RÉSUMÉ
The Authors report a case of abdominal traumatism by gunshot wound, presenting with retroperitoneal hematoma and hematoma of the mesocolon, treated in emergency laparoscopy. After a literature review and their case report analysis, they confirm the importance of emergency laparoscopy in hemodynamically stable patients, as well as the diagnostic value of peritoneal lavage, positive for minimal and moderate hemoperitoneum. Laparoscopy allows, as the same time in most cases, the diagnosis and the management of the lesion, while surgery is reserved to the cases of severe hemoperitoneum and perforating injuries. The use of laparoscopy in abdominal blunt injuries, has reduced the number of unnecessary laparotomies with related higher incidence of morbidity. The Authors conclude confirming the importance of this technique for its diagnostic efficacy, lower costs, minimal traumatism, and good aesthetic results as observed in the case report for the modality of the injuries, the young age and the previous sternotomy of the patient.
Sujet(s)
Traumatismes de l'abdomen/diagnostic , Laparoscopie , Plaies par arme à feu/diagnostic , Traumatismes de l'abdomen/chirurgie , Adolescent , Soins de réanimation , Urgences , Femelle , Humains , Plaies par arme à feu/chirurgieSujet(s)
Calcitonine/sang , Hormone parathyroïdienne/sang , Dialyse rénale/effets indésirables , Adolescent , Adulte , Sujet âgé , Phosphatase alcaline/sang , Calcitonine/usage thérapeutique , Ostéodystrophie rénale/sang , Ostéodystrophie rénale/traitement médicamenteux , Ostéodystrophie rénale/étiologie , Femelle , Humains , Défaillance rénale chronique/sang , Défaillance rénale chronique/thérapie , Mâle , Adulte d'âge moyen , Phosphore/sangSujet(s)
Glandes parathyroïdes/anatomopathologie , Tumeurs de la parathyroïde/étiologie , Dialyse rénale/effets indésirables , Diagnostic différentiel , Humains , Hyperplasie/étiologie , Hyperplasie/anatomopathologie , Défaillance rénale chronique/thérapie , Mâle , Adulte d'âge moyen , Tumeurs de la parathyroïde/anatomopathologieRÉSUMÉ
The authors report their first experience with two techniques for preoperative localization of hyperfunctioning parathyroid glands: double-tracer (99mTc-201Tl) scintigraphy and venous sampling from thyroid veins. Nineteen patients affected by primary hyperparathyroidism were examined by both methods and subsequently submitted to surgery. Scintigraphy showed a sensitivity of 77.3% while the positivity of sampling was 63.6%; with the two techniques combined a correct localization was obtained in 90.9% of all cases. The authors emphasize the usefulness of both methods combined for locating enlarged hyperfunctioning parathyroids.
Sujet(s)
Hyperparathyroïdie/imagerie diagnostique , Glandes parathyroïdes/imagerie diagnostique , Adénomes/chirurgie , Carcinomes/chirurgie , Humains , Hyperparathyroïdie/chirurgie , Hyperplasie/chirurgie , Glandes parathyroïdes/anatomopathologie , Tumeurs de la parathyroïde/chirurgie , Radio-isotopes , Scintigraphie , Technétium , ThalliumRÉSUMÉ
Double-tracer scanning (Tc-99m as pertechnetate and Tl-201 as chloride) with an Anger camera and computerized image subtraction was performed in 61 patients whose clinical and biochemical findings had suggested primary hyperparathyroidism. This study showed intra- or extrathyroidal focal uptake of thallium in 37 cases. Among these, 24 patients underwent surgery, and 18 parathyroid adenomas, five carcinomas, and one hyperplastic gland were found exactly in the sites predicted by scintigraphy. Among 24 patients with negative scans, only two underwent surgery; a hyperplastic parathyroid gland (diam less than 0.5 cm) was found in both. The success rate was 92% in the cases in which operation was performed. We believe that the new method may be useful in the preoperative detection of parathyroid enlargements.