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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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Castinetti F, Qi XP, Walz MK, Maia AL, Sansó G, Peczkowska M, Hasse-Lazar K, Links TP, Dvorakova S, Toledo RA, Mian C, Bugalho MJ, Wohllk N, Kollyukh O, Canu L, Loli P, Bergmann SR, Biarnes Costa J, Makay O, Patocs A, Pfeifer M, Shah NS, Cuny T, Brauckhoff M, Bausch B, von Dobschuetz E, Letizia C, Barczynski M, Alevizaki MK, Czetwertynska M, Ugurlu MU, Valk G, Plukker JTM, Sartorato P, Siqueira DR, Barontini M, Szperl M, Jarzab B, Verbeek HHG, Zelinka T, Vlcek P, Toledo SPA, Coutinho FL, Mannelli M, Recasens M, Demarquet L, Petramala L, Yaremchuk S, Zabolotnyi D, Schiavi F, Opocher G, Racz K, Januszewicz A, Weryha G, Henry JF, Brue T, Conte-Devolx B, Eng C, Neumann HPH. Outcomes of adrenal-sparing surgery or total adrenalectomy in phaeochromocytoma associated with multiple endocrine neoplasia type 2: an international retrospective population-based study. Lancet Oncol 2014; 15:648-55. [PMID: 24745698 DOI: 10.1016/s1470-2045(14)70154-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevention of medullary thyroid cancer in patients with multiple endocrine neoplasia type 2 syndrome has demonstrated the ability of molecular diagnosis and prophylactic surgery to improve patient outcomes. However, the other major neoplasia associated with multiple endocrine neoplasia type 2, phaeochromocytoma, is not as well characterised in terms of occurrence and treatment outcomes. In this study, we aimed to systematically characterise the outcomes of management of phaeochromocytoma associated with multiple endocrine neoplasia type 2. METHODS This multinational observational retrospective population-based study compiled data on patients with multiple endocrine neoplasia type 2 from 30 academic medical centres across Europe, the Americas, and Asia. Patients were included if they were carriers of germline pathogenic mutations of the RET gene, or were first-degree relatives with histologically proven medullary thyroid cancer and phaeochromocytoma. We gathered clinical information about patients'RET genotype, type of treatment for phaeochromocytoma (ie, unilateral or bilateral operations as adrenalectomy or adrenal-sparing surgery, and as open or endoscopic operations), and postoperative outcomes (adrenal function, malignancy, and death). The type of surgery was decided by each investigator and the timing of surgery was patient driven. The primary aim of our analysis was to compare disease-free survival after either adrenal-sparing surgery or adrenalectomy. FINDINGS 1210 patients with multiple endocrine neoplasia type 2 were included in our database, 563 of whom had phaeochromocytoma. Treatment was adrenalectomy in 438 (79%) of 552 operated patients, and adrenal-sparing surgery in 114 (21%). Phaeochromocytoma recurrence occurred in four (3%) of 153 of the operated glands after adrenal-sparing surgery after 6-13 years, compared with 11 (2%) of 717 glands operated by adrenalectomy (p=0.57). Postoperative adrenal insufficiency or steroid dependency developed in 292 (86%) of 339 patients with bilateral phaeochromocytoma who underwent surgery. However, 47 (57%) of 82 patients with bilateral phaeochromocytoma who underwent adrenal-sparing surgery did not become steroid dependent. INTERPRETATION The treatment of multiple endocrine neoplasia type 2-related phaeochromocytoma continues to rely on adrenalectomies with their associated Addisonian-like complications and consequent lifelong dependency on steroids. Adrenal-sparing surgery, a highly successful treatment option in experienced centres, should be the surgical approach of choice to reduce these complications.
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Affiliation(s)
- Frederic Castinetti
- Department of Endocrinology, La Timone Hospital, Hopitaux de Marseille and Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille, Aix-Marseille University, Marseille, France.
| | - Xiao-Ping Qi
- Departments of Oncologic and Urologic Surgery, The 117th PLA Hospital, PLA Hangzhou Clinical College, Anhui Medical University, Hangzhou, China
| | - Martin K Walz
- Department of Surgery and Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - Ana Luiza Maia
- Thyroid Section, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Gabriela Sansó
- Center for Endocrinological Investigations, Hospital de Ninos R Gutierrez, Buenos Aires, Argentina
| | | | - Kornelia Hasse-Lazar
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska Curie Memorial Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Netherlands
| | - Sarka Dvorakova
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Rodrigo A Toledo
- Department of Endocrinology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Caterina Mian
- Operative Unit of the Endocrinology Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Maria Joao Bugalho
- Servico de Endocrinologia, Instituto Portugues de Oncologia de Lisboa Francisco Gentil E.P.E. and Faculdade de Ciencias Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nelson Wohllk
- Endocrine Section, Universidad de Chile, Hospital del Salvador, Santiago de Chile, Chile
| | | | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - Paola Loli
- Department of Endocrinology, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Simona R Bergmann
- Division of Endocrinology and Diabetology, Faculty of Medicine, Philipps University of Marburg, Marburg, Germany
| | - Josefina Biarnes Costa
- Hospital Universitari de Girona, Gerencia Territorial Girona, Institut Català de la Salut, Girona, Spain
| | - Ozer Makay
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Izmir, Turkey
| | - Attila Patocs
- Molecular Medicine Research Group, HSA-SE "Lendület" Hereditary Endocrine Tumor Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Marija Pfeifer
- Department of Endocrinology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Nalini S Shah
- Department of Endocrinology, Seth G S Medical College, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Thomas Cuny
- Department of Endocrinology, University Hospital, Nancy, France
| | | | - Birke Bausch
- 2nd Department of Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Ernst von Dobschuetz
- Department of Visceral Surgery, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - Claudio Letizia
- Department of Internal Medicine and Medical Specialties, University La Sapienza, Rome, Italy
| | - Marcin Barczynski
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University, Medical College, Krakow, Poland
| | - Maria K Alevizaki
- Endocrine Unit Evgenideion Hospital and Department of Medical Therapeutics, Alexandra Hospital, Athens University School of Medicine, Athens, Greece
| | - Malgorzata Czetwertynska
- Department of Endocrinology, Maria Sklodowska Curie Memorial Center and Institute of Oncology, Warsaw, Poland
| | - M Umit Ugurlu
- Department of General Surgery, Breast and Endocrine Surgery Unit, Marmara University, Istanbul, Turkey
| | - Gerlof Valk
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - John T M Plukker
- Department of Surgery, University Medical Centre, Groningen, Netherlands
| | - Paola Sartorato
- Department of Internal Medicine, General Hospital, Montebelluna, Treviso, Italy
| | - Debora R Siqueira
- Thyroid Section, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Marta Barontini
- Center for Endocrinological Investigations, Hospital de Ninos R Gutierrez, Buenos Aires, Argentina
| | | | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska Curie Memorial Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Hans H G Verbeek
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Netherlands
| | - Tomas Zelinka
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Vlcek
- Department of Nuclear Medicine and Endocrinology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sergio P A Toledo
- Department of Endocrinology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Flavia L Coutinho
- Department of Endocrinology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy
| | - Monica Recasens
- Hospital Universitari de Girona, Gerencia Territorial Girona, Institut Català de la Salut, Girona, Spain
| | - Lea Demarquet
- Department of Endocrinology, University Hospital, Nancy, France
| | - Luigi Petramala
- Department of Internal Medicine and Medical Specialties, University La Sapienza, Rome, Italy
| | | | | | - Francesca Schiavi
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS Padova, Padova, Italy
| | - Giuseppe Opocher
- Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Karoly Racz
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | | | - Georges Weryha
- Department of Endocrinology, University Hospital, Nancy, France
| | - Jean-Francois Henry
- Aix-Marseille University, Department of Endocrine Surgery, La Timone Hospital, Marseille, France
| | - Thierry Brue
- Department of Endocrinology, La Timone Hospital, Hopitaux de Marseille and Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille, Aix-Marseille University, Marseille, France
| | - Bernard Conte-Devolx
- Department of Endocrinology, La Timone Hospital, Hopitaux de Marseille and Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille, Aix-Marseille University, Marseille, France
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hartmut P H Neumann
- Section for Preventive Medicine, Department of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany
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Kirkby-Bott J, Brunaud L, Mathonet M, Hamoir E, Kraimps JL, Trésallet C, Amar L, Rault A, Henry JF, Carnaille B. Ectopic hormone-secreting pheochromocytoma: a francophone observational study. World J Surg 2012; 36:1382-8. [PMID: 22362045 DOI: 10.1007/s00268-012-1488-1] [Citation(s) in RCA: 21] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ectopic hormone-secreting pheochromocytomas are rare; only case reports exist in the literature. This condition has been linked with increased malignancy, familial syndromes, and ACTH secretion. We wanted to test these hypotheses and shed light on the nature of ectopic hormone-secreting pheochromocytomas. METHODS This is a multicenter (francophone) observational study. Inclusion was based upon abnormal preoperative hormone tests in patients with pheochromocytoma that normalized after removal of the tumor. Where possible, immunohistochemistry was performed to confirm that ectopic secretion came from the tumor. RESULTS Sixteen cases were found: nine female and seven male patients. Median age was 50.5 (range 31-89) years. Most presented with hypertension, diabetes, or cushingoid features. Ten patients had specific symptoms from the ectopic hormone secretion. Two had a familial syndrome. Of eight patients with excess cortisol secretion, three died as a result of the tumor resection: two had pheochromocytomas >15 cm and their associated cortisol hypersecretion complicated their postoperative course. The other died from a torn subhepatic vein. The 13 survivors did not develop any evidence of malignancy during follow-up (median 50 months). Symptoms from the ectopic secretion resolved after removal of the tumor. Immunohistochemistry was performed and was positive in eight tumors: five ACTH, three calcitonins, and one VIP. CONCLUSIONS Most pheochromocytomas with ectopic secretion are neither malignant nor familial. Most ectopic hormone-secreting pheochromocytoma cause hypercortisolemia. Patients with a pheochromocytoma should be worked up for ectopic hormones, because removal of the pheochromocytoma resolves those symptoms. Associated cortisol secretion needs careful attention.
