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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Dans la plupart des cas d'hyperparathyroïdie (HPT) persistante ou récidivante, la glande parathyroïdienne (PT) pathologique responsable se trouve souvent dans le cou ou est au moins accessible par une incision cervicale. Il est rare qu'une sternotomie médiane soit nécessaire. Nous présentons 3 cas d'HPT persistante dans lesquels la glande PT restante se trouvait dans le médiastin moyen. Nous reconnaissons qu'il s'agit d'une éventualité rare qui ne peut être expliquée par l'embryologie classique. Dans les cas où une exploration médiastinale réglée est nécessaire, il faut, pour être complet, ne pas oublier d'explorer le médiastin moyen pour exclure toute possibilité d'existence de tissu PT ectopique.
    Abstract: Resumen En la mayoría de los casos de hiperparatiroidismo persistente o recurrente la glándula patológica se encuentra en el cuello o es accessible por un abordaje cervical, y sólo en un mínimo porcentaje se hace necesario realizar esternotomía. Presentamos 3 casos de hiperpartiroidismo persistente en los cuales el tejido paratiroideo anormal fue hallado en el mediastino medio, posterior al arco aórtico pero anterior a la carina y a los bronquios principales. Reconocemos que este es un hallazgo raro y que no puede ser adecuadamente explicado a la luz de los conocimientos embriológicos ordinarios. En casos que requieran exploracíon mediastinal formal, la exploración no puede ser considerada como completa a menos que el mediastino medio sea cuidadosamente inspeccionado a fín de excluir la presencia de tejido paratiroideo ectópico.
    Notes: Abstract In most cases of persistent or recurrent hyperparathyroidism (HPT), the pathological parathyroid (PT) will be in the neck or accessible through the cervical approach, and in only a small percentage will median sternotomy be required. We present 3 cases of persistent HPT where the PT tissue was in the middle mediastinum. We acknowledge that this is a rare occurrence and that it cannot be explained adequately by standard embryological teaching. In cases requiring formal mediastinal exploration, the mediastinal exploration is not complete unless the middle mediastinum is carefully explored to exclude ectopic PT tissue.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Chez 3 chiens, la gastrinémie a été dosée après un repas de viande: dès la 10e minute, les valeurs s'élèvent de faÇon significative. Les mesures ont été répétées après antrectomie avec anastomose type Billroth I et après conversion en Billroth II: le taux de gastrine à jeun est inchangé, mais il n'y a plus d'augmentation postprandiale. Chez 4 chiens avec antrectomie, anastomose de type BII et canules dans le duodénum et l'estomac, les effets d'une perfusion duodénale sur la gastrinémie ont été étudiés: la perfusion de solutions de NaCl 150 mM, d'HCl 150 mM ou d'acéthylcholine 0.1% est sans effet significatif sur la gastrinémie. Chez des chiens antrectomisés, la vagotomie par voie thoracique élève le taux de gastrine à jeun, mais la réponse à un repas de viande ou à une perfusion duodénale reste abolie. Des études parallèles ont été faites chez 6 malades antrectomisés et vagotomisés qui avaient subi, pour vomissements bilieux post-gastrectomie, une transformation en Roux en Y, et chez 2 malades opérés de gastrectomie totale. La perfusion par un drain intraduodénal de solutions de NaCl 150 mM ou d'HCl 150 mM, d'émulsion de graisse ou de solution d'acides aminés, n'entraÎne aucune élévation du taux de gastrine. L'absence d'élévation de la gastrinémie après repas de viande ou perfusion duodénale chez le chien et chez l'homme antrectomisés indique que la gastrine n'est vraisemblablement pas le médiateur de la phase intestinale de la sécrétion gastrique. Les résultats obtenus après vagotomie chez le chien suggèrent, soit une inhibition vagale de la libération de gastrine d'origine extragastrique, soit une modification du catabolisme de la gastrine par la vagotomie.
    Notes: Abstract Serum gastrin concentration was measured in 3 dogs after a meat meal; basal levels rose significantly after 10 minutes. After antrectomy with a Billroth I, and later a Billroth II anastomosis, the tests were repeated. Basal gastrin levels were unchanged but the rise after meat feeding was abolished. Four antrectomized dogs with a BII anastomosis and cannulae in both the duodenum and stomach were used to examine the effect of duodenal perfusion on serum gastrin. Whether the perfusate was 150 mM NaCl, 150 mM HCl or 0.1% acetylcholine, the mean serum gastrin levels did not differ significantly from basal levels. Transthoracic vagotomy in antrectomized dogs produced a significant rise in basal gastrin levels, but did not restore the response to a meat meal or duodenal perfusion. Parallel studies were conducted in 6 antrectomized, vagotomized patients who had undergone Roux-en-Y conversion for postgastrectomy bilious vomiting, and in 2 patients after total gastrectomy. Duodenal perfusion via duodenostomy tubes with 150 mM NaCl, 150 mM HCl, fat emulsion, and an amino acid mixture did not raise serum gastrin above basal levels. Since meat feeding and duodenal perfusion in antrectomized dogs and humans failed to stimulate a rise in serum gastrin, we conclude that the intestinal phase of gastric secretion is unlikely to be mediated by gastrin. The results following vagotomy in the dog suggest that extragastric basal gastrin release is vagally inhibited or that vagotomy interferes with the catabolic destruction of gastrin.
