RESUMO
BACKGROUND: For radiologists, the venous drainage of adrenal glands is a key to the technique of selective adrenal venous sampling. For endocrine surgeons, it is key to adrenalectomy for carcinoma and pheochromocytoma. This study aims to demonstrate direct anastomosis between the left adrenal vein, the diaphragmatic circulation and the azygos system. Anatomical textbooks only offer very little information concerning the left adrenal vein (LAV) and its potential anastomosis with the reno-lumbo-azygo trunk (RLAT) and the diaphragmatic circulation. METHODS: Between November 2014 and October 2015 in the LADAF (French Alps Anatomy Laboratory), we dissected 44 formalin-fixed adult cadavers. RESULTS: We found no direct anastomosis between the left adrenal vein and the reno-azygo-lumbar trunk and two anastomoses (4.5%) between the adrenal capsular vein and azygos system. A lumbo-azygo trunk has been found 38 times (86.3%), drained 35 times (79.5%) into the left renal vein and 3 times (6.8%) into the left genital vein. An inferior phrenic vein ending into an adrenal vein was highlighted in all cases, 6 times (13.7%) in a double adrenal vein and 38 times (86.3%) in a single one. CONCLUSIONS: No connections have been found between left adrenal vein and the RLAT, and frequency of the IPV is discordant with the literature. However, our findings concerning the capsular vessels' anastomosis with the azygos system, inferior diaphragmatic flow and double adrenal vein could have two clinical applications: Firstly, the ligation of the adrenal vein solely is not enough to entirely interrupt the adrenal vein drainage, and secondly, sampling of hormones in the LAV could be underestimated because of the risk of dilution.
Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Veias/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veias Renais/anatomia & histologia , Veia Cava Inferior/anatomia & histologiaRESUMO
PURPOSE: To determine the position of the lower loop of the ansa cervicalis (AC) compared to the inferior edge of the omohyoid muscle to guide minimally invasive surgery for the lateral oblique approach of parathyroid glands. METHODS: Authors performed 36 anatomical dissections in the laboratory of anatomy (Laboratoire d'Anatomie Des Alpes Françaises) of the Grenoble medical school in 2012 on human cadavers. They independently measured the distance between the caudal extremity of the AC and the lower edge of the superior belly of the omohyoid muscle. Then, they controlled this measure on pictures. RESULTS: The study shows a majority of long AC (under the omohyoid muscle) in 66.7 % of cases. In addition, the AC was located on an average value of 0.1 cm below the lower edge of the omohyoid muscle (median -0.5 cm). Thus, two-thirds of AC are between 0 and -2 cm under the omohyoid muscle. Furthermore, the AC is generally non-symmetrical: there is a mean difference of 1.3 cm between the left and right AC. In this series, there are as many long AC on the right side as on the left side. CONCLUSIONS: These results are in contradiction with literature data. To preserve the ansa cervicalis and its phonatory functions, it is necessary for the surgeon to perform a systematic per operative identification of the AC because the position of the AC is mainly under the omohyoid muscle and because of an asymmetry. Per operative neurostimulation and/or magnified lenses might be helpful during the surgical approach.
Assuntos
Plexo Cervical/anatomia & histologia , Músculo Esquelético/anatomia & histologia , Glândulas Paratireoides/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças das Paratireoides/cirurgiaRESUMO
Between 1992 and 2002, 542 patients underwent a surgical treatment for hyperparathyroidism in our department. Twenty-three selective venous sampling procedures (SVS) were performed because of the failure of the other methods of diagnosis. These patients have recurrent or persistent hyperparathyroidism. Noninvasive methods of topographical diagnosis have failed or they have given contradictory results. In our experience, the surgeon needs a precise localization of the pathological glands in these difficult cases. In our series of SVS, specificity was 85.7% and sensitivity was 94.7%. Our results show that a high postoperative gradient of parathyroid hormone in the internal thoracic veins indicates an ectopic pathological gland in the thymus. A high gradient in a vertebral vein indicates a pathological superior parathyroid gland, usually in a retro-esophageal position.
Assuntos
Coleta de Amostras Sanguíneas/métodos , Hiperparatireoidismo/diagnóstico , Adulto , Idoso , Feminino , Humanos , Hiperparatireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/anormalidades , Recidiva , Sensibilidade e EspecificidadeRESUMO
The objective of this study was to standardize surgical treatment of cervicothoracic hematoma due to parathyroid gland rupture. Only 19 such hematomas have been reported in the literature, and there is no consensus about the best time to operate or the surgical approach. We have now treated four new cases of extensive hematoma from the time of the initial bleeding except in the case of severe hemodynamic or respiratory troubles or nerve compression. Two of the patients were operated on after a minimal 3 months delay, with perfect results. The other two were operated on during the first month with great technical difficulty and incomplete results. In one case the gland was not excised, but parathyroid apoplexy afforded a spontaneous remission, although the hyperparathyroidism recurred 7 years later. We concluded that, first, if there are no severe compressive or hemodynamic symptoms, the surgical treatment must be performed more than 3 months after the bleeding, as the dissection then is as simple as any well ordered surgery. In case of an extensive hematoma accompanied by shock or compression, we propose simple emergency drainage, with reoperation 3 months later. Second, parathyroid apoplexy sometimes offers spontaneous remission of primary hyperparathyroidism, although late recurrence is always possible and surgical treatment then cannot be avoided.