Treatment of primary hyperparathyroidism at Cochin hospital (Paris). Changes in procedures during the last thirty years

The association of high performance techniques and low morbidity has enabled the development of preventive surgery for hyperparathyroidism. Over the last 30 years, 2500 patients have undergone this type of procedure at the Visceral Surgery Unit of the Cochin Hospital in Paris. This experience has enabled us to achieve the current concept of surgical treatment for primary hyperparathyroidism, particularly with the development of minimally invasive techniques performed under local anesthesia. The promotional role played by our institution over the last 30 years in this area has enabled sturdy evidence-based reflection. The report of the work accomplished would not be complete without the story of the rich adventure which began in the 19th century. We propose here a review of the major advance achieved in order to better apprehend the principles currently regulation our approach to surgery of the parathyroid glands.     

Needle breakage: a rare and potentially dangerous complication during local anaesthesia

INTRODUCTION: Needle breakage is a rare complication during local oral anesthesia administration. The authors describe the surgical procedure used to remove a broken dental needle and how to prevent this complication. CASE REPORT: The authors present the case of a 52-year-old man who was referred by his general dental practitioner for needle breakage during an inferior alveolar nerve block. Surgical management involved localizing the broken needle using radioscopy and removing it under general atomax 00041 anesthesia. DISCUSSION: Today, needle breakage during local anesthesia is mainly attributed to an incorrect anesthetic injection technique. The prevention, investigation, and management of such complication are discussed.     

Lidocaine intoxication in newborn following maternal pudendal anesthesia: report of three cases

Pudendal nerve block may be indicated during instrumental delivery in situations where peridural anesthesia is unavailable. We report three cases of neonatal lidocaine intoxication following maternal pudendal block during delivery. Clinical features were hypotonia, pupillary mydriasis fixed to light, apnea, cyanosis and seizures. Two neonates required mechanical ventilation. Lidocaine was found in the serum of two babies. In all three cases, recovery was complete. The pharmacokinetics of lidocaine in a highly vascularized perineum during labor increase the risk of neonatal intoxication. A possible intoxication by local anesthetics should be considered in neonates presenting an acute distress in the delivery room.