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Biomedical subjects

A Pech

Publications and source records attributed to A Pech.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Tumors of the cerebellopontile angle, with the exception of acoustic neuromas].

Based on a review of 38 cases of tumors of pontocerebellar angle, excluding acoustic neurinoma, and a literature review, clinical, radiologic and therapeutic characteristics of these lesions are described. Diagnosis depends on accurate pre-operative identification of the type of tumor. Based on frequency data it can be estimated that tumors of pontocerebellar angle are nearly always acoustic neurinomas : this infers that these other tumors of the angle represent a differential diagnosis where major orientation signs are radiologic. This is fundamental, since when considering all tumors of pontocerebellar angle those requiring a totally different approach to treatment than that for acoustic neurinomas must be distinguished from those for which inability to identify them is not of marked importance since their operatibility is identical.

Adult↗
PubMed1986

[Venous and meningeal prolapse during enlarged trans-labyrinth approach].

One hundred consecutive operations using the enlarged trans-labyrinthic (ETL) approach for acoustic neurinoma performed by the same surgeon were analyzed to determine incidence of venous and/or meningeal prolapses. Findings showed that ETL approaches were normal in 51 cases : normal superficial sinusodural space--external auditory canal and on deep dissection a superior petrous sinus and jugular space separated from the internal auditory canal. Prolapse was observed in 49 approaches : 30 very narrow sinusodural spaces due usually to temporal meninges prolapse (76%) associated in 25% of cases with a prolapse of lateral sinus; 29 prolapses of jugular space and 10 of superior petrous sinus, detected mainly in the narrow sinusodural spaces. In these cases, superficial displacement of the temporal meninges and lateral sinus appears indispensable in order to recover normal operating conditions towards the labyrinth and pontocerebellar angle.

Ear, Inner↗
PubMed1986

[Requisite selection of surgical technics in the treatment of cancer of the larynx].

Rules for functional surgery of cancer of larynx are defined by means of a detaited analysis of results of 43 cases of reconstructive anterior frontal laryngectomy, 17 cases of crico-hyoide-epiglottopexy and 32 cases of crico-hyoidopexy. The carcinologic features of this surgery are discussed, and emphasis placed on the importance of the paraglottic space and its functional conditions in the light of recent physiologic data. Surgical procedures used are outlined with, for each of them, the neoplastic localization suitable for treatment and a critical analysis of postoperative functional results. Carcinologic follow up is still insufficient for several techniques used, preventing any precise conclusions to be drawn, but the authors consider it is justifiable to perform 66% of partial as against 34% of total laryngectomies.

Humans↗
PubMed1985

[The external fronto-ethmoidal approach].

A lateral fronto-ethmoidal approach simultaneously exposing the frontal sinus and the nasal fossae appears to be a necessity for the surgical treatment of fronto-ethmoidal pathology. It is possible to fashion an osteo-plastic flap in the fronto-naso-maxillary region. The technique of the approach is described. The operation leaves no ocular functional sequelae and the scar is minimal. Twenty one operations by fronto-nasal flap approach are described, 10 for benign tumours of the fronto-ethmoidal system and 11 with the aim of re-aerating the frontal sinus for cases of complicated or iatrogenic serious sinusitis. The results are studied. The indications of the fronto-nasal flap are described: In tumour pathology, this technique must be used for osteomas and mucoceles of the fronto-ethmoidal system as soon as the ethmoidal component reaches or goes beyond the middle ethmoid. If the fronto-ethmoidal lesion only involves the anterior ethmoid, it is then accessible via simple frontal flap. Inverted papillomas which require wide exposure should also be treated via this approach. In infectious pathology, the fronto-nasal flap offers the possibility, after eradication of fronto-ethmoidal lesions and calibration of the naso-frontal canal, of re-aeration of the frontal sinus which seems preferable to its exclusion. The possibility of re-aeration of the frontal sinus by an osteo-plastic procedure is progress in comparison with lost bone craniotomy procedures.

Craniotomy↗
PubMed1985

[Vestibular neurectomy in Ménière's disease. Results and comments apropos of 77 cases].

The authors report 77 cases of vestibular neurectomy performed between 1972 and 1984 (40 male and 37 female) for incapacitating Meniere's vertigo. Neurectomy was via a sub-petrous (S.P.) approach in 55 cases, by posterior trans-labyrinthine (P.T.L.) approach in 9 and anterior trans-labyrinthine (A.T.L.) in 13 cases. A.T.L. was abandoned because of the frequency of leaks of CSF and of meningitis. The P.T.L. approach did not result in any facial paralysis, even transient. There were 2 CSF leaks, without meningitis and one of which required reoperation. For the 55 S.P. cases, hearing worsened in 22.2% with 8 cases of deafness, including three appearing secondarily. There were two transient auditory improvements. Vertigo was cured in 73 cases (94.8%) with 25.9% instability after several months. The authors stress the frequent bilateralisation of the disease and the need to reserve vestibular neurectomy for cases of longstanding incapacitating vertigo, resistant to all other treatment, as well as the value of surgery on the endolymphatic surgery provided that the criteria of indication are complied with. Medical treatment remains the essential basis, including the analysis and, where applicable, treatment of psychosomatic factors by a trained psychiatrist. Finally, when vestibular neurectomy is indicated, the S.P. approach is otologically most suitable, the P.T.L. being reserved for deaf ears or the elderly.

