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R Gras

Publications and source records attributed to R Gras.

34 records · Page 2Linked to original sources
PubMed1992

[Repair of the auricular area after petrosectomy].

The authors report a retrospective series of 12 patients presenting periauricular tumors having invaded the external auditory canal and concha: 5 squamous cell carcinomas, 3 basal cell carcinomas, 2 Darrier-Ferrand sarcomas, 1 parotidean adenocarcinoma, 1 radionecrosis. The operation included an extralabyrinthic petrosectomy, an amputation of the pavilion, and a ganglionic evidement following a histological analysis. The reconstruction processes used 3 pedicle grafts and 9 free grafts. The carcinological extension modalities of the cancers invading the entire external auditory canal require the sacrifice of the tympanic cavity and an external temporalectomy in a single block for carcinological and functional reasons. The massive invasion of the concha inevitably leads to the sacrifice of the auricular pavilion. The best means of reconstruction is with the free graft of the musculus latissimus dorsi. The price to be pay esthetically must be reduced by the placement of an epithesis.

Adult↗
PubMed1991

[Nasopharyngeal fibroma. Forms extended to the infratemporal fossa].

There are two clinicopathologic forms of nasopharyngeal fibroma: a median, compact form for which surgical treatment is simple, and a racemose, pedicled form raising problems for exeresis due to its extensions into the infratemporal fossa and the middle cranial fossa. A 4-stage grading is essential, and it has become easier with the progress made by imaging. The clinical findings, the contribution of imaging and the surgical procedures are studied for stages III and IV. Statistics are presented for 26 nasopharyngeal fibromas, including 10 invasive forms. Two approaches of the infratemporal fossa have been used in this series; the PLN approach with a large fronto-naso-maxillary flap, and the pre-auricular infratemporal lateral approach. The exeresis of stage III lesions requires the lateral approach.

Adolescent↗
PubMed1991

[Surgery for hyperthyroidism. Results and current trends].

From 1974 to 1990, the same surgeon operated 96 cases of hyperthyroidism: 72 cases of Basedow's disease, and 24 basedoid goiters. The preliminary preparation with antithyroid agents, sedation, Lugol and beta-blockers is particularly important, as is rehydration, high-dose sedation and beta-blockers, if required, during the postoperative period. There are few complications: 1 hematoma, 1 permanent unilateral laryngeal paralysis, 1 permanent hypocalcemia, 5 transient psychical and/or cardiac disorders, 1 malignant exophthalmia. There was no thyrotoxic crisis. Long-term follow-up allows nothing 4 recurrences as well as hypothyroidism in 46% of all cases. The size of the thyroid remains left in place is closely related to hypothyroidism. One case of vesiculo-papillary carcinoma is noted among the 24 cases of basedoid goiters (4.5%), which justifies total thyroidectomy in such cases. There also was one papillary carcinoma among the 72 patients with Basedow's disease (1.3%).

Antithyroid Agents↗
PubMed1991

[Surgical excision of giant venous angioma of the face under extracorporeal circulation: apropos of a case by a multidisciplinary team].

Because of the risk of haemorrhage related to their resection, deep angiomas of the face are often considered to be inaccessible to treatment. The use of cardiopulmonary bypass with profound hypothermia allows the surgeon to operate in a bloodless field, enabling almost oncological resection of the tumour. The authors report a case of venous angioma of the submaxillary region treated in this way after failure of limited surgery and embolisation. Complete resection of the lesion was achieved and the defect was repaired with a pectoralis major flap and a latissimus dorsi flap. The authors stress the value of a multidisciplinary approach: a cardiac surgeon for CPB, an ENT surgeon for resection and a plastic surgeon for reconstruction.

Extracorporeal Circulation↗
PubMed1990

[Excision-reconstruction of voluminous facial angioma under extracorporeal circulation and deep hypothermia].

