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Biomedical subjects

M Freidel

Publications and source records attributed to M Freidel.

At least 19 recordsLinked to original sources
PubMed2007

[Oxcarbazepine in the treatment of epilepsy].

BACKGROUND: Oxcarbazepine (OXC; Timox) is a new antiepileptic drug (AED) chemically related to carbamazepine (CBZ), with comparable efficacy but superior safety according to controlled clinical trials. In a prospective, post-marketing surveillance (PMS) study the efficacy and tolerability of OXC were investigated under conditions of daily routine practice. METHODS: The treatment of 1385 male and female epilepsy patients aged between 1 month and 94 years, who were newly stabilized on OXC or changed over from another AED, was documented in 362 centers over a period of 8 weeks. Efficacy and tolerability were assessed by documenting the frequency of seizures and adverse drug reactions (ADRs) and by global efficacy and tolerability ratings obtained from the patients and investigators. RESULTS: Before the PMS study, 688/1335 patients (49.7 %) had received pre-treatment with CBZ, 342 (24.7 %) had received another AED and 335 (25.6 %) had had no AED pre-treatment (initial OXC monotherapy). In 161 patients pre-treated with CBZ (23,4 % of 688) an immediate (overnight) switch to OXC was performed while most others were switched during a titration phase. Of the patients with CBZ pre-treatment 21 % were switched to OXC at the recommended dose ratio of 1 : 1.4 - 1 : 1.6 (CBZ : OXC) while roughly 60 % were changed to OXC with a lower ratio. In the total sample the median OXC maintenance dose was 900 mg/day. During treatment with OXC the frequency of seizures per 4 weeks decreased by an average of 76 % in comparison to a retrospective pre-phase. 74 % of the patients showed an improved seizure situation, and 40.5 % became seizure-free under OXC (patients with initial monotherapy became seizure-free in 62 % of the cases). 71 % of the patients showed a reduction of their seizure frequency versus baseline by > or = 50 %. ADRs were reported in 10,8 % of the participants (incidence: 1 in 459 days of exposition to OXC; overnight switching from CBZ to OXC: 1 event in 1284 days). Only 2.5 % of the patients terminated OXC administration due to ADRs while 92 % continued treatment with OXC beyond the end of the study. CONCLUSIONS: The results underline the high antiepileptic efficacy and good tolerability of OXC previously demonstrated in controlled clinical trials. When changing from CBZ to OXC, immediate (overnight) switching showed particularly favorable results.

Adolescent↗
PubMed2005

[Grave's ophthalmopathy: therapeutic strategy. Review of 30 patients].

BACKGROUND: Graves' ophthalmopathy is the primary etiology for exophthalmos in adults. It is a complex orbital disease whose pathophysiology remains controversial. Since its initial description more than 150 years ago, its heterogeneous clinical manifestations and poorly understood links with thyroid pathology remain unresolved issues. Disease activity is the main determinant for the management of Graves' ophthalmopathy, but treatments are often symptomatic, aiming at decreasing orbital inflammation. MATERIAL AND METHODS: We report a retrospective analysis of 30 patients diagnosed with Graves' ophthalmopathy followed in our department between 1991 and 2002. Following a phase of medical management of their disease, all patients underwent surgical orbital decompression. RESULTS: Medical and surgical care provided as well as results are presented with a mean follow-up of 23 months. DISCUSSION: Based on our clinical experience, new concepts in the field of Graves' ophthalmopathy are discussed. Disease activity, evaluated through various means, appears to be the primary guide for therapeutic management. Moreover, the importance of a multidisciplinary approach is highlighted, in order to improve the management of this difficult disorder.

Adult↗
PubMed2005

[Orbital decompression for Graves' ophthalmopathy].

Graves' ophthalmopathy is a complex orbital condition with a controversial pathogenesis. It is the clinical expression of a discordance between the inextensible orbit and hypertrophic muscular and fatty elements within the orbit responding to immunological stimulation. The relationship between the orbital and its content can be improved by surgical expansion which increases the useful volume of the orbit. This procedure can be combined with lipectomy to decrease the volume of the orbital contents. We briefly recall the history of surgical decompression techniques and present our experience with Graves' ophthalmopathy patients.

Decompression, Surgical↗
PubMed2005

[Free fibular flaps in children: morbidity of the donor site and pitfalls to avoid].

