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Biomedical subjects

E Delay

Publications and source records attributed to E Delay.

At least 37 records · Page 2Linked to original sources
PubMed2003

[An unusual risk of liposuction: liposuction of a malignant tumor. About 2 patients].

Liposuction is a simple and elegant way to treat fatty excess; it has been even used for the treatment of lipomas and some gynecomasties. The goal of this article is to present 2 patients with an unusual complication of this use: the liposuction of a malignant tumor. The first patient consulted following the liposuction of a "gynecomasty", which was in fact a breast cancer. The second was treated by liposuction for an ankle "lipoma"; it proved to be a liposarcoma. In order to avoid liposuction and dissemination of a malignant tumor, the pre-operative investigations have to search clinical peculiarities evoking the diagnosis: an unilateral "gynecomasty", irregular, hard or painless, in a 50-years-old patient, must incite the surgeon to perform a classical excision, just as a recurrent "lipoma", deeply located, voluminous or quickly extensive, situated on the limbs or in the humeroscapular area. Paraclinic investigations may be indicated; doubtful cases must be right away rejected for liposuction, and treated by a surgical excision with strict safety margins and complete anatomopathologic examination of the lesion. Liposuction has become a very useful technique for the plastic surgeon; however, we must not forget, despite of its many advantages the risk for dissemination of an unknown malignant tumor. Every surgeon must keep it in mind and prefer a surgical removal in atypical cases.

Breast Neoplasms↗
PubMed2003

[Surgical management of cutaneous necrosis in the purpura fulminans: report of 2 clinical cases].

The authors report their experience of the management of 2 patients with purpura fulminans. After a review of the epidemiology, diagnostic methods, natural course and prognosis of the disease, the various stages of the treatment are described. The urgency of the medical treatment is stressed and the specific technique of the surgical approach to the artificial dermis is detailed. The quality of initial management is of crucial importance and such extensive and deep cutaneous destruction is best dealt in burn centers.

Adolescent↗
PubMed2002

[Cutaneous angiosarcoma of the head: three cases].

Cutaneous angiosarcoma of the head is an uncommon finding. We report three cases, two women with a scalp localization and a man with a facial (frontal) localization. Recurrence was observed in one woman after surgery; this patient was given palliative treatment due to her poor health condition. The other women experienced three recurrences. After the last surgery, latissmus dorsi free flap graft, she has been disease free. The man was treated with surgery and radiotherapy. Regional lymph node metastasis appeared 5 years after the initial treatment. He is now disease free after surgery and cervical radiotherapy. Wide surgery and careful long-term follow-up are essential. The latissimus dorsi free flap can provide successful cure.

Aged↗
PubMed2000

Sensitivity of breasts reconstructed with the autologous latissimus dorsi flap.

The purpose of this study was to measure, both objectively and subjectively, the sensitivity of breasts reconstructed with the autologous latissimus dorsi flap and to compare these results with those of other reconstruction techniques, especially the transverse rectus abdominis myocutaneous flap. The study population included 50 patients with autologous latissimus dorsi flap breast reconstruction; these patients had an average age of 51 years and an average follow-up of 27 months. Patients answered a seven-item questionnaire that attempted to define the sensitivity of the reconstructed and opposite breasts. This sensitivity was then measured objectively using standard techniques for heat, cold, and tactile sensations. After statistical analysis, these results were compared with those published for other reconstruction techniques. Overall results were comparable or superior to those published for other techniques for autologous breast reconstruction. A total of 56 percent of patients had fine or very fine sensitivity, but 70 percent deemed this sensitivity to be less than that of the opposite breast. A total of 94 percent of patients perceived the reconstructed breast as integral to their body image. The superior medial part of the breast had the greatest sensitivity, both objectively and subjectively. Autologous latissimus dorsi breast reconstruction, a good technique with excellent aesthetic results, affords satisfactory sensitivity. This is yet another advantage of the technique.

