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Biomedical subjects

A Pech

Publications and source records attributed to A Pech.

At least 91 records · Page 5Linked to original sources
PubMed1982

[Results of rhinoplasties. A computer study of 351 medical records].

The authors studied the cosmetic results of 1380 rhinoplasties carried out over a period of 10 years by two surgeons, Professor A. Pech and Professor M. Cannoni. They used a classical reduction rhinoplasty technique. Different procedures were used for the tip of the nose depending on the individual indications, and the development of ideas over a period of time. Only 351 files, complete with pre- and post-operative photographs have been selected. The photographs have been analyzed on the basis of 70 criteria by an independent, young female ENT specialist, and the results of her analysis were fed to the computer. The study provides three types of answer. Firstly, the results were good in 69% of cases, and the greater the experience of the surgeon, the greater the success. Secondly, the different techniques for correcting the tip of the nose are analysed with good scores for Cinelli's technique (69%). The tip modeling procedures of Converse and of Lipsett have been abandoned owing to the high frequency of round tips. Finally, the different types of anomalies encountered are listed: 42% round tips, 20% asymmetrical tips, 17% residual humps, 11% of wide nasal bones, hooked noses and postoperative deviations. The authors then comment on the results, focusing on following points: the frequency of incomplete files (70%); the general improvement in the results with the gaining of experience, the decline in the proportion of hooked noses, also in line with experience, from 24% in the first 5 years to 7% after 10 years; the development of ideas concerning the techniques to be used in correcting the tip of the nose with an evergrowing place for those sacrificing the dome of the alar cartilages, such as the "Hockey stick" and a personal procedure derived from Pollot; wide nasal bones and failures in the tracing of the naso-frontal angle (64%) for which no solution is suggested; and, finally, postoperative nasal deviations. Since undertaking this study, the authors have successfully avoided this defect by using the external approach.

Computers↗
PubMed1982

[Hypoglossofacial anastomosis, results in 19 cases].

Hypoglossofacial anastomoses was performed in 19 patients, in the majority of cases for tumors located in the pontocerebellar angle. Results were a total success in 16 cases, one patient has not been seen again, and operation had been performed too recently to assess results in two cases. Anastomosis was conducted during initial surgery in 12 cases, and at a later stage in the other 7. In one patient, anastomosis 3 years after facial paralysis following excision of an acoustic nerve neuroma resulted in satisfactory re-innervation of the face after 13 months. Results were not significantly different in 6 patients with an intramastoid anastomosis and in 13 where it was performed in the parotid region. In 11 cases, a classical anastomosis was performed, involving suture of the XIIth and VIIth nerve trunks (type I anastomosis). A more complex procedure in the remaining 8 cases involved separate anastomosis of the XIIth and facial nerve branches, with, in some patients, implantation of sternothyroid muscle fragments, supplied by the descending branch of XII, into the orbicularis muscle. Results were good using these modifications, but valid comparison with those following classical methods cannot be made at the present time. Technical features of the procedure employed are described. Hypoglossofacial anastomosis is currently the only method giving satisfactory constant results when end-to-end suturing of the facial nerve or a superficial cervival plexus graft is obligatory.

Cerebellar Neoplasms↗
PubMed1982

[Reconstructive anterior frontal laryngectomy (author's transl)].

Sliding epiglottoplasty was employed for reconstruction of the glottis after subtotal laryngectomy. Technical aspects are described, and the indications and limitations of this reconstructive partial laryngectomy procedure are discussed from the anatomic and carcinologic points of view. Its advantages include lack of postoperative complications, the very good functional results obtained, and the fact that it can be conducted following radiotherapy and in debilitated patients. It has a limited but definite place among partial laryngectomy procedures.

Adult↗
PubMed1982

[The parathyroid risk in thyroidectomy].

The authors report their experience of parathyroid risk in thyroid surgery on the basis of 1 188 thyroidectomies performed between 1973 and 1980. The benign thyroid pathology, the risk is negligeable, approximately 1%, though with the exception of operations for recurrence. In malignant tumour pathology, amongst 98 carcinomas treated by total thyroidectomy and mediastino-recurrent laryngeal lymph node dissection, the authors report an overall percentage of definitive major hypocalcaemia of 22.5%. Routine identification of the parathyroids at the start of the operation, at least on the healthy side, and care not to damage their vascular supply has made it possible to reduce the rate of hypoparathyroidism to 10% in the past two years. A study of anatomical dissection of 200 parathyroid glands with vascular injection is reported in the preamble. Finally, the authors analyse in the literature the results of parathyroid transplant and report their own experience.

Humans↗
PubMed1981

[Diagnosis of glomus jugulare tumours (author's transl)].

The present study is based on 16 personal cases and on an analysis of the principal series published since 1968. Clinical investigations aim at detecting lesions of the sensory-motor and XIIth cranial nerves, deafness which indicates invasion of the labyrinth, lesions of central auditory and vestibular pathways and possible associated conditions. Radio-otology is fundamental in revealing alterations of the jugular foramen and above all perhaps, changes in the tympanic bone and in the 3rd segment of the fallopian canal. The most significant sign of invasion is infra-labyrinthic hollowing out on tomographic sections in lateral projection and Guillen's incidence. Angiography and jugulography supply information on the size of the tumour and on its feeding vessels which usually arise from the external carotid artery but also, in advanced forms, from the internal carotid and vertebral arteries. Computerized tomography for the time being has one single major applications : detection of lesions extending to the posterior and middle fossae. Taken together, these investigations should help to classify tumours of the glomus jugulare into : exclusively tympanic, tympano-mastoidal, tumours extending posteriorly and to the petrous bone, and tumours extending intracranially. Such a classification is of paramount importance in deciding on the best surgical approach.

Carotid Arteries↗
PubMed1980

[Prevention and pretherapeutic evaluation of laryngo-tracheal stenosis in adult (author's transl)].

The prevention of laryngo-tracheal stenosis and their etiological factors are the subject of this study. The used material (tube, balloon,...) and the patient could be the principal reason of these etiology, either for intubation or tracheotomy. The pressure in the balloon and the tracheal mucosal puls are developed. The knowledgement of the principal etiologic factors in the constitution of laryngo-tracheal stenosis, make us able to prevent them with efficacity. Finaly, a preoperative evaluation by tomography and endoscopy is establiched.

Aged↗
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↗