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Biomedical subjects

M Revol

Publications and source records attributed to M Revol.

At least 37 records · Page 2Linked to original sources
PubMed1998

[What is the cost of excision-suture of a skin lesion under local anesthesia? 2-month prospective evaluation in a public sector hospital].

The purpose of this study was to assess the cost of a minimal surgical operation: skin surgery under local anesthesia in the outpatients department. A two-month prospective study was carried out on 149 operations, with a mean duration of 33 minutes. The mean cost of the operation was 434 FF. Although this study is very specific and its results cannot be generalized, it gives a method and an order of magnitude. It shows that it is difficult to save money without decreasing the quality of the operation. The price list of the French national health care system, and the price of the surgeon himself are discussed.

Ambulatory Surgical Procedures↗
PubMed1997

Surgical treatment of dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans is a rare dermal tumor that recurs after inadequate primary treatment. In a retrospective study, we analyzed the outcomes of 117 patients (mean age 39 years) treated surgically for a dermatofibrosarcoma protuberans. In most cases (107 patients), surgery was performed according to a protocol of taking wide peripheral resection margins of 5 cm and by resecting a disease-free anatomic zone deep to the lesion. The mean follow-up was 61 months. The results suggest a difference in prognosis between patients treated primarily with wide initial resection and those referred secondarily with recurrent disease following previous treatment by narrow resection margins. There was no recurrent disease in the 66 patients treated primarily by wide peripheral (5 cm) and deep resection of the tumor. Of the 41 patients referred secondarily at the time of recurrence, 2 developed further local disease within a year, despite equally aggressive local treatments. Both patients eventually died of metastatic fibrosarcoma. We emphasize the value of a highly aggressive local resection in the primary treatment of dermatofibrosarcoma protuberans to minimize local recurrence and potential malignant transformation. Modern reconstructive techniques provide satisfactory solutions for defects of almost any size and composition. Our findings suggest that radical primary resection of dermatofibrosarcoma protuberans in conjunction with immediate reconstruction of the primary defect provides the best outcome for the patient.

Adult↗
PubMed1997

[Iatrogenic extravasations of cytotoxic or hyperosmolar aqueous solutions. Value of surgical emergency by aspiration and lavage].

Iatrogenic extravasations are characterized by their unpredictable course, the possible repercussions of functional, cosmetic and psychological sequelae, and the absence of a therapeutic consensus. The authors present the protocol used in Hôpital Saint-Louis, based on a synthesis of current procedures, consisting of emergency conservative surgical aspiration and lavage, performed in a context of close collaboration with oncolosits, intensive care physicians and radiologists. From 1994 to March 1997, fifteen patients were operated following extravasation during seven chemotherapeutic protocols, three radiographic examinations with injection of contrast agents and five resuscitation procedures. This simple protocol, applied systematically, achieved cure without cutaneous or functional sequelae in all patients. Aspiration-lavage during the first twelve hours therefore constitutes the treatment of choice of iatrogenic extravasation with cytotoxic or hyperosmolar aqueous solutions.

Aged↗
PubMed1997

[Lipoma of the superficial lobe of the parotid gland. A case report].

We report the case of a patient with a lipoma of the superficial lobe of the right parotid gland. Lipomas of the parotid gland are very rare. They are said to constitute one to two percent of all parotid tumours. Only six cases were found in the recent literature. Preoperative diagnosis is difficult when the physical examination reveals a renitent, well-localized and painless mass. However, magnetic resonance imaging is now the imaging modality of choice to facilitate the diagnosis, but the diagnosis can only be confirmed by histological examination of the tumour. We discuss the value of superficial parotidectomy, while some authors suggest an enucleation of lipomas of the superficial lobe of parotid.

Humans↗
PubMed1997

[Rectus abdominis free flap breast reconstruction. A series of 23 cases].

Free TRAM flap breast reconstruction was performed in 23 patients from july 1993 through november 1995 at the Saint-Louis Hospital in Paris. The surgical team was composed of eight different surgeons. In all cases a delayed breast reconstruction procedure was performed. All patients in this series had previously received radiation therapy and 82.6% patients presented with excess body weight. Decision to perform a free flap procedure was confirmed peroperatively under two conditions. Adequate caliber of the donor and recipient vessels was required, allowing the anastomoses to be performed without magnification in most cases. Preservation of the thoraco-dorsal vessels was the rule so as to allow later use of a latissimus dorsi flap if necessary. Thus in 8 of the 31 cases in which a free flap was initially indicated a pedicled flap was actually performed so as to satisfy the above conditions. All procedures were performed by two surgical teams working simultaneously. Flap harvest met local tissue requirements in all cases. A lateral strip of rectus abdominis muscle and fascia was preserved when this appeared feasible. The abdominal wall was reinforced by prosthetic means in 82.6% of cases. The average operative time was 9 hours. Results were considered satisfactory or very satisfactory in most cases. The complication rate was 39.1%. Among the complications noted were 1 case of partial flap necrosis, 1 case of fat necrosis, 1 abdominal hernia, 1 abdominal bulge (both abdominal complications occurred in patients in whom no prosthetic material was used for abdominal repair). This complication rate also includes revision of the microsurgical anastomoses in 2 cases; in both cases the flap survived completely. This study tends to suggest that the free TRAM flap for breast reconstruction is a reliable technique. It is the authors' belief that it should replace the bipedicled TRAM flap since it combines ample flap vascularization with minimal rectus harvest.