INTRODUCTION: We report a case of donor site morbidity late after harvesting a free fibular flap for reconstruction of the mandibular symphsis. CASE REPORT: An 8-year-old boy presented a valgus deformity of the ankle 4 years harvesting of a vascularized fibular graft for mandibular reconstruction. The deformation was repaired with a tibial bone slit and pin fixation. The biomechanical result was very satisfactory, allowing normal gait. DISCUSSION: We recall the rules for fibular flap harvesting needed to prevent deformation of the donor site in children aged less than 9 years.

Bone Transplantation↗
PubMed2005

[Growth defects of fibular flaps in children].

BACKGROUND: Mandibular reconstruction with fibula free flap is a challenge in pediatric patients because of the size of the bone and absence of growth without epiphyseal transplantation. CASE REPORT: We report 2 cases of free fibula flap in children for mandibular reconstruction. The 2 patients presented with growth insufficiency of the bone graft after few years of evolution. DISCUSSION: Growth insufficiency was treated with different surgical procedures which were discussed We review the consequences on growth after fibula free flap and the specific indications to achieve epiphyseal fibular growth in children.

Bone Diseases, Developmental↗
PubMed2004

[Severe Class III malocclusion: long-term stability. Retrospective analysis of 12 cases].

PURPOSE: Long-term stability of severe class III is rarely evaluated in the literature. We present our findings with 12 patients who underwent surgery from June 1995 to December 1997 and analyze cephalometric superpositions. MATERIALS AND METHODS: Twelve operated patients were reviewed to analyze long-term results (follow-up 3 years 8 months). The sex ratio was well balanced. Mean age was 23 years. All patients were given pre- and postoperative orthodontic care and underwent bimaxillary surgery with Lefort 1 osteotomy and sagittal osteotomy of the rami. Delaire cephalometry on preoperative and early and late postoperative films was used to analyze outcome. Skeletal instability was defined as displacement greater than 4 mm. Recurrence was defined as secondary loss of the functional and esthetic result. RESULTS: Four patients (33%) developed skeletal instability. All patients achieved long-term stability. DISCUSSION: To detail the cause of skeletal instability, study of the principal factors of instability is presented together with a discussion of data in the literature.

Adolescent↗
PubMed2004

[Vascularized osseous flaps for mandibular reconstruction after osteoradionecrosis].

INTRODUCTION: The reconstruction of mandibular continuity destroyed by osteoradionecrosis can be a difficult task. The aim of this study was to evaluate the reliability and contribution of vascular osseous flaps for mandibular reconstruction after osteoradionecrosis. MATERIAL AND METHOD: A retrospective study of patients undergoing mandibular reconstruction after osteoradionecrosis between 1989 and 2002 was performed. Twenty-five mandibular reconstructions were performed in 23 patients: 16 fibular free flaps, 5 osteomuscular serrato-costal free flaps, 1 osteocutaneous external brachial free flap, 1 medial femoral condylar free flap and 2 armed pectoralis major pediculed flaps. RESULTS: We observed two major complications (8%): loss of one fibular flap and one medial femoral condylar free flap. We observed 42% minor complications. Overall quality of life was constantly enhanced. DISCUSSION: Fibular flap is definitely a good method for immediate or secondary mandibular reconstruction. A serratocostal flap must be considered as an alternative flap when the fibular flap is unavailable.

Adult↗
PubMed2004

[Focus on the effect of orthognathic surgery on condylar remodeling].

Condylar remodeling is a physiologic process that aims to adapt the structure of the temporo-mandibular joint (TMJ) to meet the functional demands. It is based on an interaction between the mechanical forces sustained by the TMJ and the adaptative capacities of the condyle. Orthognathic surgery can sometimes be responsible for an excessive physical stress to the articular surfaces. In these cases, normal functional condylar remodelling shifts to the process of progressive condylar resorption. Effect of orthognathic surgery on condylar remodeling is a poorly understood and controversial issue. It is however considered as an etiology of postoperative skeletal relapse following orthognathic surgery. Based on two case reports, etiopathogenic hypotheses of this process are discussed as well as predisposing factors to condylar resorption following orthognathic surgery.

Adaptation, Physiological↗
PubMed2003

[Protocol for adapting treatment with vitamin K antagonists before dental extraction].

