[Results of unilateral adrenalectomy for primary hyperaldosteronism]. / Résultats de la surrénalectomie unilatérale pour hyperaldostéronisme primaire.

From 1970 to 1992, 57 patients underwent unilateral adrenalectomy for primary hyperaldosteronism. All were hypertensive and the biochemical profile was diagnosed in all cases but two. 44 out of 57 were operated on using to the posterior Young Mayor approach. The present series included 44 macroadenomas > or = 1 cm in diameter (21 > 2 cm; 23 < or = 2 cm), 7 microadenomas (< 1 cm), 3 associations of macro and microadenomas and 3 cases of unilateral hyperplasia. All were biochemically cured. 4/57 patients remained hypertensive postoperatively (3/44 macroadenomas and 1/3 unilateral hyperplasia). There were two late recurrences, which were both clinical and biochemical (2 macroadenomas < or = 2 cm), and one of these was reoperated on for contralateral multiple "adenomas". Pathological background was defined by preoperative imaging studies with a sensitivity of 100% for MRI (23 cases), 96% for CT-scan (52 cases), 73% for NP 59 scanning (15 cases), 38% for sonography (16 cases) and 85% for venous sampling (7 cases). Cure of hyperaldosteronism or hypertension after unilateral adrenalectomy was therefore not predictable by the pathological background. If a firm diagnosis of primary hyperaldosteronism has been made and the unilaterality of the disease has been established, the patient should be operated. Even adrenalectomy for unilateral hyperplasia can lead to cure, and the syndrome can recur after removal of a solitary macroadenoma.

[Mortality in the surgical unit of a general hospital. Study of 27 postoperative deaths among patients operated on during 1990-1492]. / Mortalité d'un service de chirurgie générale de C.H.U. Etude sur l'année 1990. 1492 opérés, 27 décès postopératoires.

This study takes in account all post operative deaths during the year 1990 in one surgical Professorial unit of Lille academic hospital (France). During this year, 1492 consecutive patients underwent surgery. The mean age of deceased patients was 63.7 years. 15 died after emergency procedure and 12 after elective surgery. Lastly 2 patients died without any operation. The most common condition encountered in those cases was oesophageal carcinoma, thereafter gastric or duodenal complicated peptic ulcer, and finally colonic carcinoma and diverticular disease. 13 patients had neoplasia (45%). From a critical point of view, 14 patients died after surgical indication or procedure of questionable legitimacy. The comparison with a similar study conducted five years ago and the analysis of these charts allow us to reaffirm some basic principles of surgery.

[The parathyroid risk in thyroid surgery. Argument against the early postoperative prescription of vitamin D. Experience with 729 thyroidectomies in 1988]. / Le risque parathyroïdien en chirurgie thyroïdienne. Plaidoyer contre la prescription post-opératoire précoce de vitamine D. Expérience de 729 thyroïdectomies en 1988.

729 consecutive patients underwent thyroidectomy in 1988 in the same institution, including 477 (68%) bilateral resections and 242 (33%) total thyroidectomies. An effort was made to see and save all 4 parathyroids and their blood supply. Early post-operative hypoparathyroidism was defined at day 5, by serum calcium less than 8 mg/dl. and serum phosphate less than 4 mg/dl or by serum calcium only if greater than 7.5 mg/dl. Patients afflicted with early hypoparathyroidism were given calcium tablets without any vit D for 1 year at most. Follow-up, checking serum Ca, P and i PIH was done on a 3 months basis during 1 year. Permanent hypoparathyroidism was defined by persistence of the above-mentioned criteria after 1 year, and eventually vit D was started. 27 patients (5.6% our of 477 bilateral thyroid resections) experienced early post-op hypoparathyroidism. Inciting factors were previous thyroid surgery (4), radioiodine treatment (2), modified neck dissection (2), sternal split with mediastinal node clearance (1), visualization of 1 parathyroid gland only (3 redo cases) and autotransplantation of more than 1 parathyroid (1 case). 1 patient was lost for follow-up. 25 others recovered a normal parathyroid function. 1 is permanently hypoparathyroid (1 redo case with other risk factors). Painstaking parathyroid dissection allows a 0% rate of permanent hypoparathyroidism after primary surgery, if vit D is not given in the early post-operative period. We suggest that avoidance of early vit D prescription in cases of early post-operative hypoparathyroidism, leading to mild sustained hypocalcemia, stimulates the spared parathyroid glands (including a possible 5th) and therefore allows full recovery of the parathyroid function.

[Surgical reduction of the external ligament for chronic instability of the tibio-tarsal joint. Apropos of 58 reviewed cases]. / Instabilité chronique de l'articulation tibio-tarsienne remise en tension ligamentaire externe. A propos de 58 cas revus.

Between 1975 and 1986, 75 cases of surgical tightening of the lateral ligament have been performed for chronic instability of the ankle. 58 of them have been reviewed with a mean delay of 36 months (extremes of 6 months to 6 years). Surgery corrected completely the instability four out of five times. In six patients there still remained more or less incapacitating pain. Talo-navicular movements were constantly preserved, as well as that of the sub-talar joint, except in six cases where it was slightly diminished. The results have been excellent in 18 cases; very good in 18 cases; good in 6 cases; mild in 8 cases and poor in 4 cases. Furthermore, four patients who originally had an excellent or very good results have subsequently presented with a recurrence of joint laxity and instability following a new severe ankle sprain. X-ray results were less satisfactory as the joint laxity was only partially controlled (average tilt of 7 degrees). But all joint laxities except one have been improved by this type of surgery. After failure of proprioceptive rehabilitation which must be performed systematically, surgical tightening of the lateral ligament can be proposed, and should be preferred to peroneus brevis ligamentoplasties, which are more traumatic and less physiological.