Adult↗
PubMed1996

["Beret" flap and other flaps in the reconstruction of cancer related loss of substance of the ear].

Major tissue loss involving the ears and periauricular area due to carcinologic exeresis is an important problem in reconstructive surgery. We present the "béret" flap, a frontal flap with an occipital pedicle, emphasizing the simplicity of the procedure and its reliability. We present our personal experience and data in the literature and recall the main clinical and histological features of these tumors as well as the clinical course and treatment.

Aged↗
PubMed1995

Progressive facial hemiatrophy with multiple benign tumors and hamartomas.

We report the unusual association of Progressive Facial Hemiatrophy (Parry-Romberg syndrome) with multiple benign tumors (orbital neurinoma, mandibular odontogenous fibroma) and hamartomas. The neurological clinical features were infantile hemiplegia, mild mental retardation and focal seizures. Brain CT-scan and MRI showed porencephaly and cerebral calcifications ipsilateral to hemifacial atrophy. Immunological investigations proved negative. The etiology of the disease and the bridging of this case to phakomatoses are discussed.

Adolescent↗
PubMed1994

Narcolepsy in children.

The clinical and polygraphic characteristics of narcolepsy in children were established on the analysis of 97 reported cases in children (including 12 personal cases). In idiopathic narcolepsies (77 cases) narcoleptic attacks occurred in 97% of the cases, cataplexy in 80.5%, hypnagogic hallucination in 39% and sleep paralysis in 29%; 13% of the children had the tetrad; dyssomnia was a prominent feature. Polygraphic data showed no significant differences between adults and children. In symptomatic narcolepsies (20 cases): cataplexy was the prominent feature occurring in 95% of the cases, 26% of the children had status cataplecticus; in these narcoleptic-cataplectic syndromes there was often an absence of polygraphic evidence of narcolepsy. Symptomatic narcolepsy should be suspected in cases where narcolepsy is detected in preteenage children, where cataplectic attacks are abnormally frequent, where there is an absence of polygraphic evidence of classical narcolepsy (although this criterion may not apply in the case of younger children) or where human leukocyte antigen typing for DR2 is negative. An association with a Niemann-Pick disease type C was found in 12 out of the 20 symptomatic cases, this association merits further study.

Catalepsy↗
PubMed1994

[Generalized idiopathic epilepsy in older children and adolescents].

Generalized idiopathic epilepsies starting between 12 and 18 years of age are mostly represented by juvenile myoclonic epilepsy, juvenile absence epilepsy and grand-mal on awakening. The EEG and clinical description of the seizures, the different epileptic syndromes with their therapeutics, the prognosis and the familial forms with the molecular genetic aspects are studied. The importance of the history for the positive diagnosis is emphasized, in order to display the often overlooked myoclonies occurring in the morning. Differential diagnosis concerns mostly absences which are sometimes difficult to separate from frontal seizures, and in the case of first generalized tonico-clonic seizure, partial epilepsy which needs further investigations, and the exceptional progressive myoclonic epilepsy which begins the same way, but has a totally different prognosis. Psycho-social difficulties due to epilepsy and lack of therapeutic compliance are frequent. The therapeutic results are generally good but there is a high rate of relapse after medication withdrawal.

Adolescent↗
PubMed1994

[Treatment of Darier-Ferrand tumors of the head and neck. Retrospective analysis of 20 cases].

Dermatofibrosarcoma protuberans is an unusual cutaneous neoplasm. Because of its high propensity for local recurrence, a wide and deep excision is recommended as the only satisfactory treatment. This tumour can raise difficult problems of reconstruction to plastic surgeons particularly when located in the face. The authors present a retrospective study of twenty cases of dermatofibrosarcoma protuberans of the head and neck treated at the Saint-Louis hospital over a period of twelve years.

Adolescent↗
PubMed1994

[Microsurgical expanded musculocutaneous flaps of the latissimus dorsi].

Four successful cases of expanded free latissimus dorsi myocutaneous flaps are reported. Expansion of free latissimus dorsi flaps has 2 distinct advantages: moulding of the flap prior to its transfer to a convex surface (cranium); primary closure of the donor site. The latissimus dorsi myocutaneous flap seems to be the flap of choice for pre-transfer expansion.

