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Biomedical subjects

M Pannier

Publications and source records attributed to M Pannier.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Covering of a thoraco-lumbar defect by omentoplasty].

With a case of thoraco-lumbar defect, the authors discuss about different procedures to cover it. In this place, the better procedure is certainly the latissimus dorsi flap, in all combinations. The indication for omentoplasty at this spinal site should not be performed by first intention but by exclusion of other procedures, as in the case considered by the authors. It was a 37-year-old man, paraplegic from the age of 16, with a deep chronic spinal wound, secondary to sepsis of a posterior segmental fixations. A staphylococcus aureus infection which developed as a surgical complication was initially treated with antibiotics and surgical cleaning procedures without removing instrumentation. However, the infection remained active and the material was finally removed. Spinal immobilisation was strengthened by external fixation. The area was cleared of all suspect material, including bone graft, leaving a wide back-wound open to the spine. Spontaneous healing was first attempted, but the size and the chronicity of the wound led us to use pedicled greater omentum to close the defect. The omentum was pedicled on the right gastroepiploic vessels and transferred to the back wound through the posterior abdominal wall muscles, next to the right kidney. This procedure allows rapid healing. In association with suitable antibiotics, it has prevented any recurrent infection after 18 months of follow-up. It was no feasible to cover the wound with a latissimus dorsi flap, considering the importance of this muscle in the movements of a paraplegic and considering the initial impossibility of removing the external fixation.

Adult↗
PubMed1996

[Lyell syndrome after amoxicillin administration in a 2 year old child].

The authors report a toxic epidermal necrolysis (TEN) due to ampicillin (Agram) in a 2-year-old child. During the acute phase a septic syndrome occurred. The severity of the clinical and biological symptoms led to the administration of antibiotics, their systematic use remaining controversial. Recovery was favourable in a paediatric burn centre. Sequelae were minor. TEN, the physiopathological mechanism of which remaining still unknown, may carry a vital risk.

Amoxicillin↗
PubMed1994

Pseudomonas aeruginosa outbreak in a burn unit: role of antimicrobials in the emergence of multiply resistant strains.

An environmental survey and a cohort study were done to analyze an outbreak of infections in a burn unit caused by a serotype O:11 and a multidrug-resistant serotype O:12 Pseudomonas aeruginosa. The P. aeruginosa O:11 outbreak was controlled by eradicating an environmental source, contaminated hydrotherapy equipment. To assess risk factors for infections caused by P. aeruginosa O:12, 15 infected burn patients were compared with 32 noninfected burn patients hospitalized during the outbreak. Patients had similar extent, severity, location, and care of burn injuries, exposure to invasive procedures, and past history of P. aeruginosa infection. Prior treatment with ceftazidime (3 g/day) was the only independent risk factor for P. aeruginosa O:12 infection. The outbreak was controlled by increasing the daily administration of ceftazidime from 3 to 6 g and by a reinforcement of isolation precautions.

Adult↗
PubMed1994

[Use of the omentum in the treatment of chronic thoracic empyema].

Thoracic empyema (development of suppuration in the thoracic cavity, usually after pneumonectomy) remains a serious complication which is difficult to treat. Failure of classical procedures (lavage-drainage) in the treatment of certain forms of pleural empyema (post-pulmonary resections), with or without associated fistula, led the authors to use the pedicled omental flaps filling material for the chronic empyema cavity. They report their experience (6 cases over a period of 4 years) and define the indications. Omentoplasty has a real place, next to myoplasty, in the therapeutic arsenal for chronic empyema due to its detersion capacity, particularly useful in a "septic" context and because of its volume which is usually sufficient in retracted cavities. The existence of an associated bronchial fistula, history of radiotherapy, posterolateral thoracostomy (sectioned latissimus dorsi) are additional reasons to prefer omentoplasty over myoplasty.

Adult↗
PubMed1994

[Cover of trochanter pressure sores by V-Y musculocutaneous flap of the fascia lata].

Authors report their experience with the V-Y advancement flap in the coverage of trochanteric pressure sores. Nine flaps have been performed concerning 7 patients. Trochanteric sores in paraplegia or tetraplegia may lead to suppurative arthritis of the hip, with a risk of anaerobic infection and acute septicaemia. The treatment has to be as complete as possible. The trochanteric sore is debrided, with special attention given to removing all necrotic material, the surrounding bursa, and the bony prominence of the greater trochanter. The debrided trochanteric region is then covered by a well-vascularized and thick tissue. We observed only one complication at the donor site which can be closed primarily by this technique. The V-Y advancement technique is a new, simple and safe design of tensor fasciae latae flap. The defect is covered by the thicker and the best vascularized portion of the musculo-cutaneous flap. It allows preservation of other donor sites of the gluteal region to cover other sores, which are often associated.

