Biomedical subjects

E Watier

Publications and source records attributed to E Watier.

At least 19 recordsLinked to original sources

PubMed2003

[Contribution to the detection of Melan-A/Mart-1 specific CD8+ T cells in surgery of melanoma. Preliminary study].

Melanoma treatment is based on surgery. In metastatic cases, vaccine therapy has been recently developed to overcome T cell or dendritic cell dysfunction. HLA tetramerbased assays are useful for immunologic monitoring of this trial and to quantitate CD8+ specific lymphocytes. In the present work, we used tetrameric technology to detect expanded populations of tumor specific CD8+ Tcells specific of Melan-A/Mart-1 Antigen have been quantified using flow cytometry. The feasibility of routinely detection of 0,1% +/- 0,03 of CD8 T cells has been demonstrated, without any difference the levels observed before and after (day 30) surgery. The value of experimentation of these cells should be determined in clinic and particularly to analyze surgical practice.

Adult↗

PubMed2002

Breast feeding after reduction mammaplasty performed during adolescence.

UNLABELLED: Reduction mammaplasty (RM) can be performed during adolescence if the functional capacity of the breast is preserved. Future breast feeding must be carefully considered in the therapeutic decision making process. PURPOSE OF THE STUDY: Breast feeding after reduction mammaplasty performed during adolescence was assessed to determine surgical factors influencing outcome and patient reception of information concerning breast feeding. METHODS: A questionnaire was sent to 109 women who had undergone reduction mammaplasty between 1981 and 1997 when they were 15-17 years old to ascertain their reasons for having surgery, their satisfaction, and their attitude towards breast feeding. RESULTS: Sixty-five questionnaires (60%) could be analyzed. Mean delay since surgery was 8.1 years. Seventeen women (26%) had delivered 25 infants (mean 1.5). Mean delay after surgery to first delivery was 7.68 years. Five women (29%) nursed their first infant for a mean 11.3 days. None of the women interrupted breast feeding for a reason related to a nipple anomaly or difficult sucking. Twelve women (71%) did not nurse their first infant, because of the prior breast surgery for six of them. Among the 48 nulliparous women, 24 (50%) stated they would nurse their future infant. Although information on breast feeding was systematically delivered, 41 women (63%) stated they had not been informed. There was no statistical relationship between breast feeding and degree of satisfaction, patient-assessed scar quality, or nipple disorders. CONCLUSION: Adolescents who undergo reduction mammaplasty can nurse their future infants with a complication rate similar to that in the general population. Special attention must be given to delivery of information on breast feeding.

Adult↗

PubMed2002

[Post-inflammatory cutis laxa. A case report].

Cutis laxa (CL) is a rare disorder in which the skin hangs in loose fields, so that affected individuals appear to be prematurely aged. The changes are more evident when effect the face with a prematurely-aged appearance. The acute form follows an inflammatory skin lesions. Its aetiology is not well known. We report a case of a head acute CL of a 17 years patient, secondary to a generalized skin eruption. The prematurely-aged appearance concern especially forehead, ear lobes and nasolabial folds. A two stages surgical treatment has associated: a forehead lifting associated to a Coleman lipofilling and an ear lobe reduction, a secondary Coleman lipofilling of the nasolabial folds. The skin biopsy confirm the diagnosis. The correction is stable and satisfactory after one year. The confrontation of our findings to those previously described confirm complexity of diagnosis and histological observations of this rare disorder.

Adolescent↗

PubMed2001

[Juvenile breast hypertrophy: analysis of long-term results of reductive mammoplasty].

UNLABELLED: Reduction mammaplasty has now become routine surgery with good results in middle-aged women. However the scars it leaves, its psychological and functional (breastfeeding) impact could limited its indications in teenage girls. AIM: The purpose of our study was to report the long-term results of reduction mammaplasty in teenage girls and to assess their consequences. MATERIAL AND METHODS: We conducted a retrospective study of 65 reduction mammaplasty carried out between 1981 and 1997 in 15 to 17 years old girls. The study was based on data in their medical records and answers to a questionnaire which was sent to each patient. RESULTS: Average followup was 8.1 years. The reduction technique with superior pedicle were mainly used. Average breast tissue excised was 1050 g. Minor complications occurred in three cases. Eleven revisions had to be carried out with 1.6 years on average after primary surgery. The psychological and functional complaints observed preoperatively disappeared in more than 90% of the cases. In over 80% of the cases the patients were pleased or very pleased with the shape, the volume kept and the symmetry. Scars were well accepted in 83% of the cases. Seventeen women were given birth to 25 children. Five of whom breast-fed their babies, while six refused because of their breast surgery history. Although information about breast-feeding after such surgery is systematically given, 41 women claimed they had not received it. CONCLUSION: Reduction mammaplasty is reliable in teenage girls. Patients are generally satisfied and the remaining scar is well accepted. Breast-feeding is possible after this surgery and information on that point ought to be better developed.

