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Biomedical subjects

L Beguin

Publications and source records attributed to L Beguin.

6 recordsLinked to original sources
PubMed2001

[Plaque variant of trichoblastic fibroma].

BACKGROUND: Tricoblastic fibroma is a rare benign skin tumor originating in the hair follicle. There are two clinical presentations: nodular and plaque variants. The plaque variant is almost exclusively located on the face with deep tissue infiltration. CASE REPORT: A 38-year-old man presented with a 2 cm diameter cutaneous plaque located on the right cheek. It had first been noted by the patient 3 years earlier and had enlarged slowly. On examination, the plaque was well defined, yellowish and slightly indurated. The first clinical diagnosis was basal cell carcinoma and the plaque was removed. Histology provided the diagnosis of trichoblastic fibroma. The patient remains well, with no evidence of recurrence, 10 months after excision. DISCUSSION: Trichoblastoma is an inclusive term for all benign cutaneous neoplasms that are mostly composed of follicular germinative cells. According to Altman, the plaque variant of trichoblastic fibroma is a poorly circumscribed neoplasm, particularly at its lateral and deep margins. This author also states that mitotic figures are more numerous in the plaque variant of trichoblastic fibroma and considers this clinical variant as a low-grade follicular malignancy.

Adult↗
PubMed2001

[Unstable pelvic ring fracture: osteosynthesis of the posterior lesion by percutaneous sacroiliac fixation].

PURPOSE OF THE STUDY: We report our experience with percutaneous sacroiliac screwing for unstable pelvic ring fracture. MATERIAL AND METHODS: Twenty unstable pelvic ring fractures with sacroiliac disjunction (9 cases), trans-sacral fracture (9 cases), or bilateral posterior fractures (5 cases) were managed with percutaneous sacroiliac fixation using 1 or 2 screws. There was also pubic disjunction in 7 cases, managed by osteosynthesis in 5 cases. No fixation of fractures of one or both of the obturator rings, present in 13 cases, was attempted. The posterior screwing was performed under fluoroscopic guidance in 15 cases and computed tomographic guidance in 5. RESULTS: There were no infectious or neurological complications. Radiographically, anatomic reduction of the posterior fracture was achieved in 10 cases. A vertical ascension persisted in 4 patients and a rotation in 6. Radiographic results were correlated with delay to surgery: correction of the vertical displacement was achieved in 80% of the patients operated before five days and in 55% of the others. Two patients experienced a secondary displacement. There was no cases of nonunion of either the anterior or posterior fracture. Follow-up was available for 14 patients (2 patients died and follow-up was too short for 4). The mean Majeed score was 92/100 and none of the patients experienced anterior pain. Three patients had moderate pain in the sacroiliac area. DISCUSSION: The ventral position appears to be best adapted for percutaneous sacroiliac screwing but can be contraindicated by concomitant lesions. We prefer fluoroscopic guidance for these emergency procedures. Two views, ascending and descending, appear sufficient. The better stability provided by two screws can be achieved under computed tomographic guidance without risk of neurovascular damage. CONCLUSION: Percutaneous sacroiliac screwing is a good management strategy for unstable pelvic ring fractures with little risk of morbidity.

Activities of Daily Living↗
PubMed2001

[Vascular risk and total hip arthroplasty].

PURPOSE OF THE STUDY: Though exceptional, there is a real risk of vascular complications during total hip arthroplasty procedures. The gravity of these iatrogenic accidents results from their high mortality (7%) and possible functional sequelae (19%). MATERIAL AND METHOD: We report a retrospective multicenter study of 14 vascular complications, six of which occurred during revision surgery for total hip arthroplasty. We assessed risk factors and identified situations of major risk related to acetabular revision: intrapelvic dislocation, protrusion with no bony barrier, and presence of intrapelvic foreign bodies. We advocate the retroperitoneal approach for acetabular revision in case of intrapelvic dislocation or anomalous vessel size or trajectory on the preoperative arteriography. This approach allows ablation of the implants under visual control of the iliac vessels. RESULTS AND DISCUSSION: A careful preoperative work-up is essential to avoid arterial or venous injury. A perfect knowledge of the vessel trajectories and their projection on the acetabulum is crucial. Indeed, such vascular complications are never expected and transform a well-programmed functional procedure into an emergency procedure with the inherent risks. We recall that such accidents may be expressed well after closing and the importance of careful surveillance before, during and after the surgical procedure.

