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Biomedical subjects

C Pech

Publications and source records attributed to C Pech.

16 recordsLinked to original sources
PubMed2002

[Management of cleft lip and palate by the Doctor Magalon's team in Marseille].

The goal of the treatment of patients with cleft lip and/or cleft palate was: obtain a normal appearance, a normal speech and a normal growth without severe pertubations of the quality of life. Millard technique was used to repair the cleft lip in neonatal period. Between 6 and 18 months, the palate cleft was closed by wardill-kilner technique. A gingivoperiostoplasty with osseous graft was performed between 8 and 12 years. The orthodontic treatment began at 7 years. Pharyngoplasty was necessary in several cases. Sequellae and rhinoplasty was performed at the end of the growth. The authors explained their choices.

Child↗
PubMed2000

[Cricotracheal resection in children: indications, technique and results].

The most significant advance in the surgical treatment of laryngotracheal stenosis has been the changes in external procedures, notably in laryngotracheoplasty aimed at widening the regional stenosis with prosthetic material. In opposition with this therapeutic method, cricotracheal resection which removes the regional stenosis, and a large portion of the cricoid cartilage, has been proven to be a reliable technique in adults. Between June 1993 and June 1998, 10 children underwent cricotracheal resection. There were 5 boys and 5 girls with 9 acquired and 1 congenital stenosis (grade II =5, grade III =2, grade IV =3). At the time of the procedure, the patients' mean weight was 19 kg and mean age was 7.5 years. A tracheotomy present in 5 children prior to the procedure was left in situ postoperatively. In these children a rolled silastic sheet was used to maintain the caliber for 23 days and the tracheotomy canula was removed a mean 58 days later. In the 5 children operated on without tracheaotomy, the nasotracheal tube was removed a mean 2.5 days after the procedure. Mean follow-up was 43 months, with clinical and endoscopic surveillance. No growth retardation was observed among the 5 children presenting 4.5 years after the procedure. The choice between laryngotracheoplasty enlargement and cricotracheal resection is not based on documented evidence but on case-by-case decision making. We discuss here the points which appear to us to be the most relevant in terms of indication, surgical procedure, potential complications, and outcome.

Child↗
PubMed1995

[Phonetic results after surgery of laryngotracheal stenoses in children].

The quality of the results of laryngotracheoplasties is clear evidence of the progress made in the treatment of stenoses involving the larynx and the trachea in children. the surgeon is no longer limited to helping the child breath correctly via the natural airways but can also concentrate on phonatrics since dysphonia is frequent after laryngotracheoplasty. Vocal production of 23 children who had undergone surgery for laryngotracheal stenosis was evaluated subjectively by a panel of listeners and objectively on the basis of the pitch and intensity of the voice, rate of speech and maximal time of phonation. In 11 children over the age of 5 years, assisted assessment of the voice completed the study. In 69.5% of the cases, the voice was subjectively considered to be satisfactory. Voice was considered clear in 52% of the cases. Speech flow was impaired in 39% due to frequent breath taking. Objective parameters revealed that pitch was slightly impaired (256 Hz) with a tendancy to normalize near puberty. The intensity of the voice (77 dB) and mean maximum phonation time (7 s) decreased. The phonotary quotient (270 ml/sec), jitter (1.4%) and leakage of the glottis (2.02 cm3/dB/s) were slightly above the normal range. The spectra of the voices were richly furnished with harmonics up to about 1 000 Hz above which air noises increased. An attempt was made to correlate the analysis of the voice with the characteristics of the stenosis and with the therapeutic methods used. The results would suggest the iatrogenic nature of prolonged canulation and of increasing the size the size of the posterior cricoid.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Laryngeal stenosis in children. Evaluation of 10 years of treatment].

Over a 10 year period from 1984 to 1994, 98 children underwent curative treatment for sub-glottal stenosis of the larynx at La Timone Hospital in Marseille, France. Eighty-two patients were operated on via an external approach. An endoscopic procedure with the CO2 laser was used in 16 cases. The majority of the children had acquired stenosis (77%), with greater than 70% obstruction (65%), and were under 5 years of age (60%). The details of the different therapeutic techniques used are presented. The laryngotracheoplasty technique used to widen the larynx (n = 58) with an autologous rib cartilage (n = 53) is the most important current progress. The possibilities for laryngotracheofissure (n = 21) and cricotracheal resection (n = 3) are also discussed. After decannulation, 95% of the children could breath normally via the natural airways. The quality of the outcome was not dependent on the therapeutic method used. Perspectives for new methods or modifications of existing methods are discussed.

Adolescent↗
PubMed1993

[Loco-regional anesthesia and orthopedic surgery of the shoulder].

Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. Regional anesthesia is quite useful too as a complement to general anesthesia, for it provides excellent postsurgical analgesia. A catheter may be inserted at the end of the surgical process through a nerve stimulator, but the patient does not tolerate it long, its efficiency greatly diminishes after the first day, and paresthesias may occur as after-effects. Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.

Cervical Plexus↗
PubMed1992

[How to evaluate velar insufficiency?].