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Affiliation(s)
- James Kirkby-Bott
- Service de Chirurgie Endocrinienne, Université Lille Nord, CHU, 59037 Lille Cedex, France
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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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Tessonnier L, Sebag F, Ghander C, De Micco C, Reynaud R, Palazzo FF, Conte-Devolx B, Henry JF, Mundler O, Taïeb D. Limited value of 18F-F-DOPA PET to localize pancreatic insulin-secreting tumors in adults with hyperinsulinemic hypoglycemia. J Clin Endocrinol Metab 2010; 95:303-7. [PMID: 19915018 DOI: 10.1210/jc.2009-1357] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [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 Fluorine-18-L-dihydroxyphenylalanine positron emission tomography (18F-FDOPA PET) imaging is increasingly used in the workup of neuroendocrine tumors. It has been shown to be an accurate tool in the diagnosis of congenital hyperinsulinism, but limited information is available on its value in adult disease. OBJECTIVE, PATIENTS, AND DESIGN: The objective of this study was to review our experience with 18F-FDOPA PET imaging in six consecutive patients with hyperinsulinemic hypoglycemia (HH) (four solitary insulinomas, one diffuse beta-cell hyperplasia, one malignant insulinoma). 18F-FDOPA uptake was also evaluated in 37 patients (43 procedures) without HH or other pancreatic neuroendocrine tumors, which acted as a control group. RESULTS Using visual analysis, 18F-FDOPA-PET proved positive in only one case (a multiple endocrine neoplasia type 1 related insulinoma). In diffuse beta-cell hyperplasia, the pancreatic uptake was similar to controls. In the patient with liver metastases, the extent of disease was underestimated. The pancreatic uptake was not statistically different between controls and hyperinsulinemic patients. The main limitation for identifying insulinomas or beta-cell hyperplasia in adults appears to be to the 18F-FDOPA uptake and retention in the whole pancreas. This drawback is potentially circumvented in focal hyperplasia in newborns due to a lower aromatic amino acid decarboxylase expression in the extralesional pancreatic parenchyma. CONCLUSIONS 18F-FDOPA PET is of limited value in localizing pancreatic insulin secreting tumors in adult HH. Our results contrast with the referential study and require further analysis.
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Affiliation(s)
- L Tessonnier
- Service Central de Biophysique et de Médecine Nucléaire, Centre Hospitalo-Universitaire Timone, 13385 Marseille Cedex 5, France
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Taïeb D, Sebag F, Cherenko M, Baumstarck-Barrau K, Fortanier C, Farman-Ara B, De Micco C, Vaillant J, Thomas S, Conte-Devolx B, Loundou A, Auquier P, Henry JF, Mundler O. Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study. Clin Endocrinol (Oxf) 2009; 71:115-23. [PMID: 18803678 DOI: 10.1111/j.1365-2265.2008.03424.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [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: 02/03/2023]
Abstract
BACKGROUND Recombinant human TSH (rhTSH) has become the modality of choice for radioiodine remnant ablation (RRA) in low-risk thyroid cancer patients. AIMS AND METHODS The aims of the present prospective randomized study were to evaluate the impact of TSH stimulation procedure (hypothyroidism vs. rhTSH) on quality of life (QoL) of thyroid cancer patients undergoing RRA and to evaluate efficacy of both procedures. L-T4 was initiated in both groups after thyroidectomy. After randomization, L-T4 was discontinued in hypothyroid (hypo) group and continued in rhTSH group. A measure of 3.7 GBq of radioiodine was given to both groups. The functional assessment of chronic illness therapy-fatigue (FACIT-F) was administered from the early postoperative period to 9 months. Socio-demographic parameters, anxiety and depression scales were also evaluated (CES-D, BDI and Spielberger state-trait questionnaires). At 9 months, patients underwent an rhTSH stimulation test, diagnostic (131)I whole body scan (dxWBS) and neck ultrasonography. RESULTS A total of 74 patients were enrolled for the study. There was a significant decrease in QoL from baseline (t0) to t1 (RRA period) in the hypothyroid group with significant differences in FACIT-F TOI (P < 10(-3)), FACT-G total score (P = 0.005) and FACIT-F total score (P = 0.003). By contrast, QoL was preserved in the rhTSH group. In the multivariate analysis, FACIT-TOI changes were only affected by the modality of TSH stimulation performed for RRA. From 3 to 9 months, changes of QoL scales and subscales were no longer statistically different in both groups of patients. Based on serum rhTSH-stimulated Tg alone (Tg < 0.8 microg/l, BRAHMS Tg Kryptor), no difference in ablation success was observed between rhTSH and hypothyroidism groups, 91.7% and 97.1%, respectively. A higher rate of persistent thyroid remnants was observed in the rhTSH arm, although in most cases uptake was < 0.1% and of no clinical significance. CONCLUSIONS rhTSH preserves QoL of patients undergoing RRA with similar rates of ablation success compared to hypothyrodism. However, there is a wide heterogeneity in the clinical impact of hypothyroidism.
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Affiliation(s)
- D Taïeb
- Service Central de Biophysique et de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, Marseille Cedex 5, France.
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Sebag F, Fortanier C, Ippolito G, Lagier A, Auquier P, Henry JF. Harmonic Scalpel in Multinodular Goiter Surgery: Impact on Surgery and Cost Analysis. J Laparoendosc Adv Surg Tech A 2009; 19:171-4. [DOI: 10.1089/lap.2008.0043] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frederic Sebag
- Department of General and Endocrine Surgery, Hôpital de La Timone, Marseille, France
| | - Cécile Fortanier
- Public Health Department, School of Medicine, AP-HM, Marseille, France
| | - Guiseppe Ippolito
- Department of General and Endocrine Surgery, Hôpital de La Timone, Marseille, France
| | - Aude Lagier
- Department of General and Endocrine Surgery, Hôpital de La Timone, Marseille, France
| | - Pascal Auquier
- Public Health Department, School of Medicine, AP-HM, Marseille, France
| | - Jean-Francois Henry
- Department of General and Endocrine Surgery, Hôpital de La Timone, Marseille, France
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Abstract
Background Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope, in a closed area maintained by insufflation or mechanical retraction. ET by direct cervical approach (anterior or lateral) is minimally invasive, but ET using an extracervical access (chest wall, breast, or axillary) is not. No technique seems to be universally accepted yet. This review was designed to clarify the existing evidence for performing endoscopic thyroid resections in the management of benign thyroid nodules. Methods A database search was conducted in PubMed and Embase from which summaries and abstracts were screened for relevant data, matching our definition. Publications were further assessed and assigned their respective levels of evidence. Additional data derived from our own unit’s experience with endoscopic thyroidectomy were included. Results Thirty mainly retrospective cohort studies have been published in which morbidity, such as unilateral vocal cord palsy, is poorly evaluated. ET takes from 90 to 280 minutes for lobectomy by cervical access and total thyroidectomy by chest wall approach, respectively. Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach. Extracervical approach avoids a neck scar but implies invasiveness in terms of dissection and postoperative discomfort. Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published. Conclusions Currently it is not possible to recommend the application of ET based on evidence. Reported complications stress the importance of advanced endoscopic skills. ET should only be offered to carefully selected patients and, therefore, a high volume of patients requiring thyroid surgery is needed. Superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. Possible advantages of endoscopic thyroid techniques and our patient’s desire for the highest cosmetic outcome possible justify further development of ET in expert hands of endocrine surgeons.
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Affiliation(s)
- E Th Slotema
- Department of Endocrine Surgery University Hospital Marseille, Service de Chirurgie Générale et Endocrinienne, CHU-Hôpital de la Timone, 264 Rue Saint-Pierre, 13385, Marseille cedex 05, France.
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15
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Taïeb D, Tessonnier L, Sebag F, Niccoli-Sire P, Morange I, Colavolpe C, De Micco C, Barlier A, Palazzo FF, Henry JF, Mundler O. The role of 18F-FDOPA and 18F-FDG-PET in the management of malignant and multifocal phaeochromocytomas. Clin Endocrinol (Oxf) 2008; 69:580-6. [PMID: 18394015 DOI: 10.1111/j.1365-2265.2008.03257.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [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: 01/16/2023]
Abstract
BACKGROUND (18)F-DOPA has emerged as a promising tool in the localization of chromaffin-tissue-derived tumours. Interestingly, phaeochromocytomas (PHEO) are also FDG avid. AIM AND METHODS The aim of this study was to retrospectively evaluate the results of (18)F-FDOPA and/or (18)F-FDG-PET in patients with PHEO and paragangliomas (PGLs) and to compare the outcome of this approach with the traditional therapeutic work-up. Nine patients with non-MEN2 related PHEO or PGL were evaluated. At the time of the PET studies, the patients were classified into three groups based on their clinical history, conventional and SPECT imaging. The groups were malignant disease (n = 5, 1 VHL), apparently unique tumour site in patients with previous surgery (n = 1, SDHB) and multifocal tumours (n = 3, 1 VHL, 1 SDHD). (18)F-FDOPA and (18)F-FDG-PET PET/CT were then performed in all patients. RESULTS PET successfully identified additional tumour sites in five out of five patients with metastatic disease that had not been identified with SPECT + CI. Whilst tumour tracer uptake varied between patients it exhibited a consistently favourable residence time for delayed acquisitions. (18)F-FDOPA uptake (SUVmax) was superior to (18)F-FDG uptake in cases of neck PGL (three patients, four tumours). If only metastatic forms and abdominal PGLs were considered, (18)F-FDG provided additional information in three cases (two metastatic forms, one multifocal disease with SDHD mutation) compared to (18)F-FDOPA. CONCLUSIONS Our results suggest that tumour staging can be improved by combining (18)F-FDOPA and (18)F-FDG in the preoperative work-up of patients with abdominal and malignant PHEOs. (18)F-FDOPA is also an effective localization tool for neck PGLs. MIBG however, still has a role in these patients as MIBG and FDOPA images did not completely overlap.