The authors report a case of voluminous cervicofacial angioma with pelvi-lingual extension which had undergone multiple operations and had embolized. The exeresis consisted of cutaneous sacrifice of 10 x 10 cm combined with a longitudinal hemi-pelvi-glossectomy. Two pediculated musculocutaneous strips of greater pectoris and greater dorsal muscle were associated for reconstruction. The operation took place under extracorporeal circulation by femoral cannulation and deep hypothermia. Post-operative recovery was simple, with resumption of normal phonation and eating. No recurrence was observed upon arteriographic control at six months. The use of extracorporeal circulation is exceptional outside cardiac problems (low tracheal stenosis, intracranial aneurysm). The authors suggest the value of this technique for the treatment of angiomas purportedly inoperable because of the risk of major blood loss.

Adult↗
PubMed1990

[Results of surgery of acoustic neuroma via translabyrinth and suprapetrous approaches. Development of a classification by House and Brackmann based on facial function].

Two studies were conducted consecutively on two series of post-operative acoustic neurinoma patients. The first one included 104 patients over a period spanning from January 1982 through April 1986; the second one bore on 75 cases enrolled between October 1985 and April 1988. Post-operative complications, sequelae, and findings were analyzed. As far as facial function was concerned, this was assessed on the basis of a classification worked out by J.W. House and D.E. Brackmann. For the first series (93 patients tested, 86 followed up and 7 who completed and returned a form arranged from Brackmann's questionnaire), the following results were obtained: 94% with anatomically intact nerves, including 50.0% grade I; 8.6% grade II; 10.7% grade III; 12.8% grade IV; 4.3% grade V, and 2.2% grade VI cases. 10 nerve sections pertaining to grade III and grade IV surgical repair cases including 10 hypoglossofacial anatomoses were reported. In the second series, 75 patients were followed up for at least 2 years. The facial nerve condition was recorded at the end of the operation, corresponding to the beginning of the nerve recuperation period. A very tight relationship was noted between the nerve condition and the end result as reflected by facial function; such correlation was also found to exist between facial function and tumor size. Likewise, end-point facial function was strictly dependent upon the incipient recuperation phase, whenever palsy had been complete or partial post-operatively. That is to say, if recovery started out after the third month following surgery, the affected hemiface would never retrieve its normal or subnormal function (grade I and II as per J.W. House and D.E. Brackmann). In this series, facial function was restored in 45%, 15%, 21%, 11%, 1%, and 0 cases corresponding to grade I, II, III, IV, V and VI, respectively. Five grade III and IV nerve sections were repaired via five hypoglossofacial anastomosis operations. We propose a slight modification be brought to the House-Brackmann classification. The aim of this study was to accurately assess the complications and sequelae secondary to surgical ablation of unilateral acoustic neurinoma by an otoneurosurgical team utilizing almost exclusively the broadened translabyrinthic (B.TL) and medial cerebral fossa or supra-petrous (SP) approaches Despite achievements realized since W.F. House [23] described those, the main problem encountered has been-excluding major complications which are fortunately rare, remains the preservation of normal or subnormal facial function.

Adult↗
PubMed1989

[Superficial temporal fascia pedicle flap. Applications in cervicofacial surgery. Apropos of 20 cases].

The superficial temporal fascia is formed by a fine fibro-muscular layer situated between the subcutaneous plane of the temporal region and the temporal muscle aponeurosis. The superficial temporal artery and its branches run within the fascia which acts as a veritable vessel carrying sheet. The therefore useful in that in minimises esthetic and functional complications at the donor site. This reliable, polyvalent arterialised aponeurotic type flap behaves above all as a covering or interpositional flap. Our clinical experience involves 20 cases, in addition to the applications already published: covering material in cases of loss of facial substance, otopoiesis, organisation of open techniques, we propose its use during oro-bucco-pharyngoplasty and for sealing the base of the skull.

Adolescent↗
PubMed1985

[Sequelae of condylar fractures in the experience of the department and that of medical expertise].

Statistical analysis was conducted on findings in 104 cases of fractures in the condylar region and 25 patients examined to determine degree of incapacity as a result of these types of fracture. Data obtained illustrated the adverse effects of ascending ramus shortening, and the improvement obtained after surgical restoration of its height whenever this was indicated. Long-term follow up surveillance is also necessary after high subcondylar fractures with impaction of the ascending ramus because of the risk of external temporomandibular ankylosis.

Adolescent↗
PubMed1985

[A technic for osteotomy of the malar bone].

On the basis of the results of osteotomy of the malar in malunion of facial fractures, the authors suggest the use of this operation in the correction of maxillary malformations including faulty development of the cheeks. Two cases are described.