Adult↗
PubMed1993

Dermatofibrosarcoma protuberans of the chest and the shoulder: wide and deep excisions with immediate reconstruction.

Dermatofibrosarcoma protuberans is a rare malignant tumor of the skin. The only satisfactory treatment is surgical and consists of a wide excision. In our department, we have established the limits of the excision required to be a margin of 5 cm on the surface, whereas in the depth, we excise the first healthy anatomical structure encountered. Latissimus dorsi flap reconstruction was used for the major tissue deficit for 15 patients with dermatofibrosarcoma protuberans of the chest and the shoulder. When compared to skin grafting, this technique results in an improved aesthetic appearance and a stable cover for the periosteumless clavicle. Fourteen patients were followed for an average of 37.6 months and all remained free of disease.

Adolescent↗
PubMed1993

[Use of parascapular semi-free flap in the covering of substance loss of the lower third of the leg and foot. Apropos of 3 cases].

The authors present the use of semi-free parascapular flap for coverage of defects on the distal part of the leg and the foot. 3 cases illustrate this technic. This is a microsurgical cross-leg flap. The flap is temporarily anastomosed on vessels on the opposite leg when local and free flaps are not suitable on the ipsilateral limb. This procedure needs one or two separating operations. The cross-leg fasciocutaneous flap must be discussed.

Adolescent↗
PubMed1993

[Principles of palliative motor surgery of paralysis of the hand].

The purpose of surgical restoration of the paralysed hand is to use or to reconstruct the physiological tenodesis effects which are linked on to flexion-extension motions of the wrist. Active movements of interphalangeal (IP) flexion and metacarpo-phalangeal (MP) extension of the fingers are made by extrinsic muscles coming from the forearm. The intrinsic muscles of the fingers produce MP flexion and IP extension. A claw deformity occurs when they are completely paralysed in a finger whose joints are flexible, and whose extrinsic muscles remains functional or are restored. When Bouvier's maneuver is positive, the claw is said simple, and its treatment is either MP capsuloplasty when there is no motors, or an active palliative procedure with proximal (or MP) effect when motors exist: lasso and/or direct interosseous activation. Indications of the classical active palliative procedures with distal (or IP) effect remain rare, only in a few complicated claw deformities. Circumduction of the thumb may be decomposed into three elementary movements: reposition, antepulsion, and adduction, which are respectively controlled by the radial, median, and ulnar nerves. Each of these movements may be restored by a specific tendinous transfer. In the total paralysis of the thumb as we observe in high tetraplegia, a key-grip may be restored by joint stabilization of the thumb, associated with activation of the Flexor Pollicis Longus and Extensor Pollicis Longus by means of tenodesis or tendinous transfers.

Hand↗
PubMed1992

Ontogenesis of nocturnal organization of sleep spindles: a longitudinal study during the first 6 months of life.

Ontogenesis of sleep spindles was studied on overnight longitudinal recordings in 12 full-term infants at 1.5-3-4.5 and 6 months of life. Six parameters (density, duration, frequency, amplitude, asymmetry and asynchrony) were analyzed during both slow wave sleep (SII and delta) and during 5 periods of the night. Results show a significant increase of most parameters between 1.5 and 3 months of age. All spindle patterns developed quite rapidly during the first 3 months of infancy, possibly reflecting developmental changes in thalamo-cortical structures and maturation of the physiological system that produces spindles. The density of 12-14 Hz spindle frequency was higher in stage II when compared to stage delta, as in adults. Our data confirm previous reports on spindle ontogenesis and give a more complete aspect of this ontogenesis in relation to sleep development. Three months of age appeared to be a turning point in maturational processes and might reflect changes in central nervous system activity and behavior which take place during that period. Sleep spindle evolution seems to be an accurate reflection of the slow wave sleep (SWS) development, and our results are discussed in terms of the developmental aspect of SWS production and characterization of sleep stages in young infants. Concordance between quantitative aspects and nocturnal organization leads us to consider that the individualization of slow wave sleep (SWS) in infants occurs from 4.5 months of life.

Aging↗
PubMed1992

[Free radial antebrachial flap. A retrospective study of 48 cases. Practical applications].

The authors have studied 48 chinese forearm free flaps operated since 1982 at St-Louis, Hospital Paris. Analysis of early complications and failures shows that the few problems that occurred seem to involve hemodynamics more than technical problems. The results support the hemodynamic theory about radial forearm free flaps: low-flow flap which contrasts with the wide diameter of the radial artery. This kind of free flap may not support interpositional vein graft for arterial bridging (stasis, distension of the graft then thrombosis), which must be taken into account in the operating procedure. When the radial artery needs to be lengthened, we therefore systematically reduce the risk of thrombosis by re-establishing radial artery outflow for safety: either by distal radial artery anastomosis, or with an arteriovenous shunt.

Adolescent↗