Adult↗
PubMed2000

[Tolerance, reliability and efficiency of inflatable breast implants after breast reconstruction. Retrospective study of 101 consecutive cases].

A long-term retrospective study of breast reconstruction with inflatable implants is presented. One hundred and one patients were studied, with a median follow-up of 44 months. Prosthetic implants used were round McGhan implants, model 168. Median volume was 215 mL. Twenty-two patients had contralateral symmetrisation, an average of five months after implant. The advantages of this sort of reconstruction are ease, speed and homogenously good results. Drawbacks include the appearance of prosthetic leaks (7%), waves and folds (13%), stage III and IV capsular contractures (26%), asymmetry and incorrect placement of the implant (25%). Breast reconstruction with implants alone gives good results for specific indications: immediate reconstructions, bilateral reconstructions, no history of radiotherapy, and good quality chest wall tissues.

Adult↗
PubMed1999

Desmoid tumor arising in a cesarean section scar during pregnancy: monitoring and management.

Desmoid tumors (DTs) are frequently associated with either surgical trauma, like scars, or physiologic trauma, like pregnancy. A DT arising in a cesarean scar during pregnancy shows both correlations. A case of DT that grew gradually in a cesarean scar during the first trimester of a subsequent pregnancy is presented. After initial MR imaging, the lesion was biopsied and carefully monitored; immediate surgical removal was considered at any time if indicated by the follow-up results. No increase in the tumor size was observed during the following 6 months of gestation, and the lesion was extirpated with mesh replacement of the abdominal defect at the time of cesarean section.

Adult↗
PubMed1999

Autologous latissimus breast reconstruction in association with the abdominal advancement flap: a new refinement in breast reconstruction.

The authors present a technique that combines autologous latissimus breast reconstruction with the thoracoabdominal advancement flap. The aim is to reduce the patched effect of the dorsal skin paddle and to minimize scars on the reconstructed breast. Fifty patients underwent delayed breast reconstruction using this technique from March 1993 through May 1997. Of these 50 patients, 42 (84%) had unilateral reconstruction and 8 (16%) had two-stage bilateral reconstruction at 5- to 7-month intervals. Forty-one patients (82%) had previously received radiotherapy of the thoracic wall. The abdominal advancement flap allowed subtotal burial of the latissimus dorsi flap (preserving only the future nipple-areolar complex) in 40 patients (80%) and total burial in 10 patients (20%). Reduction surgery was done on the other breast in 17 patients (34%) and mastopexy in 3 patients (6%). In 8 patients (16%) the opposite breast required mastectomy and reconstruction using an autologous latissimus dorsi flap. The aesthetic results, as evaluated by two plastic surgeons on the basis of pre- and postoperative photographs, were rated as very good in 44 patients (88%), good in 5 patients (10%), and poor in 1 patient (2%). No result was considered bad. The main drawback was dorsal seroma, which occurred in 68% of patients but was managed easily by repeated aspiration. Subtotal or total burial of the skin paddle through the original association of the autologous latissimus dorsi flap with the abdominal advancement flap gives markedly improved results by reducing the scars on the reconstructed breast, avoiding the patched effect, and providing a supple breast with a natural ptotic shape.

Abdomen↗
PubMed1999

Composite cervicofacial flap for reconstruction of complex cheek defects.