Adolescent↗
PubMed1984

Cytophysiological correlations between prothoracic gland activity and hemolymph ecdysteroid concentrations in Rhodnius prolixus during the fifth larval instar: further studies in normal and decapitated larvae.

Hemolymph ecdysteroid titers in fifth instar larvae of Rhodnius prolixus were determined by radioimmunoassay, and their prothoracic glands were excised and examined by electron microscopy. During the last larval instar, the titer of ecdysteroid increased between the head-critical period until Day 13, at which time the peak titer was 3100 pg 20-hydroxyecdysone equivalents/microliter. The activation of secretory cells at the time of the second period of prothoracicotropic hormone release was correlated with the development of major cellular organelles. The smooth endoplasmic reticulum first appeared at the head-critical period and then proliferated in close relation to the increase in ecdysteroid titer until Day 13, after which time it disappeared. Mitochondria expand and develop tubular cristae. They are closely associated with the smooth endoplasmic reticulum. When insects were decapitated, hemolymph ecdysteroid titer remained below 10 pg/microliter and the prothoracic gland cells failed to develop smooth endoplasmic reticulum. We conclude that in the prothoracic gland cells as well as other steroidogenic tissues the smooth endoplasmic reticulum in association with mitochondria is involved in ecdysone biosynthesis.

Animals↗
PubMedDate not supplied

Juvenile nasopharyngeal angiofibroma: comparison of blood loss during removal in embolized group versus nonembolized group.

PURPOSE: This retrospective study was performed to assess the beneficial effect of preoperative embolization of juvenile nasopharyngeal angiofibromas (JNA) in terms of blood loss during surgery. METHODS: Intraoperative blood loss in a group of 7 patients who underwent 10 procedures for JNA without preoperative embolization was compared with the blood loss of 13 patients who underwent 16 procedures after embolization of one or both external carotid arteries. RESULTS: Mean blood loss was 5380 ml in patients without embolization and 1037.5 ml in those with embolization. This difference was not statistically significant because of the high standard deviation in the nonembolized group. However, when data were analyzed by tumor stage, a significant difference was noted between the embolized and the nonembolized patients with high-grade tumors but not between those with low-grade tumors. CONCLUSION: Preoperative embolization of the branches of the external carotid appears to facilitate removal of high grade tumors. The benefit of embolization in those with low-grade tumors is less clear cut, probably because there is less vascularity in low-grade tumors and so removal is easier.

Adolescent↗
PubMedDate not supplied

Near total laryngectomy with epiglottic reconstruction: long-term results in 57 patients.

INTRODUCTION: Extended partial laryngectomy procedures may offer patients the potential for a cure with preservation of voice. This report characterizes our patients managed with near laryngectomy and reconstructed with epiglottic tissue. MATERIALS AND METHODS: A total of 57 patients with T1 or T2 glottic carcinoma undergoing total laryngectomy with epiglottic reconstruction were reviewed retrospectively. This group included 15 patients with T1 lesions and 42 patients with T2 lesions. In the standard operation the specimen includes the thyroid ala, both vocal cords, both false vocal cords, and one arytenoid cartilage. The epiglottis is mobilized and delivered inferiorly for reconstruction of the glottic larynx. RESULT: Tumor control was obtained in 93% of T1 patients and 79% of T2 patients. All patients tolerated decannulation. After a mean duration of 12 days (range 5 to 22 days), all patients were able to swallow. Voice evaluation revealed 5 patients had whispery voices, 25 were difficult to understand in a noisy environment, and 27 were easily understood. DISCUSSION: This technique is an effective approach to cancer therapy with cure rates comparable to total laryngectomy. The main limitation of this technique is that voice recovery is unpredictable.

Deglutition↗
PubMedDate not supplied

[Extensive pharyngeal necrosis: an unusual complication of dermatomyositis].

To our knowledge, the occurrence of extensive pharyngeal necrosis in patients with dermatomyositis has not yet been reported. We report such a case characterized by a vast ulceration of the posterior laryngeal wall, extending from the velum palati to the larynx and responsible for both dysphagia and dysphonia. Treatment with an immunosuppressant had no effect on the lesions.

Aged↗