut-Lévêque Pessac, 33600 Pessac, France
| | - Anderson Loundou
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, 13005 Marseille, France
| | - Cendrine Archange
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, 13385 Marseille, France
| | - Antoine Tabarin
- Service d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut-Lévêque Pessac, 33600 Pessac, France
| | - Fréderic Sebag
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, 13005 Marseille, France
| | - Karine Baumstarck
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, 13005 Marseille, France
| | - David Taïeb
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, 13385 Marseille, France
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Moreddu E, Baumstarck-Barrau K, Gabriel S, Fakhry N, Sebag F, Mundler O, Chossegros C, Taïeb D. Incidence of salivary side effects after radioiodine treatment using a new specifically-designed questionnaire. Br J Oral Maxillofac Surg 2017; 55:609-612. [DOI: 10.1016/j.bjoms.2017.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/28/2017] [Indexed: 11/16/2022]
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25
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Abdullah AE, Guerin C, Imperiale A, Barlier A, Battini S, Pertuit M, Roche P, Essamet W, Vaisse B, Pacak K, Sebag F, Taïeb D. Paraganglioma of the organ of Zuckerkandl associated with a somatic HIF2α mutation: A case report. Oncol Lett 2017; 13:1083-1086. [PMID: 28454217 PMCID: PMC5403169 DOI: 10.3892/ol.2017.5599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 05/10/2016] [Indexed: 11/24/2022] Open
Abstract
Paragangliomas of the organ of Zuckerkandl (OZ-PGL) are rare tumors that, in >70% of cases, occur in association with succinate dehydrogenase complex iron sulfur subunit B (SDHB) or SDHD gene mutations. The aim of the current study was to determine whether a somatic genetic defect in the hypoxia-inducible factor 2α (HIF2α) gene was present in a case of sporadic OZ-PGL. A 32-year-old African female presented with uncontrolled hypertension during the first trimester of pregnancy. A diagnostic hysteroscopy was performed 3 months after delivery, precipitating a hypertensive crisis. Thereafter, the patient was diagnosed with noradrenaline-secreting OZ-PGL. A complete blood count identified mild normocytic anemia of an inflammatory origin. Surgical removal of the tumor resulted in normalization of plasma and urinary normetanephrine levels. Genetic testing for germline mutations (including large deletions) in the von Hippel-Lindau tumor suppressor, SDHB, SDHC and SDHD genes was normal. However, a heterozygous missense mutation (c.1589Cys>Tyr) was detected in exon 12 of HIF2α, which results in a substitution of alanine 530 with valine (Ala530Val) in the HIF2α protein. A germline mutation was excluded based on the negative results of blood DNA testing. A three-dimensional homology model of Ala530Val was constructed, which showed impaired HIF2α/VHL interaction and decreased HIF2α ubiquitination. 1H-high-resolution magic-angle-spinning nuclear magnetic resonance spectroscopy detected low succinate levels and high α and β glucose levels. To the best of our knowledge, the present case represents the first of its kind to associate a somatic HIF2α gain-of-function mutation with OZ-PGL. It is therefore recommended that patients without germline SDHx mutations should be tested for HIF2α mutations.
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Affiliation(s)
- Ahmad Esmaeel Abdullah
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Carole Guerin
- Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Alessio Imperiale
- Department of Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 67200 Strasbourg, France.,ICube Joint Research Unit 7357, University of Strasbourg/French National Center for Scientific Research and Federation of Translational Medicine of Strasbourg, Faculty of Medicine, 67085 Strasbourg, France
| | - Anne Barlier
- Laboratory of Biochemistry and Molecular Biology, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Stéphanie Battini
- Integrative Structural and Chemical Biology and Interaction Dynamics and Drug Design Platform, Cancer Research Centre of Marseille, Institut Paoli Calmettes, 13273 Marseille, France.,Department of Neuropathology, La Timone University Hospital, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Morgane Pertuit
- Laboratory of Biochemistry and Molecular Biology, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - Philippe Roche
- Integrative Structural and Chemical Biology and Interaction Dynamics and Drug Design Platform, Cancer Research Centre of Marseille, Institut Paoli Calmettes, 13273 Marseille, France
| | - Wassim Essamet
- Department of Neuropathology, La Timone University Hospital, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Bernard Vaisse
- Department of Hypertension, La Timone University Hospital, Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Fréderic Sebag
- Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, 13005 Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, 13385 Marseille Cedex 5, France.,Cancer Research Centre of Marseille Affiliated to Inserm (UMR1068), Institut Paoli-Calmettes, 13273 Marseille, France
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Guerin C, Paladino NC, Lowery A, Castinetti F, Taieb D, Sebag F. Persistent and recurrent hyperparathyroidism. Updates Surg 2017; 69:161-169. [PMID: 28434176 DOI: 10.1007/s13304-017-0447-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/08/2017] [Indexed: 12/26/2022]
Abstract
Despite remarkable progress in imaging modalities and surgical management, persistence or recurrence of primary hyperparathyroidism (PHPT) still occurs in 2.5-5% of cases of PHPT. The aim of this review is to expose the management of persistent and recurrent hyperparathyroidism. A literature search was performed on MEDLINE using the search terms "recurrent" or "persistent" and "hyperparathyroidism" within the past 10 years. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Before considering reoperation, the surgeon must confirm the diagnosis of PHPT. Then, the patient must be evaluated with new imaging modalities. A single adenoma is found in 68% of cases, multiglandular disease in 28%, and parathyroid carcinoma in 3%. Others causes (<1%) include parathyromatosis and graft recurrence. The surgeon must balance the benefits against the risks of a reoperation (permanent hypocalcemia and recurrent laryngeal nerve palsy). If surgery is necessary, a focused approach can be considered in cases of significant imaging foci, but in the case of multiglandular disease, a bilateral neck exploration could be necessary. Patients with multiple endocrine neoplasia syndromes are at high risk of recurrence and should be managed regarding their hereditary pathology. The cure rate of persistent-PHPT or recurrent-PHPT in expert centers is estimated from 93 to 97%. After confirming the diagnosis of PHPT, patients with persistent-PHPT and recurrent-PHPT should be managed in an expert center with all dedicated competencies.