Adolescent↗

PubMed2001

Use of tissue expansion in revision of unhealed below-knee amputation stumps.

When local tissue is insufficient for the revision of unhealed below-knee stumps tissue expansion offers an interesting alternative for local coverage. We used this method in seven patients (five men, two women; mean age 30 years) who had had below-knee amputations, six of them after injury to a healthy limb and one for purpura fulminans. Ten tissue expanders were inflated slowly and intermittently either weekly or twice weekly depending on the patients. The mean expansion period was 92 days. Mean hospital stay for the two operations was 5.8 (range 4-9) and 7.6 (range 6-10) days, respectively. Using subjective and objective criteria, functional outcome was excellent in five patients and good in one. Expansion failed in one because of infection. Expanded skin flaps allow good cover with a minimal scar area in appropriate cases, while preserving the skin sensitivity and length of the tibial shaft.

Adult↗

PubMed2000

[Value of pulsed color Doppler before transverse rectus abdominis musculocutaneous flap breast reconstruction. 45 cases].

The transverse rectus abdominis musculocutaneous TRAM flap is an interesting alternative for breast reconstruction after mastectomy for cancer disease in patients who refuse mammary prosthesis and when the clinical situation allows it. There is however a risk of unpredictable partial necrosis even after rigorous surgical procedure. Some authors have proposed a Doppler evaluation before reconstruction surgery to better identify the vascular network and optimize patient selection. We performed a preliminary study in 45 patients between January 1996 and December 1999. An echo-Doppler Ultramark 9 HDI (Advanced Technology Laboratories) equipped with a high frequency (10 MHz) linear probe was used to compare blood flow and vessel caliber in the superior epigastric artery and the perforating vessels (number, localization, peak flow). The results obtained in this series could be used to determine indications for TRAM flap with or without delay procedure.

Female↗

PubMed1999

Immediate breast reconstruction with deepidermalized transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy.

Use of the transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction is widely accepted and indications have been well-defined over the past years. More recently, the moratorium prohibiting pre-filled silicone gel implants both in esthetic surgery and in reconstruction breast surgery, has incited more and more patients to refuse prostheses, even saline filled implants. Total mastectomy with skin-sparing technique, beyond the limitations dictated by oncology factors which must be taken into account because of the risk of local recurrence, raises the question of immediate breast reconstruction since implants, when possible, may give unsatisfactory results either more or less short-term. The deepidermalized TRAM flap is an interesting alternative for selected patients, especially those with an adapted abdominal morphology, allowing stable and natural autologous breast reconstruction.

Adult↗

PubMed1999

[Tuberous breast syndrome. Report on a series of 22 operated patients].

The tuberous breast syndrome is a rare unilateral or bilateral breast malformation presenting at the age of mammary development. It requires surgical correction, depending on the severity of the clinical expression, because of its inaesthetic appearance. We report a series of 22 patients (35 breasts) treated and followed up in the plastic and reconstructive surgery department of Rennes over a period of nearly ten years. The average age was 18 +/- 3.2 years (range: 15-26 years old). Long-term results were assessed by the surgical team and the patients on the basis of objective and subjective criteria with an average follow-up of 36 months (12 to 116 months). In our opinion, surgical correction should be proposed after puberty with, whenever possible, section of the basal fibrous ring and glandular plasty via a periareolar incision. The use of mammary implant alone or in combination with breast tissue remodelling must be reserved for hypoplastic cases only.

Adolescent↗

PubMed1998

[Intracystic breast carcinoma. A case report].

Intracystic breast carcinoma is a malignant which develops within breast ducts. The clinical examination reveals a breast cyst containing a blood fluid which persists after the puncture. Fine-needle aspiration cytology may be benign. The endocystic mass is detected well by the ultrasound and US-guided puncture is possible. Papillary carcinoma is the most frequent histological type. Conservative prophylactic radiotherapy with surgery can be proposed. Prognosis is poorer with stromal involvement.

