Intérêt du bleu de méthylène dans la chirurgie de l'hyperparathyroïdisme primaire

Article Article scientifique Article Intérêt du bleu de méthylène dans la chirurgie de l'hyperparathyroïdisme primaire fre 1998 author Robert John 55421 author Delay Dominique Jacques 41628 author Buehler Leo Hans 71923 author Garcia A author Spiliopoulos Anastase 49910 23-26 9752395 0003-4266 Is surgery for primary hyperparathyroidism easier when methylene blue (MB) is given preoperatively? This retrospective study compares the durations of interventions for primary hyperparathyroidism carried out after i.v. MB administration to those when no MB was given. Over a period of 20 years (June 1976 to December 1996), 175 consecutive patients (56 men and 119 women, with ages ranging from 16 to 92, mean 59.6) were operated upon for primary hyperparathyrodism; 55 were operated before February 1986--the period when BM was introduced routinely, and 120 after. Thirty-two other patients were excluded from the study: 14 had had a previous cervicotomy and 18 another procedure in addition to the parathyroidectomy (usually on the thyroid gland), two conditions which prolonged the time devoted to parathyroid identification and excision. Preoperative calcemia averaged 2.97 mmol/L (2.34 to 4.59) and mean preoperative PTH was equal to 2.6 times the upper normal limit (0.5 to 24.1). Both groups were similar for as age, sex, preoperative calcium and PTH, and histologies. Methylene blue was administered intravenously (5 mg/kg diluted in 500 cc of 5% glucose) over a period of time of one hour starting two hours prior to surgery. All 175 procedures were performed by two surgeons and duration of surgery was recorded from the anesthesiologist's notes. There were 149 adenomas (85%), 24 hyperplasias (14%), a combination of both in two, and unspecified in two others. Except for a case of acute lower back pain synchronous to the injection of the dye (which was immediately stopped), MB was well tolerated. Mean duration for the 55 interventions performed without MB was 68 minutes (35 to 140, median 60), compared to 49 minutes for the 120 procedures carried out after MB had been given (20 to 155, median 45). Differences in operative, times were highly significant (p < 10(-6) and represented a gain of time of 27%. Surgery for primary hyperparathyroidism was significantly shorter when it was preceded by the administration of MB, a dye which facilitates the identification of pathologic parathyroid gland(s). Adenoma/diagnosis/surgery Adolescent Adult Aged Aged, 80 and over Female Humans Hyperparathyroidism/diagnosis/surgery Male Methylene Blue/diagnostic use Middle Aged Parathyroid Neoplasms/diagnosis/surgery Parathyroidectomy Retrospective Studies Dewey 617 57 Département de chirurgie 222 false Annales d'endocrinologie 59 1 8b341ae1-023e-49b8-9f9d-b325d79e768a Article (Published version) Restricted 1998_robert_ann_endocrinol.pdf 2754803 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Intérêt du bleu de méthylène dans la chirurgie de l'hyperparathyroïdisme primaire	Annales d'endocrinologie			1998	630	0

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Delay, Dominique Jacques