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Biomedical subjects

A Danino

Publications and source records attributed to A Danino.

At least 19 recordsLinked to original sources
PubMed2006

[Evaluation of a method to reduce the number of sentinel nodes removed in melanoma patients: prospective study].

INTRODUCTION: Since 1992, sentinel node (SLN) biopsy was generally applied to melanoma for carcinologic staging. Literature points out an increase of nodes removed for each procedure. It means to a high cost for this procedure and it wanders from the defining concept of SLN. The aim of our study was to evaluate whether, we can minimize number of SLN removed, without influencing the reliability of carcinologic staging. MATERIAL AND METHODS: We conducted a prospective study about 50 patients with stage one melanoma. For each patient, the SLN was identified with hand-held gamma probe technique. We removed only the hottest and all nodes greater than 70% of the hottest. We analysed the characteristics of melanoma, the success rate of this procedure, how many nodes have been removed and how many have had micro-metastases. This result was compared to two main studies with chi(2) test. RESULTS: The success rate of this technique was 100%. We dissected 1,3 SLN for each patient, with 22% positive SLN. Statistical analyse pointed out a better selectivity of our study, rate of pathological positivity and recurrence was alike. DISCUSSION: Our technique decreasing number of removed SLN is reliable. A minimal number of nodes doesn't distort sensitivity of carcinologic staging, and reduce cost of the procedure.

Adult↗
PubMed2006

The prognostic impact of the extent of lymph node dissection in patients with stage III melanoma.

AIMS: To analyse disease-free and overall survival in 67 melanoma patients who underwent dissection for clinically apparent regional lymph node metastases, taking into account the total number of excised lymph nodes. METHODS: After a median follow-up time of 16 months, 47 recurrences were observed and 43 patients died. The median disease-free and overall survival intervals were 14 and 24 months respectively. RESULTS: Multivariate analyses revealed that the number of excised lymph nodes had a significant impact on overall survival (P=0.036) but not on disease-free survival (P=0.97). Extranodal growth was the only statistically significant prognostic factor both for disease-free (P=0.005) and overall (P=0.038) survival. Age, nodal basin, primary tumor ulceration, tumor thickness and number of positive lymph nodes were not significant prognostic factors. CONCLUSIONS: Our results suggest that the total number of lymph nodes excised in the dissection has impact on overall survival of stage III melanoma patients and should be considered in clinical assays.

Adult↗
PubMed2006

[Dynamic distraction and early reeducation in proximal interphalangeal joint fractures: preliminary results of a 15 patients' prospective series].

INTRODUCTION: The authors present early results of the treatment of interphalangeal fractures with external dynamic distractor and early reeducation. PATIENTS AND METHODS: Fifteen proximal interphalangeal fractures were treated with a "do-it-yourself" external distracter. Distraction was performed with rubber band or steel stitches. Patients sustained immediate self-mobilization and physiotherapy. Total duration of the treatment was 45 days. RESULTS: Thirteen patients had good results with normal mobility after three months and recovered 80% of their controlateral force. Algodystrophia occurred in one case with poor functional results. One late management led to severe interphalangeal rigidity. CONCLUSION: External distraction is a safe and economical treatment providing good early results with few complications. Long-term follow-up is necessary to make this procedure a standard-of-care in the management of proximal interphalangeal fractures.

Adolescent↗
PubMed2006

[Boxer's fracture: Cost evaluation orthopaedic or surgical treatment].

UNLABELLED: Many methods of treatment have been proposed for fractures of the neck of the fifth metacarpal ranging from early mobilization to various surgical techniques. The aim of this retrospective study was to evaluate the functional results and the costs of closed as opposed to open treatment (Foucher's K-Wire technique). MATERIALS AND METHODS: We conducted a retrospective study on all fractures without rotational deformity and with a palmar angulation less than 40 degrees C. Details of the patients, the fractures, functional results and the cost of management were analyzed. RESULTS: The functional results were similar between the two groups, but surgical treatment increased the cost of treatment to 1100 euros. CONCLUSIONS: We advocate the use of closed treatment for these fractures. The functional results are the same as with surgical management, but the costs are much reduced.

Accidental Falls↗
PubMed2005

[Calciphylaxis: a severe but unrecognized complication in end-stage renal disease patients. A review of 2 cases].