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Affiliation(s)
- D Taïeb
- Service Central de Biophysique et de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, Marseille Cedex 5, France.
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Tessonnier L, Sebag F, Palazzo FF, Colavolpe C, De Micco C, Mancini J, Conte-Devolx B, Henry JF, Mundler O, Taïeb D. Does 18F-FDG PET/CT add diagnostic accuracy in incidentally identified non-secreting adrenal tumours? Eur J Nucl Med Mol Imaging 2008; 35:2018-25. [PMID: 18566816 DOI: 10.1007/s00259-008-0849-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 05/11/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE The widespread use of high-resolution cross-sectional imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) for the investigation of the abdomen is associated with an increasing detection of incidental adrenal masses. We evaluated the ability of (18)F-fluorodeoxyglucose positron emission tomography to distinguish benign from malignant adrenal masses when CT or MRI results had been inconclusive. METHODS We included only patients with no evidence of hormonal hypersecretion and no personal history of cancer or in whom previously diagnosed cancer was in prolonged remission. PET/CT scans were acquired after 90 min (mean, range 60-140 min) after FDG injection. The visual interpretation, maximum standardised uptake values (SUVmax) and adrenal compared to liver uptake ratio were correlated with the final histological diagnosis or clinico-radiological follow-up when surgery had not been performed. RESULTS Thirty-seven patients with 41 adrenal masses were prospectively evaluated. The final diagnosis was 12 malignant, 17 benign tumours, and 12 tumours classified as benign on follow-up. The visual interpretation was more accurate than SUVmax alone, tumour diameter or unenhanced density, with a sensitivity of 100% (12/12), a specificity of 86% (25/29) and a negative predictive value of 100% (25/25). The use of 1.8 as the threshold for tumour/liver SUVmax ratio, retrospectively established, demonstrated 100% sensitivity and specificity. CONCLUSION FDG PET/CT accurately characterises adrenal tumours, with an excellent sensitivity and negative predictive values. Thus, a negative PET may predict a benign tumour that would potentially prevent the need for surgery of adrenal tumours with inconclusive conventional imaging.
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Affiliation(s)
- L Tessonnier
- 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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Henry JF. Authors' reply: Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma ( Br J Surg 2007; 94: 566–570). Br J Surg 2007. [DOI: 10.1002/bjs.5975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J F Henry
- Department of Endocrine Surgery, La Timone Hospital, 264 Rue Saint-Pierre, 13385 Marseille, France
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Ippolito G, Palazzo FF, Sebag F, De Micco C, Henry JF. Intraoperative diagnosis and treatment of parathyroid cancer and atypical parathyroid adenoma. Br J Surg 2007; 94:566-70. [PMID: 17380564 DOI: 10.1002/bjs.5570] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Distinction of parathyroid cancer from atypical parathyroid adenoma (APA) at operation is difficult. The aim of this study was to determine whether parathyroid cancer and APA have different operative findings and long-term outcomes.
Methods
A retrospective review was undertaken of patients with suspicious or malignant parathyroid tumours treated between 1974 and 2005. Parathyroid cancer was defined as a lesion with vascular or tissue invasion, and APA as a neoplasm with broad fibrous bands, trabecular growth, mitosis and nuclear atypia.
Results
Twenty-seven patients with suspicious or malignant parathyroid tumours were identified. After histological review, parathyroid cancer was confirmed in 11 patients (group 1) and 16 tumours were classified as APA (group 2). The clinical presentation and operative findings of the two types of tumour were indistinguishable. At initial surgery, seven patients in group 1 underwent en bloc resection, and four had parathyroidectomy. Four of the seven patients who had en bloc resection had recurrences. No recurrences were observed in the other seven patients in group 1 at a median follow-up of 65 months. In group 2, eight patients had en bloc resection and eight had parathyroidectomy; no patient had recurrence at a median follow-up of 91 months.
Conclusion
Operative findings cannot distinguish APA from parathyroid cancer reliably. Without evidence of macroscopic local invasion, the value of en bloc resection at initial surgery remains debatable.
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Affiliation(s)
- G Ippolito
- Department of Endocrine Surgery, La Timone University Hospital, Marseilles, France
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Abstract
BACKGROUND Solitary adrenal metastases (AM) are rare and their management unclear. Surgery, especially laparoscopic adrenalectomy (LA), is debatable in the management of AM. This retrospective study analysed the feasibility and the results of LA for AM. METHODS From 1997 to 2003, 16 patients underwent LA for isolated AM. Completeness of resection, postoperative morbidity and follow-up (FU) were recorded. RESULTS There were 10 synchronous AM and 6 metachronous AM. Primary tumours included lung cancer (n = 9), melanoma (n = 3), mesothelioma (n = 1), rhabdomyosarcoma (n = 1), colonic adenocarcinoma (n = 1) and renal cell carcinoma (n = 1). Five patients required conversion to an open procedure. Minor complications occurred in three patients. Pathology confirmed the diagnosis of AM. Mean tumour size was 60 (range: 15-110) mm. Nine patients (56%) had complete resections, 3 had positive margins and 4 had incomplete macroscopic resections. Mean observed FU was 25 (range: 1-68) months. Median overall calculated survival was 23 months. Overall 5-year survival was 33% (Kaplan-Meyer). At the end of study, 8 patients were alive with a mean FU of 35 months (3 without evidence of disease). No patient presented with local relapse or port-site metastasis. We did not identify any predictive factors. All patients with incomplete macroscopic resection died within 24 months. CONCLUSIONS LA can achieve an acceptable 5-year survival, comparable to open surgery but with better postoperative comfort. It should be considered for AM with the intention of complete resection. It offers the patient the possibility of tumour resection with the benefit of a laparoscopic approach.
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Affiliation(s)
- F Sebag
- Department of General and Endocrine Surgery, Hôpital de la Timone, Boulevard Jean Moulin, Marseille Cedex 5, 13385, France.
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Sebag F, Palazzo FF, Harding J, Sierra M, Ippolito G, Henry JF. Endoscopic lateral approach thyroid lobectomy: safe evolution from endoscopic parathyroidectomy. World J Surg 2006; 30:802-5. [PMID: 16680595 DOI: 10.1007/s00268-005-0353-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Endoscopic thyroid surgery has been shown to be feasible. Most minimal access procedures have been performed via a midline approach. Based on our experience of more than 500 endoscopic parathyroidectomies via a lateral approach we have used the same method for thyroid lobectomy. METHODS We present our experience of endoscopic thyroid lobectomy via a lateral approach (ETLA) and review of the results over a 1-year period (2004). Inclusion criteria for ETLA were (1) solitary nodule with atypical/suspicious fine-needle biopsy (FNB) or solitary toxic nodule; (2) lesions with a diameter of < 3 cm. Patients with a history of previous neck surgery or radiation exposure were excluded. All patients underwent postoperative vocal cord checks and plasma calcium evaluation. RESULTS A total of 742 thyroid procedures were performed during 2004. Among them, 38 patients (5.1%) underwent ETLA. Indications for surgery were suspicious FNB results (36 patients) and a toxic nodule (2 patients). Mean nodule size was 19.2 mm. Mean +/- SD operating time was 102 +/- 27 minutes. All recurrent laryngeal nerves were identified (including one that was nonrecurrent). Of the 38 patients, the superior parathyroid gland was identified in 36 and the inferior parathyroid gland in 33. There were two conversions due to difficulty with the dissection. Two operations were converted because malignancy was diagnosed on frozen section examination. Two patients underwent a delayed completion thyroidectomy when definitive histology necessitated it. There were no permanent operative complications, and all patients were discharged on the first postoperative day. CONCLUSIONS ETLA offers excellent intraoperative visualization of the vital structures and is a safe alternative to conventional thyroid lobectomy in selected cases.
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Affiliation(s)
- F Sebag
- Department of General and Endocrine Surgery, Hôpital de la Timone, Boulevard Jean Moulin, Marseille, Cedex 5, 13385, France.