Aged↗
PubMed2001

[Iliopsoas impingement in 12 patients with a total hip arthroplasty].

PURPOSE OF THE STUDY: We report 12 cases of iliopsoas impingement, an under-recognized cause of hip pain in total hip arthroplasty patients. MATERIAL AND METHODS: Between January 1998 and October 2000, we diagnosed 12 cases of iliopsoas impingement among 280 total hip arthroplasty patients with hip pain (4.3%). Our population was composed of 9 women and 3 men aged 62 to 80 years (mean 72 years). Nine patients had a first intention arthroplasty and 3 had a revision prosthesis. Delay from implantation to diagnosis of impingement ranged from 6 months to 5 years. Common cases of pain after hip arthroplasty, infection, loosening, were ruled out in all cases. A standard x-ray series including an AP view of the pelvis, an AP view of the hip and a surgical false-lateral view of the hip as well as a CT scan were obtained when iliopsoas impingement was suspected. The CT series extended from the lower part of the acetabulum through the fixation screws. RESULTS: Pain had been observed immediately after implantation in 10 cases (83%) and in 2 cases (17%) 3 to 5 years later. These patients did not have to use crutches when pain started to develop. Pain projected anteriorly and was always exaggerated when moving from the sitting position to the upright position and when going up stairs. In one patient, palpation revealed a mass in the groin that corresponded to a massive iliopsoas bursitis. Two non-pathognomonic physical signs were found in all cases: groin pain induced by active flexion against force in the lateral reclining position and at hip extension, and pain in the dorsal reclining position at deflexion of the hip, starting at 45 degrees. The standard AP views showed evidence of defective anteversion of 4 press fit cups, 1 off-centered screwed cup and 3 oversized cups. The CT scan demonstrated that the impingement involved the anterior border of the cup applied against the iliopsoas tendon in 8 cases either due to anterior uncovering in a dysplasic hip or anterior cup overhang. In 4 cases the cup fixation screws protruded anteriorly in front of the ilion and came in contact with the posterior aspect of the iliopsoas muscle. A bursitis had developed in 50% of the cases. DISCUSSION: When infection and loosening have been ruled out, hip pain after total hip arthroplasty would suggest a possible impingement of the acetebular component on the iliopsoas muscle due to defective anteversion or centering, the use of oversized cups, and/or the use of fixation screws. We emphasize the importance of a correct position for the cup to avoid an overhanging anterior border and discuss the use of screwed cups for primary total hip arthroplasty and of oversized cups for revision procedures.

Aged↗
PubMed1986

Plasma exchange: an important part of the therapeutic procedure in a small child with autoimmune hemolytic anemia.

The case history of a child with autoimmune hemolytic anemia with complement activating warm antibodies of the pdl type is presented. This child also had giant cell hepatitis. Although plasma exchange is not curative in such a patient, the removal of antibodies and bilirubin by means of plasma exchange has alleviated the patient's condition on two occasions (at age 19 and 33 months respectively), and has permitted the institution of effective immunosuppression. A technique for plasma exchange is described, which by use of plasma filters and the usual hemodialysis equipment allows to safely perform the procedure in any pediatric hemodialysis unit. Its use in this patient stresses the technical practicability even in very young children. It is suggested that plasma exchange, if indicated, should be considered more often as part of a therapeutic concept.

Anemia, Hemolytic, Autoimmune↗