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  • 3
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Une série de 7 malades hyperparathyroïdiens qui présentaient des glandes parathyroïdiennes hyperfonctionnelles situées au sein de la thyroïde est présentée par les auteurs. Dans 7 cas sur 8, elles répondaient aux glandes parathyroïdiennes inférieures et ce fait est discuté en fonction de nos connaissances actuelles de l'embryologie. La présence d'une glande parathyroïdienne hyperfonctionnelle au sein de la thyroïde doit être envisagée en cas d'échec de la chirurgie parathyroïdienne. En fait quand une glande parathyroïde inférieure n'est pas retrouvée en cours d'intervention les auteurs recommandent d'inciser le pôle inférieur de la thyroïde et de pratiquer, si nécessaire, une lobectomie thyroïdienne.
    Abstract: Resumen La glándula paratiroides de ubicación anormal es una bien reconocida causa de fracaso en cirugía paratiroidea. Una de las anomalías más interesantes y provocadoras es la paratiroides hiperfuncionante intratiroidea. Se define la paratiroides intratiroidea como la glándula paratiroides, normal o anormal, que se encuentra totalmente ubicada en el interior de la tiroides y rodeada por parenquima tiroideo. Se presentan las características clínicas, quirúrgicas, y patológicas de 7 pacientes con hiperparatiroidismo, en quienes 8 glándulas paratiroides intratiroideas fueron halladas. Estos 7 casos representan 3.5% de 200 pacientes sometidos a exploración cervical por hiperparatiroidismo entre 1978 y 1984. Siete de las 8 glándulas fueron paratiroides inferiores, hallazgo que es discutido a la luz de conocimientos embriológicos actuales. La paratiroides hiperfuncionante intratiroidea no es una anomalía rara y es considerada como una potencial causa de fracaso en cirugía de paratiroides; por consiguiente, cuando en el curso de la exploración no se encuentre una de las paratiroides inferiores se debe incidir el polo inferior de la tiroides y, si necesario, realizar lobectomía.
    Notes: Abstract The details of 7 patients with hyperparathyroidism in whom 8 intrathyroid hyperfunctioning parathyroid glands were located are presented. Seven of the 8 glands were inferior parathyroids and this observation is discussed in the light of current embryological teaching. The intrathyroidal hyperfunctioning parathyroid is considered to be a potential cause of failed parathyroid surgery and, therefore, when an inferior parathyroid gland is missing, it is recommended that the lower pole of the thyroid be incised and, if necessary, a thyroid lobectomy performed.
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  • 4
    ISSN: 1432-2218
    Keywords: Adrenalectomy ; Laparoscopy ; Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic approach for adrenalectomy was recently described and the operative technique is not yet well defined. Methods: Twenty-seven laparoscopic adrenalectomies were performed between 1992 and 1995. There were 18 women and nine men ranging in age from 31 to 70 years (mean, 50.8 years). The surgical procedure was a lateral decubitus transperitoneal flank approach in 26 patients, and a retroperitoneal approach in one. Twelve right and 15 left glands were removed. Adrenal diseases were primary aldosteronism in 20 patients, nonfunctional adenoma in four patients, Cushing adenoma in two, and an adrenal cyst in one. Median adrenal gland size was 2.0 cm (range 0.5–8 cm). Results: Five patients were converted to laparotomy (18%)—for dissection problems in four and for an unrecognized gland in one. The median anesthesia time was 200 min and the median surgical time was 140 min. Operative morbidity was one adrenal vein injury sectioned close to the vena cava. The hemorrhage was controlled by laparoscopic suturing without conversion. This patient required a three-unit blood transfusion. No mortality occurred and postoperative morbidity was one minor chest infection. The median postoperative in-hospital stay was 4.6 days (range 2–8) for nonconverted patients. Conclusions: Laparoscopic adrenal gland removal is safe and offers fast recovery and short in-hospital stay. Laparoscopic adrenalectomy combines the advantages of both the conventional anterior and posterior approach.
