Jean Van Geertruyden

Total parathyroidectomy and parathyroid autograft for renal osteodystrophy: Analysis of the cause of failure

Between September, 1979, and December 31, 1983, thirtyone patients with renal osteodystrophy and high serum immune parathyroid hormone (iPTH) levels underwent total parathyroidectomy with parathyroid autograft. Three failures (10%) were due to residual parathyroid tissue. In 2 of these patients, 4 and 6 glands respectively, had been removed. This indicates the need for thorough dissection of the neck even when 4 glands have been found. Painful symptoms and vitamin D3 intolerance persisted after surgery in 3 other patients (10%), although iPTH levels dropped significantly. Further work-up disclosed aluminum intoxication.RésuméDe septembre 1979 au 31 décembre 1983, 31 malades qui présentaient une ostéodystrophie rénale avec un taux élevé di.P.T.H. ont subi une parathyroïdectomie totale suivie dune autogreffe parathyroïdienne. Trois case déchecs (10%) dûs à la présence de tissu parathyroïdien résiduel ont été constatés. Chez 2 de ces patients 4 et 6 glandes respectivement ont été extirpées. Ce fait, soulignons-le, implique la nécessité de procéder à une dissection complète du cou, même quand les 4 parathyroïdes ont été exposées. Dautre part, il est à signaler que des symptômes douloureux et une intolérance à la vitame D3 ont persisté en postopératoire chez 3 autres malades (10%), bien que le taux di.P.T.H. se soit abaissé de façon significative. Lobservation ultérieure permit de mettre en évidence une intoxication à laluminium.ResumenTreinta y un pacientes con osteodistrofia renal y altos niveles de parathormona inmuno-reactiva carboxiterminal (PTHi) sérica fueron sometidos a paratiroidectomíra y autotransplante paratiroideo durante el período comprendido entre septiembre de 1979 y diciembre 31 de 1983. Tres fracasos (10%) se debieron a enfermedad paratiroidea residual. En dos de estos pacientes se removieron 4 y 6 glándulas respectivamente, lo cual indica la necesidad de una disección meticulosa del cuello aun cuando ya se hayan encontrado 4 glándulas. Síntomas de dolor e intolerancia a la vitamina D3 persistieron en otros 3 pacientes (10%) a pesar de una disminución significativa de los nivelés de PTHi. Una investigación mas profunda reveló intoxication por alumino.

A rare manifestation of gout at the wrist--a case report

A 34-year-old right-handed gravedigger, with no known past medical history, had had chronic pain in his left wrist for 4 years, intermittent locking and dysesthesias affecting the thumb, index and middle x8e ngers, but no acute episodes of pain. The pain, located over the dorsal aspect of the scaphoid, was not associated with swelling of the wrist. We found a moderate reduction in dorsal x8f exion and pronation. Tinel and Phalen signs were absent, and there were no objective signs of sensory or motor loss affecting the median nerve. Radiographs and CT scan revealed small cysts in the proximal pole of the scaphoid and lunate, and small calcix8e cations in the radioscapholunate ligament (Figure 1). Scintigraphy showed moderate isotope uptake at the level of the scaphoid, and electroconduction studies a slight reduction in velocities along the median nerve at the carpal tunnel. These x8e ndings were initially interpreted as indicating scaphoid and lunate osteonecrosis, with a mild carpal tunnel syndrome, and the patient was started on splinting and nonsteroidal antiinx8f ammatory medications. A diagnostic arthroscopy was later done because of persistent pain. A large (12 ́ 4 mm) white, soft, loose body, A rare manifestation of gout at the wrist—a case report

Erythropoiesis in renal insufficiency and in anephric man.

While the role of the kidney in erythropoiesis has been experimentally demonstrated,1.2 we have only indirect arguments concerning the eventual production of erythropoietin by this organ in man. The fact that acute anuria is followed by a sudden and marked depletion of the erythroid as opposed to the moderate normoblastic depression observed in chronic renal disease, has led us to think that uremic intoxication is not the main cause of the erythropoietic depression in renal insufficiency, but that the kidney has a predominent role in erythropoiesis independent of its excretory function.2 Erythropoietin plasma level is not measurable in patients with chronic renal disorders regardless of the severity of anemia, while increased values are generally found in patients with similar anemia but normal renal f~nction.5.~ On the other hand, polycythemia has been reported in some renal diseases (renal tumors, cysts or hydronephrosis) . In certain cases erythropoietin has been detected in plasma and in tumor extracts or cystic fl~id.~JO These facts corroborate the hypothesis that in man, the kidney is concerned with the elaboration of erythropoietin, if not with the exclusive source of the hormone. In this study we have presented determinations of erythropoietin plasma levels in patients with chronic uremia or acute anuria, treated or not by extrarenal epuration, nephrectomy or transplantation, and compared the modifications of normoblast percentage observed in the bone marrow after nephrectomy or acute anuria.

Effect of parathyroid surgery on cartilage calcification

The incidence of chondrocalcinosis in 4 locations (knees, wrists, lumbar discs, and symphysis pubis) has been compared on x-rays made before and after parathyroid surgery in patients operated on for primary and secondary hyperparathyroidism. Before parathyroid surgery, the overall incidence of chondrocalcinosis in primary and secondary hyperparathyroidism is comparable. However, the distribution by age, the number of joints affected, and the locations are different. Parathyroid surgery changes neither the incidence nor the severity of chondrocalcinosis, in patients with primary or secondary hyperparathyroidism.RésuméLa fréquence de la chondrocalcinose a été étudiée sur clichés radiographiques dans quatre localisations (genoux, poignets, colonne lombaire, et symphyse pubienne) et comparée avant et après parathyroïdectomie pour hyperparathyroïdie primaire et secondaire. Avant parathyroïdectomie, la fréquence globale de la chondrocalcinose est semblable dans lhyperparathyroïdie primaire et secondaire. La fréquence en fonction de lâge, le nombre darticulations atteintes, et les localisations sont différentes dans les deux groupes. La cure chirurgicale de lhyperparathyroïdie, primaire et secondaire, ne modifie ni la fréquence, ni la gravité de la chondrocalcinose.ResumenLa persistencia de la condrocalcinosis después de cirugía paratiroidea para hiperparatiroidismo primario ha sido informada en escasas publicaciones sobre reducidos grupos de casos. Además, a nuestro saber, ningún estudio ha enfocado la evolución de la condrocalcinosis después de paratiroidectomía para hiperparatiroidismo secundario a falla renal crónica. La incidencia de condrocalcinosis en 4 ubicaciones (rodillas, muñecas, discos lumbares, y sínfisis pubis) ha sido comparada sobre radiografías realizadas antes y después de cirugía paratiroidea en pacientes operados por hiperparatiroidismo primario y secundario. Antes de la cirugía paratiroidea, la incidencia global de condrocalcinosis en el hiperparatiroidismo primario y en el secundario es comparable. La distribución por edad, el número de articulaciones afectadas, la ubicación, son, sin embargo, diferentes. La cirugía paratiroidea no cambia la incidencia ni la severidad de la condrocalcinosis, tanto en el hiperparatiroidismo primario como el secundario.