Biomedical subjects

A Fitoussi

Publications and source records attributed to A Fitoussi.

11 recordsLinked to original sources

PubMed2005

[Evaluation of asymetric implants in breast cancer].

Since more than twenty years, methods of breast reconstruction using implants have continued to evolve in order to improve their aesthetic results. Shapes and materials of these implants have also evolved to obtain contours similar to that of the natural opposite breast. Therefore it can be considered that the use of asymmetric implants is the last step in implant technology before using made to measure implants. Asymmetric implants allow obtaining different contours in harmony to the different breast shapes according to the side, left or right, of the reconstructed breast which maximise the naturalness of the result. Such implants have an axis directed towards the exterior and lower part of the chest wall, are wider than high with a thinner part on their inner edge and a concave rear side moulding the curves of the chest wall. In our own experience, we placed more than 500 asymmetric implants. When analysing retrospectively the medical records of 156 patients, no distinctive features were observed when compared to symmetric classic implants in easiness in the surgical procedure or in complications except a slightly higher rate of seroma formation. When compared to usual implants the main benefits of asymmetric implants are: to offer a wider breadth, to slope down gently on their upper and inner sides according to their concave rear side, and therefore to better match subtle curves of a normal breast. Moreover such contours allow a distribution of the volume which fit better to the usual natural breast configuration of patients who underwent surgery for breast carcinoma. At last, such implants are easy to place and a very low rate of secondary rotation has been observed. In summary, for all these reasons, asymmetric implants, can be considered to be the class one in the choice of implants for breast reconstruction after breast surgery.

Adult↗

PubMed2005

[Breast reconstruction: late cosmetic results of implant reconstruction].

The long cosmetic outcome of breast implant reconstruction is unknown. The morbidity and cosmetic outcome of 360 patients who underwent immediate breast reconstruction with various types of implant has been prospectively analysed over a 10-year period. 334 patients who completed their reconstruction were suitable for evaluation of their cosmetic outcome. The early complication rate (<2 months) was 9.1%, with an explantation rate of 1.6%. The late complication rate (>2 months) was 23%, with a pathological capsular contracture rate of 11% at two years and 15% at five years, and an implant removal rate of 7%. The revisional surgery rate was 30.2%. The cosmetic results were prospectively assessed using an objective five point global scale. Every patient was scored at each visit once surgery was completed. The overall cosmetic outcome deteriorates in a linear fashion from an initial acceptable result in 86% of patients two years after completion of their reconstruction to only 54% at five years. This fall off in the cosmetic outcome was not associated with the type of implant used, the volume of the implant, the age of the patient or the type of mastectomy incision employed. Radiotherapy was not a significant factor as only 28 patients were irradiated. However, on Cox model analysis pathological capsular contracture was the only factor which significantly contributed to a poor cosmetic outcome(P<0.0001 (relative risk 6.3). In spite of a high revisional surgery rate, deterioration still occurred, suggesting that other unaccounted for variables were responsible. On photographic retrospective review of those patients without a capsular contracture who demonstrated a deterioration in their cosmetic scores, it became clear that a possible reason for their poor result was late asymmetry produced by the failure of both breasts to undergo symmetrical ptosis as the patients aged.

Adult↗

PubMed2003

[Mediation perspectives in the field of aesthetic surgery].

Since the law of 4 March 2002, that confirms the right of each person to dispose of his own body with respect for his own dignity, cosmetic surgery becomes the most regulated medical discipline. The establishment of regional commissions for conciliation and indemnification, which could within the framework of their mission of conciliation delegate their competences to one or more independent mediators, opens perspectives for mediation.

France↗

PubMed2000

[Autologous breast reconstruction with latissimus dorsi flap].

The gold standard technique for autologous breast reconstruction is the transverse rectus abdominis flap (TRAM). Recently, techniques of harvesting a latissimus dorsi flap have been modified in such a way as to increase the flap and allow breast reconstruction without an associated implant. The aim of this study was to evaluate aesthetic results obtained with this method and to assess early morbidity related to the changes in the technique. Between January 1994 and August 1998, 43 patients underwent breast reconstruction with an autologous latissimus dorsi flap. Their postoperative outcome was compared to that of 30 patients who underwent reconstruction with a latissimus dorsi flap associated with an implant. These 43 patients were asked to come back for aesthetic evaluation by a physician and to answer a questionnaire about cosmetic results. Mean duration of follow-up was 18.6 months (range 8 to 60). Mean size of the breast reconstructed with this technique was 340 g (up to 835 g). Dorsal seroma was the most frequent complication (72%), followed by delayed dorsal healing (19%). The frequency of seroma was significantly increased when compared to a classic latissimus dorsi flap (P = 0.003), but frequency of skin slough was not. The aesthetic result was considered satisfactory in 93% of the cases by the patient and 77% of the cases by the physician. In conclusion, the extended latissimus dorsi flap allows reconstruction of small and medium size breasts, with a good aesthetic result. This flap appears to be an interesting alternative to the TRAM flap for autologous reconstruction in selected patients.