Adult↗
PubMed1992

[Hemodynamic effects of bathing in severe burnt patients].

Repeated water immersion is currently used in France in the treatment of severe burn injury. A prospective study was carried out to assess the haemodynamic effects of immersing such patients in a half sitting position in water, the temperature of which was kept at 35 degrees C. The burn exceeded 50% of body surface area (BSA), with at least 30% being third degree burns. The study was carried out during the first bath, three days after the injury. The patients were immersed up to the clavicles. They were sedated with 2 mg.h-1 of both flunitrazepam and phenoperidine, and were mechanically ventilated. The following haemodynamic parameters were monitored: heart rate, arterial blood pressure (the transducer being level with the arterial catheter), right atrial and pulmonary arterial pressures (the transducer being level with the right atrium, level which had been marked on the chest before immersion and placed two intercostal spaces higher after immersion because of the change in position of the heart). The cardiac output was measured using the thermodilution method. The patient's temperature was monitored with the thermistance of the Swan-Ganz catheter. Values were obtained before immersion, after 15 and 30 minutes of immersion, and 5 minutes after the end of the bath. Nine patients were included, 2 women and 7 men, aged between 24 and 45 years, weighing 73.7 kg on average. Burn size was 78% of BSA (range 64 to 95%). Water immersion was maintained for 34 +/- 3 min. The right atrial, mean pulmonary arterial, and wedge pressures, and the cardiac and systolic indices increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Beta-hemolytic streptococcal periorbital necrotizing fasciitis in a child].

The authors report a case of beta-haemolytic streptococcal periorbital necrosing fasciitis in a two old girl. Extensive cutaneous necrosis of the four eyelids developed after the installation of a major septic syndrome. Excision of the necrotic tissues required removal of the palpebral part of the orbicularis muscle and opening of the orbital septum. A graft was performed on the 23rd day. Active palpebral occlusion was retained by means of the orbital portion of the orbicularis muscle. Two complementary grafts had to be performed to ensure satisfactory palpebral occlusion. The periorbital localization, exceptional in children, must not be confused with periorbital cellulitis, a common disease, which never progresses towards necrosis. The authors stress the necessity of an early diagnosis in view of the importance of medical treatment and surgical drainage with opening of the septum, which is the only way of decompressing the oedema and preventing palpebral necrosis due to tissue ischaemia.

Anti-Bacterial Agents↗
PubMed1991

[Necrotizing fasciitis of the upper limb. Apropos of a case].

Necrotizing fasciitis is a rare infection, serious because of its risk of functional sequelae and mortality. The first clinical and histological descriptions of acute Streptococcal infection of the fascia were published in 1924 by Meleney, who referred to this condition as "Streptococcal haemolytic gangrene". However, since Meleney, numerous authors have reported cases of necrotizing fasciitis due to a wide range of bacteria. The authors report a case of necrotizing fasciitis of the upper limb in a 45 year old man following a superficial lesion of the dorsum of the hand. Despite the use of antibiotics, the morbidity and mortality of this disease are still high. Treatment is surgical and must be performed urgently. A review of the literature groups together the published cases and analyses the various aetiologies and risk factors.

Arm↗
PubMed1991

[Dermoid cyst of the scalp. Apropos of a case].

A subgaleal dermoid cyst of a 32 years old white adult is reported. The lesion appeared at the age of several years and ten regularly. Clinical examination, complementary exams as well as the result of the operation are reported. Embryology, histological classification and the main clinical, laboratory and histological characteristics of such lesions are defined by the review of the literature. Subgaleal dermoid cyst is rare in childhood and exceptionally occurs in adults. Only six cases of subgaleal dermoid cyst of adult are mentioned in the literature. Most of the time, the lesion is situated on the anterior fontanelle. The treatment is surgical and the prognosis is excellent.

Adult↗
PubMed1990

[Intraoperative and postoperative analgesia in pediatric surgery. 1 years' experience].

Operative and postoperative analgesia has become in a few years a major concern for pediatric anesthesiologists. The fact that pain can have dramatic metabolic and hemodynamic consequences has been well documented. This study shows the activity in our department in the field of analgesia during 1989. 82% of the 2,675 children having undergone surgery have received analgesia during the operative period either by the way of an i.v. narcotic or an regional block. No morbidity or mortality resulted from these techniques during the operative period. When a regional block was prolonged by the mean of a catheter, there were no major complication (2 seizures). The use of oral, rectal and i.v. analgesics follows the classic recommendations. Morphine by all routes of administration is used increasingly in our department. Two moderate respiratory depressions occurred in 1989 due to error in dosage with no consequence for the child. The authors underline the importance of well established protocols which have been discussed and approved by all, the importance of emergency procedures and treatment, which only can guaranteed the necessary safety.

