Publications by authors named "Florence Bihain"

9 Publications

  • Page 1 of 1

Somatostatin analogue pasireotide (SOM230) inhibits catecholamine secretion in human pheochromocytoma cells.

Cancer Lett 2021 Oct 9. Epub 2021 Oct 9.

Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France. Electronic address:

Increasingly common, neuroendocrine tumors (NETs) are regarded nowadays as neoplasms potentially causing debilitating symptoms and life-threatening medical conditions. Pheochromocytoma is a NET that develops from chromaffin cells of the adrenal medulla, and is responsible for an excessive secretion of catecholamines. Consequently, patients have an increased risk for clinical symptoms such as hypertension, elevated stroke risk and various cardiovascular complications. Somatostatin analogues are among the main anti-secretory medical drugs used in current clinical practice in patient with NETs. However, their impact on pheochromocytoma-associated catecholamine hypersecretion remains incompletely explored. This study investigated the potential efficacy of octreotide and pasireotide (SOM230) on human tumor cells directly cultured from freshly resected pheochromocytomas using an implemented catecholamine secretion measurement by carbon fiber amperometry. SOM230 treatment efficiently inhibited nicotine-induced catecholamine secretion both in bovine chromaffin cells and in human tumor cells whereas octreotide had no effect. Moreover, SOM230 specifically decreased the number of exocytic events by impairing the stimulation-evoked calcium influx as well as the nicotinic receptor-activated inward current in human pheochromocytoma cells. Altogether, our findings indicate that SOM230 acts as an inhibitor of catecholamine secretion through a mechanism involving the nicotinic receptor and might be considered as a potential anti-secretory treatment for patients with pheochromocytoma.
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http://dx.doi.org/10.1016/j.canlet.2021.10.009DOI Listing
October 2021

Impact of rocuronium on intraoperative neuromonitoring vagal amplitudes during thyroidectomy.

Langenbecks Arch Surg 2021 Sep 12;406(6):2019-2025. Epub 2021 Jun 12.

Department of Surgery (CVMC), Unit of Metabolic, Endocrine, and Thyroid Surgery, Université de Lorraine, CHRU Nancy-Brabois (7Eme Étage), Vandœuvre-lès-Nancy, France.

Purpose: Neuromuscular blocking agents (NMBA) facilitate endotracheal intubation and reduce related laryngeal morbidity. However, NMBA interfere with intraoperative neuromonitoring amplitudes during thyroidectomy. The goal of this study was to evaluate the impact of rocuronium used for tracheal intubation on early intraoperative neuromonitoring vagal amplitudes observed during first thyroid lobe dissection.

Methods: This is an observational pharmacoepidemiological study with prospective data collection and retrospective analysis. During the study period, all consecutive patients who underwent thyroid surgery with neuromonitoring were included. Patients underwent endotracheal intubation either using a single dose of rocuronium (NMBA group) or without NMBA (NMBA-free group) according to the anesthesiologist's preference.

Results: Six hundred six patients were included (213 NMBA and 393 NMBA-free group patients). At V1, 39 patients (18%) in the NMBA group had an amplitude < 100 µV (need for curarization reversal in 30 patients) and 13 patients (3.3%) in the NMBA-free group (p < 0.001). In the remaining 554 patients, the mean V1 amplitude was significantly decreased in the NMBA group (544 versus 685 µV; p < 0.001). After exclusion of 25 patients with loss of signal types 1 and 2 during dissection, the difference between mean V1 and mean V2 was significantly lower in NMBA group patients (- 22 versus - 86 µV; p = 0.016).

Conclusion: This study provides new data showing how NMBA used for tracheal intubation significantly decrease V1 amplitude baseline and modify amplitude variations from V1 to V2 values during the first thyroid lobe dissection.

Level Of Evidence: Pharmacoepidemiological study.
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http://dx.doi.org/10.1007/s00423-021-02234-5DOI Listing
September 2021

Robotic approach for partial adrenalectomy.

Updates Surg 2021 Jun 7;73(3):1147-1154. Epub 2021 Jan 7.

Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), CHRU Nancy, Hôpital de Brabois, Université de Lorraine, (7(ème) étage), Vandeuvre-lès-Nancy, France.