Adult↗

PubMed1998

Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapy.

AIMS: This series analyses the results of conservative surgery for large lower pole breast cancers by lumpectomy associated with a bilateral remodelling mammoplasty, in order to avoid residual deformities. METHODS: This retrospective study concerns 50 patients with a lower pole breast cancer treated between 1986 and 1996 by lumpectomy, mammoplasty and irradiation. The contralateral breast was immediately made symmetrical in all cases. The mean tumour size was 32.5 mm. RESULTS: The mean weight of the lumpectomy specimen was 270 g. Resection margins were tumour-free in 90% of cases. The main complication observed was delayed healing, thus postponing post-operative treatment in 6.5% of cases. The median follow-up was 48 months. The 5-year actuarial ipsilateral local recurrence rate was 7% and 5-year actuarial metastasis-free and overall survival rates were 81 and 97%, respectively. Cosmesis was satisfactory in 85% of patients. We observed better results when radiotherapy was performed after rather than prior to surgery (92 vs. 67%: NS). CONCLUSIONS: Performing a bilateral mammoplasty at the time of initial surgery for large breast cancers situated in the lower quadrants of the breast facilitates larger lumpectomies with good cosmetic results.

Adult↗

PubMed1998

Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction.

After conservative treatment for breast cancer, 20% to 30% of patients have a residual deformity that sometimes requires surgical correction. Thirty-five of these patients were operated between 1990 and 1995 at the Institut Curie. The authors classify these sequelae into three types: type I, asymmetrical breasts with no deformity of the treated breast; type II, deformity of the treated breast, compatible with partial reconstruction and breast conservation; and type III, major deformity of the breast, requires mastectomy. Fourteen patients had a type I deformity; all but 1 patient were treated with mammaplasty. Seventy-one percent underwent unilateral surgery contralateral to the irradiated breast; 80% had a satisfactory cosmetic result (good or very good). Seventeen patients had a type II deformity. They were treated by various techniques (implant, mammaplasty, latissimus dorsi flap, or transverse rectus abdominis musculocutaneous flap). Only 43.8% of patients in this group had a late satisfactory cosmetic result. Four patients had a type III deformity. They were treated with mastectomy and immediate reconstruction using a musculocutaneous flap. All 4 patients had a very good cosmetic result. This classification is a valuable guide for technique selection. For type I deformities, surgery to the irradiated breast should be avoided when possible. Type II deformities raise the most difficult therapeutic problems. Because they are mainly postoperative, optimal treatment should be preventive--by performing immediate remodeling of the treated breast before radiotherapy. This pleads for integration of plastic surgical techniques at the time of the original lumpectomy, thus reducing the need for delayed reconstructive surgery.

Adult↗

PubMed1997

[Functional evaluation of the abdominal wall after raising a rectus abdominis myocutaneous flap].

Breast reconstruction with transverse rectus abdominis muscle (TRAM) flap raises two contradictory questions: the vascular safety of the flap and the late abdominal wall sequellae. In order to analyse these sequellae, 71 patients with TRAM flap breast reconstruction at the Institut Curie had a late postoperative evaluation by both a physiotherapist and a surgeon, an average 28 months after their reconstruction. 12 had had a double pedicled TRAM (DPT) and 59 a single pedicled TRAM (SPT). Hernias and bulges were systematically recorded, and all patients had an evaluation of their abdominal wall function by questioning (subjective evaluation) and muscular testing (objective evaluation). The overall hernia rate (including bulges) was 5.6%. This rate was 2.5% when mesh was used, and 9.5% when direct closure was performed. This hernia rate was not influenced by the type of TRAM (SPT or DPT). 20% of patients complained of residual abdominal pain, and 36% of a decrease of their abdominal strength after SPT. Both these figures were 75% after DPT. Testing showed that these sequellae were related to an impairment of the supraombilical portion of the rectus, this impairment being much higher after DPT than SPT: none of the 12 patients with DPT were able, from a lying position, to sit down without using their hands (not reaching 4 in Lacote's test), whereas 47% of the SPT could do it. The oblique muscles were also impaired, as less than 20% of patients reached Lacote 4. However, this impairment was not influenced by the type of flap harvested. Testing was also equivalent after both techniques of SPT (standart or "supercharged"). The post-operative hernia rate was not higher for DPT and seemed related to the technique used for abdominal wall closing (mesh vs direct closure). However, the functional sequellae (pain, muscle strength decrease) were much higher after DPT than SPT. It thus confirms us in our attitude to restrict the indications of DPT, when feasible, to the profit of microsurgical flaps.