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  • 5
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Nous avons étudié une série de 22 cancers médullaires (CM), primitifs et secondaires, par l'immunohistochimie (IHC) et par l'hybridation in situ (HIS) afin de localiser respectivement d'une part les peptides calcitonine et la somatostatine et d'autre part les mRNA de la calcitonine et la somatostatine. Toutes les tumeurs étaient positives pour le peptide calcitonine par HIS mais présentaient par ailleurs une hétérogénéité intercellulaire beaucoup de cellules n'ayant pas de calcitonine détectable. Le mRNA de la calcitonine, détecté par HIS, était uniformément distribué indiquant que certaines cellules tumorales CM peuvent à la fois assurer la synthèse et stocker la calcitonine alors que d'autres perdent leur pouvoir de stockage mais pas leurs propriétés de synthèse. Les peptides de la somatostatine et la calcitonine ont été retrouvés dans les tumeurs provenant de 15 patients. Au contraire de ce que l'on observe avec la calcitonine, le mARN de la somatostatine et le peptide étaient généralement repartis dans des cellules dispersées. Lorsque la corrélation a été recherchée, la même cellule pouvait être positive pour la somatostatine par l'IHC et par HIS. Dans une même tumeur, cependant, il y avait beaucoup plus de cellules positives pour le mARN que pour les peptides, suggérant que seule une petite proportion de cellules avait gardé leur capacité de stocker le peptide. La variation du contenu cellulaire de calcitonine immunoréactive est interprétée comme étant le résultat soit d'une augmentation de la croissance cellulaire, soit d'une diminution du stockage du peptide par la tumeur. La corrélation entre le mARNde la somatostatine et le peptide était bonne, mais cette corrélation était notée surtout dans les cellules dispersées, la majorité des cellules tumorales étant négatives et pour le mARN et pour le peptide. On suggère que la production de somatostatine peut être associée à une réduction de la croissance cellulaire soit par un étape intermédiaire soit directement par l'effet de l'hormone. Nous concluons aussi que les études par HIS pour les substances mARN et l'IHC pour les peptides sont utiles pour la localisation de la production hormonale des tumeurs endocrines.
    Abstract: Resumen Hemos estudiado una serie de 22 carcinomas medulares tiroideos humanos (CMT), tanto primarios como metastásicos, utilizando immunocitoquímica (ICQ) para localizar calcitonina, y péptido somatostátinico e hibridación in situ (HIS) para localizar calcitonina y somatostatina mRNA. Todos los tumores fueron positivos para péptido calcitotínico con ICC, que con frecuencia mostró considerable heterogenecidad celular, con muchas células con niveles no detectables de calcitonina. Sin embargo, la calcitonina mRNA localizada por HIS apareció más uniformemente distribuída, indicando que las células del CMT pueden retener la capacidad tanto de sintetizar como la de almacenar calcitonina, mientras otras pierden su capacidad de almacenar mas no de sintetizar. El péptido somatostátinico y la somatostatina mRNA fueron hallados en los tumores de 15 pacientes. en contraste con el patrón observado con la calcitonina, la somatostatina mRNA y el péptido usualmente fueron hallados en células únicas dispersas. Cuando fue posible la correlación, la misma célula mostró positividad para la somatostatina mRNA en HIS y positividad para el péptido en ICQ. Sin embargo, en un tumor muchas más células fueron positivas para mRNA que para el péptido, lo cual sugiere que sólo una proporción de las células retiene la habilidad de almacenar el péptido. La variación en el contenido de calcitonina inmunoreactiva es interpretada como el resultado o bien de una incrementada rata de crecimiento rumoral, o como una reducida capacidad para almacenar el péptido en un tumor menos diferenciado. Con la somatostatina se encontró una muy buena correlación entre el contenido de mRNA y de péptido, pero esto ocurrió sólamente en células ampliamente dispersas, con la gran mayoría de las células tumorales permaneciendo negativas tanto para péptido como para mRNA. Se sugiere que la producción de somatostatina puede estar asociada con una reducción en el crecimiento de la célula concerniente, bien a través de una fase de diferenciación o bien como efecto directo de la hormona. También es nuestra conclusión que los estudios de localización de la producción hormonal en los tumores endocrinos se benefician de la aplicación combinada de HIS para mRNA y de ICQ para péptido.
    Notes: Abstract We have studied a series of 22 human medullary carcinomas (MCTs), both primary and metastatic, using immunocytochemistry (ICC) to localize calcitonin and somatostatin peptide and in situ hybridization (ISH) to localize calcitonin and somatostatin mRNA. All tumors were positive for calcitonin peptide with ICC, which often showed considerable intercellular heterogeneity, with many cells having undetectable levels of calcitonin. However, calcitonin mRNA localized by ISH was much more uniformly distributed, indicating that MCT tumor cells may retain the capacity to both synthesize and store calcitonin, whereas others lose their storage but not their synthetic capacity. Somatostatin peptide and mRNA were found in tumors from 15 patients. In contrast to the pattern seen with calcitonin, somatostatin mRNA and peptide were usually found in single scattered cells. When correlation was possible, the same cell showed positivity for somatostatin mRNA on ISH and positivity for somatostatin peptide on ICC. However, in one tumor many more cells were positive for mRNA than for peptide, suggesting that only a proportion of cells retained the ability to store the peptide. The variation in cellular content of immunoreactive calcitonin is interpreted as resulting from either an increased tumor growth rate r reduced ability to store peptide in a less differentiated tumor. With somatostatin there was good correlation between mRNA and peptide content, but it occurred in single widely scattered cells, most tumor cells being negative for both peptide and mRNA It is suggested that somatostatin production might be associated with a reduction in the growth of the cell concerned, either through a differentiation step or through a direct effect of the hormone. We also conclude that studies of the localization of hormone production in endocrine tumors benefit from the combined application of ISH for mRNA and ICC for peptide.