Biopsy, Needle↗

PubMed1997

Preoperative color-Doppler assessment of vascularisation of the rectus abdominis: anatomic basis of breast reconstruction with a transverse rectus abdominis myocutaneous flap--a prospective study.

The unipedicled TRAM flap is an useful alternative to breast reconstruction after mastectomy in patients who refuse mammary implants. There is however the risk of unpredictable partial skin necrosis even after rigorous surgical procedures. Certain authors have proposed color flow doppler assessment before reconstructive surgery better to identify the vascular network and optimise patient selection. We performed a prospective study in 20 outpatients in order to compare preoperative assessment of the blood supply to the abdominal flap with the operative findings. An Ultramark 9 HDI (Advanced Technology Laboratories) equipped with a high frequency (10 Mhz) linear probe was used to measure blood flow and vessel caliber in the epigastric a. and perforating vessels (localisation, number; peak flow). Despite three limiting factors (anatomic, technical, morphologic) the results obtained in this series could be used to determine the indications for a TRAM flap.

Female↗

PubMed1997

[Malignant melanoma in a 7-year-old child. A report of a dramatic case].

Malignant melanoma developed on the scalp at the site of a congenital nevus in a 7-year-old girl. At birth, simple observation was proposed, despite the recognized desirable but non-urgent indication for excision, in order to avoid subjecting the infant to general anesthesia. At the first sign of a change in the macroscopic appearance of the nevus, surgical resection was performed, but the short-term outcome was fatal.... This case focuses our attention on malignant progression of even small congenital nevi and emphasizes the need for early preventive and systematic resection even when the patient's age of the patient requires general anesthesia.

Child↗

PubMed1996

Culture and drug biotransformation capacity of adult human keratinocytes from post-mortem skin.

The aim of this study was to analyse viability, growth, differentiation and drug metabolic capacity of cultured human keratinocytes obtained from post-mortem skin. Epidermal cells were prepared from 1-day post-mortem paired sun-exposed (outer) and sun-protected (inner) sites of the upper arm, of donors aged 47-80 years. The percentage of viable cells obtained from post-mortem skin was only slightly lower than that usually obtained for keratinocytes isolated from fresh skin, and no alterations of epidermal markers were noted. Keratinocytes isolated post-mortem from non-exposed skin had a higher viability (78 versus 73%), and a more active proliferation, while their attachment rate, keratin composition, lipid synthesis capacity and transglutaminase activity levels were similar to those of epidermal cells obtained from the sun-exposed skin. Keratinocytes isolated from post-mortem skin expressed various phase I and II activities at levels similar to those obtained with keratinocytes isolated from fresh skin while drug metabolizing enzyme activities were consistently higher in sun-exposed compared to sun-protected cells. The results support the conclusion that skin collected post-mortem can represent an alternative source of viable and functional epidermal cells, and that the functional changes that occur in adult keratinocytes habitually exposed to the sun, affect much more strongly the drug metabolism capacity than the expression of differentiation markers.

Aged↗

PubMed1996

[Use of tissue expansion on defective amputation stumps of the lower limbs. Apropos of 5 cases].

Skin flaps are usually required to cover amputation stumps, especially below the knee. Cross-leg flaps or free flaps can be used when local tissue is insufficient, but as emphasized by Rees in 1986, tissue expansion offers another interesting possibility for local coverage. The risk of complications, especially infection, in below-knee tissue expansion is well known, requiring rigorous patient selection based on an evaluation of skin quality, vascularization, and the patient's metabolic and psychologic status. We used this method in 5 patients (3 females, 2 males; mean age 30.4 years) who had been amputated below (n = 4) and above (n = 1) the knee. In 4 cases, amputation of a healthy limb was required after trauma and in 1 case due to purpura fulminans. Seven tissue expanders were used with slow intermittent expansion applied daily. The mean expansion period was 89.4 days. Mean hospital stay for the two operations was 5.66 and 7.33 days, respectively. Assessed on the basis of subjective and objective criteria, functional outcome was excellent in 3 patients and good in one patient. Failure occurred in one case due to infection. Despite the longer treatment period, tissue expansion for skin coverage of defective amputation stumps appears to have several advantages. It is a simple, reliable and reproducible method with a minimal scar area while preserving skin sensitivity. In addition, the length of the tibial shaft can be spared and minimal modifications are needed to fit the prosthesis.

Adolescent↗

PubMed1994

[Colpoplasty for vaginal aplasia by rectovesical dissection and thin skin graft with adjustable stent. Review of the literature apropos of 4 cases of surgically treated Mayer-Rokitansky-Küster-Hauser syndrome].