The evaluation of velar insufficiency is absolutely necessary in order to assess the results of surgery of the labial palatal cleft. In addition to the clinical examination which remains indispensable, the aerophonometer, applicable to adults and children as from the age of 3, enables simultaneous measurement of the flow of buccal air, the flow of nasal air, and the buccal phonogram. The comparison of the lines, the relation of the nasal air and buccal air flows, upon the emission of two standard sentences with and without nasal components, enables an objective assessment of velar functioning.

Child, Preschool↗
PubMed1991

Interaction between diabetic patients, their general practitioners and a hospital diabetic clinic.

OBJECTIVE: The aim of this study was to examine the sociodemographic data of diabetic patients referred to our clinic and to correlate these with characteristics of their individual general practitioners. How these factors affect the interaction between patients, general practitioners and a hospital diabetic clinic was evaluated. DESIGN: Prospective recruitment of consecutive referrals. SETTING: The diabetic clinic of a teaching hospital located in the inner city suburbs of Sydney. PATIENTS: Two hundred and forty-six patients with diabetes (10% insulin dependent), aged 20-86 years, participating in our Shared Care Project, a randomised controlled study on various methods of following up diabetic patients. INTERVENTIONS: Data for the study were gathered by interview and questionnaire during first assessment at the clinic. MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients; the location of general practitioners, their diagnostic equipment and type of practice; and the level of detail recorded in referral letters from general practitioners. RESULTS: Diabetic patients of migrant background who cannot speak English are older and have less formal education. They see their doctors more often and seek out general practitioners who speak their language, even if it means travelling longer distances. Patients referred from 24 hour medical centres are younger, more educated and have less contact with their doctors both in duration and frequency of visits when compared with patients whose general practitioners operate in conventional sole or partnership practices. Many patients have more than one general practitioner, making communication with hospitals difficult. In their referral letters, general practitioners usually concentrate on hypertension, hypercholesterolaemia and metabolic aspects of diabetes, but under-emphasise diabetic complications; they make insufficient use of measurement of the glycosylated haemoglobin level to assess diabetic control while over-using glucose tolerance testing in making the diagnosis. The referral letter often does not contain enough information to help clinical decision making. CONCLUSIONS: Demography of patients and characteristics of general practitioners are important factors which can affect their interaction with public hospitals. Bearing in mind the work load of general practitioners and the diverse nature of patients, hospitals must implement systems which make it easier for general practitioners and patients to interact with them.

Adult↗
PubMed1985

[Locoregional anesthesia of the foot for forefoot surgery].

A technique of regional anaesthesia of the foot for forefoot surgery (ingrowing toe-nail, hallux valgus, amputation, etc.) is described. It consists of a block of the superficial peroneal nerve at the ankle combined with a block of the posterior tibial nerve behind the medial malleolus. A volume of 5-6 ml of 1% lidocaine or 1% mepivacaine is injected. A pneumatic tourniquet was placed on the upper part of the thigh after the patient had been given an intramuscular premedication. The results of 52 such blocks carried out in 40 patients are discussed.

Adolescent↗
PubMed1985

Outpatient stabilization programme--an innovative approach in the management of diabetes.

An outpatient stabilization programme for diabetic patients was established to overcome the disadvantages of inpatient treatment. The day to day management of patients was carried out by experienced nurse/educators under the supervision of physicians. The telephone was used extensively for communication between the patients and staff of the Diabetes Centre. In a 12 month period, 73 patients were commenced on insulin and 83 patients (62 on insulin) had their diabetic control re-stabilized. In both groups of patients there was a significant fall in glycosylated haemoglobin levels indicating improved metabolic control. Results were similar to those for patients admitted to hospital for stabilization. There are important social and economic benefits from the avoidance of repeated hospitalization.

Academic Medical Centers↗
PubMed1984

[Axillary block of the brachial plexus and flunitrazepam premedication in surgery of the upper limb (study of 1,500 cases)].

The authors report their experience of regional block using anaesthesia of the brachial plexus by the axillary approach. 1 500 axillary blocks have been done since 1976. They perfect their technology and report their results. Because of the innocuity of regional block and its simplicity, they use it in seventy per cent of superior limb acute or regular surgery.

Adolescent↗
PubMedDate not supplied

[Brachial plexus block anesthesia in the upper limb surgery (author's transl)].

This work, during a period of 2 years, has been carried out on 139 brachial plexus block anesthesias out of which --92 through axillary approach--47 through supraclavicular approach. Our failure rate was--6,5 p. cent in the case of the axillary block--10,6 p. cent in the case of the supraclavicular block. This gives us a failure average of 7,9 p. cent. Depending on the duration of the operation we have been using three kinds of drugs, always without adrelanine--Lidocaïne . . . 2 p. cent--Mepivacaïne . . . 2 p. cent--Bupivacaïne . . . 0,5 p. cent. We finally adopted two mixtures based on lidocaïne together with mepivacaine or bupivacaine keeping the same concentration but reducing to half the doses of these last two drugs. In our work, we have not noted any complication, and we think that a locoregional anesthesia, should, as far as it is possible, be used as a substitute for general anesthesia instead of being used when general anesthesia is contra-indicated.

Anesthesia, Local↗