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary Twelve days after subtotal thyroidectomy, an air pocket developed in a patient's neck. The pressure in this pocket had gradually increased as small amounts of air, probably associated with coughing, came out of a tiny hole in the trachea to form a pneumocoele. This produced limited surgical emphysema, causing venous congestion and oedema of the soft tissues of the larynx, which in turn led to increasing airway obstruction. We believe that this is the first reported case of a pneumocoele that gradually increased in size, causing airway obstruction that was almost certainly due to secondary laryngeal oedema.
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  • 7
    ISSN: 1432-2218
    Keywords: Key words: Adrenalectomy — Laparoscopy — Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic approach for adrenalectomy was recently described and the operative technique is not yet well defined. Methods: Twenty-seven laparoscopic adrenalectomies were performed between 1992 and 1995. There were 18 women and nine men ranging in age from 31 to 70 years (mean, 50.8 years). The surgical procedure was a lateral decubitus transperitoneal flank approach in 26 patients, and a retroperitoneal approach in one. Twelve right and 15 left glands were removed. Adrenal diseases were primary aldosteronism in 20 patients, nonfunctional adenoma in four patients, Cushing adenoma in two, and an adrenal cyst in one. Median adrenal gland size was 2.0 cm (range 0.5–8 cm). Results: Five patients were converted to laparotomy (18%)—for dissection problems in four and for an unrecognized gland in one. The median anesthesia time was 200 min and the median surgical time was 140 min. Operative morbidity was one adrenal vein injury sectioned close to the vena cava. The hemorrhage was controlled by laparoscopic suturing without conversion. This patient required a three-unit blood transfusion. No mortality occurred and postoperative morbidity was one minor chest infection. The median postoperative in-hospital stay was 4.6 days (range 2–8) for nonconverted patients. Conclusions: Laparoscopic adrenal gland removal is safe and offers fast recovery and short in-hospital stay. Laparoscopic adrenalectomy combines the advantages of both the conventional anterior and posterior approach.
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  • 8
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three patients who bled from curious vascular lesions of the gastric antrum are described. Each presented with an iron-deficiency anemial. Histological examination in two of the patients demonstrated numerous ectatic submucosal vessels in the antrum, the appearances being somewhat similar to angiodysplasia of the colon. The gastric lesions were not shown by barium meal examination or angiography but gave characteristic appearances on endoscopy. We believe that Billroth I partial gatrectomy is the treatment of choice for this condition.
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  • 9
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The gastric mucosa in four canine Heidenhain pouches was damaged with sodium taurocholate in a concentration which was just sufficient in each dog to produce consistent changes. Solutions were placed in the pouches and changes in the volume, concentrations, and fluxes of both hydrogen ion and sodium ion were measured before and during exposure to taurocholate. Changes which occurred with taurocholate were compared with control periods; taurocholate caused a relative increase in volume of 1 ml and approximately a fourfold increase in the hydrogen ion and sodium ion concentrations and the sodium ion flux. Changes in the hydrogen ion flux were smaller and, in some experiments, insignificant. Change in the hydrogen ion flux is less sensitive than the other parameters as an indicator of minimal mucosal damage.
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  • 10
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of diverting bile from the duodenum in four dogs with cholecystojejunostomy was studied using a double-marker perfusion technique. After the diversion procedure, a liquid meal increased acid secretion from 0.8 mmol H+/min to 1.48 mmol H+/min (P〈0.05, pairedt test); there was an associated rise in serum levels of gastrin 120 min after feeding (P〈0.001, pairedt test). Pancreatic secretion of trypsin decreased from 3.91 IU/min to 2.66 IU/min after bile diversion (P〈0.01, pairedt test), and the level of CCK was significantly lower 60 min after feeding (P〈0.05, pairedt test). There was no significant change in the rate of gastric emptying after bile diversion, but the pH of duodenal contents was lower in the later stages of digestion. These changes may explain the reported increase of peptic ulcer after diverting bile from the duodenum, and the procedure should not be considered unless the consequences of acid hypersecretion and pancreatic inhibition have been anticipated.
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