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Hubbard JGH, Sebag F, Maweja S, Henry JF. Subtotal parathyroidectomy as an adequate treatment for primary hyperparathyroidism in multiple endocrine neoplasia type 1. ACTA ACUST UNITED AC 2006; 141:235-9. [PMID: 16549687 DOI: 10.1001/archsurg.141.3.235] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESIS The most appropriate surgical approach for hyperparathyroidism (HPT) in multiple endocrine neoplasia type 1 remains controversial. It has been advocated that reoperations for recurrent disease are easier to perform after total parathyroidectomy (TP) with autotransplantation than after subtotal parathyroidectomy (SP). In view of our large experience in patients with secondary HPT for whom TP with autotransplantation did not simplify reoperations, SP remains our preferred treatment for patients with HPT and multiple endocrine neoplasia type 1. DESIGN Retrospective cohort study. SETTING Tertiary referral medical center. PATIENTS A total of 29 consecutive patients (22 women, 7 men; mean age, 42.2 years) with multiple endocrine neoplasia type 1 who underwent definitive cervical exploration for HPT. MAIN OUTCOME MEASURES Temporary and permanent hypocalcemia, pattern of parathyroid disease, and sites and timing of recurrent HPT. Definitive primary surgery included SP in 21 patients, TP with autotransplantation in 4 patients, and less-than-subtotal parathyroidectomy in 4 selected patients. RESULTS The mean follow-up was 88.5 months (range, 8-285 months). Four patients died during follow-up; 2 of these deaths were related to multiple endocrine neoplasia. No patients had persistent HPT. Temporary hypocalcemia occurred in 12 SP cases (57%), 4 TP with autotransplantation cases (100%), and 0 less-than-subtotal parathyroidectomy cases. Permanent hypocalcemia requiring long-term treatment occurred in 2 SP cases (10%), 1 TP with autotransplantation case (25%), and 0 less-than-subtotal parathyroidectomy cases. Four patients developed recurrent disease, including 1 with SP, 2 with TP with autotransplantation, and 1 with less-than-subtotal parathyroidectomy at 57 months, 197 and 180 months, and 164 months, respectively, representing 14% of all of the patients and 43% of patients with more than 10 years of follow-up. CONCLUSIONS Recurrent HPT occurs many years after definitive primary surgery (median, 14.3 years). Surgical treatment should therefore aim to minimize the risk of permanent hypocalcemia and facilitate future surgery. When correctly performed, SP fulfills these objectives.
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St-Pierre DH, Faraj M, Karelis AD, Conus F, Henry JF, St-Onge M, Tremblay-Lebeau A, Cianflone K, Rabasa-Lhoret R. Lifestyle behaviours and components of energy balance as independent predictors of ghrelin and adiponectin in young non-obese women. Diabetes & Metabolism 2006; 32:131-9. [PMID: 16735961 DOI: 10.1016/s1262-3636(07)70259-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Dysregulation of the normal levels of ghrelin, leptin and adiponectin in young non-obese subjects could promote food intake, diabetes and cardiovascular disease in later stages of life. Little information is available on how plasmatic concentrations of these hormones may be influenced by eating habits and/or components of energy balance in a young population, which if known, could facilitate their voluntary regulation. METHODS In this cross-sectional study we examined the predictors of fasting plasma ghrelin, adiponectin and leptin in a population of well-characterized young non-obese women (N = 63). Energy intake was assessed by 24-hour dietary recall, resting metabolic rate (RMR) by indirect calorimetry, physical activity energy expenditure (PAEE) by tri-axial accelerometer, physical fitness by VO(2 peak), and eating behaviors by self administrated questionnaire. RESULTS Lower RMR and higher HDL-cholesterol were independent predictors of higher plasma ghrelin explaining 17.6% of its variation even after correcting for BMI. Higher total or central fat mass was the only predictor of higher plasma leptin, and no other variable added any power to the prediction equation. Finally, higher energy intake and waist circumference and lower PAEE predicted lower plasma adiponectin in young non-obese women, explaining 43% of the variation in its concentrations even after correcting for total or central fat mass. CONCLUSION Components of the energy balance (ie: energy intake and/or expenditure) influence adiponectin and ghrelin circulating levels. That is, higher energy intake and lower physical activity independently predict lower adiponectin concentrations, whereas lower resting metabolic rate independently predicts higher ghrelin levels in young non-obese women. Prospective studies are needed to examine whether circulating concentrations of ghrelin and adiponectin can be voluntarily regulated by lifestyle interventions.
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Affiliation(s)
- D H St-Pierre
- Unité Métabolique, Département de Nutrition, Faculté de Médicine, Université de Montréal, Canada
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23
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Henry JF, Sebag F. [Applied embryology of parathyroid glands]. Vestn Khir Im I I Grek 2006; 165:41-4. [PMID: 17315687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The article describes the normal structure of the parathyroid glands (PTG) and their development, anomalies of migration in the process of embryogenesis and congenital ectopias of PTG as well as possible supplementary PTG and their congenital ectopias.
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24
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Palazzo FF, Sebag F, Henry JF. Endocrine surgical technique: endoscopic thyroidectomy via the lateral approach. Surg Endosc 2005; 20:339-42. [PMID: 16362471 DOI: 10.1007/s00464-005-0385-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 10/07/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimal access approaches are increasingly used in endocrine surgery. Several minimal access approaches to the thyroid gland have been described, including a small-incision lateral approach and a video-assisted central approach, but to date no technique has been universally accepted. METHODS Benefiting from the experience of more than 500 endoscopic parathyroidectomies via a lateral neck approach, the authors developed an endoscopic thyroidectomy based on the same approach and principles. Patients with solitary nodules smaller than 3 cm in diameter and no history of neck surgery or irradiation were offered this operation. A detailed description of the surgical technique is provided. RESULTS Of the 742 thyroidectomies performed in 2004, 38 (5.1%) were endoscopic thyroidectomies. The mean nodule size was 22-mm (range, 7-47-mm), and the mean operating time was 99 min (range, 64-150-min). In all cases, the recurrent laryngeal nerve was preserved intact, and the superior and inferior parathyroids were identified, respectively, in 36 and 33 of the 38 patients. Two patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. CONCLUSIONS The described endoscopic lateral approach combines the coherence of the minimal access lateral approach and the benefits of fiberoptic magnification. It is a safe and effective technique in the hands of an appropriately trained surgeon.
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Affiliation(s)
- F F Palazzo
- Department Endocrine Surgery, La Timone University Hospital, Boulevard Jean Moulin, Marseille Cedex 4, 13385, France
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25
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Sierra M, Sebag F, De Micco C, Loudot C, Misso C, Calzolari F, Henry JF. [Abrikossoff tumor of the proximal esophagus misdiagnosed as a thyroid nodule]. ACTA ACUST UNITED AC 2005; 131:219-21. [PMID: 16242662 DOI: 10.1016/j.anchir.2005.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 09/02/2005] [Indexed: 11/29/2022]
Abstract
The diagnosis of thyroid nodules is straightforward and rarely mistaken. We present a case of a paraesophageal granular cell tumor, discovered incidentally during surgery for what it was diagnosed as a suspicious thyroid nodule by ultrasound and FNA. Complete resection was achieved without disruption of the esophageal mucosa. A terminal branch of the recurrent laryngeal nerve had to be resected en bloc with the tumor. Morphological and immunohistochemical diagnosis was established postoperatively. A review of the literature is presented.
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Affiliation(s)
- M Sierra
- Service de Chirurgie Générale et Endocrinienne, Hôpital de La Timone, 27, boulevard Jean-Moulin, 13385 Marseille, France
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Di Cristofaro J, Vasko V, Savchenko V, Cherenko S, Larin A, Ringel MD, Saji M, Marcy M, Henry JF, Carayon P, De Micco C. ret/PTC1 and ret/PTC3 in thyroid tumors from Chernobyl liquidators: comparison with sporadic tumors from Ukrainian and French patients. Endocr Relat Cancer 2005; 12:173-83. [PMID: 15788648 DOI: 10.1677/erc.1.00884] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 11/27/2022]
Abstract
Like children exposed to Chernobyl fallout, the workers who cleaned up after the accident, also known as liquidators, have exhibited an increased incidence of thyroid cancer. A high prevalence of ret/PTC3 rearrangement has been found in pediatric post-Chernobyl thyroid tumors, but this feature has not been investigated in liquidator thyroid tumors. In this study we analyzed the prevalence of ret/PTC1 and ret/PTC3 in thyroid tumors from 21 liquidators, 31 nonirradiated adult Ukrainian patients, and 34 nonirradiated adult French patients. ret rearrangements in carcinomas were found in 83.3% of liquidators, 64.7% of Ukrainian patients, and 42.9% of French patients. The prevalence of ret/PTC1 was statistically similar in the three groups. The prevalence of ret/PTC3 was significantly higher in liquidators than in French patients (P = 0.03) but it was also high in nonirradiated Ukrainian patients who exhibited values intermediate between liquidators and French patients. In adenomas the prevalence of rearrangement was significantly higher in all Ukrainians than in French patients (P = 0.004). Like children exposed to Chernobyl fallout, liquidators showed a high prevalence of ret/PTC3. This finding suggests that irradiation had the same effect regardless of age. However, given the high rate of ret/PTC3 in nonirradiated adult Ukrainians, the possibility of genetic susceptibility or low-level exposure to radiation in that group cannot be excluded.
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Affiliation(s)
- J Di Cristofaro
- Institut National de la Santé et de la Recherche Médicale (U555), IPHM, Faculté de médecine, Mediterranean University, Marseille, France.
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Abstract
Abstract
Background
Medullary thyroid carcinoma (MTC) is a rare disease, with variable tendency to lymphatic spread. The aim of this retrospective study was to identify distinctive features of large MTC with and without nodal metastases.
Methods
Between 1993 and 2003, 28 consecutive patients underwent total thyroidectomy and neck node dissection for sporadic MTC larger than 10 mm in diameter.
Results
All tumours were confirmed to be malignant with a locally invasive pattern of growth. Lymph node metastases were present in 16 patients (N1) and absent in 12 (N0). There were no statistically significant differences between patients with N0 and N1 tumours concerning age (mean 52·1 versus 53·4 years), male:female ratio (0·7 versus 1·0), basal preoperative calcitonin concentration (mean 3238 versus 3076 pg/ml) and tumour size (23·3 versus 23·9 mm). There were differences in the incidence of tumour invasion (P < 0·001), vascular embolism (P = 0·011) and peritumoral thyroiditis (P = 0·039). Measurement of basal and stimulated calcitonin levels after surgery confirmed biochemical cure in all patients with N0 tumours and half of those with N1 disease (P = 0·006).