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Affiliation(s)
- Carole Guerin
- Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France. .,Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France.
| | - Nunzia Cinzia Paladino
- Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France
| | - Aoife Lowery
- Department of Surgery, University Hospital Limerick and Graduate Entry Medical School University of Limerick, Limerick, Ireland
| | - Fréderic Castinetti
- Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France.,Department of Endocrinology, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France
| | - David Taieb
- Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France.,Department of Nuclear Medicine, La Timone Hospital, Assistance Publique Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Fréderic Sebag
- Department of Endocrine Surgery, La Conception Hospital, Assistance Publique Hopitaux de Marseille, 147 BD Baille, 13005, Marseille, France.,Aix-Marseille University, Medical School, 27, bd Jean Moulin, 13385, Marseille Cedex 05, France
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Daher R, Lifante JC, Voirin N, Peix JL, Colin C, Kraimps JL, Menegaux F, Pattou F, Sebag F, Touzet S, Bourdy S, Duclos A. Is it possible to limit the risks of thyroid surgery? Ann Endocrinol (Paris) 2016; 76:1S16-26. [PMID: 26826478 DOI: 10.1016/s0003-4266(16)30010-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Inferior laryngeal nerve (ILN) palsy and hypocalcemia remain the two most frequent major complications after thyroid surgery. Their occurrences may be explained by the influence of factors related to the patient, the surgical procedure, thyroid pathology, or the surgeon's technique. This study aims To assess whether systematically following a rigorous surgical technique during thyroidectomy affects postoperative complications and long-term patient recovery. METHODS We conducted a multicenter, cross-sectional study of prospectively collected data in five high-volume referral centers enrolling all patients who underwent thyroid surgery between April 2008 and December 2009. Inferior laryngeal nerve (ILN) palsy and hypocalcemia were systematically assessed during hospitalization based on objective criteria. A six-month follow-up was conducted in cases of early complications. Multivariate regression models were computed to quantify their relationship with potential risk factors. RESULTS A total of 3574 thyroid procedures were completed. Non-visualization of the ILN during dissection and a large thyroid mass were major risk factors for permanent ILN palsy (OR, 4.17 and 2.61, p<0.01) and persistent complications after initial injury (OR, 4.17 and 2.42, p<0.05). The presence of thyroiditis on the surgical specimen was an independent risk factor for permanent hypoparathyroidism and poor recovery after initial dysfunction (OR, 1.76 and 1.88, p<0.05). CONCLUSIONS Thorough meticulous technique in thyroid surgery is a determinant of ILN function but fails to prevent persistent hypoparathyroidism.
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Affiliation(s)
- R Daher
- Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France
| | - J-C Lifante
- Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France.
| | - N Voirin
- Hospices civils de Lyon, Hôpital Édouard-Herriot, Service d'hygiène, épidémiologie et prévention, Lyon, F-6943, France; Université de Lyon 1, Laboratoire de biométrie et biologie évolutive, Lyon, F-69373, France; CNRS, UMR 5558, Laboratoire de biométrie et biologie évolutive, Lyon, F-69373, France
| | - J-L Peix
- Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France
| | - C Colin
- Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France
| | - J-L Kraimps
- Department of Endocrine Surgery, Poitiers University, Jean-Bernard Hospital, 86021-Poitiers, France
| | - F Menegaux
- Assistance publique-Hôpitaux de Paris, Hôpital la Pitié-Salpêtrière, Service de chirurgie générale, viscérale et endocrinienne, Paris, France
| | - F Pattou
- CHRU de Lille, Chirurgie générale et endocrinienne, Lille, 59000, France; Université Lille-Nord de France, INSERM, UMR 859, Lille, 59000, France
| | - F Sebag
- Assistance publique-Hôpitaux de Marseille, CHU la Timone-Adulte, France
| | - S Touzet
- Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France
| | - S Bourdy
- Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France
| | - A Duclos
- Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France
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Abstract
INTRODUCTION Oligometastatic cancer prognosis is distinct from polymetastatic cancer prognosis and surgery can improve survival. The objective of this study was to assess the role of adrenalectomy and to look for prognostic or predictive factors for the treatment of patients with oligometastatic solid tumors and adrenal metastasis. MATERIAL AND METHODS Patients with oligometastatic solid tumors undergoing adrenalectomy were selected. Clinical data were retrieved from electronic patients records. Progression-free survival (PFS), overall survival (OS) and clinical outcomes were assessed. RESULTS Forty patients were analyzed. Median PFS was 7.4 months and PFS was longer for metachronous versus synchronous adrenal metastasis (10.8 versus 4.5 months; P=0.008). Median OS was 22.8 months and OS was better with laparoscopic adrenalectomy versus open adrenalectomy (24.4 versus 11.2 months; P=0.05). DISCUSSION Adrenalectomy part of the treatment plan of oligometastatic solid tumors but patients have to be selected. Surgery might be indicated for metachronous metastasis when laparoscopic adrenalectomy is possible.