BACKGROUND: The purpose of this study was to validate a protocol for dental extraction in patients taking vitamin K antagonists without changing the treatment when the INR is lower than 2.8. MATERIAL AND METHODS: One hundred four extractions (96 patients) were performed during a 9 month period in patients taking vitamin K antagonists. Extraction was performed when the international normalized ratio (INR) was less than 2.8, otherwise, the treatment was modified until the desired INR was reached. Extractions were performed under para-apical and alveolar local anesthesia and sutured with hemostatic gauze. RESULTS: Three patients developed postoperative bleeding requiring alveolar revision with local application of tranexamic acid and in one case use of a biological glue. DISCUSSION: The following protocol can be proposed: ambulatory extraction under local anesthesia with an INR the day before extraction: the extraction is performed if the INR is<=2.8 using hemostatic gauze suture and tranexamic acid in case of persistent bleeding.

Adolescent↗
PubMed2003

[Brain abscess and diffuse cervico-facial cellulitis: complication after mandibular third molar extraction].

The authors report a case of cervico-facial cellulitis with brain abscess after mandibular third molar removal. This is the observation of a 26 years old boy surgically treated for a cervico-facial cellulitis ten days after a third molar's removal. He was given anti-inflammatory drugs after removal for analgesia. After a phase of clinical improving, the patient developed pulmonary and brain abscess with neurological signs. He needed neurosurgery in emergency. After eight weeks of antibiotic treatment, the patient was cured with aftereffects (jaw constriction and sensory disorders of the right thigh). Cerebro-meningeal complications of diffuse cervico-facial cellulitis are exceptional but are responsible for heavy aftereffects. This observation confirms that using anti-inflammatory drugs for analgesia is associated with a higher rate of complications after dental removal.

Adult↗
PubMed2003

[Results of an evaluation of clinical practice in orthognathic surgery in France in 2002].

BACKGROUND: Over the years, orthognathic surgery has become a mainstay of maxillofacial surgery and is the object of many publications and oral communications. However, in spite of well-established methodology, disparities still exist in France basically concerning the way orthognathic surgery is performed. MATERIALS AND METHODS: In relation with the XXXIXth congress of Stomatology and Maxillofacial surgery, a questionnaire was mailed to 100 French maxillofacial surgeons. Questions dealing with some practical points of orthognathic surgery (condylar positioning, osteosynthesis technique, rate of condylar resorption.) were asked. RESULTS: Overall reply rate was 37%. Condylar positioning was performed empirically in 73% of the cases. Mandibular osteosynthesis was achieved by titanium miniplates alone in 70%. Post-operative condylar resorption rate was about 2%. This survey produced numerous astute comments. DISCUSSION: This survey highlighted the interest of maxillofacial surgeons for practical aspects of orthognathic surgery including the questions of condylar positioning or osteosynthesis technique. These points are instrumental in achieving high-quality surgical result.

Bone Plates↗
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↗
PubMed2002

[The retromolar area, an alternative for the mandibular symphisis graft in implant surgery: quantitative and qualitative analysis of 52 samples].

BACKGROUND: We conducted an comparative anatomy study of two sites for harvesting bone grafts for implant surgery: the mandibular symphysis and the ramus area. MATERIAL AND METHOD: Fifty-two anatomical specimens were studied (34 from the retormolar region and 18 from the symphysis region. Measurement were: size, weight, bone volume, bone density, cortical/cancellous ratio. RESULTS: Samples from the two sites gave equivalent results. DISCUSSION: We describe the harvesting method and the difficulties encountered at each site. The retromolar site appears to be an attractive alternative to the symphysis region for bone graft harvesting.

Bone Density↗
PubMed2001

[Perioperative medical complications in orthognathic surgery].

PURPOSE: To describe per and postoperative medical complications. STUDY DESIGN: Prospective, observational study. PATIENTS: Between July and December 1999, 59 patients scheduled for programmed orthognathic surgery were included. METHODS: Anaesthetic and surgical procedures were standardised including patient information and training of surgical ward' nurses. During perioperative periods (in operative and recovery theater and in surgical ward), all the events were qualified on an anaesthetic spreadsheet for a qualitative analysis (description of events and treatment procedures). RESULTS: Two main complications were described 1) one atelectasia due to blood inhalation during the recovery period and 2) local sepsis in surgical ward. These two events were medically treated and recovered. No need of blood transfusion or stay in ICU were noted. CONCLUSION: Anaesthetic and surgical cooperation is associated with poor morbidity of this functional surgery performed in young subjects.

Adolescent↗