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Biomedical subjects

M Costagliola

Publications and source records attributed to M Costagliola.

At least 19 recordsLinked to original sources
PubMed1995

[An unusual complication of cervicofacial lift: paralysis of the external branch of the accessory spinal nerve].

Paralysis of the lateral branch of the accessory nerve is an extremely rare lesion during cervico-facial facelift. Based on 3 detailed and published personal cases observed over a period of 15 years, the authors review the literature, revealing a total of 9 cases over a period of 30 years, but other cases have probably not been published. Their review reveals the following points. This is an exceptional lesion. However, the nerve can be damaged as it emerges from the posterior border of the sternocleidomastoid muscle during slightly deep dissection and the electrical scalpel must be used cautiously. Even, partial paralysis of the trapezius muscle induces pain and considerable functional impairment with partial permanent disability. The natural history of this paralysis is very long and may be followed by regression after several years. Although there is an obvious cause-and-effect relationship between the operation and accessory nerve paralysis, it is always difficult to attribute this lesion to a possible surgical error, as the exact mechanism of the nerve lesion remain hypothetical and once again raises the problem of therapeutic risk.

Accessory Nerve Injuries↗
PubMed1994

[Continuous administration of vancomycin in patients with severe burns].

OBJECTIVES: In the severely burned patient, a marked, rapid fall in serum concentrations is often observed after intermittent infusion of vancomycin at the usual dose of 30 mg/kg. This specific "jagged" pharmokinetic course with inadequate residual concentrations raises the problem of the efficacy of this time-dependent antibiotic. Studies in patients in general resuscitation units have shown the interest of vancomycin administration in continuous infusion. METHODS: We analyzed variations in serum concentrations of vancomycin during continuous infusion in 18 patients with burns involving a mean of 40% total body surface and reported the doses necessary to maintain serum vancomycin at therapeutic levels; the possible correlations between serum vancomycin concentrations, burn parameters, age and renal function; and clinical and biological tolerance. RESULTS: Higher initial doses were required in burn patients (40 mg/kg in patients aged under 60) than in other patients. Impairment of renal function is a contra-indication of continuous infusion. CONCLUSION: This mode of administration has the advantage of ensuring greater efficacy by preventing fluctuations in serum concentrations.

Adult↗
PubMed1994

[Merkel cell carcinoma of the skin].

This study reports five cases of Merkel-cell carcinoma of the skin. Then the authors review the present state of the art from the data already available in the literature concerning this malignant primary skin tumor. A part from local excision, no standard procedures are described. The literature provides a lot of discrepancies concerning the additional treatments such as lymph mode excision, radio and chemotherapy. The prognosis of this tumor remains poor because of a high incidence of local recurrence, a frequent spread to regional lymph modes and the development metastases.

Aged↗
PubMed1994

[Difficult diagnosis of a hypervascularized tumor: "angiomatous epulis"].

Based on a case presented by the patient himself, the authors describe the difficult management of a very large, recurrent epulis arising in a context of flat angioma of one half of the face according to a vascular mode. After a brief review of the clinical and aetiopathogenic aspects, the authors discuss the value of complete surgical treatment and raise the question of the possible relation, in this particular case, between angioma and this recurrent so-called angiomatous epulis.

Adult↗
PubMed1994

[Iliac transosseous transposition of rectus abdominis muscle flap to cover a sacral pressure sore].

The use of an inferiorly based rectus abdominis myocutaneous flap to cover a pelvic pressure sore offers a solution when the possibilities of other local flaps have been exhausted. For sacral pressure sores, the iliac bone is an obstacle for the transposition of this flap. In this case report, we describe how this obstacle can be overcome by creating a trans-osseous tunnel in the ala of the iliac bone through which the flap takes the most direct route to the recepient site.

Adult↗
PubMed1994

[Launois Bensaude disease. Focus apropos of 16 cases].

After a review of the clinical, pathological and aetiological features, the authors describe the various surgical techniques used (conventional surgery or liposuction) to restore a normal social life to these patients, deformed by their disease. They confirm the predominant role of conventional surgery and define the limited indications in which liposuction can be used. Based on a review of 16 cases, the surgeon must make sure that the patient has ceased his or her alcohol abuse before performing this difficult treatment associated with a number of complications.

Alcoholism↗
PubMed1993

[Esthetic reconstruction of the face in burnt patients].

All reconstruction should be aesthetic but in burned patient, everything combines to make a cosmetically satisfactory result more difficult to achieve. However the burns patients, deformed and disfigured has to confront the gaze of others in daily life. Three points are discussed by authors: skin quality can be improved or replaced by a full thickness pressure graft; surgical modification of the underlying structures; repair of peri-orificial areas and free edges.