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Affiliation(s)
- P Tomasini
- Aix Marseille university, Assistance publique-Hôpitaux de Marseille, multidisciplinary oncology & therapeutic innovations department, 13015 Marseille, France; Aix Marseille university, Inserm U911 CRO2, 13005 Marseille, France.
| | - M-E Garcia
- Aix Marseille university, Assistance publique-Hôpitaux de Marseille, multidisciplinary oncology & therapeutic innovations department, 13015 Marseille, France
| | - L Greillier
- Aix Marseille university, Assistance publique-Hôpitaux de Marseille, multidisciplinary oncology & therapeutic innovations department, 13015 Marseille, France; Aix Marseille university, Inserm U911 CRO2, 13005 Marseille, France
| | - C Paladino
- Aix Marseille university, Assistance publique-Hôpitaux de Marseille, endocrine surgery department, 13005 Marseille, France
| | - F Sebag
- Aix Marseille university, Assistance publique-Hôpitaux de Marseille, endocrine surgery department, 13005 Marseille, France
| | - F Barlesi
- Aix Marseille university, Assistance publique-Hôpitaux de Marseille, multidisciplinary oncology & therapeutic innovations department, 13015 Marseille, France; Aix Marseille university, Inserm U911 CRO2, 13005 Marseille, France
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Varoquaux A, Kebebew E, Sebag F, Wolf K, Henry JF, Pacak K, Taïeb D. Endocrine tumors associated with the vagus nerve. Endocr Relat Cancer 2016; 23:R371-9. [PMID: 27406876 PMCID: PMC5022786 DOI: 10.1530/erc-16-0241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 12/24/2022]
Abstract
The vagus nerve (cranial nerve X) is the main nerve of the parasympathetic division of the autonomic nervous system. Vagal paragangliomas (VPGLs) are a prime example of an endocrine tumor associated with the vagus nerve. This rare, neural crest tumor constitutes the second most common site of hereditary head and neck paragangliomas (HNPGLs), most often in relation to mutations in the succinate dehydrogenase complex subunit D (SDHD) gene. The treatment paradigm for VPGL has progressively shifted from surgery to abstention or therapeutic radiation with curative-like outcomes. Parathyroid tissue and parathyroid adenoma can also be found in close association with the vagus nerve in intra or paravagal situations. Vagal parathyroid adenoma can be identified with preoperative imaging or suspected intraoperatively by experienced surgeons. Vagal parathyroid adenomas located in the neck or superior mediastinum can be removed via initial cervicotomy, while those located in the aortopulmonary window require a thoracic approach. This review particularly emphasizes the embryology, molecular genetics, and modern imaging of these tumors.
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Affiliation(s)
- Arthur Varoquaux
- Department of RadiologyConception Hospital, Aix-Marseille University, Marseille, France
| | - Electron Kebebew
- Endocrine Oncology BranchNational Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Fréderic Sebag
- Department of Endocrine SurgeryConception Hospital, Aix-Marseille University, Marseille, France
| | - Katherine Wolf
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland, USA
| | - Jean-François Henry
- Department of Endocrine SurgeryConception Hospital, Aix-Marseille University, Marseille, France
| | - Karel Pacak
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland, USA
| | - David Taïeb
- Department of Nuclear MedicineLa Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
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Vanbrugghe C, Lowery AJ, Golffier C, Taieb D, Sebag F. Adrenocortical carcinoma surgery-surgical extent and approach. Langenbecks Arch Surg 2016; 401:991-997. [PMID: 27412357 DOI: 10.1007/s00423-016-1462-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Adequate tumour resection is the gold standard of care for adrenocortical carcinoma (ACC). However, the optimal surgical strategy remains debatable. In our opinion, the extent of surgery (adequate tumour resection) is the primary concern, rather than the surgical approach (laparoscopic or open). We propose that both surgical approaches have a role in the management of ACC provided the extent of resection is selected based on patient and tumour characteristics and accurate pre-operative investigations. METHODS A review of 25 curative intent resections for ACC between 2002 and 2013 was done. Group A (16 patients-64 %) included all patients who underwent planned radical adrenalectomy without any other resection and group B (9 patients-36 %) included all patients who underwent a planned extensive resection based on pre-operative investigations. RESULTS Of 471 adrenalectomies, 25 were performed for ACC with curative intent. Tumours were significantly larger in group B with mean size of 119.6 versus 62.4 mm in group A (p = 0.002). Tumours in group B also had higher WEISS scores (mean score 7 vs 5.2, p = 0.033) and almost always required multi-organ resection. The recurrence rate was 37.5 % (n = 6) for group A and 44.4 % for group B (n = 4), p = 1.00. Poor prognosis was associated with significantly higher WEISS scores (p = 0.016) and a trend towards more advanced ENSAT disease stage (p = 0.06). Estimated overall survival was 74.17 months (group A 67.3 vs group B 70.1, p = 0.244). CONCLUSIONS Accurate pre-operative staging is critical to select a tailored surgical strategy. Multi-organ resection remains the preferred approach for large and potentially invasive ACC. Some patients presenting with smaller ACC may benefit from a more extensive resection.
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Affiliation(s)
- C Vanbrugghe
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France.
| | - A J Lowery
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France
| | - C Golffier
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France
| | - D Taieb
- Department of Nuclear Medicine, La Timone University Hospital, 264, rue Saint-Pierre, 13005, Marseille, France
| | - F Sebag
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France
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Devèze A, Sebag F, Pili S, Henry JF. Parathyroid Adenoma Disclosed by a Massive Cervical Hematoma. Otolaryngol Head Neck Surg 2016; 134:710-2. [PMID: 16564403 DOI: 10.1016/j.otohns.2005.03.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 01/05/2005] [Accepted: 03/09/2005] [Indexed: 11/20/2022]
Affiliation(s)
- A Devèze
- Department of Otolaryngology-Head and Neck Surgery, North University Hospital, Marseille, France.