Conclusion
There were no preoperative factors that predicted node status for MTC larger than 1 cm in this series. Total thyroidectomy and nodal dissection remains the optimal treatment.
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Affiliation(s)
- P Tamagnini
- Department of General and Endocrine Surgery, University Hospital La Timone, 13385 Marseilles, France.
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28
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Karelis AD, Henry JF, Malita F, St-Pierre DH, Vigneault I, Poehlman ET, Rabasa-Lhoret R. Comparison of insulin sensitivity values using the hyperinsulinemic euglycemic clamp: 2 vs 3 hours. Diabetes & Metabolism 2004; 30:413-4. [PMID: 15671908 DOI: 10.1016/s1262-3636(07)70135-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Goudet P, Peschaud F, Mignon M, Nicoli-Sire P, Cadiot G, Ruszniewski P, Calender A, Murat A, Sarfati E, Peix JL, Kraimps JL, Henry JF, Cougard P, Proye C. [Gastrinomas in multiple endocrine neoplasia type-1. A 127-case cohort study from the endocrine tumor group (ETG)]. ACTA ACUST UNITED AC 2004; 129:149-55. [PMID: 15142812 DOI: 10.1016/j.anchir.2003.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Accepted: 11/19/2003] [Indexed: 11/15/2022]
Abstract
UNLABELLED On July 2000, 127 gastrinomas (31.1%) were studied by the Endocrine Tumour Group (GTE) using a 408-patient cohort of Multiple Endocrine Neoplasia Type 1 patients. The aim of this study was to assess clinical, biological, surgical data as well as their trends over three periods (<1980-1980/1989->1990). A Zollinger-Ellison syndrome (SZE) was present in 96% of the cases. Mean age at the onset of the disease was 39.4 years. There were 55.9% of men. Synchronous liver metastasis was present in 7.1%. Taken independently, the positivity of the four main diagnosis tests decreased over the time. The diagnosis of oesophagitis increased (4.5-29.7%), as well as the size of the resected tumours (9.9-16.8 mm). There was an increase in the familial background diagnosis (73.1-80%), an increasing use of Octreoscan scintigraphy and transduodenal ultrasound with positive detection of metastasis and tumours in 81.3% and 92.3%, respectively after 1991. Patients were operated on less frequently (96-52.5%), less frequently from the pancreas (87.5-37.5%), and from the gastro-intestinal tract (70.8-30%). The relative percentage of major pancreatic resections increased (with at least removal of the duodenum and the pancreatic head) (10-26.7%). The operative mortality disappeared. Six out of the seven patients (85.7%) who benefited from major pancreatic resections normalized their gastrine level postoperatively versus 15% in less radical techniques. Overall 5 years survival was 90 +/- 4.4%. Survival increased after 1985 (85 +/- 4.8% versus 95 +/- 3.6, P = 0.1). CONCLUSION SZE in NEM1 were diagnosed at an earlier stage and were less frequently operated on. Nevertheless, the incidence of synchronous metastasis did not change significantly. Patients were mainly operated on for gastric emergencies and pancreatic tumours in order to prevent metastasis without mortality after 1991.
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Affiliation(s)
- P Goudet
- Service de chirurgie viscérale et endocrinienne, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon cedex, France.
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Mirallié E, Iacobone M, Sebag F, Henry JF. Results of surgical treatment of sporadic medullary thyroid carcinoma following routine measurement of serum calcitonin. Eur J Surg Oncol 2004; 30:790-5. [PMID: 15296996 DOI: 10.1016/j.ejso.2004.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 05/20/2004] [Indexed: 10/26/2022] Open
Abstract
AIM The aim of this study was to evaluate the results of the surgical management of medullary thyroid carcinoma (MTC), following the introduction of systematic calcitonin measurement in patients referred for thyroid diseases. METHOD We included all the patients with elevated calcitonin and MTC from January 1993 to March 2001. RESULTS Among 8497 patients, MTC was diagnosed in 52 with a mean age of 56.1 years. Thirty-two fine needle biopsies led to diagnose MTC in 19 cases. The median basal pre-operative calcitonin level was 245 pg/ml. Elevated calcitonin serum was the only indicator of MTC in 31 patients. Fifty-one patients underwent total thyroidectomies, with lymphadenectomy in 45. Thirteen patients had lymph node involvement. Post-operatively, 40 (77%) had normal basal and pentagastrin (Pg) stimulated calcitonin serum levels, and remained normal at a mean follow-up of 5.16 years (1.8-8). CONCLUSION Routine pre-operative measurement of calcitonin should be performed because it is often the only indicator of MTC at an early stage. This could lead to an improved MTC cure rate.
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Affiliation(s)
- E Mirallié
- Department of General and Endocrine Surgery, University Hospital La Timone, Boulevard Jean Moulin, 13385 Marseille 05, France.
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31
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Taïeb D, Sebag F, Hubbard JG, Mundler O, Henry JF, Conte-Devolx B. Does iodine-131 meta-iodobenzylguanidine (MIBG) scintigraphy have an impact on the management of sporadic and familial phaeochromocytoma? Clin Endocrinol (Oxf) 2004; 61:102-8. [PMID: 15212651 DOI: 10.1111/j.1365-2265.2004.02077.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [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: 01/02/2023]
Abstract
OBJECTIVES To assess the impact of [(131)I]meta-iodobenzylguanidine ((131)MIBG) scintigraphy on the management of phaeochromocytoma. DESIGN AND PATIENTS Between 1982 and 2002, 83 patients with histologically proven phaeochromocytoma or paraganglioma were investigated using (131)MIBG scintigraphy. Seventeen of these patients, with a hereditary form of the disease, presented with 23 phaeochromocytomas [three neurofibromatosis type 1 (NF1), five von Hippel-Lindau disease (VHL), eight multiple endocrine neoplasia type 2A (MEN2A) and one type 2B (MEN2B)]. RESULTS MIBG uptake was observed in 44/54 sporadic phaeochromocytomas (sensitivity 81.5%), 14/23 familial phaeochromocytomas (60.9%), 3/6 paragangliomas and 4/6 malignant phaeochromocytomas. No significant correlations were found between the degree of tracer uptake, tumour size and urinary metanephrine levels. No patients undergoing surgery for sporadic phaeochromocytoma had a second tumour located. Nine of 54 sporadic phaeochromocytomas had normal or mildly elevated urinary metanephrine levels (< 1.5 greater than normal). In eight of these patients, (131)MIBG was positive and confirmed the diagnosis of phaeochromocytoma. In malignant phaeochromocytomas (n = 6), MIBG demonstrated additional lesions not detected with computed tomography (CT) and/or magnetic resonance imaging (MRI) in three cases. The MIBG findings in the group with apparently sporadic paragangliomas (n = 6) were negative in four cases and failed to detect a cervical lesion in one multifocal paraganglioma. CONCLUSION (131)MIBG was useful in confirming the diagnosis in phaeochromocytomas with low levels of catecholamine secretion. It contributed little to the management of patients when used as a means of screening for multifocality in sporadic phaeochromocytoma, or the management of patients with familial phaeochromocytoma. However, MIBG can be an informative method of investigation when dealing with malignant/ectopic forms, although the sensitivity of MIBG is lower in this group of patients.
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Affiliation(s)
- D Taïeb
- Service central de Biophysique et de Médecine Nucléaire, Centre hospitalo-universitaire de la Timone, Marseille, France.
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Sebag F, Hubbard JGH, Maweja S, Misso C, Tardivet L, Henry JF. Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism. Surgery 2003; 134:1038-41; discussion 1041-2. [PMID: 14668738 DOI: 10.1016/j.surg.2003.07.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The development of localization studies and quick parathyroid hormone assay (QPTH) has allowed the development of focused surgery in sporadic primary hyperparathyroidism. The aim of this investigation was to determine whether localization studies select a specific population of patients. METHODS From 1999 to 2001, 213 patients underwent surgery for sporadic primary hyperparathyroidism. All were investigated with sestamibi scanning and ultrasonography. When at least 1 study showed a positive result (n=175), the patient underwent a video-assisted approach with QPTH. When results were negative (n=38), the patient underwent cervicotomy and exploratory procedures of all 4 parathyroid glands. RESULTS All patients are cured (mean follow-up, 17.8+/-10.3 months [SD]). Patients with negative preoperative study results had a high risk of multiglandular disease (12/38 patients; 31,6%), compared with patients with 1 positive study result (3/83 patients; 3.6%; P<.0001) and those with 2 concordant positive study results (0/92 patients; P<.0001). CONCLUSION When preoperative localization study results are negative, the patient has a high risk of multiglandular disease, and a conventional cervicotomy with identification of the 4 glands is recommended strongly. When only 1 localization study is positive, the risk of multiglandular disease justifies the use of QPTH during a focused approach. When positive localization study results are concordant, the use of QPTH is questionable during a focused approach.