Aged↗
PubMed1985

[Cholesteatoma of the ear. Experience with an eclectic therapeutic attitude].

In the light of 702 cases of cholesteatoma seen over a 20 year period, the authors report the experience of a hospital team based upon analysis of the last 517 cases. 322 patients were treated by a conservative attitude to the bony meatus, including 120 undergoing routine revision between 14 and 24 months. 195 cases were treated by an open technique, either primarily or following massive recurrences despite the use of closed techniques. In 33% of cases, patients had already undergone at least a tympanoplasty. The authors discuss the indications of the treatment of cholesteatoma. Each patient must be considered as an individual case and whilst our preference would be for conservation of the bony meatus, certain anatomical and functional conditions make a so-called open technique necessary in 1/3 of cases.

Adolescent↗
PubMed1985

[Rare cervicofacial cysts and fistulas in children].

Among the various congenital cervicofacial swellings observed in children, three types are rarely encountered in general practice: auriculobranchial cysts and fistulae, thymic cysts and cystic lymphangiomas. To resolve diagnostic and therapeutic problems related to these rare lesions it is essential that their etiopathogenic bases be understood. Auriculobranchial cysts and fistulae present clinical symptoms (cervical, parotid, auricular) that are only poorly evidenced and are related mainly to infection. Surgical excision requires a wide approach route of the parotidectomy type with preliminary isolation of the facial nerve. Thymic cysts result from embryogenic anomalies leading to remnants from the 3rd endobranchial pouch and/or degenerative disorders of Hassal's corpuscles. Of mainly perioperative detection their exeresis requires investigation of possible inferior mediastinal prolongations and preservation of healthy thymic parenchyma. Cystic lymphangiomas arise from dysembryoplasia of the lymphatic system, two opposing pathogenic theories existing to explain their origin. They are serious lesions because of their dissecting tendencies and their inexorable growth in the vast majority of cases. Two forms of lymphangioma, from the embryologic, diagnostic and therapeutic points of view, can be distinguished: those of extraparotid origin and those developing from the parotid.

Branchioma↗
PubMed1979

[The enlarged trans-labyrinthine approach of House. The use of this method in the surgical treatment of cerebello-pontine angle tumours (author's transl)].

The authors report a series of 43 cases of cerebello-pontine angle tumours operated by an oto-neuro-surgical team. The approaches used were, once the supra-petrous approach, twice the posterior fossa, 12 times a combined trans-labyrinthine and posterior fossa approach, and 28 times the enlarged trans-labyrinthine route. This last approach, which is now being used exclusively for the last two years, is described in detail. Forty-three tumours operated on broke down into 40 neurinomas, 2 meningiomas and 1 malignant melanoma. The size of the tumours varied from 1 cm to 11 cm in diameter. Overall statistics show 9.3% of deaths and 65% of functioning facial nerves. The statistics for the nelarged trans-labyrinthine route (the last 28 cases) are: 10.7% of deaths and 75% of functioning facial nerves. In the enlarged trans-labyrinthine route, there is no complication and no mortality in the small and medium-sized tumours, i.e. up to 4 cm in diameter.

Cerebellar Neoplasms↗
PubMed1979

[Acoustic neurinomas. Trans-labyrinthine approach (author's transl)].

The authors, supporters of a tight oto-neuro-surgical collaboration, show their tactical evolution in front of acoustic neurinomas which they operated at first in two stages, trans-labyrinthine then sub-occipital, and now they approach only by trans-labyrinthine way. They report their experience and their results to the point of a first serie of 30 cases : 10 combined approaches in two stages, and 20 trans-labyrinthine approaches. The mortality (3 cases-10%) for this first serie is still raised. One patient, after a softening of the pons, maintained important sequelles. On the other hand, among the remaining 26 patients, 13 kept a normal facial motricity and 5 recovered but with syncinesis. These first results are still perfectible : among the 20 last cases only trans-labyrinthine approached the facial nerve preservation was realised in 72% of the cases. The most frequent surgical complication is a cerebro-spinal fluid leak (7 cases) which fortunately the most often spontaneously dry up (6 cases) but which justify a very attentive closure technic. The authors show the arguments which convinced them of the interest of the trans-labyrinthine approach such it is done by W. House.

Adult↗