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Castinetti F, Taieb D, Henry JF, Walz M, Guerin C, Brue T, Conte-Devolx B, Neumann HPH, Sebag F. MANAGEMENT OF ENDOCRINE DISEASE: Outcome of adrenal sparing surgery in heritable pheochromocytoma. Eur J Endocrinol 2016; 174:R9-18. [PMID: 26297495 DOI: 10.1530/eje-15-0549] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/21/2015] [Indexed: 11/08/2022]
Abstract
The management of hereditary pheochromocytoma has drastically evolved in the last 20 years. Bilateral pheochromocytoma does not increase mortality in MEN2 or von Hippel-Lindau (VHL) mutation carriers who are followed regularly, but these mutations induce major morbidities if total bilateral adrenalectomy is performed. Cortical sparing adrenal surgery may be proposed to avoid definitive adrenal insufficiency. The surgical goal is to leave sufficient cortical tissue to avoid glucocorticoid replacement therapy. This approach was achieved by the progressive experience of minimally invasive surgery via the transperitoneal or retroperitoneal route. Cortical sparing adrenal surgery exhibits <5% significant recurrence after 10 years of follow-up and normal glucocorticoid function in more than 50% of the cases. Therefore, cortical sparing adrenal surgery should be systematically considered in the management of all patients with MEN2 or VHL hereditary pheochromocytoma. Hereditary pheochromocytoma is a rare disease, and a randomized trial comparing cortical sparing vs classical adrenalectomy is probably not possible. This lack of data most likely explains why cortical sparing surgery has not been adopted in most expert centers that perform at least 20 procedures per year for the treatment of this disease. This review examined recent data to provide insight into the technique, its indications, and the results and subsequent follow-up in the management of patients with hereditary pheochromocytoma with a special emphasis on MEN2.
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Affiliation(s)
- F Castinetti
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - D Taieb
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - J F Henry
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - M Walz
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - C Guerin
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - T Brue
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - B Conte-Devolx
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - H P H Neumann
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - F Sebag
- Department of EndocrinologyLa Conception HospitalDepartment of Nuclear MedicineLa Timone HospitalDepartment of Endocrine SurgeryLa Conception Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, FranceDepartment of SurgeryCenter of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, GermanySection for Preventive MedicineDepartment of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
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Menegaux F, Chéreau N, Peix JL, Christou N, Lifante JC, Paladino N, Sebag F, Ghander C, Trésallet C, Mathonnet M. Management of adrenal incidentaloma. J Visc Surg 2014; 151:355-64. [DOI: 10.1016/j.jviscsurg.2014.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blanchard C, Brient C, Volteau C, Sebag F, Roy M, Drui D, Hamy A, Mathonnet M, Henry JF, Mirallié E. Factors predictive of lymph node metastasis in the follicular variant of papillary thyroid carcinoma. Br J Surg 2013; 100:1312-7. [PMID: 23939843 DOI: 10.1002/bjs.9210] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND The treatment of papillary thyroid carcinomas larger than 1 cm usually consists of total thyroidectomy and central lymph node dissection (LND). In patients with the follicular variant of papillary thyroid carcinoma (FVPTC), preoperative cytology and intraoperative frozen-section analysis cannot always establish the diagnosis. The aim of this study was to evaluate predictive factors for lymph node metastasis in patients with FVPTC and to identify patients who might benefit from LND. METHODS The study included patients with FVPTC treated by total thyroidectomy and LND between 2000 and 2010 in four departments. When fewer than six non-involved lymph nodes were removed, the patient was excluded from the analysis. RESULTS Some 199 patients were included. The median tumour size was 17 (range 1-85) mm, and tumours were classified as T1a in 28 patients, T1b in 40, T2 in 53, and T3 in 78. Eighty-one patients (40·7 per cent) had lymph node metastasis (51 classified as N1a and 30 as N1b). Four risk factors were predictive of lymph node metastasis in the multivariable analysis: multifocality (odds ratio (OR) 2·36, 95 per cent confidence interval 1·15 to 4·86), angiolymphatic invasion (OR 3·67, 1·01 to 13·36), absence of tumour capsule (OR 3·00, 1·47 to 6·14) and tumour involvement of perithyroid tissue (OR 3·89, 1·85 to 8·18). The rate of lymph node metastasis varied between 14 and 94 per cent depending on the presence of risk factors. CONCLUSION The rate of lymph node metastasis in patients with FVPTC varies widely according to the presence or absence of predictive risk factors.