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Affiliation(s)
- Frederic Sebag
- Department of Endocrine Surgery, La Timone Hospital, 264 Rue Saint Pierre, 13005 Marseilles, France
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33
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Maweja S, Sebag F, Hubbard J, Misso C, Henry JF. Hématome cervical spontané secondaire à une hémorragie extracapsulaire d’un adénome parathyroïdien : à propos de 2 cas. ACTA ACUST UNITED AC 2003; 128:561-2. [PMID: 14559311 DOI: 10.1016/s0003-3944(03)00184-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The usual clinical manifestations of a parathyroid adenoma are due, in most of the cases, to hypercalcemia. The development of a spontaneous cervical or cervicomediastinal haematoma is a rare form of presentation. In case of a spontaneous cervical haematoma associated with dysphagia: measurement of serum calcium, phosphate and parathyroid hormone allows the diagnosis of haematoma due to extracapsular haemorrhage from a parathyroid adenoma. We report herein 2 cases.
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Affiliation(s)
- S Maweja
- Service de chirurgie générale et endocrinienne, hôpital d'adultes la Timone, 264, rue Saint-Pierre, 13385 Marseille 05, France.
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Henry JF, Sebag F, Maweja S, Hubbard J, Misso C, Da Costa V, Tardivet L. [Video-assisted parathyroidectomy in the management of patients with primary hyperparathyroidism]. Ann Chir 2003; 128:379-84. [PMID: 12943834 DOI: 10.1016/s0003-3944(03)00110-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In recent years, different minimally invasive techniques of parathyroidectomy have been described. We performed a retrospective study to evaluate the indications and results of video-assisted parathyroidectomy (Vap) in the management of our patients with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS During the last 5 years (1998-2002), we operated on 528 patients with PHPT. Vap was proposed for patients with sporadic PHPT, without associated goiter and without previous neck surgery, in whom a single adenoma was localized by means of sonography and/or sestamibi scanning. Vap was performed by lateral approach with insufflation for patients with adenoma located deeply in the neck and by gasless midline approach for patients with adenoma located anteriorly. A quick parathyroid (qPTH) assay was used during the surgical procedures. Calcemia, phosphoremia and PTH were systematically evaluated in patients on days 1 and 8, 1 month and 1 year after surgery. All patients underwent pre-operative and postoperative investigations of vocal cord movements. RESULTS Among 528 patients with PHPT, 228 (43%) were not eligible for Vap: associated nodular goiter (99 cases), previous neck surgery (42 cases), suspicion of multiglandular disease (25 cases), lack of pre-operative localization (48 cases), and miscellaneous causes (14 cases). Vap was performed in 300 patients with sporadic PHPT: 282 lateral access, 17 midline access and 1 thoracoscopy. Median operative time was 50 min (20-130 min). Conversion to conventional parathyroidectomy was required in 42 patients (14%): missed adenomas (11 cases), difficulties of dissection (7 cases), multiglandular disease correctly predicted by qPTH (10 cases); qPTH assay false negative results (3 cases), sestamibi scan false positive results (10 cases) and 1 sonography false positive result. One patient presented definitive recurrent nerve palsy. One patient had a persistent PHPT and one other patient had a recurrent PHPT. CONCLUSION Vap can be proposed for more than half of patients with PHPT. In our experience Vap and conventional parathyroidectomy are complementary. Immediate results of Vap are similar to those obtained with conventional parathyroidectomy but no conclusions can be drawn in terms of influence of Vap on the outcome of the patients operated for PHPT.
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Affiliation(s)
- J F Henry
- Service de chirurgie générale et endocrinienne, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille 05, France.
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Henry JF, Misso C, Sebag F, Iacobone M. [Video-assisted minimally invasive parathyroidectomy with lateral approach in patients with primary hyperparathyroidism]. Ann Ital Chir 2003; 74:401-5. [PMID: 14971282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Different minimally invasive techniques of parathyroidectomy have been described. We performed a retrospective study to evaluate the indications and results of video-assisted parathyroidectomy (VAP) in the management of patients with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS Between 1998 and 2002, 528 patients were operated on because PHPT. VAP was proposed for patients with sporadic PHPT, without associated goiter and previous neck surgery, in whom a single adenoma was localized. VAP was performed by lateral approach with insufflation for patients with adenoma located deeply in the neck and by gasless midline approach for anteriorly located adenomas. A quick parathyroid (qPTH) assay was used during the surgical procedure. Calcemia, phosphoremia and PTH were systematically evaluated after surgery. RESULT Of 528 patients with PHPT, 228 (43%) were not eligible for VAP because associated nodular goiter (99 cases), previous neck surgery (42 cases), suspicion of multiglandular disease (25 cases), lack of preoperative localization (48 cases), and miscellaneous causes (14 cases). VAP was performed in 300 patients with sporadic PHPT: 282 lateral access, 17 midline access and one thoracoscopy. Mean operative time was 50'. Conversion to conventional parathyroidectomy was required in 14% of cases. One patient presented a definitive recurrent nerve palsy. One persistent and one recurrent PHPT were observed. CONCLUSION VAP can be proposed for patients with PHPT. Immediate results of VAP are similar to those obtained with conventional parathyroidectomy; no conclusions can be drawn in terms of influence of VAP on the outcome of the patients operated for PHPT.
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Affiliation(s)
- J F Henry
- Service de Chirurgie Generale et Endocrinienne, Chu Timone, Università di Marsiglia, Francia
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Abstract
The prevalence of H-RAS, K-RAS, and N-RAS gene mutations in thyroid tumors according to malignancy and histology is controversial. Differences in methodology and histological classifications may explain discrepant results. To address this issue, we first performed a pooled analysis of 269 mutations garnered from 39 previous studies. Mutations proved significantly less frequent when detected with direct sequencing than without (12.3% vs. 17%). The rate of mutation involving N-RAS exon 1 (N1) and K-RAS exon 2 (K2) was less than 1%. Mutations of codon 61 of N-RAS (N2) were significantly more frequent in follicular tumors (19%) than in papillary cancers (5%) and significantly more frequent in malignant (25%) than in benign (14%) tumors. H-RAS mutations in codons 12/13 (H1) were found in 2-3% of all types of tumors, but H-RAS mutations in codon 61 (H2) were observed in only 1.4% of tumors, and almost all of them were malignant. K-RAS mutations in exon 1 were found more often in papillary than follicular cancers (2.7% vs. 1.6%) and were sometimes correlated with special epidemiological circumstances. The second part of this study involved analysis of 80 follicular tumors from patients living in Marseille (France) and Kiev (Ukraine). We used direct sequencing after PCR amplification of exons 1 and 2 of the three RAS genes. Common and atypical adenomas were separated using strict cytological criteria. Mutations of H1-RAS were found in 12.5% of common adenomas and one follicular carcinoma (2.9%). Mutations of N2-RAS occurred in 23.3% and 17.6% of atypical adenomas and follicular carcinomas, respectively. These results confirm the predominance of N2-RAS mutations in thyroid follicular tumors and their correlation with malignancy. They support the implication of N2-RAS mutations in the malignant progression of thyroid follicular tumors and the assumption that some atypical adenomas are precursors of follicular carcinomas.
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Affiliation(s)
- V Vasko
- Institut National de la Santé et de la Recherche Médicale U555, Faculty of Medicine, Mediterranean University, Marseille, 13385 France
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Rafaelli M, Henry JF. The ‘false’ non-recurrent inferior laryngeal nerve. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2000.01601-49.x] [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: 11/20/2022]
Abstract
Abstract
Background
A communication between the middle cervical sympathetic ganglion (MCSG) and the inferior laryngeal nerve (ILN) has been described. The anastomotic branch (sympathetic–inferior laryngeal anastomotic branch; SILAB) is usually thin, but is sometimes larger and has the same diameter as the ILN. The purpose of this study was to evaluate prospectively the frequency of this condition and its implications during neck exploration.
Methods
From November 1998 to October 1999, 791 neck explorations were performed: 677 for thyroid, 99 for parathyroid and 15 for concomitant lesions. Some 1253 ILNs were dissected: 656 (52·3 per cent) on the right and 597 (47·7 per cent) on the left side.
Results
The ILN was identified in all cases. On the right side a non-recurrent ILN (NRILN) was found in three patients (0·5 per cent) and a large SILAB in ten (1·5 per cent). No anomalous branch was found on the left side. The SILAB originated from the superior cervical sympathetic ganglion (SCSG) in two patients and directly from the sympathetic chain (SC) above the MCSG in eight. No branch originating from the MCSG was found. The SILAB connected with the ILN less than 2 cm from the cricoid in all patients.
Conclusion
The SILAB may originate not only from the MCSG but also from the SCSG and directly from the SC. When the SILAB is as large as the ILN, it could be mistaken for a NRILN. Before concluding that the anomalous branch is a NRILN, one should check if it originates from the vagus or from the cervical sympathetic system. Awareness of this anatomical condition during neck exploration may help the surgeon to avoid injuries of an ILN running in the usual pathway.
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Affiliation(s)
- M Rafaelli
- Department of General and Endocrine Surgery, Hopital Timone Adultes, Marseille, France
| | - J F Henry
- Department of General and Endocrine Surgery, Hopital Timone Adultes, Marseille, France
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Goudet P, Calender A, Cougard P, Murat A, Henry JF, Kraimps JL, Cadiot G, Peix JL, Sarfati E, Mignon M, Proye C. [Multiple endocrine neoplasia type I or Werner syndrome. What is important to know about surgery of a rate disease]. Ann Chir 2002; 127:591-9. [PMID: 12491633 DOI: 10.1016/s0003-3944(02)00848-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a rare but misleading disease. The diagnosis is evocated when two main lesions are present (parathyroid, endocrine pancreas, pituary gland) but also when a family tree shows recurrent lesions. Other lesions must be taken into account (adrenal glands, neuroendocrine thymic or bronchic lesions, cutaneous lesions, lipomas, nervous central system tumors). Any surgical cure without knowing the MEN1 background leads to failure. Specific treatment of each lesion is reviewed. Genetic diagnosis is possible but the mutation is not found in all cases. Nevertheless, when the mutation is known in a family, a negative genetic test allows to exclude the disease. Prognosis is related to hepatic metastases and to thymic neuroendocrine tumors which are rare (2.1%) but aggressive. As a general rule, any apparently isolated endocrine lesion such hyperparathyroidism must prompt the surgeon to look for another endocrine lesion and to look for an abnormal family tree with recurent monoglandular or pluriglandular lesions.