The authors present the reconstructive technique for complex cheek defects using the composite cervicofacial flap and study the possibilities, advantages, disadvantages, and results that can be expected. The design follows the classic outline of Mustardé's flap. The skin is undermined for 2 cm anterior to the ear, then after incision of the superficial musculoaponeurotic system (SMAS), undermining is continued below the plane of the SMAS, level with the facial nerve branches. It is continued forward to the facial vessels, which give rise to branches that ensure the blood supply of this composite flap and contribute to its high reliability. In the cervical region, undermining is done beneath the platysma, which is transected transversely in the lower cervical region to allow good upward mobility and satisfactory transposition of the flap. The flap is adapted to the defect and the medial suture line is placed as near as possible to the medial limit of the cheek aesthetic unit. The authors carried out a retrospective study of 7 patients with complex facial reconstruction after excision of malignant lesions. The defects measured from 4x4 cm to 9x7 cm. In 4 patients excision included the periosteum, and in 1 patient excision involved the entire thickness and removed the entire anterior half of the cheek. In 4 patients reconstruction involved the cheek and eyelid. In spite of the advanced age of the patients (88, 69, 91, 67, 70, 82, and 59 years), there was no distal edge necrosis. The only complication was a single case of facial paresis, which resolved spontaneously. The results were considered very good in all 7 patients. The authors conclude that the composite flap increases the possibilities of the cervicofacial flap. It is more mobile, more reliable, thicker, and more adaptable. It can be used in complex cheek defects that involve the periosteum, or even in full-thickness defects. The quality of the results obtained using this flap represents a considerable advance in facial reconstruction.

Aged↗
PubMed1998

Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients.

This article presents our technique of autologous breast reconstruction using the latissimus dorsi flap and studies the advantages, disadvantages, and results that can be expected. A consecutive sample of 100 patients was studied. The average length of follow-up was 20 months (range 8 to 44 months), and all of the subjects were reviewed in consultation without loss to follow-up. The supplementary volume of the latissimus dorsi was obtained from five fatty zones: fat on the cutaneous paddle, fat taken from the surface of the muscle, the scapular fat pad, the anterior fatty zone, and the supra-iliac fat pad. This technique must be measured against the transverse rectus abdominis muscle (TRAM) flap, free or pedicled, when the patient needs an autologous breast reconstruction. It can be used when the TRAM flap is contraindicated (this corresponds to 45 percent of patients of our sample) or when the dorsal donor site is preferred (55 percent of cases of our sample). The major complications are rare (1 percent partial necrosis and 1 percent total necrosis of the flap). The minor complications are represented mainly by the dorsal seroma. This is the main drawback of the technique, as it occurs in 79 percent of cases and regularly in obese patients. In view of this frequency, patients should be warned of its likely occurrence. The dorsal donor-site morbidity is relatively low; 4 percent of dorsal sequelae were classed as moderate, and 96 percent were considered low. The scapular sequelae have been classed as low in 97 percent of cases, and temporary scapular sequelae aggravation has been noted in 3 percent. Results of breast reconstruction using this technique are most encouraging. The level of patient satisfaction is high; 87 percent of them were deeply satisfied, 10 percent were satisfied, and only 3 percent were poorly satisfied. This group of poorly satisfied subjects (3 percent) consists of patients who suffered a serious postoperative complication. The aesthetic results have been judged excellent by surgeons in 85 percent of the cases, good in 12 percent of the cases, and poor in 3 percent of the cases; no result has been judged bad. This technique of breast reconstruction by autologous latissimus dorsi brings a major advance in breast reconstruction. The best indications of this technique are when one can bury the cutaneous paddle: cases of skin-sparing mastectomy, cases where the latissimus dorsi flap can be combined with an abdominal advancement flap, and cases of conversion of implant reconstruction to an autologous reconstruction.

Adult↗
PubMed1998

[Posterior thoracic reconstruction with latissimus dorsi flap after partial amputation of the latissimus dorsi muscle for sarcoma of the back. Report of four cases].

Malignant fibrous histiocytomas (MFH) arising from the subcutaneous tissues of the posterior thoracic wall require wide, but usually non-transfixing, resection to ensure adequate resection margins, the only way to reduce the local recurrent rate. Due to its size and position, the Latissimus dorsi muscle usually requires partial amputation. However, its vascular anatomy allows it to be used as a musculocutaneous flap of the residual muscle to fill the defects created. Four clinical cases are reported. This technique reduces the complication rate and simplifies the postoperative course.

Adult↗
PubMed1998

[Mammaplasty with an L-shaped scar and a pre-established design. Apropos of 80 cases].