Although safe and feasible, partial adrenalectomy is not a widespread procedure. Endorsement of robotic technologies and fluorescence techniques in adrenal surgery might help develop partial adrenalectomy and could avoid unnecessary total adrenalectomies. When performed in selected cases, partial adrenalectomy is associated with good postoperative outcomes comparable with those reported after total adrenalectomy. It has been hypothesized that one of the advantages of the robotic approach in adrenal-sparing surgery is to reduce manipulation of the gland allowing preservation of the vascularization of the residual adrenal, overcoming some limits when performing a laparoscopic conventional approach. A major drawback of the robotic surgery is its cost, but the overcost due to the use of the robotic system could be balanced by the execution of a high number of partial adrenalectomies leading to fewer life-long replacement steroid treatment. Partial adrenalectomy could become the recommended management for small benign and hormonal active adrenal tumors. Indocyanine green fluorescence (IGF) also seems to be a useful technique to help surgeons identify the adrenal gland and to locate small tumors from the normal adrenal tissue in difficult patients. It is likely that the use of a robotic approach associated with IGF may extend indications of partial adrenalectomy in the years to come.
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http://dx.doi.org/10.1007/s13304-020-00957-6DOI Listing
June 2021

Robotic adrenalectomy in patients with pheochromocytoma: a systematic review.

Gland Surg 2020 Jun;9(3):844-848

Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), Unité multidisciplinaire de chirurgie métabolique, endocrinienne et thyroïdienne (UMET), CHRU Brabois, Université de Lorraine, Nancy, France.

Pheochromocytomas (PHEOs) are neural crest cell tumors producing catecholamines. PHEOS need to be early diagnosed and adequately managed. Adrenalectomy is the gold standard treatment of these type of tumors. There has been major improvement of surgical technologies with the development of laparoscopic and robotic systems these past several years. We conducted a review of the literature to evaluate the robotic approach for adrenalectomy for patients with PHEO.
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http://dx.doi.org/10.21037/gs-2019-ra-05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347808PMC
June 2020

What is the impact of continuous neuromonitoring on the incidence of injury to the recurrent laryngeal nerve during total thyroidectomy?

Surgery 2021 01 12;169(1):63-69. Epub 2020 May 12.

Université de Lorraine, Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), CHRU Nancy, Hopital de Brabois (7(ème) étage), Vandoeuvre-les-Nancy, France; Université de Lorraine, INSERM U1256, « Nutrition, Genetics, Environmental Risks », Faculté de Médecine, Vandoeuvre-les-Nancy, France. Electronic address:

Background: Continuous intraoperative neuromonitoring may facilitate reversal of intraoperative injurious operative maneuvers in comparison with intermittent intraoperative neuromonitoring. The aim of this study was to evaluate the impact of the routine use of continuous intraoperative neuromonitoring on intraoperative injuries to the recurrent laryngeal nerve.

Method: This study was a prospective case series with retrospective analysis of consecutive patients undergoing total thyroidectomy from August 2013 to August 2019. During this period, intermittent intraoperative neuromonitoring (before Mar 2016) and continuous intraoperative neuromonitoring (after Mar 2016) were used in all patients.

Results: We reviewed the outcomes of 603 patients (466 female patients) comprising 236 who underwent intermittent intraoperative neuromonitoring and 367 who underwent continuous intraoperative neuromonitoring. Intraoperative adverse electromyography events (>50% decrease in amplitude between VN1 and VN2) were observed in 87 patients (14.5%) and were less frequent in the continuous intraoperative neuromonitoring group (10.6 vs 20.3%, P = .001). Intraoperative loss of signal (electromyography events with VN2 ≤100μV) were observed in 35 patients (5.8%) without any difference between the 2 groups of patients (5.2 vs 6.8%, P = .415). Postoperative recurrent laryngeal nerve palsies were observed in 36 patients (5.9%) without any difference between the 2 groups of patients (4.9 vs 7.6%, P = .168).

Conclusion: The routine use of continuous intraoperative neuromonitoring improves the rate of intraoperative adverse electromyography events but does not impact significantly the rates of loss of signal and recurrent laryngeal nerve palsy.
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http://dx.doi.org/10.1016/j.surg.2020.03.029DOI Listing
January 2021

Reoperation Incidence and Severity Within 6 Months After Bariatric Surgery: a Propensity-Matched Study from Nationwide Data.

Obes Surg 2020 Sep;30(9):3378-3386

Department of Medical Information Evaluation and Research, Lyon University Hospital, Lyon, France Health Services and Performance Research Lab (EA 7425 HESPER), Lyon 1 Claude Bernard University, Lyon, France.

Background: Data about incidence and severity of reoperations up to 6 months after bariatric surgery are currently limited. The aim of this cohort study was to evaluate the incidence and severity of reoperations after initial bariatric surgical procedures and to compare this between the 3 most frequent current surgical procedures (sleeve, gastric bypass, gastric banding).