Adult↗
PubMed1992

Primary pressure grafts in early reconstruction of deep facial burns.

The face is an area of great cosmetic importance where the repair of deep burns is particularly delicate, as both appearance and function must be taken into account. In order to improve the aesthetic prognosis of full skin thickness facial burns, a primary pressure graft technique was used in eight patients. Early excision was carried out during postburn day 3 and after good-quality granulation tissue was obtained around day 10, a full skin thickness graft was applied. Pressure was applied to the graft and maintained for 10 days. The grafts took successfully in all patients with very satisfactory cosmetic results. This is an original technique as it replaces burned tissue at a very early stage with tissue which is normal in thickness and quality.

Burns↗
PubMed1991

[Sagittal rhinoplasty for broad noses].

Normal profile wide noses, without osteo-cartilaginous bump, are rare and very few cases have been described in the literature, to our knowledge. Based on a short experience of 4 cases, we describe a surgical variant of the classic rhinoplasty technique. The resection of two osteo-cartilaginous symmetrical quadrilaterals resolves this specific problem with no risk of profile modification with sagging and necessity of reinclusion.

Esthetics↗
PubMed1991

[Use of frequency doubled Nd-YAG laser and automatic scanning in the treatment of portwine hemangioma].

The authors report their experience in the treatment of portwine stains by means of two recent improvements. The first improvement concerns the use of frequency doubled Nd-YAG laser which emits at 532 nanometres. This wave-length corresponds to an absorption peak of haemoglobin and is therefore more selectively absorbed by haemangiomatous tissue. This helps to explain the better clinical results obtained and the elimination of the other effects classically induced by argon laser, with complete preservation of the healthy, non-angiomatous skin as well as skin and scalp hair. Treatment is consequently facilitated, as illustrated by a series of 79 patients who received a total of 92 treatment sessions over a period of 14 months. The second improvement consists of the addition of an automat which allows the beam to be used continuously with scanning of adjacent bands. This automat not only allows a very homogeneous treatment by eliminating all of the errors associated with manual scanning, but can also be used to treat large portwine stains in a single session instead of the multiple sessions required previously. An interval of 5 to 6 months should be respected before treating the residual part of the portwine stain situated more deeply in the dermis, which should be considered to be a new portwine stain. The combination of these two apparatuses allows fluences (fluence is the product of the power selected by the exposure time per unit area) of only 8 to 15 joules/cm2 due to the dynamics of the treatment in contrast with other static modalities which require higher fluences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[The inframammary fold: myth or reality?].

Is the inframammary fold an anatomical entity? In order to answer this question, the authors conducted an anatomical, histological and radiological study. The results of these studies were concordant and were able to anatomically define the inframammary fold. The inframammary fold corresponds to a division of the fascia superficialis. It contains numerous fibres stretched between the fascia superficialis and the fascia prepectoralis. In contrast, there are no fibres connecting the fascia superficialis to the deep dermis.

Adult↗
PubMed1991

[Degeneration of scars. Apropos of 14 cases].

The authors report 14 cases of scar carcinomas, arising in different types of scars, over a 5-year period. The histological type of tumour was squamous cell carcinoma. The different sites of occurrence, from those of spontaneous skin neoplasms reflect their different pathogenesis. The diagnosis must be made early, before lymph node involvement, which is the most significant prognostic factor. Treatment should be first prophylactic to ensure good quality healing. Once the tumour has appeared, only aggressive wide excision provides a hope of cure.

Adult↗
PubMed1991

[Failure and problems: apropos of a cranioplasty].

The authors report a case of post-traumatic cranioplasty associated with various complications. They stress the difficulties in managing this type of reconstruction when a vast cerebral defect is associated with ventriculo-peritoneal by-pass.

Craniocerebral Trauma↗
PubMed1990

[Development of jurisprudence concerning the medical contract in esthetic surgery].

The authors report a study of 60 years of French Jurisprudence in relation to the medical contract in cosmetic surgery. Although the obligation can only be in the form of means in the case of surgery of living tissues, a special obligation nevertheless applies when the operation is not performed as a therapeutic procedure but at the patient's wishes. It is an obligation of caution and diligence, respecting the role of proportionality in the indications and the means applied to obtain the desired objective and the safety of the patient. The application of these means will be judged by the magistrate more severely than in therapeutic surgery. A certain degree of laxity in the investigation of a causal relationship in civil law has led to the use of the concept of decreased chance of survival for the compensation of victims of serious complications occurring during cosmetic surgical operations.

France↗