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Affiliation(s)
- P Goudet
- Service de chirurgie viscérale et endocrinienne (Pr. Patrick Cougard), centre hospitalier universitaire de Dijon, hôpital général, 3, rue du Faubourg-Raines, 21033 Dijon, France.
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Abstract
AIMS To define the role of minimally invasive video-assisted surgery in the surgical management of adrenal disease and discuss the respective indications of the trans and retroperitoneal video assisted approaches. MATERIALS AND METHODS During the last 8 years (1994-2001), 330 adrenalectomies were performed in 305 patients: 274 (83%) laparoscopic approaches and 56 (17%) open approach. Open surgery was reserved for patients presenting with large or malignant tumours (29 cases), multiple and/or extraadrenal phaeochromocytomas (13 cases), previous intraabdominal intestinal surgery (10 cases), and in those requiring concomitant intraabdominal surgery (4 cases). Laparoscopic adrenalectomy was performed using the lateral transperitoneal approach for 89 Conn's syndrome, 67 Cushing's syndrome, 2 virilizing tumours, 51 phaeochromocytomas and 65 non secretory tumours greater than 4 cm in diameter. Nineteen patients underwent bilateral adrenalectomy. RESULTS There were no deaths. Twenty patients (7.3%) had a complication. Eleven cases required open conversion (4%) because of difficulties with dissection (8 cases), preoperative suspicion of malignancy (2 cases), and one pneumothorax. The average size of tumours was 34 mm (7-110 mm). There were 18 malignant tumours (6.5%): 8 adrenocortical carcinomas, 1 leiomyosarcoma, and 9 metastases. All patients with hormonally secreting tumours were cured of their endocrinopathy. There was 1 death secondary to hepatic metastases in a patient with an adrenocortical carcinoma. CONCLUSION Most adrenal tumours are suitable for video assisted excision. The only absolute contraindication is an invasive carcinoma requiring an extended excision. The lateral, transperitoneal approach is the most suitable for tumours greater than 5-6 cm in diameter. Both the transperitoneal or retroperitoneal approaches are suitable for smaller tumours depending on operator choice and experience. However in the presence of a large right lobe of liver or previous intraabdominal surgery the retroperitoneal approach may be preferable.
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Affiliation(s)
- J F Henry
- Service de Chirurgie Générale et Endocrinienne, Hôpital de la Timone, boulevard Jean-Moulin, 13385, Marseille, France.
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Abstract
AIM OF THIS STUDY Hypokaliemic thyrotoxic periodic paralysis (HTPP) is an uncommon complication of hypothyroidism. Mostly described among Asian patients, it is rare in the other ethnic groups, in particular in caucasians people. Among the possible mechanisms, modification of potassic flows in relation to anomalies of the sodium-potassium pump were evoked. PATIENTS AND METHOD We present the cases of three caucasians patients operated on for HTPP. These patients had all previous history of several paretic episodes. The flask paralytic attacks occurred in a brutal way or were preceded by diffuse myalgias. They reached the proximal muscles, especially in inferior limbs. No patient had any respiratory complications. These three patients underwent total thyroidectomy to treat the symptoms of HTPP. RESULTS In the three cases, a total thyroidectomy allowed the recovery of the symptoms. After a four years average period of post-operative follow-up, no patient presented any repetition of HTPP. The hyperthyroidism is the cause of decompensation of the molecular anomaly. CONCLUSION In our opinion, surgical treatment (total thyroidectomy) is needed in order to reduce the potential gravity of this pathology.
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Affiliation(s)
- S Pili
- Service de chirurgie générale et endocrinienne, hôpital La Timone, boulevard Jean-Moulin, 13385 Marseille, France
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Henry JF, Iacobone M, Mirallie E, Deveze A, Pili S. Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery 2001; 130:999-1004. [PMID: 11742329 DOI: 10.1067/msy.2001.119112] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Different minimally invasive techniques of parathyroidectomy have been described. We performed a retrospective study to evaluate the indications and results of video-assisted parathyroidectomy by lateral approach (VAPLA) in the management of our patients with primary hyperparathyroidism (PHPT). METHODS From December 1997 to December 2000, we operated on 293 patients with PHPT. VAPLA was proposed for patients with sporadic PHPT in whom a single adenoma was localized by means of sonography or sestamibi scanning, or both. VAPLA was performed on the anterior border of the sternocleidomastoid muscle. A quick parathormone (PTH) assay was used during the surgical procedures. RESULTS Of the 293 patients, 127 (43.3%) were not eligible for VAPLA: ipsilateral previous neck surgery (28 cases), associated nodular goiter (59 cases), suspicion of multiglandular disease (15 cases), no preoperative localization (17 cases), and miscellaneous causes (8 cases). VAPLA was performed in 166 patients (56.7%). Conversion to conventional parathyroidectomy was required in 26 patients (15.6%). Morbidity included 2 local hematomas, 1 definitive recurrent nerve palsy, and 4 capsular fractures. All of the 166 patients were normocalcemic, with follow-up ranging from 3 to 33 months. CONCLUSIONS VAPLA is safe and effective. It should be reserved for patients with sporadic PHPT, with a small single adenoma clearly localized preoperatively.
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Affiliation(s)
- J F Henry
- Department of General and Endocrine Surgery, University Hospital La Timone, Marseilles, France
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van der Schoor SR, van Goudoever JB, Stoll B, Henry JF, Rosenberger JR, Burrin DG, Reeds PJ. The pattern of intestinal substrate oxidation is altered by protein restriction in pigs. Gastroenterology 2001; 121:1167-75. [PMID: 11677209 DOI: 10.1053/gast.2001.29334] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [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: 12/02/2022]
Abstract
BACKGROUND & AIMS Previous studies indicate that amino acids and glucose are the major oxidative substrates for intestinal energy generation. We hypothesized that low protein feeding would lower the contribution of amino acids to energy metabolism, thereby increasing the contribution of glucose. METHODS Piglets, implanted with portal, arterial, and duodenal catheters and a portal flow probe, were fed isocaloric diets of either a high protein (0.9 g/[kg/h] protein, 1.8 g/[kg/h] carbohydrate, and 0.4 g/[kg/h] lipid) or a low protein (0.4 g/[kg/h] protein, 2.2 g/[kg/h] carbohydrate, and 0.5 g/[kg/h] lipid) content. They received enteral or intravenous infusions of [1-13C]leucine (n = 17), [U-13C]glucose (n = 15), or enteral [U-13C]glutamate (n = 8). RESULTS CO2 production by the splanchnic bed was not affected by the diet. The oxidation of leucine, glutamate, and glucose accounted for 82% of the total CO2 production in high protein-fed pigs. Visceral amino acid oxidation was substantially suppressed during a low protein intake. Although glucose oxidation increased to 50% of the total visceral CO2 production during a low protein diet, this increase did not compensate entirely for the fall in amino acid oxidation. CONCLUSIONS Although low protein feeding increases the contribution of enteral glucose oxidation to total CO2 production, this adaptation is insufficient. To compensate for the fall in amino acid oxidation, other substrates become increasingly important to intestinal energy generation.
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Affiliation(s)
- S R van der Schoor
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
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Henry JF, Raffaelli M, Iacobone M, Volot F. Video-assisted parathyroidectomy via the lateral approach vs conventional surgery in the treatment of sporadic primary hyperparathyroidism: results of a case-control study. Surg Endosc 2001; 15:1116-9. [PMID: 11727082 DOI: 10.1007/s00464-001-9013-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We previously demonstrated that minimally invasive video-assisted parathyroidectomy (VAP) can be performed via a lateral approach on the line of the sternocleidomastoid muscle. The aim of this study was to compare the results of this technique with those of conventional parathyroidectomy (CP) in a case-control study. METHODS Over a 2-year period, 80 VAP were attempted. The selection criteria were as follows: sporadic primary hyperparathyroidism, no history of previous neck surgery, no thyroid disease, suggestion of a single adenoma on preoperative imaging. A rapid intraoperative parathyroid hormone (PTH) assay was performed. The procedure was completed successfully in 68 patients. A case-control study of 68 patients who underwent CP for a single adenoma was performed. The controls were matched for age and sex. RESULTS All of the patients were normocalcemic at follow-up. No statistically significant differences between the VAP and the control groups were found for age, sex, pre- and postoperative calcemia and PTH, adenoma weight, operating time, complication rate, or postoperative stay. One VAP patient developed recurrent laryngeal nerve palsy. Patients who underwent VAP required less analgesics (p < 0.0001) and were more satisfied with the cosmetic results (p < 0.0001). CONCLUSIONS This study suggests that VAP by the lateral approach has some advantages over CP in terms of postoperative pain and cosmetic results.
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Affiliation(s)
- J F Henry
- Department of General and Endocrine Surgery, University Hospital La Timone, Boulevard Jean Moulin, 13385 Marseilles Cedex 5, France.
