Selective intraarterial DSA of the parathyroid glands in patients with hyperparathyroidism after parathyroidectomy.

Eighteen patients with recurrent hyperparathyroidism after parathyroidectomy were prospectively examined with selective intraarterial digital subtraction angiography (DSA) of the brachiocephalic arteries. The results were compared with findings at reoperation. Seventeen of the 21 remaining abnormal parathyroid glands were correctly detected by selective DSA (sensitivity = 81%). In the neck and mediastinum, sensitivities were 73% (8/11) and 90% (9/10), respectively. All patients with histopathologic confirmation of primary hyperparathyroidism (17/18) became normocalcemic postoperatively. We conclude that selective intraarterial DSA is indicated in patients with recurrent hypercalcemia after parathyroidectomy when the results of noninvasive imaging techniques are uncertain.

Management of caustic ingestion in adults.

The treatment of 484 adults with caustic ingestion injury is discussed. Signs and symptoms are an unreliable guide to injury and a chest X-ray and fibreoptic endoscopy should be performed as soon as possible. All of the 250 patients who developed superficial lesions of the oesophagus, stomach or duodenum experienced healing without sequelae. Forty-four patients required emergency surgery of whom twenty-four died and oesophagectomy without thoracotomy is now advocated for this group, followed by interval surgery to restore continuity. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complication, 3 succumbed to aorto-oesophageal fistula, 12 survived following delayed surgery for complications and 83 developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment.

[Parathyroid adenoma at an atypical site, ectopic or not]. / Adénomes parathyroïdiens de sièges inhabituels, ectopiques ou non.

Of 800 patients undergoing operation for primary hyperparathyroidism between 1960 and 1985, 163 presented parathyroid adenomas located in other than typical sites in normal parathyroid glands. A retrospective study of case-reports is used to demonstrate the value of complementary investigations in the localization of these lesions, and to emphasize certain operative factors indispensable for their detection.

[Gastropericardial fistula. Late complication of the treatment of hiatal hernia]. / Fistule gastro-péricardique. Complication tardive d'une cure de hernie hiatale.

An exceptional case of gastropericardial fistula is reported, the lesion developing from a gastric ulcer on an antireflux valve instituted ten years previously. A literature review showed 31 similar cases: 14 gastropericardial fistulae, 16 esophagopericardial fistulae and one jejunopericardial fistula. Three features common to all these fistulae were determined: the frequency of hiatus hernia in the genesis of these lesions, either from an ulcer on esophagitis or herniated stomach or from surgical complication; the extremely high mortality of these fistulae (68% mortality); the need for aggressive treatment.

[Diagnostic and therapeutic problems in a severe case of hyperparathyroidism with renal insufficiency]. / Les difficultés diagnostiques et thérapeutiques dans un cas d'hyperparathyroïdie sévère avec insuffisance rénale.

It may sometimes be difficult to distinguish primary from secondary hyperparathyroidism when advanced renal failure coexists. We report here the case of a patient with end-stage renal failure who had severe hyperparathyroidism. Cervical exploration revealed only the presence of four parathyroid glands normal in size and histological appearance which were removed. Because the existence of severe hyperparathyroidism had been firmly established based on biochemical and radiological evidence, the diagnosis of primary hyperparathyroidism due to an ectopic adenoma became obvious. Digital angiography and computerized tomography were then carried out. The results of angiography were inconclusive but computerized tomography revealed and precisely localized a mediastinal adenoma which was subsequently removed via sternotomy. The existence of a hypoparathyroid state was confirmed over the following two months. Reimplantation of parathyroid fragments which had been cryopreserved during the first operation, was then performed with success.

[A parathyroid adenoma of uncommon localization in the middle mediastinum]. / Un adénome parathyroïdien de localisation exceptionnelle au médiastin moyen.

A case of parathyroid adenoma is reported which was of interest in two respects: the very atypical localization in the middle mediastinum and the clearly visible lesion on a straight thoracic film.

[Vascular malformations of the digestive tract: a cause of severe digestive hemorrhage. Apropos of 2 cases]. / Les malformations vasculaires du tube digestif: une cause d'hémorragie digestive grave. A propos de deux cas.

We report on two cases of angiodysplasia of the digestive tract complicated by serious acute bleeding. The preoperative diagnoses were made by angiography. One case concerned a voluminous jejunal lesion which was macroscopically visible; the other concerned a punctiform lesion detected only by angiography and not found on the pathology specimen. The authors insist on the potential gravity of these angiodysplastic lesions, the necessity to perform an emergency celio-mesenteric angiogram when confronted with a serious digestive tract hemorrhage non-explained by conventional methods of exploration when they can be performed.

[Uni- or bipolar temporary exclusion of the esophagus by stapling. A simple technic, not damaging to the esophagus]. / L'exclusion temporaire unipolaire ou bipolaire de l'oesophage par agrafage. Une technique simple n'endommageant pas l'oesophage.

Many surgical procedures have been put forward to treat perforations of the thoracic oesophagus seen late. The authors propose a simple stapling technique which can be applied in the cervical segment or below the lesion if required, and report the results obtained in 4 cases. The spontaneously reversible temporary derivation obtained ensures better healing of the lesion and avoids the need for subsequent reconstructive surgery.

[Surgical treatment of primary hyperparathyroidism in patients over 70 years of age]. / Traitement chirurgical de l'hyperparathyroïdie primaire après 70 ans.

Hyperparathyroidism is a frequent, often fortuitous finding in elderly people. Our series includes 103 patients over 70 years of age, 90 of whom were operated upon. Elderly patients rarely are without any symptom, but it is difficult, prior to surgery, to associate their clinical disorders with hyperparathyroidism. Our results show that surgical treatment is virtually without danger and that most patients were distinctly improved. The innocuousness and effectiveness of surgery in these patients, as well as the absence of medical treatment are as many reasons to widen the indications of the surgical approach.

[Cystic teratoma of the diaphragm. Apropos of a case, review of the literature]. / Tératome kystique du diaphragme. A propos d'un cas, revue de la littérature.

Benign tumors of the diaphragm are rare lesions. The cystic teratoma of this muscle is an internal axial tumor, a benign dysembryoma, and only 4 cases could be found in the published literature. The cystic teratoma reported was discovered fortuitously during investigation of hypertension. It was located in the diaphragm above the psoas arch.

[Giant fibroma of the pleura. Apropos of 2 cases]. / Fibromes géants de la plèvre. A propos de deux observations.

Two cases are reported of giant pleural fibroma (2.9 and 4.2 kg), of slow growth (both had been present for 17 years), developing in the parietal pleura in a 56-year-old woman and in the triangular ligament of a 35-year-old man respectively, and treated by surgical excision. Findings in these cases and data on those reported in the literature indicate the principal pathologic and clinical characteristics of these very rare benign tumors of the pleura: onset in the absent of any history of exposure to dust (asbestos); usually fortuitous discovery; suggestive radiological appearances (calcification in some cases) that are not pathognomonic however; differentiation from fibrous mesothelioma by the microscopic or particularly gross pathologic appearance; treatment exclusively surgical and of variable difficulty according to the size of and especially the structures related to the tumor, with the need for careful preoperative screening.