[Parathyroid autotransplantation in hemodialysed chronic renal failure. Attempts to modulate secretion. First results apropos of 45 cases]. / L'autotransplantation parathyroïdienne chez l'insuffisant rénal chronique hémodialysé. Essais de modulation de la sécrétion. Premiers résultats à propos de quarante-cinq cas.

The authors report their experience of parathyroid autotransplantation in 45 cases of renal insufficiency undergoing hemodialysis. The operation, carried out by two teams, reduces to the minimum the time during which the grafts are exposed to environmental factors likely to impair their function. An immediate anatomopathological examination is necessary to determine the degree of hyperplasia in each gland and the corresponding choice of grafts. The tissue to be implanted must be raised in the least hyperplastic gland and the size of the graft, always difficult to specify, is dictated by the intensity of the hyperplasia. This technique ultimately permits and almost permanent modulation of the parathyroid secretion by action on the secreting tissue. In the event of post-operative persistent hypoparathyroidism, a second operation is desirable, using cryopreserved fragments for the implant. Conversely, in the event of clinical and biological recurrence, the ablation of a precise volume of grafted tissue can be performed without difficulty, under local anaesthetic.

Parathyroid carcinoma, adenoma and hyperplasia in a case of chronic renal insufficiency on dialysis.

A 62 year-old female patient with polycystic disease and chronic renal insufficiency who had required dialysis for 3 years, presented with diffuse but predominantly lumbar bone pain associated with lassitude. Radiologic studies showed diffuse osteoporosis and destruction of the 4th lumbar vertebra. Calcium levels were normal (2.30-2.50 mmoles) with increased PTH levels (1820 microliter Eq/ml). The presence of a cervical mass suggested a diagnosis of hyperparathyroidism. A cervical exploration was performed with ablation of 4 parathyroid glands and autotransplantation of a portion of the left inferior gland into the arm. Pathological studies showed the existence of carcinoma in the right superior and inferior glands, adenoma of the left superior gland and hyperplasia of the left inferior gland. The association of hyperplasia, adenoma and carcinoma could be explained by an initial hyperplasia of the 4 glands due to renal insufficiency, with subsequent transformation of 3 into adenomas of which 2 became cancerous. The patient's status was significantly improved following surgery.

[Water and electrolytes disorders in apudocarcinomas (author's transl)]. / Les troubles hydroélectrolytiques des apudomes.

The authors report an analytic study of hydroelectrolytic disorders in patients with APUD tumors. In most of the cases a diarrhea occurs. The type of this diarrhea is: -- a motrice diarrhea (in the great majority of carcinoid tumor and medullary carcinoma of the thyroid); -- a secretory diarrhea (W.D.H.A.): it is the case in gastrinoma (gastric hypersecretion), in secretinoma (pancreatic hypersecretion) and in vipoma (intestinal hypersecretion). The others disorders could be no diarrhea dependant (hyponatremia by ADH hypersecretion, hypercalcemia). The personal cases of the authors are: 12 medullary carcinoma of the thyroid, 19 enteraminoma and 2 others apudomas.

[Toxic thyroid adenoma and malignant hypercalcemia of parathyroid origin]. / Adénome thyroïdien toxique et hypercalcémie maligne d'origine parathyroïdienne

Malignant hypercalcemia due to the association of hyperthyroidism and hyperparathyroidism is rare. We report a case with a fatal course in spite of surgical treatment of both lesions. Death occurred seven days after the operation due to ventricular tachycardia, in spite of return to normal of the calcemia, the serum phosphorus, the serum electrolytes and relief of the thyro-toxicosis. There is a great deal of histopathological evidence for the association of a toxic parathyroid carcinoma and a thyroid adenoma.