Over recent years, surgeons have tried to reduce the reduction mammaplasty scar. In this context, we use a surgical technique described by J.P. Chavoin, privileging "the remaining breast". Three advantages of this surgical method are derived from its technical choices: a superior dermal pedicle for preservation of the areolar nipple complex, preoperative drawing and finally a short incision with an inverted L scar. A retrospective study of 80 patients with 27 months of follow-up defines the advantages and disadvantages of this technique. Discomfort, indications, quality of results are evaluated with charts. Preoperative drawing and technique are described. This study shows this to be a reliable technique with good and constant results. Lastly, its indication is described in comparison with other techniques designed to achieve. Its preferential indication is moderately severe hypertrophy (500 g), which represents the majority of patients consulting us, but it can also be used in severe hypertrophy or even gigantomastia. Reduction of asymmetry also constitutes a good indication, facilitated by rigorous skin drawing based on precise anatomical landmarks. In addition to its broad indications, its advantages are marked vascular safety, rapid execution, constant results, while preserving the median part of the thorax from any scars.

Adolescent↗
PubMed1998

[Parital cutaneous necrosis of the abdominal wall after cesarean section].

The authors report an original case of large cutaneous necrosis of the abdominal wall following a first cesarean section in a patient with a background of pemphigoid gestationis. There was no direct skin burn nor infection of the dermis and this necrosis is typical of venous suffering. The mechanism is debated, probably the thrombosis of the superficial inferior epigastric vein due to the spreading out of a monopolar coagulation current. A one-step treatment was done using a wide excision and an abdominal advancement flap. This surgical technique allowed a fast cicatrisation and led to a very good long-term esthetical result.

Abdominal Muscles↗
PubMed1998

[Esthetic reconstruction of the superior hemilip using the Abbé technique modified by Burget. Apropos of 5 cases].

When a patient must undergo resection of part of the upper lip for the treatment of a cancer or following a traumatic defect of the upper hemilip, the surgeon is faced with the problem of reconstruction of a lip whose appearance and function must be as close as possible to the normal lip. The limits of the normal lip must be restored: the symmetry, equilibrium of the lips and position of the commissures must be maintained. The upper lip esthetic unit can be divided into subunits, as described by Burget and Menick. If a large part of a subunit is removed, replacement of the entire subunit rather than simple reconstruction of the defect often gives a better esthetic result (Burget). The best tissue for esthetic reconstruction of a full thickness defect of the upper lip is the lower lip. We apply Burget's principles to raise an Abbé flap, which is transferred in two stages. This approach is illustrated by 5 patients operated by this technique. Finally, this technique is compared to other techniques allowing reconstruction of the upper hemilip.

Adult↗
PubMed1997

[Cryosurgery of liver neoplasms].

Cryosurgery is the in situ destruction of tissue using subzero temperatures. Its use for the treatment of some unresectable liver tumors has been clearly established as a therapeutic option. Experimental studies have demonstrated the feasibility of freezing of large liver volumes without any major metabolic and hemorrhagic complications. Modern cryosurgery has received substantial impetus from the development of automated cryosurgical apparatuses using liquid nitrogen. Intraoperative ultrasound has enhanced the process by enabling visualization of tissue freezing and ensuring precise and optimal treatment of the tumor. Clinical reports of cryosurgery for liver primary tumors and metastases have confirmed the safety of the procedure. Major complications include myoglobinuria, coagulopathy and pleural effusions. The benefit of cryosurgery is that it broadens the number of patients that can be brought to surgery and can potentially become disease-free.

Colorectal Neoplasms↗
PubMed1997

[Breast reconstruction with the autologous latissimus dorsi flap. Preliminary report of 60 consecutive reconstructions].