Acetaminophen↗
PubMed1990

[Prevention of complications in inguinal lymphadenectomy].

Inguinal lymphadenectomy, as indicated in the treatment of metastases of carcinoma of the penis and of malignant melanoma in the inguinal lymph nodes, involves considerable mortality and morbidity. From February, 1988, to January, 1990, we performed 15 inguinal lymphadenectomies in 10 patients with an average age 51.9 +/- 5.3 years. The technique used combined a transverse incision parallel to the inguinal fold, complete inguinal lymphadenectomy, transposition of the sartorius muscle and vaporization of a film of fibrin glue. The last 2 operations, besides the effectives protection of the femoral pedicle, aim at suppressing dead spaces that may produce hematomas, subcutaneous infection or lymphoceles, and at avoiding the insertion of an aspiration drain, which causes persistent lymphorrhea. Out of the 15 cases of lymphadenectomy, 5 presented with a small- (48 ml in average) or medium-volume (200 ml) lymphocele, which was treated by a simple evacuating puncture. No necrosis of the skin edges, subcutaneous infection or lymphorrhea were observed. These results are encouraging, since our patients can rapidly resume their social life and have an acceptable quality of survival.

Adult↗
PubMed1985

Radiological anatomy of the bile ducts based on intraoperative investigation in 250 cases.

Intraoperative cholangiograms were studied in 250 patients. Analysis of the data obtained led to the establishment of a protocol for intraoperative cholangiography aimed at identification of anatomical anomalies and variations. Diagnosis of the latter must be achieved in order to avoid possible intraoperative complications. The common hepatic duct was formed by the junction of the right and left hepatic ducts in 52% of the cases studied. Absence of convergence of the posterior and anterior rami of the right hepatic duct was found in 30% of cases. Anatomical variations of the right sectorial duct system were seen in 12% of cases. Conversely, variations of the left sectorial duct system were rarely seen (2% of cases). Careful examination of the intraoperative cholangiograms led us to suspect certain anatomical variations in close to 1% of cases. These variations included abnormal hepatocystic duct, which if undiagnosed could lead to choleperitoneum or inadvertent ligation of the right hepatic duct. An abnormal hepatocystic duct terminating on the gall bladder was found in one patient. Study of the origin of the common bile duct allowed us to define the mode of termination of the cystic duct (on the right margin of the common hepatic duct in 80% of cases) and to identify a short choledochus in 2% of cases. Finally, variations of the duodenal termination of the common bile duct were studied and reflux into the pancreatic duct was seen in 27% of cases. However, the pathological significance of such reflux was rarely found.

Bile Ducts↗
PubMed1984

[Pharmacokinetics of azlocillin in the burn patient].

Pharmacokinetic values of azlocillin were determined in burned patients during the exudation and repair periods. A single dose of 80 mg/kg was administered intravenously over 30 min. Pharmacokinetic constants were calculated using an open two-compartment model. During the exudation period the ultimate serum half-lives (t 1/2 beta) were 1.17 to 1.4 h, 1.73 to 1.78 h and 3.3 h respectively with creatinine clearances of 111-131, 60-94 and 14 ml/min/1.73 m2. Renal clearances varied from 30.9 to 128 ml/min/1.73 m2. During the repair period little change was observed in t 1/2 beta, but renal clearance increased from 36.6 to 116 ml/min/1.73 m2 in one patient. It is concluded that azlocillin behaves in burned patients as in patients with impaired renal function.

Adult↗
PubMed1978

[Cecum perforation, complication of an acute idiopathic dilatation of the colon, or Ogilvie's syndrome. Practical interest of various pathogenic data. Apropos of one case].

The authors report a new case of caecal perforation complicating acute dilatation of the colon without organic obstruction (Ogilvie's syndrome). They recall the two characteristics of this syndrome : abdominal distension due to colonic ileus, without any organic cause, and the constant coexistence of an associated pathological condition (traumatic, post-operative, infective, cardio-vascular, respiratory or neurological). The major complication is caecal perforation, announced by a clinical and radiological preperforative syndrome. The pathogenesis of Ogilvie's syndrome remains mysterious. Two facts are worth attention : the role of the sympathetic nerve in intestinal paralysis and the direct intervention of an extra-intestinal pathological factor in the onset of this syndrome. Hence two therapeutic consequences : the favourable effect of splanchnic infiltrations on intestinal motility, and the parallel course of acute colonic dilatation and the extra-intestinal disease.

Cecal Diseases↗