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Affiliation(s)
- C Blanchard
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire (CHU) Nantes – Hôtel Dieu, Nantes, France
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Lazraq M, Sarlon G, Silhol F, Sebag F, Vaisse B. Long-term follow up after adrenalectomy for primary hyperaldosteronism. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tessonnier L, Ansquer C, Bournaud C, Sebag F, Mirallié E, Lifante JC, Palazzo FF, Morange I, Drui D, de la Foucardère C, Mancini J, Taïeb D. (18)F-FDG uptake at initial staging of the adrenocortical cancers: a diagnostic tool but not of prognostic value. World J Surg 2013; 37:107-12. [PMID: 23001287 DOI: 10.1007/s00268-012-1802-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare cancer for which little level evidence exists to guide management. (18)F-FDG PET ((18)F-fluorodeoxyglucose positron emission tomography) is an increasingly used diagnostic tool in patients with suspicious or indeterminate adrenal tumors. In some other solid tumors, (18)F-FDG PET may offer prognostic information that can guide optimal patient treatment. The aim of the present study was to evaluate whether preoperative (18)F-FDG PET based on SUVs assessments has a prognostic value in ACC patients. METHODS A retrospective analysis was performed in patients who underwent (18)F-FDG PET/CT for the evaluation of ACC. Inclusion criteria were an unequivocal diagnosis of ACC; all data from primary diagnosis available; (18)F-FDG PET/CT performed prior to surgery or other treatment of the primary tumor; a minimum of 6-months follow-up for surviving patients. All (18)F-FDG PET/CT procedures were reinterpreted in a blind fashion. RESULTS Thirty-seven patients (23 without metastasis [M0], 14 with metastasis [M1]) fulfilled the study criteria. Median uptake values were tumor standardized uptake values (SUV)(max) = 11 (range: 3-56) and a tumor/liver SUV(max) ratio = 4.2 (range: 1.3-15). Median follow-up was 20 months. Although classic risk factors (tumoral stage, Weiss score) were associated with poor outcome, there was no correlation between primary tumor FDG uptake with overall survival (OS) and disease free survival (DFS) in M0 patients and with overall survival in M1 patients. (18)F-FDG uptake correlated inconsistently with sinister histological features, such as atypical mitoses or necrosis. CONCLUSIONS At initial staging, primary tumor FDG uptake in ACC patients does not correlate with OS and DFS at 2 years. Patient prognosis and treatment strategy should not be based on uptake values.
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Affiliation(s)
- L Tessonnier
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 rue Saint-Pierre, 13385 Marseille Cedex 5, France
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Taïeb D, Yang C, Delenne B, Zhuang Z, Barlier A, Sebag F, Pacak K. First report of bilateral pheochromocytoma in the clinical spectrum of HIF2A-related polycythemia-paraganglioma syndrome. J Clin Endocrinol Metab 2013; 98:E908-13. [PMID: 23539726 PMCID: PMC3644612 DOI: 10.1210/jc.2013-1217] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Molecular genetic research has so far resulted in the identification of 10 well-characterized susceptibility genes for hereditary pheochromocytoma (PHEO) or paraganglioma (PGL). Recently, a new syndrome characterized by multiple PGLs and somatostatinomas associated with congenital polycythemia due to somatic mutations in HIF2A has been reported. OBJECTIVE The aim of the study was to define the genetic defect in a new case of bilateral PHEO and multiple PGLs associated with congenital polycythemia. PATIENT A female patient presented with neonatal polycythemia (treated by phlebotomies, 1 session approximately every 4 mo), mildly enlarged cerebral ventricles, and bilateral PHEO and multiple PGLs. There was no family history of any neuroendocrine tumor or polycythemia. Surgical removal of the tumors only temporarily normalized plasma erythropoietin (Epo) levels and discontinued phlebotomies. No germline mutations were initially detected in the SDHB, SDHC, SDHD, VHL, and PHD2 genes, known to be associated with polycythemia. The PHEOs presented with a typical noradrenergic biochemical phenotype. RESULTS A heterozygous missense mutation (c.1589C>T) was identified in exon 12 of HIF2A, resulting in an alanine 530 substitution in the HIF-2α protein with valine (A530V). This somatic mutation was detected in the tissue from 1 PHEO and 1 PGL, with no HIF2A germline mutation found. This mutation led to stabilization of HIF-2α and hence a gain-of-function phenotype, as in previously published studies. CONCLUSION This case represents the first association of a somatic HIF2A gain-of-function mutation with PHEO and congenital polycythemia, and it alerts physicians to perform proper genetic screening in patients presenting with multiple norepinephrine-producing PHEOs and polycythemia. This report also extends the previous findings of a new syndrome of only multiple PGLs, somatostatinomas, and polycythemia to multiple PHEOs.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille University, 13005 Marseille, France
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Cerdan F, Gabriel S, Sebag F, Fakhry N, Deveze A, Barlier A, Cammilleri S, Mundler O, Taïeb D. Évaluation fonctionnelle par TEP 18F-FDopa des paragangliomes et phéochromocytomes non métastatiques : impact de la localisation lésionnelle et du statut génétique. Médecine Nucléaire 2013. [DOI: 10.1016/j.mednuc.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Affiliation(s)
- Ghislain Pauleau
- Department of Endocrine Surgery, La Timone University Hospital, CERIMED, Aix-Marseille University, 13005 Marseille, France
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Castinetti F, Verschueren A, Cassagneau P, Brue T, Sebag F, Daniel L, Taieb D. Adrenal myelolipoma: an unusual cause of bilateral highly 18F-FDG-avid adrenal masses. J Clin Endocrinol Metab 2012; 97:2577-8. [PMID: 22622025 DOI: 10.1210/jc.2012-1713] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- F Castinetti
- Departments of Endocrinology, La Timone Hospital, Aix Marseille University, 13005 Marseille, France
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Duclos A, Carty MJ, Peix JL, Colin C, Lipsitz SR, Kraimps JL, Menegaux F, Pattou F, Sebag F, Voirin N, Touzet S, Bourdy S, Lifante JC. Development of a charting method to monitor the individual performance of surgeons at the beginning of their career. PLoS One 2012; 7:e41944. [PMID: 22860036 PMCID: PMC3409207 DOI: 10.1371/journal.pone.0041944] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/27/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Efforts to provide a valid picture of surgeons' individual performance evolution should frame their outcomes in relation to what is expected depending on their experience. We derived the learning curve of young thyroidectomy surgeons as a baseline to enable the accurate assessment of their individual outcomes and avoid erroneous conclusions that may derive from more traditional approaches. METHODS Operative time and postoperative recurrent laryngeal nerve palsy of 2006 patients who underwent a thyroidectomy performed by 19 young surgeons in five academic hospitals were monitored from April 2008 to December 2009. The database was randomly divided into training and testing datasets. The training data served to determine the expected performance curve of surgeons during their career and factors influencing outcome variation using generalized estimating equations (GEEs). To simulate prospective monitoring of individual surgeon outcomes, the testing data were plotted on funnel plots and cumulative sum charts (CUSUM). Performance charting methods were utilized to present outcomes adjusted both for patient case-mix and surgeon experience. RESULTS Generation of performance curves demonstrated a gradual reduction in operative time from 139 (95% CI, 137 to 141) to 75 (71 to 80) minutes, and from 15.7% (15.1% to 16.3%) to 3.3% (3.0% to 3.6%) regarding the nerve palsy rate. Charts interpretation revealed that a very young surgeon had better outcomes than expected, whereas a more experienced surgeon appeared to be a poor performer given the number of years that he had already spent in practice. CONCLUSIONS Not considering the initial learning curve of surgeons exposes them to biased measurement and to misinterpretation in assessing their individual performance for thyroidectomy. The performance chart represents a valuable tool to monitor the outcome of surgeons with the expectation to provide safe and efficient care to patients.