Abdominal Muscles↗

PubMed1993

[The vaginal cesarean, a necessary review].

Having carried out four cases of vaginal caesarean section the authors describe the technique they used. The advantages of the operation are: it is simple and can be carried out quickly, future obstetric behaviour is not compromised. It is important to avoid two complications of the operation: haemorrhage and injury to the bladder. These are reduced if the vertical incision in the cervix is made in the midline and long enough. The ideal indications for the operation are absence of cervical dilatation, or the occurrence of severe maternal haemorrhage during the operation to terminate a pregnancy, or while the uterine contents are being expelled towards the end of the second trimester. It is disputable whether there is a place for vaginal caesarean operation when the fetus is alive, in view of the recent studies on fetal prognosis.

Adult↗

PubMed1990

[Analysis of 10 cases of pregnancy after renal transplantation].

Renal transplantation has changed completely the fertility of women who had been dialysed. Our study is on 10 pregnancies which we followed up in 7 women who had had renal transplants in the University Hospital of Pitié Salpêtrière (Professor Y. Darbois) between 1979 and 1985. All patients were treated by the same technique and the same methods of prevention of rejection of the transplant. The mean interval between the transplant and pregnancy was 53 months. In 3 cases there was hypertension and raised creatinine levels (more than 150 in 3 cases). In 2 cases the two conditions were associated. The prognosis is bad when a raised blood pressure or a change in renal function occurs before pregnancy starts, leading to a real deterioration in renal function during the pregnancy when such function was abnormal before the pregnancy started. As far as the infants were concerned, the most common complication was IUGR (intrauterine growth retardation) which was found in half of all cases. Blood flow studies in these fetuses are particularity interesting. There were two cases of intra-uterine fetal death. The reasons for these were not necessarily connected with the deterioration in renal function. All the deliveries were by caesarean section, for medical reasons in 7 out of 10 cases. The average duration of the pregnancy was 35 weeks of amenorrhoea. As far as the mothers were concerned, they did not have more infections than other women in spite of being immuno-suppressed (this was excluding urinary tract infections).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Analysis of 42 membrane ruptures during the second pregnancy trimester].

65 cases of premature rupture of the membranes before the 28th week of amenorrhoea occurred during the 5 years between 1983 and 1987 in two maternity units in Paris. A retrospective study was carried out on 42 of these cases where conservative measures had been decided on. In two-thirds of the cases, of which 42% had had bleeding and 40% vaginal infection, the pregnancy had appeared to be progressing normally before the rupture of the membranes. 14% had had cerclage and 12% had had selective intrauterine fetal reduction or biopsy of the trophoblast or removal of an intrauterine device. Rupture of the membranes rarely happens in isolation because it is usually accompanied by uterine contraction or bleeding, which may occur separately or associated with one another in half the cases. In 21% of cases bacteriological examination was positive after the rupture. All patients were treated conservatively in this study. Antibiotics were prescribed in 35 cases and tocolysis in 13 cases. The membranes were ruptured on an average for 7 days. It was almost impossible to avoid infection except in two patients who delivered rapidly. The pregnancies resulted in 8 intrauterine deaths, 15 deliveries of babies that were not viable, 19 deliveries of live babies of which 7 were by caesarean section. 15 babies survived the neonatal period. This work makes it possible to judge whether it is really hazardous to try to be conservative before the 24th week of amenorrhea. Even if neonatal mortality is being lowered at term, overall in our series it was 25%. Finally, it does not seen that tocolytics or antibiotics help to lower this mortality significantly.

Adolescent↗

PubMedDate not supplied

[Axillary lymph node surgery in 1998].

The need for a systematic axillary clearance in breast cancer is presently under question. Alternative methods include the omission of node biopsy in very small tumours and lymphadenectomy limited to the sentinel node. This article discusses the current procedures in axillary surgery in 1998, with information concerning the relationships between the tumour characteristics and the probability of nodal involvement, the new surgical techniques aiming at reducing morbidity, with special emphasis on sentinel node biopsy, and the therapeutic protocols presently being used at the Institut Curie.

Axilla↗