Autofluorescence pattern of parathyroid adenomas.

BACKGROUND: Primary hyperparathyroidism (pHPT) is a common endocrine pathology, and it is due to a single parathyroid adenoma in 80-85 per cent of patients. Near-infrared autofluorescence (NIRAF) has recently been used in endocrine surgery to help in the identification of parathyroid tissue, although there is currently no consensus on whether this technique can differentiate between normal and abnormal parathyroid glands. The aim of this study was to describe the autofluorescence pattern of parathyroid adenoma in pHPT. METHODS: Between January and June 2019, patients with pHPT who underwent surgical treatment for parathyroid adenoma were enrolled. Parathyroid autofluorescence was measured. RESULTS: Twenty-three patients with histologically confirmed parathyroid adenomas were included. Parathyroid adenomas showed a heterogeneous fluorescence pattern, and a well defined autofluorescent 'cap' region was observed in 17 of 23 specimens. This region was on average 28 per cent more fluorescent than the rest of the adenoma, and corresponded to a rim of normal histological parathyroid tissue (sensitivity and specificity 88 and 67 per cent respectively). After resection, all patients were treated successfully, with normal postoperative values of calcium and parathyroid hormone documented. CONCLUSION: Parathyroid adenomas show a heterogeneous autofluorescence pattern. Using NIRAF imaging, the majority of specimens showed a well defined autofluorescent portion corresponding to a rim of normal parathyroid tissue. Further studies should be conducted to validate these findings.

Unexpected Massive Hemothorax After Pancreatic Islet Transplantation: A Case Report.

The percutaneous transhepatic portal approach is the most commonly used technique for islet transplantation, largely owing to its safety and minimally invasive characteristic. Bleeding complications after islet transplantation are rare and include portal vein thrombosis and subcapsular liver hematoma. We report a massive hemothorax after portal vein catheterization in a patient with brittle type 1 diabetes undergoing hepatic islet embolization. The patient was under long-term aspirin therapy because of vascular complications and received heparin in low doses to prevent the instant blood-mediated inflammatory reaction and reduce the risk of portal vein thrombosis. The present case illustrates the particular risk of bleeding complications in patients with brittle type 1 diabetes, who represent a frail population. This uncommon adverse event highlights the importance of close monitoring in the first days following islet transplantation.

Dual-detector spiral CT arthrography of the knee: accuracy for detection of meniscal abnormalities and unstable meniscal tears.

PURPOSE: To determine the sensitivity and specificity of dual-detector spiral computed tomographic (CT) arthrography of the knee in the detection of meniscal abnormalities and unstable meniscal tears. MATERIALS AND METHODS: The meniscal changes in 50 consecutive patients who underwent dual-detector spiral CT of the knee after intraarticular injection of iodinated contrast material (0.55-mm effective section thickness, 0.75 pitch value, 0.3-mm increment reconstruction, 0.43-mm in-plane resolution, 0.3-mm longitudinal resolution) were determined by two observers and were compared with arthroscopic findings. The sensitivity and specificity of CT arthrography for the detection of meniscal abnormalities and unstable meniscal tears and the kappa statistics for assessing interobserver reproducibility were determined. RESULTS: The sensitivity and specificity for the detection of meniscal abnormalities were 98% and 94%, respectively. The sensitivity and specificity for the detection of unstable meniscal tears were 97% and 90%, respectively. Interobserver agreement was excellent for the detection of meniscal abnormalities (kappa = 0.899) and of unstable meniscal tears (kappa = 0.885). CONCLUSION: Dual-detector spiral CT arthrography of the knee is an accurate and reproducible method for detecting meniscal abnormalities and unstable meniscal tears.

[Fractures of the sacrum and neurologic lesions. Apropos of a case]. / Fractures du sacrum et lésions neurologiques. A propos d'un cas.

Sacral fracture is a difficult diagnosis due to the lack of specific signs and the inaccuracy of conventional radiology. This kind of fracture affects either polytraumatised or aged patients, in whom the fracture can be diagnosed. However these fracture have to be recognized because of their potentially adverse consequences, particularly on neurological structures. The case of a 56 years old man who fell from his height is reported. Two weeks later, due to mild neurologic symptoms, an X-ray and CT of the pelvis were performed, showing a fracture of both sacral alae. A complex neurologic sensitive and motor impairement appeared involving S1 to S5 levels on the left side and L2 to S5 levels on the right side. Many investigations were done to rule out any other etiologic factor of this complex and progressive neurologic deficit. The probable cause was an iterative stretching of the lumbosacral roots ambulating with a floating sacrum fracture.

[Laparoscopy: obstacle or revolution in the development of surgery?]. / La laparoscopie: entrave ou révolution de la formation de chirurgie?

Laparoscopy is a new fascinating technique. However, after the first wave of enthusiasm, laparoscopy currently raises different problems related with surgical training. A national survey concerning laparoscopy and its teaching was sent to every surgeon-in-chief, chief resident and resident of all Swiss teaching hospitals. Surgical training is nowadays an important problem in Switzerland. Our survey revealed that laparoscopy intensifies this problem: a specific training in laparoscopy is desired by all surgeons and has to take place in the Swiss Board of Surgery (FMH). A preliminary experience of conventional surgery is desirable. Then a laparoscopic training should start on experimental certified models and be applied progressively on patients in attendance with a trained surgeon.

[Surgical treatment of malignant tumors with mono- or multivisceral involvement]. / Traitement chirurgical des tumeurs malignes avec envahissement mono- ou pluriviscéral.

Abdominal malignant tumors with a mono- or multivisceral involvement have a poor prognosis. Surgery is the only treatment with a hope to be curative. Between January 1989 and December 1992, 30 patients (12 men, 18 women, mean age 67.9) with abdominal malignancy involving one or more adjacent organs were operated on at the Department of Surgery, General Hospital, La Chaux-de-Fonds, Switzerland. The majority of the tumors originated from the colon and rectum. 64 organs were partially or totally resected. Every curative procedure consisted of an "en bloc" resection. 53% of the procedures were curative, 37% palliative and 10% explorative. Surgical morbidity reached 30% and hospital mortality 13% (one peroperative death). Surgery obtained a local control of the tumor in 75% of the cases. After curative procedures, local recurrence and secondary metastases appeared respectively in 25% and 19% of the cases. After a palliative operation, preoperative symptoms diminished or disappeared in 82% of the patients. Tumor curability essentially depends on invaded organs. Mobile organs can nearly always be excised. Non-mobile organs and retroperitoneum are resected much more difficultly. Surgical treatment of multiorgan malignancies is difficult. It involves a long and tenacious exploration before declaring the tumor non-resectable.