Study Design: Nationwide observational cohort study using data from French Hospital Information System (2013-2015) to evaluate incidence and severity of reoperations within 6 months after bariatric surgery. Hazard ratios (HR) of longitudinal comparison between historical propensity-matched cohorts were estimated from a Fine and Gray's model using competing risk of death.

Results: Cumulative reoperation rates increased from postoperative day-30 to day-180. Consequently, 31.1 to 90.0% of procedures would have been missed if the reoperation rate was based solely on a 30-day follow-up. Reoperation rate at 6 months was significantly higher after gastric bypass than after sleeve (HR 0.64; IC 95% [0.53-0.77]) and corresponded to moderate-risk reoperations (HR 0.65; IC 95% [0.53-0.78]). Reoperation rate at 6 months was significantly higher after gastric banding than after sleeve (HR 0.08; IC 95% [0.07-0.09]) and corresponded to moderate-risk reoperations (HR 0.08; IC 95% [0.07-0.10]).

Conclusion: Cumulative incidence of reoperations increased from 30 days to 6 months after sleeve, gastric bypass, or gastric banding and corresponded to moderate-risk surgical procedures. Consequently, 30-day reoperation rate should no longer be considered when evaluating complications and surgical performance after bariatric surgery.
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http://dx.doi.org/10.1007/s11695-020-04570-9DOI Listing
September 2020

Robotic adrenalectomy: when and how?

Gland Surg 2020 Feb;9(Suppl 2):S166-S172

Unit of Metabolic, Endocrine, and Thyroid Surgery (UMET), Department of Visceral and Metabolic Surgery, Hospital Brabois Adultes, CHRU Nancy, University of Lorraine, Nancy, France.

Currently, laparoscopic adrenalectomy is considered as the preferred technique to manage adrenal tumors. However, there are no prospective randomized studies evaluating this strategy. With the recent advances in surgical equipment and the widespread of robotic technology, a robotic approach is considered as an interesting option in some medical centers. This approach seems to be feasible and safe but high-level evidence of its benefits is still lacking. This review summarizes indications, advantages and drawbacks of robotic adrenalectomy and describes its surgical technique.
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http://dx.doi.org/10.21037/gs.2019.12.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044087PMC
February 2020

Needle electrodes inserted in the thyroid cartilage may provide better neuromonitoring signals during thyroidectomy.

Gland Surg 2019 Oct;8(5):583-584

Department of Surgery, Unit of Metabolic, Endocrine, and Thyroid Surgery, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France.

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http://dx.doi.org/10.21037/gs.2019.07.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842763PMC
October 2019

Coronary artery disease is more severe in patients with primary hyperparathyroidism.

Surgery 2020 01 24;167(1):149-154. Epub 2019 Oct 24.

Department of Surgery, Section of Endocrine, Thyroid and Metabolic Surgery, University of Lorraine, CHU Nancy, Brabois Hospital, France; Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, INSERM U1256, Nancy, France. Electronic address:

Background: Primary hyperparathyroidism is associated with an increased cardiovascular mortality, but mechanisms underlying this association are unclear. The goal of this study was to evaluate coronary artery calcifications via the coronary calcification score in primary hyperparathyroidism patients, to compare with control subjects, and to identify risk factors for high to intermediate risk coronary calcification scores (coronary calcification score >100).

Method: Cross-sectional study of primary hyperparathyroidism patients without a history of coronary artery disease, diabetes, or severe, chronic kidney disease. Coronary calcification scores were compared with a cohort of population-based control subjects.

Results: The mean coronary calcification score was 120 ± 344 in 130 primary hyperparathyroidism patients. The coronary calcification score was >100 in 27 patients (21%). When compared with control subjects, the percentage of positive coronary calcification scores was similar in primary hyperparathyroidism patients (53% vs 50%); however, positive coronary calcification scores were at the 67 percentile of the control subjects cohort (P < .001). In multivariable regression, patient age (1.1; 1.1-1.2; P < .001), patients in the mild normocalcemic primary hyperparathyroidism group (5.1; 1.1-22.6; P = .037), and the need for antihypertensive medications (6.1; 1.8-20.9; P < .001) remained independent predictors for a coronary calcification score >100.

Conclusion: Positive coronary calcification scores were greater in primary hyperparathyroidism patients than in population-based control subjects. These study data may provide new criteria for parathyroidectomy in patients with primary hyperparathyroidism.
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http://dx.doi.org/10.1016/j.surg.2019.05.094DOI Listing
January 2020
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