The congenital absence of the vagina has a low incidency but it is a very invalidating condition. The Mayer-Rokitansky-Küster-Hauser syndrome represents 90% of all cases of vaginal aplasia. The authors review the anatomical classification, etiopathogenesis, epidemiology, diagnosis and treatment. Between 1981 and 1991, four cases were treated by recto-vesical dissection and split thickness skin graft technique with adjustable stent. The results are good and correspond to those of the literature. Their quality and duration depend on maintaining the stent for a sufficient length of time. Frequent post-operative follow-up is necessary to prevent graft retraction and to give psychological support when it is needed.

Abnormalities, Multiple↗

PubMed1994

[Pectoralis major muscular flap in thoracic substance loss following mediastinitis. Apropos of 7 cases].

Mediastinitis is a rare complication but can occur after any form of cardiac surgery via midline sternotomy. Despite early diagnosis, management in intensive care and appropriate treatment, the prognosis remains severe. Progression towards a chest wall defect, exposing a sternal flap is not uncommon and requires reconstructive surgery because of the potential life-threatening risk. Among the techniques currently used, the authors emphasize the value of pectoralis major myoplasty centered on perforating vessels derived from the internal mammary artery according to the technique described by Nahai in 1982. They have performed this procedure in 7 patients with a high-risk context, always using a single muscle, and also assessed its technical simplicity, low morbidity, absence of obvious functional handicap associated with the aesthetic aspects by means of regular review with a mean follow-up of 18 months.

Cardiac Surgical Procedures↗

PubMed1994

[Breast reconstruction in Poland syndrome. Apropos of 9 cases].

The authors describe their experience of breast reconstruction in Poland's syndrome and analyse 9 cases (eight females, one male) between 1981-1991. The mean age was 25 years (17-53 years). Three women were operated by the Mouly-Dufourmentel surgical procedure: translation of the homolateral latissimus dorsi muscle flap with a mammary prosthesis. The muscle flap was used alone in the male. Mammary prostheses were performed alone in four other women. Breast asymmetry was corrected by mammaplasty alone in one woman. In three cases, in order to achieve optimal symmetry, the controlateral ptosed hypertrophic breast was corrected (two cases in the same procedure, one case later). In three cases, a nipple-areolar restoration was performed at the patient's request. These results are analysed with an average follow-up of 5.4 years (2-11 years) and are compared to the literature data.

Adolescent↗

PubMed1994

[Radiosurgical correlations of 61 breast microcalcification foci].

OBJECTIVE. Diagnostic value of breast clustered microcalcifications discovered by mammography. DESIGN. A retrospective study. SETTING. Oncology Center of Rennes. SUBJECTS. 58 women (study group) with breast clustered microcalcifications without palpable tumour were operated. SURGERY. Prior to surgical removal of microcalcification, needle localization was performed. Histological results. We observed, 36 benign lesions (59%), 25 carcinomas (45%), 10 of them in situ and 15 infiltrative. RESULTS. Different radiological parameters were studied in relation to histological results, the vermicular morphology of microcalcification, an increased number, their triangular aspect, provide clue to the presence of breast carcinoma. The cluster of stippled calcification is not, in our series suggestive of a carcinoma, but also requires histopathological study, owig to the fact that in such cases, we have as many carcinomas as benign lesions. FINDING. Careful analysis of microcalcifications, within the clinical context, ensures a safe attitude, and enables one to operate only carcinomas.

Adult↗

PubMed1994

[Free latissimus dorsi flap revascularized by double venous graft on the femoral trifurcation in the treatment of lumbar radionecrosis. Apropos of 2 cases].

Two patients were operated in 1989 and 1992 for lumbar chronic osteoradionecrosis (toxi-infection collapsus in one of the two cases). Conventional coverage procedures (skin graft, local flaps) or distally based latissimus dorsi musculo-cutaneous flap (second case) were attempted but failed. So we realised in a one stage procedure a free musculo-cutaneous flap in the case no. 1 and a free muscular flap, later skin grafted, in the case no. 2. Venous and arterial bypass were provided by 40 cm long saphenous veins harvested from the thighs, and allowed to reach the lumbar site with proximal anastomosis performed on the femoral artery. The results were considered to be excellent. That short experience shows that long venous bypass with microsurgical free transfer can be safely performed. This results in an extremely high flow shunt.

Adult↗