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Affiliation(s)
- Antoine Duclos
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France.
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Abstract
Bronchogenic cysts are benign congenital malformations usually. A retroperitoneal location is extremely uncommon. We reported a case of bronchogenic cyst occurred in the retroperitoneum in a 60-year-old patient. An abdominal CT for a prostatic adenocarcinoma staging has reported this incidental lesion. Biological, radiological and histological assessment confirmed the bronchogenic cyst diagnosis. The treatment of choice for most authors is surgical excision. However, because of a low malignant transformation risk, we have chosen a follow-up with abdominal computerized tomography every 6 months. During 3 years, biological and radiological assessments have shown a stable lesion. Therefore, it seems reasonable to propose a simple radiological monitoring for bronchogenic cysts in selected patients.
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Affiliation(s)
- C Brient
- Endocrine surgery department, University Hospital La Timone, 13000 Marseilles, France.
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Duclos A, Peix JL, Colin C, Kraimps JL, Menegaux F, Pattou F, Sebag F, Touzet S, Bourdy S, Voirin N, Lifante JC. Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study. BMJ 2012; 344:d8041. [PMID: 22236412 PMCID: PMC3256252 DOI: 10.1136/bmj.d8041] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association between surgeons' experience and postoperative complications in thyroid surgery. DESIGN Prospective cross sectional multicentre study. SETTING High volume referral centres in five academic hospitals in France. PARTICIPANTS All patients who underwent a thyroidectomy undertaken by every surgeon in these hospitals from 1 April 2008 to 31 December 2009. MAIN OUTCOME MEASURES Presence of two permanent major complications (recurrent laryngeal nerve palsy or hypoparathyroidism), six months after thyroid surgery. We used mixed effects logistic regression to determine the association between length of experience and postoperative complications. RESULTS 28 surgeons completed 3574 thyroid procedures during a one year period. Overall rates of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% (95% confidence interval 1.53% to 2.67%) and 2.69% (2.10% to 3.31%), respectively. In a multivariate analysis, 20 years or more of practice was associated with increased probability of both recurrent laryngeal nerve palsy (odds ratio 3.06 (1.07 to 8.80), P=0.04) and hypoparathyroidism (7.56 (1.79 to 31.99), P=0.01). Surgeons' performance had a concave association with their length of experience (P=0.036) and age (P=0.035); surgeons aged 35 to 50 years had better outcomes than their younger and older colleagues. CONCLUSIONS Optimum individual performance in thyroid surgery cannot be passively achieved or maintained by accumulating experience. Factors contributing to poor performance in very experienced surgeons should be explored further.
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Affiliation(s)
- Antoine Duclos
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France.
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Oliver C, Vaillant-Lombard J, Albarel F, Berbis J, Veyrières J, Sebag F, Petit P. What is the contribution of elastography to thyroid nodules evaluation? Annales d'Endocrinologie 2011; 72:120-4. [DOI: 10.1016/j.ando.2011.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Charrier N, Deveze A, Fakhry N, Sebag F, Morange I, Gaborit B, Barlier A, Carmona E, De Micco C, Garcia S, Mancini J, Palazzo FF, Lavieille JP, Zanaret M, Henry JF, Mundler O, Taïeb D. Comparison of [¹¹¹In]pentetreotide-SPECT and [¹⁸F]FDOPA-PET in the localization of extra-adrenal paragangliomas: the case for a patient-tailored use of nuclear imaging modalities. Clin Endocrinol (Oxf) 2011; 74:21-9. [PMID: 21039729 DOI: 10.1111/j.1365-2265.2010.03893.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS AND METHODS The aim of this prospective study was to compare the diagnostic value of [¹⁸F]FDOPA-PET and [¹¹¹In]pentetreotide-SPECT somatostatin receptor scintigraphy (SRS) in patients with nonmetastatic extra-adrenal paragangliomas (PGLs). Twenty-five consecutive unrelated patients who were known or suspected of having nonmetastatic extra-adrenal PGLs were prospectively evaluated with SRS and [¹⁸F]FDOPA-PET. ¹³¹I-MIBG and [¹⁸F]FDG-PET were added to the work-up in patients with a personal or familial history of PGL, predisposing mutations, abdominal PGLs, metanephrine hypersecretion and abdominal foci on SRS and/or [¹⁸F]FDOPA-PET. RESULTS SRS correctly detected 23/45 lesions of which 20 were head or neck lesions (H&N) and 3 were abdominal lesions. [¹⁸F]FDOPA-PET detected significantly more lesions than SRS (39/45, P < 0·001). Both SRS and ¹⁸F-DOPA-PET detected significantly more H&N than abdominal lesions (66·7% vs 20%, P = 0·003 and 96·7% vs 67%, P = 0·012, respectively). In two patients with the succinate dehydrogenase D (SDHD) mutation, [¹⁸F]FDOPA-PET missed five abdominal PGLs which were detected by the combination of SRS, [¹³¹I]MIBG and [¹⁸F]FDG-PET. A lesion-based analysis using a forward stepwise logistic regression model demonstrates that size ≤ 10 mm (P = 0·002) and abdominal lesions (P = 0·031) were independently associated with "[¹⁸F]FDOPA-PET diagnosis only". In turn, a previous history of surgery and/or the presence of germline mutation was associated with lower lesion size (P = 0·001). CONCLUSIONS The sensitivity of SRS for localizing parasympathetic PGLs is lower than originally reported, and [¹⁸F]FDOPA-PET is better than SRS for localizing small lesions. SRS should be replaced by [¹⁸F]FDOPA-PET as the first-line imaging procedure in H&N PGL, especially in patients at risk of multifocal disease (predisposing mutations and or previous history of surgery).
