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Biomedical subjects

J M Prades

Publications and source records attributed to J M Prades.

At least 19 recordsLinked to original sources
PubMed1992

[Anatomical limits of endonasal ethmoidectomy].

Constant anatomic boundaries of the lateral mass of the ethnoid are described, based on data from microdissections, endoscopic examinations, computed tomography imaging and histology in 12 subjects. As with surgical progression, identification of these boundaries follows the lateral orbital and superior craniofrontal surfaces. The "starred groove formation", ethmoidal roof lamina and ethmoidosphenoidal recesses are the safety beacons for endonasal ethmoidectomy under endoscopic control.

Endoscopy↗
PubMed1992

[Endoscopic extraction of a foreign body from the distal bronchus in the middle lobe, inaccessible by usual techniques, in a 3-year old child].

The authors report on the extraction of a piece of peanut impacted into the antero-internal bronchus of the right middle lobe, inaccesible to rigid bronchoscopy. After 4 months, this foreign body was visualised by flexible endoscope and removed by this technique under general anesthesia. We initially used a brush to pull the foreign body out of the distal bronchus and then used a biopsy forceps to remove it. Three months later, the chest-X-ray is normal and the child is asymptomatic.

Arachis↗
PubMed1991

[Facial motricity of trigeminal origin. Apropos of a typical case and review of the literature].

The authors report the case of a patient who underwent the neurosurgical exeresis of an acoustic neuroma 14 years ago, and subsequently presented with a total facial palsy in spite of a spinofacial anastomosis. This patient had to be reoperated because of tumoral recurrence compressing the trigeminal nerve (V). This operation, through atranslabyrinthic that also emptied the entire internal auditory canal of its neural elements, allowed removing the neuroma. Once the facial nerve had been resected, the patient recovered some facial motricity and his masticatory function improved on the day following the operation. Since the contralateral facial nerve was not involved and the spinofacial anastomosis was absolutely not functional, only motor reinnervation from the trigeminal nerve was possible. The anatomy of the facial and trigeminal nerves in summarized, and their central connexions and peripheral anastomoses are studied. Out of the 27 cases of spontaneous motor reinnervation following the resection of the facial nerve described in the literature, only one similar case of recovery of motricity after a major nerve resection in the cerebellopontine angle is reported. Such a phenomenon can be explained only by the transformation of some sensory fibers of the 5th cranial nerve into motor fibers, which are activated by the resection of the 7th nerve and receive their nervous influx from the motor nucleus of the 5th or 7th nerve through protuberantial communications.

Facial Nerve↗
PubMed1991

[Diagnostic and surgical strategy in sporadic primary hyperparathyroidism].

The generalized use of phosphocalcic biological assays makes the discovery of sporadic primary hyperparathyroidism increasingly common. In 1989-1990, first-intention surgery was performed in 26 female patients. In all cases, an exploratory cervicotomy under cervical peridural anesthesia allowed discovering and treating a parathyroid lesion: adenoma, asymmetric or symmetric hyperplasia, cancer. We discuss: the circumstances of the clinical diagnosis and the biological criteria, the timeliness of preoperative radiological assessment, the surgical strategy advocated. In more than 90% of all cases, a cervicotomy for the exploration of all areas of parathyroid migration should allow curing primary hyperparathyroidism.

Adenoma↗
PubMed1991

[Menière's disease. A psychosomatic disease?].

Although psychosomatic aspects of Meniere's disease have already been pointed out by some authors, few papers have been publisched on this question. 48 patients suffering from Meniere's disease underwent in addition of a complete audiological examination a psychosomatic study using two psychometric auto evaluation tests. It appears that patients suffering from Meniere's disease have a significantly different psychopathologic personality than normals (anxiety, depressive tendency, phobia). Besides, an obvious correlation is found between deafness, vertigo's recurrences and psychopathological disorders. These findings must be taken into consideration to treat patients suffering from Meniere'es disease.

Ambulatory Care↗
PubMed1991

[Apparently primary cerebrospinal rhinorrhea. Apropos of 4 cases].