Many women who have undergone or will undergo mastectomy request breast reconstruction and feel that it is an important part of their total cancer treatment. Autogenous tissue methods take a place more and more important in breast reconstruction. The autologous latissimus dorsi flap, is a recent method of autologous breast reconstruction. We have done a retrospective study based on a series of 60 consecutive reconstructions operated between march 1993 and april 1995. The advantages of the autologous latissimus dorsi flap are the same of the others autologous breast reconstruction methods: the reconstructed breasts are soft and match an opposite normal breast more successfully than those made with implants. The disadvantages of this technique is mainly the dorsal seroma that was observed in 70% of cases but was easily managed by aspirations. The aesthetics results have been judged by two surgeons as very good in 85% of cases, good in 11.6% and low in 3.3%. The satisfaction rate of the patients in high: 86.6% are pleased and 13.3% are satisfied. The autologous latissimus dorsi breast reconstruction is a safe and reliable technique and provides an excellent alternative to the TRAM flap, when the patient prefer the dorsal donor site or when there are some risk factors to do a TRAM flap. Finally this technique bring a major advance in the field of breast reconstruction, immediate or delayed.

Adult↗
PubMed1996

The taste of monosodium glutamate: membrane receptors in taste buds.

Receptor proteins for photoreception have been studied for several decades. More recently, putative receptors for olfaction have been isolated and characterized. In contrast, no receptors for taste have been identified yet by molecular cloning. This report describes experiments aimed at identifying a receptor responsible for the taste of monosodium glutamate (MSG). Using reverse transcriptase (RT)-PCR, we found that several ionotropic glutamate receptors are present in rat lingual tissues. However, these receptors also could be detected in lingual tissue devoid of taste buds. On the other hand, RT-PCR and RNase protection assays indicated that a G-protein-coupled metabotropic glutamate receptor, mGluR4, also is expressed in lingual tissues and is limited only to taste buds. In situ hybridization demonstrated that mGluR4 is detectable in 40-70% of vallate and foliate taste buds but not in surrounding nonsensory epithelium, confirming the localization of this metabotropic receptor to gustatory cells. Expression of mGluR4 in taste buds is higher in preweaning rats compared with adult rats. This may correspond to the known higher sensitivity to the taste of MSG in juvenile rodents. Finally, behavioral studies have indicated that MSG and L-2-amino-4-phosphonobutyrate (L-AP4), a ligand for mGluR4, elicit similar tastes in rats. We conclude that mGluR4 may be a chemosensory receptor responsible, in part, for the taste of MSG.

Amino Acid Sequence↗
PubMed1996

Hepatic cryosurgery precision: evaluation of ultrasonography, thermometry, and impedancemetry in a pig model.

One of the main problems of the use of liver cryosurgery is to be sure that a defined hepatic volume has been completely destroyed. We undertook an experimental pig study to determine histopathological evolution of cryolesions, to evaluate the value of intraoperative sonography, thermometry, and impedancemetry to monitor necrosis and to evaluate clinical and biological repercussions of hepatic cryosurgery. Forty-eight cryolesions were obtained by freezing each liver lobe of 12 experimental pigs during a 5-min contact with a flat cryoprobe cooled with liquid nitrogen. Cryolesions and the surrounding liver were monitored during cryosurgery by six thermocouple electrodes, five impedance electrodes, and intraoperative sonography. Animals were sacrificed immediately, 6 hr and between day 1 and day 32 after the procedure. Cryolesions were excised, and a full size pathological study was carried out. No morbidity or mortality was observed. At the end of the freezing time, cryolesions were hemispheric in shape, and their radius measured by sonography was 17.7 +/- 1.2 mm (mean +/- SD). Microscopic study showed sequential tissue alterations with edema, ischemic necrosis, tissue slough, and granulation. Cryolesions were sharply delineated from the normal liver tissue. The radius of necrosis at days 2 and 3 was 17 +/- 0.3 mm (mean +/- SD). It showed good correlation with the cryolesion size measured by intraoperative sonography. The temperature threshold to obtain complete normal liver necrosis was -15 degrees C. We found impedancemetry too difficult to use and not precise enough to monitor cryonecrosis. We conclude that intraoperative sonography and thermometry are useful means to monitor the extent of cryonecrosis during liver cryosurgery.

Animals↗