Parathyroid scintigraphy findings in chronic kidney disease patients with recurrent hyperparathyroidism.

Background: Parathyroidectomy (PTX), either subtotal or total with forearm autografting, is a well-established treatment for refractory renal hyperparathyroidism (RHPT). However, 20-30% of patients develop persistent or recurrent disease. Obtaining accurate localization before reoperation is difficult.

Long-term results of venous bypass for lower extremity arteries with selective short segment prosthetic reinforcement of varicose dilatations.

The long-term benefit of venous bypass has been clearly demonstrated, but procedure feasibility is contingent upon availability of a suitable vein. In this study, we evaluated the outcome of venous bypasses performed by the first author using veins presenting dilatations that were selectively reinforced with a short prosthesis. The purpose was to answer three questions.

[Differentiated thyroid carcinoma--how to improve the long-term results? Twenty-five-year outcomes of 850 patients].

About 4000 people are diagnosed with thyroid carcinoma each year in France and as many as one in three adult patients have thyroid nodules on sonography. Nine in ten cases are differentiated (DTC). DTC may recur in the neck or metastasize very late, and final outcomes should therefore only be assessed after at least 20 years of follow-up.

Elective popliteal aneurysms: does venous availability has an impact on indications?

Aim: The aim of this retrospective study was to evaluate the patency and limb salvage rates after prosthetics or venous bypasses for asymptomatic or mildly symptomatic popliteal aneurysms, in order to determine if small uncomplicated aneurysms (caliber <300%) should be operated or periodically controlled when a venous conduit is not available.

Methods: During a 18 years period, 100 popliteal aneurysms, including 85 asymptomatic and 15 associated with intermittent claudication, were operated on: group I consisted of 80 venous bypasses, and group II consisted of 20 prosthetic bypasses.

Results: Demographics and risks factors were similar in both groups.

Extensive unilateral iliofemoral occlusions: durability of four techniques of arterial reconstructions.

In patients with long unilateral iliofemoral occlusive disease unfit for percutaneous transluminal angioplasty (PTA), most surgeons would choose some type of prosthetic bypass (aortounifemoral, iliofemoral or cross over). All these bypasses would provide excellent early results, but some may not be sufficient in patients with a good life expectancy who also need durable patency. The purpose of the study was to compare the long-term results of four types of arterial reconstructions.

Subintimal angioplasty: feasible and durable.

Objective: To assess prospectively the feasibility and durability of subintimal angioplasty (SA) clinically and by duplex scans every 3 months.

Patients And Methods: Within a period of 54 months, we selected 96 patients with 100 occlusions (mean length: 11.5 cm) of femoro-popliteal or tibial arteries, for SA.

[Primary hyperparathyroidism: three decades of evolution in diagnostic and imaging techniques and advantages of early surgery].

Recent progresses in the ability to obtain a secure diagnosis and preoperative localisation have resulted in a lower threshold for surgery of primary hyperparathyroidism. We questioned whether these trends have been accompanied by an improvement in surgical results, or changes in the profile of the disease among operated patients. From a total of 511 operations (499 patients), we retrospectively investigated the data from three successive periods of 10 years each: (1973-1982: 73 operations; (1983-1992): 155 operations; (1993-2002): 283 operations.

Robotically assisted aorto-femoral bypass grafting: lessons learned from our initial experience.

Objective: The da Vinci trade mark Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) is a computer-enhanced telemanipulator that may help to overcome some limitations of traditional laparoscopic instruments. This prospective study was performed to assess the safety and feasibility of robotically assisted aorto-femoral bypass grafting (AF).

Vascular smooth muscle cell endovascular therapy stabilizes already developed aneurysms in a model of aortic injury elicited by inflammation and proteolysis.

Objective: To investigate the efficiency of endovascular smooth muscle cell (VSMC) seeding in promoting healing and stability in already-developed aneurysms obtained by matrix metalloproteases (MMPs)-driven injury.

Summary Background Data: VSMCs are instrumental in arterial healing after injury and are in decreased number in arterial aneurysms. This cellular deficiency may account for poor healing capabilities and ongoing expansion of aneurysms.

Functioning pulmonary metastases of thyroid cancer: does radioiodine influence the prognosis?

Functioning pulmonary metastases are the most common distant lesions of differentiated thyroid cancer. About 50% of patients with such metastases die within 10 years. The impact of iodine-131 therapy is controversial.

Iliac artery rupture during balloon dilatation: what treatment?

Intraoperative and postoperative arterial ruptures associated with 657 iliac artery balloon dilatation procedures in our department from 1981 to 2000 were prospectively collected and retrospectively analyzed. Our results showed that failure to exercise basic safety principles and the presence of heavily calcified plaque are the major predictors of iliac artery rupture during balloon dilatation. If rupture is contained, surveillance alone is unreliable.