While rhino-liquorrhea is a severe condition, its incidence is not exceptionally rare, and it raises problems, namely etiopathogenic, diagnostic and therapeutical ones, which call for the close collaboration of ENT doctors, neuroradiologists and neurosurgeons. 4 relatively recent cases are reported here, whereby the diversity of the problems encountered is made apparent. ENT specialists must be aware of those when faced with refractory aqueous rhinorrhea, often triggered by forward head motion, Valsalva's maneuver... Screening for rhinorrhea is readily achieved by biochemical tests, or simply using a Labstix-type diagnostic strip. Rhinoscopic examination should be accurate and carried out optically to check for any congenital malformation (meningocele). Most of the times, but not always, a thorough radio-neurological workup (isotopic analysis, CT-scan with contrast medium, MR imaging) will provide precise data regarding the infraction site and its possible cause, invariably warranting surgical management. Surgery should be case-adapted (CSF derivation, filling of the gap via the extra- or intracranial approach).

Adolescent↗
PubMed1990

[Psychologic factor in Menière's disease].

Although a number of authors have evoked a psychosomatic etiology for Ménière's disease, few works have dealt specifically with this subject. Forty-eight patients with authentic Ménière's disease underwent a series of psychometric self-evaluation determinations, in addition to a complete, repeated ENT examination. The first questionnaire, the SCL 90, explored the psychological profile. The second questionnaire, the QD 2 A, explored the depressive tendency. This study clearly showed that patients with Ménière's disease present a psychopathological profile which significantly differs to that of a reference population, particularly in terms of level of anxiety, depressive tendency and phobia. The latter points are of real practical importance, since they imply that improvements in Ménière's disease call for treatment of the phobic component in addition to the anxious-depressive component. Finally, there is an obvious correlation between the extent of hearing loss, in turn related to the frequency of vertigo attacks, and the severity of psychopathological disorders.

Adult↗
PubMed1990

[Pre-treatment serum levels of SCC antigen in epidermoid carcinoma of the upper respiratory and digestive tract].

Results from pre-treatment SCC antigen assay were assessed in 106 patients with epidermoid carcinoma of the upper aerodigestive ways. The control population consisted of healthy blood donors (N = 61). Blood antigen levels ranged 1.6 ng/ml to 21.5 ng/ml in the patient population. 35 patients in 106 (i.e., 33% of cases) had levels considered pathological (greater than 2.00 ng/ml). Antigen levels were higher with increasing tumor size and when adenopathy was more marked (N+, N+R+). However, no correlation could be found with the T (stage)--N (histological) classification of tumors or with the site of lesion. Tumor immunologic response was obviously not uniform. Although the SCC antigen presents no diagnostic value, it appears to bear some prognostic significance, regardless of the tumoral stage. Antigen levels below 2.00 ng/ml correlate with (p less than 0.001) good immediate therapeutical results. On the other hand, serum levels greater than 2.00 ng/ml correlate either with non-sterilization, or with locoregional recurrence and/or rapid development of metastases. Other studies are required to confirm these data, and to demonstrate the value of long-term SCC antigen monitoring in these patients.

Adult↗
PubMed1989

[Endoscopy and cophosurgery].

Certain fixed adherent retraction pockets especially in the posterior aspect of the tympanic cavity and certain cholesteatomas are difficult to treat even after a posterior tympanotomy has been performed. Using 70 degrees and especially 30 degrees optical systems can be of great value as the lesions can be perfectly visualised and endoscopic copho-surgery itself can even be carried out. Study of 27 cases of fixed retraction pockets and 14 cholesteatomas which underwent microscopic surgery but with optical verification of the operative cavity demonstrated the value of this technique. The safety of the method even allows the exclusive use of the endaural route in cases which have up to now required a posterior approach and posterior tympanotomy.

Cholesteatoma↗
PubMed1989

[Cholesteatoma and labyrinthine fistula].

43 cases of large labyrinthic fistulas caused by a cholesteatoma of the middle ear were studied (33 External Semi-circular Canal fistulas, 4 External Semi-circular Canal amputations with opening of the vestibule, 3 of the promontory, 2 of the oval window, 1 of the Semi-circular Canal). The audiometric, preoperative, radiological data was analyzed. The radiological exam is often disappointing for the average-sized fistulas. Preoperative labyrinthization is moderate for External Semi-circular Canal fistulas and even for certain vestibular amputations; it is often incomplete in the other locations. Systematic exeresis of the cholesteatoma matrix is recommended by the authors, at least for the External Semi-circular Canal fistulas as it is not generally accompanied by aggravation of the bony curve. In the other locations, surprising auditory preservations were observed. In conclusion, the presence of External Semi-circular Canal fistulas should not be a counter-indication for carrying out a ossiculoplasty.