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Affiliation(s)
- N Charrier
- Centre hospitalo-universitaire de la Timone, Marseille, France
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Sebag F, Vaillant-Lombard J, Berbis J, Griset V, Henry JF, Petit P, Oliver C. Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab 2010; 95:5281-8. [PMID: 20881263 DOI: 10.1210/jc.2010-0766] [Citation(s) in RCA: 263] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Elastography uses ultrasound (US) to assess elasticity. Shear wave elastography (SWE) is a new technique that estimates tissue stiffness in real time and is quantitative and user independent. OBJECTIVES The aim of the study was to assess the efficiency of SWE in predicting malignancy and to compare SWE with US. DESIGN Ninety-three patients and 39 control subjects were included in the study. Predictive value of SWE was assessed by correlation between elasticity, US parameters, and histology. Elasticity index (EI) was first analyzed alone. Scores have been constructed with echographic parameters, i.e. vascularity, hypoechogenicity, and microcalcifications (Score 1=US Score), and with the same parameters plus EI (Score 2=US+SWE Score). For statistical analysis, univariate and multivariate analysis and receiver operating characteristic curves were used. RESULTS A total of 146 nodules from 93 patients were analyzed. Twenty-nine nodules (19.9%) were malignant. Mean (±sd) EI was 150±95 kPa (range, 30-356) in malignant nodules vs. 36±30 (range, 0-200) kPa in benign nodules (P<0.001, Student's t test). For a positive predictive value of at least 80%, characteristics of tissue elasticity (cutoff, 65 kPa) were: sensitivity=85.2%, and specificity=93.9%. Characteristics of the US Score were: sensitivity=51.9% [95% confidence interval (CI), 33.1; 70.7], and specificity=97% (95% CI, 93.6; 1). Characteristics of the US+SWE Score were: sensitivity=81.5% (95% CI, 66.9; 96.1), and specificity=97.0% (95% CI, 93.6; 1). CONCLUSION Promising results have been obtained with SWE. This technique may be applied to multinodular goiters. Larger prospective studies are needed to confirm these results and to define the respective places of SWE, US, and FNA.
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Affiliation(s)
- F Sebag
- Department of Endocrine Surgery, La Timone University Hospital, Assistance Publique Hopitaux de Marseille and Université de la Méditerranée, 264, rue Saint-Pierre, 13385 Marseille, Cedex 05, France.
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Conte-Devolx B, Morlet-Barla N, Roux F, Sebag F, Henry JF, Niccoli P. Could primary hyperparathyroidism-related hypercalcemia induce hypercalcitoninemia? Horm Res Paediatr 2010; 73:372-5. [PMID: 20389108 DOI: 10.1159/000308170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 07/31/2009] [Indexed: 11/19/2022] Open
Abstract
AIMS To determine if primary hyperparathyroidism (pHPT) per se may be responsible of hypercalcitoninemia. pHPT induces chronic hypercalcemia that should be expected to be a potential stimulatory pathway of calcitonin (CT) secretion and to cause hypercalcitoninemia. METHOD We studied relationships between CT and pHPT-related chronic hypercalcemia in 122 patients aged 25-83 years who underwent parathyroid surgery. CT, calcium and PTH plasma levels were measured in all patients preoperatively. CT was measured by a current immunometric assay specific of mature CT monomer. RESULTS Of our 122 patients with pHPT-related hypercalcemia, 120 (98.4%) had normal CT values of less than 10 pg/ml and two (1.6%) exhibited a mildly increased CT above 10 pg/ml (11 and 12 pg/ml, respectively). We evidenced no relationship between CT and calcium level or PTH level. CONCLUSIONS Chronic pHPT-related hypercalcemia per se does not cause hypercalcitoninemia. The finding of pHPT concomitant with high CT levels should raise suspicion of multiple endocrine neoplasia type 2A.