[Feasibility of ambulatory endovenous laser for the treatment of greater saphenous varicose veins: one-month outcome in a series of 20 outpatients].

The purpose of this feasibility study was to demonstrate that endovenous laser can be a useful alternative to conventional surgery for ambulatory treatment of advanced varicose veins. We assessed an open, non-randomized series of patients treated in one center by the same operator. The study protocol was approved by the local ethics committee.

Paracrine effect of vascular smooth muscle cells in the prevention of aortic aneurysm formation.

Objective: Inflammation and elastinolysis are observed in the media of abdominal aortic aneurysms (AAAs) where vascular smooth muscle cell (VSMC) density is decreased. In contrast, elastin and VSMCs are preserved in the noninflammatory media of stenotic atherosclerotic lesions. We have tested the hypothesis that VSMCs exert a protective effect against inflammation and proteolysis in a model of AAA in rats, in which medial elastin degradation is driven by inflammation and matrix metalloproteinases.

[Annual self-assessment of perioperative complications and early success: the best way to improve the medical results in the Vascular Surgery Department].

In spite of many recent advances, vascular surgery is still weighed down with serious complications which occur in 1 to 5% of open surgery cases and 0 to 2% of endovascular cases. Some of them are due to the specific characteristics of atherosclerotic and aneurysmal diseases; others are associated with the technics of arterial reconstructions; but others are surgeon-dependant as their rate vary from on center to another. Quality of results depend on the experience of one surgeon and his team.

[Progress, checks and errors in arterial surgery during the last two decades].

The Advancement of Vascular Surgery since the eighties. During the last two decades, Vascular Surgery became a specialty, vascular technics and materials were greatly improving and surgical indications have been rationalized. Results greatly improved.

Percutaneous coil embolization of postcatheterization arterial femoral pseudoaneurysms.

Study Design: This study was a prospective monocentric study to assess the safety and effectiveness of percutaneous embolization with coils of postcatheterization femoral pseudoaneurysm (PCFP).

Patients And Methods: Seventeen PCFPs of 32-mm mean diameter in 16 patients were embolized while anticoagulant or antiplatelet therapy was maintained. Ultrasound scan-guided compression repair failed at least one time in 13 cases and was contraindicated in the four remaining cases.

[Acute pancreatitis after surgical treatment of abdominal aortic aneurysm].

Introduction: Acute pancreatitis after surgical treatment of non ruptured aneurysm of abdominal aorta is a rare complication, considered to be due to pancreatic ischemia or peroperative trauma of pancreas. The aim of this study is to describe 4 new cases of this complication and to discuss its etiology.

Patients And Methods: From January 1995 to November 2000, 365 patients underwent elective surgery for a non ruptured abdominal aorta aneurysm.

Parathyroid gland radionuclide scanning--methods and indications.

The usefulness of preoperative radionuclide scanning of the parathyroid glands in patients with primary or secondary hyperparathyroidism was long controversial because available techniques were of limited diagnostic efficacy. Technetium-99m-labeled sestamibi (99Tc-sestamibi) is a new radiopharmaceutical agent easily detected by gamma cameras. The first parathyroid imaging studies done with 99Tc-sestamibi about 10 years ago used a double-phase technique to separate thyroid and parathyroid tissue.

Late reoperations after surgical and endovascular lower limb revascularisation.

Objectives: to evaluate the rate of late reoperations after primary lower limb revascularisation.

Methods: a prospectively collected database of 639 consecutive patients, undergoing 763 primary arterial reconstruction for lower limb occlusive disease during the five-year period 1989 through 1993, was analysed with regard to the rates and locations of late (after 30 days) re-operation. The reconstruction was supra-inguinal in 527 (69%) cases, surgical in 391 (Group IA) and endovascular in 136 (Group IB).

Injury in vascular surgery--the intimal hyperplastic response.

Intimal hyperplasia is extensively studied in order to improve arterial reconstruction outcome. The mechanisms leading to stenosis or restenosis may vary according to the technique used for arterial reconstruction. Lesions are mostly made of an accumulation of smooth muscle cells and fibroblasts, with only sparse inflammatory cells.

Percutaneous transluminal angioplasty in patients with ischemic tissue necrosis is worthwhile.

Purpose: Ischemic tissue necrosis is usually associated with long or sequential arterial obstructions. As a result, the role of percutaneous transluminal angioplasty (PTA), which addresses only short lesions, in patients presenting with trophic changes remains questionable. The purpose of this study was to evaluate the effectiveness of PTA in diabetic and non-diabetic patients presenting with grade 4 Fontaine's classification.