Cholesteatoma↗
PubMed1989

[Peroperative radiotherapy and cancer of the base of tongue. Technic, indications and preliminary results].

This study involved 15 patients suffering from large volume squamous carcinomas of the base of the tongue, who were likely to benefit from curative therapy (tumours graded T3, T4, N0, N1, N2, TNM UICC 1987). In 13 patients, treatment included transmaxillary bucco-pharyngectomy (TMBP) carried out either as first intention (10 cases), or as a second stage procedure after radiotherapy (3 cases). 2 patients underwent total laryngectomy with secondary basi-glossectomy. Per-operative radiotherapy was performed on the basi-lingual resection site, delivering a boost of 15 to 20 Gy using adapted localisers. A pectoralis major musculo-cutaneous flap procedure was carried out for the TMBP. Post-operative external radiotherapy to the tumour zone for patients treated as first intention was limited to 50 Gy with a boost of 15 Gy to the cervical lymphatic clearance wound in the event of capsular rupture. The aim of this method was to deliver an elective basi-lingual boost allowing better loco-regional control, while reducing the complications of high dose external oro-pharyngeal irradiation. The technique (reliability-tolerance) and the preliminary results are presented.

Adult↗
PubMed1989

[Deafness surgery in adults. The growing role of improved local anesthesia].

As deafness surgery is subject to the two imperatives of safety and reduction of bleeding, local anaesthesia constitutes a very satisfactory solution. The concomitant administration of Midazolam and Buprenorphine relaxes the patient and ensures analgesia and anterograde amnesia, allowing the surgeon to operate under excellent conditions. Over the last 6 months, except in one subject under the age of 16 years and one psychologically very fragile patient, all surgical operations for deafness, regardless of their importance, have been performed under local anaesthesia improved by means of diazanalgesia. It is probable that in the future, numerous cophosurgeons will adopt a similar protocol.

Adolescent↗
PubMed1987

[Locoregional anesthesia by peri-dural route in neck surgery].

Principal anatomical "targets" and physiological consequences of cervical epidural anesthesia are outlined, technic and aims of the method discussed and 53 patients (class ASA I and II) receiving major cervical surgery, mainly for cancer, reviewed. Effectiveness of cervical epidural anesthesia was rated as excellent for total pharyngo-laryngectomy, with or without flaps, total laryngectomy, lymph node curettage and thyroidectomy, moderate for reconstructive laryngectomy and only fair for transmaxillary buccopharyngectomy. Advantages of the method concern principally the postoperative period: immediate awakening (92% of cases) in the operating room whatever the duration of surgery, avoiding intensive care, and pain relief for at least 48 hours (85% of cases) by maintenance of catheter. Contraindications include hypocoagulability, local or general infection and impossibility of adjusting heart rate, and the method is not applicable for all patients in whom general anesthesia with assisted ventilation is contraindicated.

Adult↗
PubMed1987

[Severe laryngeal dysplasia and synthetic retinoids].

Nine patients with "severe" laryngeal dysplasia as shown by multiple microbiopsies during laryngoscopy were treated with a synthetic derivative of retinol (Etretinate 0.5 to 1 mg/kg/day) over one or two months. Follow up histology after 8 to 18 months surveillance showed histologic improvement with respect to dyskeratosis, atypical cells and to a lesser extent epithelial hyperplasia. The use of synthetic vitamin A derivatives for "severe" laryngeal dysplasia is discussed.

Adult↗
PubMed1987

[Reconstructive laryngectomies. Technical and functional aspects].

Technical aspects are described of the reconstructive laryngectomy used between 1982 and 1986 to treat 59 patients with endolaryngeal epidermoid carcinoma. Both "conservative" techniques (Tücker's laryngectomy, total endolaryngeal functional evidement) and "non-conservative" techniques (cricohyoidopexy, cricohyoidoepiglottopexy, cricobasiglossopexy) as well as their functional outcome are described. Results of surgical review of endolaryngeal spaces (paraglottic space, hyothyroepiglottic space) are analyzed for each method, and a schema for their use proposed.

Adult↗