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Affiliation(s)
- B Conte-Devolx
- Faculté de Médecine, Université de la Méditerranée et Service d'Endocrinologie, Diabète et Maladies Métaboliques, Marseille, France
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Taïeb D, Sebag F, Farman-Ara B, Portal T, Baumstarck-Barrau K, Fortanier C, Bourrelly M, Mancini J, De Micco C, Auquier P, Conte-Devolx B, Henry JF, Mundler O. Iodine biokinetics and radioiodine exposure after recombinant human thyrotropin-assisted remnant ablation in comparison with thyroid hormone withdrawal. J Clin Endocrinol Metab 2010; 95:3283-90. [PMID: 20392868 DOI: 10.1210/jc.2009-2528] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT A few prospective studies have evaluated the use of recombinant human TSH (rhTSH) for radioiodine remnant ablation. OBJECTIVE Our objective was to compare the effects of the both TSH regimens on iodine biokinetics in the thyroid remnant, dosimetry, and radiation protection. DESIGN We conducted a prospective randomized study. MATERIALS AND METHODS Eighty-eight patients were enrolled for radioiodine ablation to either the hypothyroid or rhTSH arms. A whole-body scan was performed at 48 and 144 h after therapy. Dose rates were assessed at 24, 48, and 144 h. Urinary samples were obtained during the first 48 h. Thyroglobulin was assessed before and after therapy. Iodine biokinetics in the remnants were calculated from gamma-count rates. Radiation-absorbed dose was calculated using OLINDA software. Exposure estimation was based on a validated model. RESULTS The effective half-life in the remnant thyroid tissue was significantly longer after rhTSH than during hypothyroidism (P = 0.01), whereas 48-h (131)I uptakes and residence times were similar. After therapy, thyroglobulin release (a marker of cell damage) was lower in the rhTSH arm. The mean total-body effective half-life and residence time were shorter in patients treated after rhTSH. Residence time was also lower for the colon and stomach. Absorbed dose estimates were lower in the rhTSH arm for the lower large intestine, breasts, ovaries, and the bone marrow. Dose rates at the time of discharge were lower in the rhTSH group with a reduction in cumulative radiation exposure to contact persons. CONCLUSIONS In comparison with thyroid hormone withdrawal, rhTSH is associated with longer remnant half-life of radioactive iodine while also reducing radiation exposure to the rest of the body and also to the general public who come in contact with such patients.
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Affiliation(s)
- D Taïeb
- Service central de Biophysique et de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint-Pierre 13385 Marseille Cedex 5, France.
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Taïeb D, Giusiano S, Sebag F, Marcy M, de Micco C, Palazzo FF, Dusetti NJ, Iovanna JL, Henry JF, Garcia S, Taranger-Charpin C. Tumor protein p53-induced nuclear protein (TP53INP1) expression in medullary thyroid carcinoma: a molecular guide to the optimal extent of surgery? World J Surg 2010; 34:830-5. [PMID: 20145930 DOI: 10.1007/s00268-010-0395-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Medullary thyroid cancer (MTC) is characterized by early regional lymph node metastasis, the presence of which represents a critical obstacle to cure. At present no molecular markers have been successfully integrated into the clinical care of sporadic MTC. The present study was designed to evaluate TP53INP1 expression in MTC and to assess its ability to guide the surgeon to the optimal extent of surgery performed with curative intent. METHODS Thirty-eight patients with sporadic MTC were evaluated. TP53INP1 immunoexpression was studied on embedded paraffin material and on cytological smears. RESULTS TP53INP1 was expressed in normal C cells, in C-cell hyperplasia, and in 57.9% of MTC. It was possible to identify two groups of MTC according to the proportion of TP53INP1 expressing tumor cells: group 1 from 0% to <50% and group 2 from 50% to 100% of positive cells. Patients with a decreased expression of TP53INP1 (group 1) had a lower rate of nodal metastasis (18.8% versus 63.4% in group 2; P = 0.009), with only minimal lymph node involvement per N1 patient (2.7% of positive lymph nodes versus 22.9%; P < 0.001) and better outcomes (100% of biochemical cure versus 55.5%; P < 0.001). Patients with distant metastases were only observed in group 2. Cytological samples exhibit similar results to their embedded counterparts. CONCLUSIONS TP53INP1 immunoexpression appears to be a clinical predictor of lymph node metastasis in MTC. The evaluation of TP53INP1 expression may guide the extent of lymph node dissection in the clinically node-negative neck. These findings require prospective validation.
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Affiliation(s)
- D Taïeb
- INSERM U624 Stress Cellulaire, Parc Scientifique et Technologique de Luminy, Case 915, 13288, Marseille, France.
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Abstract
Abstract
Background
Not operating on patients with mild hypercalcitoninaemia (MHCT) and sporadic thyroid disease carries the risk of omitting curative surgery for medullary thyroid cancer, but systematic surgery would result in unnecessary treatment of benign pathology. This study reviewed the management of MCHT and non-hereditary thyroid disease in one centre.
Methods
MCHT was defined as an increase in basal and stimulated calcitonin levels not exceeding 30 and 200 pg/ml respectively. Over 15 years, 125 patients who presented with MCHT and sporadic thyroid disease were followed. Surgery was indicated only if there were local pressure symptoms or suspicious histomorphological changes in solitary nodules.
Results
Fifty-five patients underwent total thyroidectomy and 18 unilateral total lobectomy. Histological examination revealed medullary microcarcinoma in six patients (two women and four men). C-cell hyperplasia was found in 54 patients (74 per cent) and 13 (18 per cent) harboured no C-cell pathology. Calcitonin levels stabilized after lobectomy and became undetectable following thyroidectomy. They normalized during follow-up in a third of patients who did not have surgery.
Conclusion
Not all patients with MHCT and sporadic thyroid disease require surgery.
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Affiliation(s)
- M Cherenko
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
| | - E Slotema
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
| | - F Sebag
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
| | - C De Micco
- Department of Pathology, University Hospital Marseilles, Marseilles, France
| | - J F Henry
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
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