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Granel B, Serratrice J, Chaudier B, Rey J, Swiader L, Pache X, Christides C, Disdier P, Weiller PJ, De Micco C, Henry JF. Multinodular goitre with giant cell vasculitis of thyroid arteries in a woman with temporal arteritis. Ann Rheum Dis 2001; 60:811-2. [PMID: 11482308 PMCID: PMC1753801 DOI: 10.1136/ard.60.8.811a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Denizot A, Pucini M, Chagnaud C, Botti G, Henry JF. Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism. Am J Surg 2001; 182:15-9. [PMID: 11532408 DOI: 10.1016/s0002-9610(01)00664-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Thirty percent of patients who undergo successful parathyroidectomy for primary hyperparathyroidism show unexplained elevated postoperative serum parathyroid hormone (PTH) levels despite normocalcemia. METHODS PTH levels were measured monthly in 97 patients for 6 months after parathyroidectomy. Renal function, 25-OH-vitamin D levels, serum alkaline phosphatase levels, osteocalcin, and bone densitometry were evaluated before and 6 months after surgery. PTH reactivity to calcium loading was tested at the sixth month. RESULTS Thirty patients had elevated PTH levels despite normocalcemia after parathyroidectomy. Before surgery, these 30 patients had higher PTH and creatinine levels, lower vitamin D levels, and more extensive bone involvement than those with normal postoperative PTH levels. In patients with normal renal function and normal vitamin D levels, postoperative PTH values correlated with preoperative PTH levels but not with bone disease. CONCLUSION In most cases, elevated PTH levels after surgery is an adaptive reaction to renal dysfunction or vitamin D deficiency. If no adaptive cause can be found, persistent hyperparathyroidism must be suspected.
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Affiliation(s)
- A Denizot
- General Surgery and Endocrinology Service, CHU Timone, Boulevard Jean Moulin, 13385 Cedex 5, Marseille, France.
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Icard P, Goudet P, Charpenay C, Andreassian B, Carnaille B, Chapuis Y, Cougard P, Henry JF, Proye C. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg 2001; 25:891-7. [PMID: 11572030 DOI: 10.1007/s00268-001-0047-y] [Citation(s) in RCA: 406] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Because of the rarity of adrenocortical carcinoma, survival rates and the prognosis for patients who have undergone operation are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors over an 18-year period. A trend study was associated to assess changes in the clinical and biochemical presentations as well as the surgical evolution. A total of 253 patients (158 women, 95 men) with a mean age of 47 years were included. Cushing syndrome was the main clinical presentation (30%), and hormonal studies revealed secreting tumors in 66% of the cases. Altogether, 72% (n = 182) of patients underwent resection for cure, and 41.5% (n = 105) of them had an extensive resection because of metastatic cancer. A lymphadenectomy was performed in 32.5% (n = 89) of the cases. The operative mortality was 5.5% (n = 14). Patients were given mitotane as adjuvant therapy in 53.8% of the cases (n = 135). The results of staging were stage I in 16 patients (6.3%), stage II (local disease) in 126 patients (49.8%), stage III (locoregional disease) in 57 patients (22.5%), and stage IV (metastases) in 54 patients (21.3%). Neither tumor staging nor the rate of curative surgery changed during the study period. More subcostal incisions were performed, and the use of mitotane increased significantly. The 5-year actuarial survival rates were 38% overall, 50% in the curative group, 66% for stage I, 58% for stage II, 24% for stage III, and 0% for stage IV. Multivariate analysis showed that mitotane benefited only the group of patients not operated on for cure. A better prognosis was found in patients operated on after 1988 (p = 0.04), in those with precursor-secreting tumors (p = 0.005), and in those at local stages of the disease (p = 0.0003). Thus mitotane benefited only patients not operated on for cure. Curative resection, precursor secretion, recent diagnosis, and local stage were favorably associated with survival.
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Affiliation(s)
- P Icard
- Service de Chirurgie Viscérale et Urgences, Hôpital Général, 3 Rue du Faubourg-Raines, BP 1519, 21033 Dijon, France.
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Abstract
The adrenals can be approached endoscopically using either transperitoneal or retroperitoneal access, most surgeons favouring the transperitoneal flank approach with the patient in the lateral decubitus position. Endoscopic retroperitoneal adrenalectomy can be performed via either a posterior or a lateral approach. The main advantage of the retroperitoneal approach in the prone position is that it allows bilateral adrenalectomy without repositioning the patient. Although technically more demanding, endoscopic adrenalectomy provides clear advantages over open procedures for tumours less than 5-6 cm in diameter. The small working space provided by the retroperitoneal approach is a contra-indication for the dissection of tumours over 5-6 cm in diameter. Peritoneal adhesions caused by previous abdominal surgery or a large right lobe of the liver may contra-indicate transperitoneal access. For small benign tumours, the transperitoneal and retroperitoneal routes are safe and effective, and there is no clear advantage of one procedure over the other. Invasive adrenal carcinoma is an absolute contra-indication for endoscopic adrenalectomy. Whether large (>5-6 cm) and potentially malignant tumours should be removed laparoscopically remains debatable.
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Affiliation(s)
- J F Henry
- General and Endocrine Surgery, Hospital La Timone, Marseilles, France
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Abstract
INTRODUCTION Lithium salts, used for the first time in 1949, had proved to be a highly effective preventive measure in bipolar illness. The first report of lithium-induced hyperparathyroidism was suggested by Garfinkel et al. in 1973. About 40 cases have been reported since, suggesting an enhancement of occurrence of hyperparathyroidism in patients cured by lithium carbonate. We report here a new case discovered by a systematic measurement of calcemia after a surgical intervention for a hip joint prosthesis. EXEGESIS Unusual metabolic features associated with this case of hyperparathyroidism include low urinary calcium excretion, normal cyclic AMP excretion and lack of calcic nephrolithiasis. The mechanism probably results from lithium linking with the calcium receptor on the parathyroid and then stimulating PTH secretion. In the same way it could enhance the tubular reabsorption of urinary calcium. Lithium withdrawal is often inefficient in clinical and laboratory test abnormalities and surgery is usually required. CONCLUSION It is very important to recognise this particular secondary effect of lithium therapy because clinical symptoms of hypercalcemia can simulate a worsening of the bipolar illness.
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Affiliation(s)
- N Pieri-Balandraud
- Service de rééducation fonctionnelle, hôpital Renée-Sabran, boulevard Edouard-Herriot, 83406 Giens, France
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Dudley MA, Schoknecht PA, Dudley AW, Jiang L, Ferraris RP, Rosenberger JN, Henry JF, Reeds PJ. Lactase synthesis is pretranslationally regulated in protein-deficient pigs fed a protein-sufficient diet. Am J Physiol Gastrointest Liver Physiol 2001; 280:G621-8. [PMID: 11254488 DOI: 10.1152/ajpgi.2001.280.4.g621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/31/2023]
Abstract
The in vivo effects of protein malnutrition and protein rehabilitation on lactase phlorizin hydrolase (LPH) synthesis were examined. Five-day-old pigs were fed isocaloric diets containing 10% (deficient, n = 12) or 24% (sufficient, n = 12) protein. After 4 wk, one-half of the animals in each dietary group were infused intravenously with [(13)C(1)]leucine for 6 h, and the jejunum was analyzed for enzyme activity, mRNA abundance, and LPH polypeptide isotopic enrichment. The remaining animals were fed the protein-sufficient diet for 1 wk, and the jejunum was analyzed. Jejunal mass and lactase enzyme activity per jejunum were significantly lower in protein-deficient vs. control animals but returned to normal with rehabilitation. Protein malnutrition did not affect LPH mRNA abundance relative to elongation factor-1alpha, but rehabilitation resulted in a significant increase in LPH mRNA relative abundance. Protein malnutrition significantly lowered the LPH fractional synthesis rate (FSR; %/day), whereas the FSR of LPH in rehabilitated and control animals was similar. These results suggest that protein malnutrition decreases LPH synthesis by altering posttranslational events, whereas the jejunum responds to rehabilitation by increasing LPH mRNA relative abundance, suggesting pretranslational regulation.
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Affiliation(s)
- M A Dudley
- Department of Pharmacology and Physiology, New Jersey School of Medicine and Dentistry, Newark 07103, USA
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Raffaelli M, De Micco C, Lubrano D, Henry JF. [Immunodetection of thyroid peroxidase in the diagnosis of follicular variants of thyroid papillary cancer]. Ann Chir 2001; 126:148-51. [PMID: 11284105 DOI: 10.1016/s0003-3944(00)00479-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
STUDY AIM The aim of this retrospective study was to assess the role of thyroid peroxidase immunodetection in the cytological diagnosis of follicular variants of thyroid papillary cancer (FVTPC) which are difficult to identify by standard cytology. PATIENTS AND METHODS Between 1991 and 1998, 3,505 thyroid fine needle aspiration biopsies were performed by thyroid peroxidase immunocytochemistry and 1,576 patients were operated on. Out of a total of 227 thyroid papillary cancers (TPC), 42 (18.5%) were diagnosed as FVTPC. The results of standard cytology and thyroid peroxidase immunodetection were compared with the histological findings. RESULTS The rate of false negatives for TPC in standard cytology was 11% (25/227 cases), with 40% of these false negatives being FVTPC; ten out of 42 (23.8%) cases of FVTPC were not identified by standard cytology. However, cytology with thyroid peroxidase immunodetection diagnosed 224 out of the 227 TPC (99%), and all the FVTPC were correctly identified (100%). CONCLUSION FVTCP are the most frequent source of false negatives in standard cytology. Thyroid peroxidase immunodetection allows most of these errors to be avoided, and correctly identifies 99% of TPC including FVTPC.
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Affiliation(s)
- M Raffaelli
- Service de chirurgie générale et endocrinienne, hôpital d'adultes de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France
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