Calciphylaxis presents like subcutaneous lesions with livedo reticularis leading to necrotic and painful ulcers, predominantly in the lower limbs and the abdomen. They initially simulate dermohypodermitis. Biology reveals secondary hyperparathyroidism, phosphocalcic metabolism abnormalities and state of hypercoagulability. Histological signs are constant: calcifications in the media of small and sub-cutaneous arteries, intimal hyperplasia and intravascular thrombosis. This complication occurs in 4% of end-stage renal disease patients. Its prognostic is awful with a rate of mortality of 60% due to sepsis. Treatment is based upon the normalization of phosphocalcic rates and local debridement.

Aged↗
PubMed2005

[Aesthetic surgery and quality of life before and four months postoperatively].

AIMS: To evaluate the improvement in the subjective quality of life and mental health after Aesthetic surgery on the basis of indices of patient satisfaction. METHOD: The population consisted of 25 women who had requested cosmetic surgery (mean age: 34.76) including 19 for breast augmentation and 6 for abdominal plastic surgery. After giving their written consent, the subjects took part in a psychological evaluation conducted at two different times: the first at the time of the second medical consultation and the second 4 months after surgery. In each case, the psychological evaluation consisted of a clinical interview and two questionnaires: the subjective quality of life profile (SQLP) and the general health questionnaire (GHQ12). RESULTS: The results of the study revealed the benefits of cosmetic surgery for the patients' subjective quality of life. The subjects' mental health and quality of life improved on a number of dimensions: physical health, pain, physical appearance, social life and inner life. Improved physical health during the postoperative period was associated with the quality of the relations with the doctor whereas deterioration in health was associated with excessively high initial expectations concerning the relations with doctors and physical health.

Adult↗
PubMed2005

[Use of nasolabial flap for mouth floor reconstruction].

SUBJECT: Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom. PURPOSE: The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques. MATERIAL AND METHOD: We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization. RESULTS: Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45-78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient. CONCLUSION: The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.

Aged↗
PubMed2005

[Enteral feeding by nasogastric tube in mandibular fracture osteosynthesis].

INTRODUCTION: Mandibular fractures are among the most common fractures of the face; their treatment consists in a reduction by intermaxillary blocking then miniplate osteosynthesis. In our unit we systematically insert a nasogastric tube for enteral feeding to improve nutrition and to protect healing. Since the beginning of 2002, a series of patients operated for simple mandibular fractures were fed immediately after the operation by a semiliquid food. The purpose of this work is to verify the real advantage of enteral feeding by nasogastric tube in patients operated for simple fractures of the mandible. MATERIAL AND METHOD: This retrospective study includes all the patients operated for closed fractures of the toothed portion of the mandible from January 1999 to October 2003. There were two series, a first series of patients operated between 1999 and 2002 fed by nasogastric tube until mouth healing and the second series of patients operated between 2002 and 2003 fed by mixed oral-enteral nutrition from the first postoperative day. We analyzed demographic features, time between trauma and operation, type of fracture, feeding modalities, duration of use of the nasogastric tube, duration of hospital stay and postoperative complications. RESULTS: A total of 111 patients were included in the study. The first group of 81 patients fed by nasogastric tubes included 19 women and 62 men with an average age of 29.7 years (from 15 to 81 years). The average time from trauma to operation was 2.3 days (0 to 5 days), the feeding by nasogastric tubes was maintained 5.9 days after the operation (4 to 12 days), the average hospital stay was 7.2 days (5 to 13 days). Eleven immediate complications were observed (13.6%). The second group of 30 patients fed orally the day after the intervention included 7 women and 23 men. The average time from trauma to operation was 2.2 days (0 to 7 days), the average hospital stay was 2.5 days (2 to 3 days). One complication was observed (3.3%). DISCUSSION: Immediate oral feeding the day after the operation for simple closed mandibular fractures provides certain comfort for the patient by avoiding the inconveniences of nasogastric feeding tubes without increasing the rate of postoperative complications such as disunion, delayed healing or infection. The hospital stay is significant shortened, enabling a real cost savings.

Adolescent↗
PubMed2005

[Natal teeth: apropos of five cases].

INTRODUCTION: The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. There are several qualifiers used to describe prematurely erupted teeth. Massler and Savara defined "natal teeth" as teeth present at birth and "neonatal teeth" as teeth erupted within the first month of life. The aim of this study, based on 5 cases, is to present clinical and structural characteristics, etiology, management techniques, complications and a review of the literature for natal teeth. MATERIAL AND METHODS: Our study is a retrospective study of 17,000 infants who were examined in the Neonatal Department of Children Hospital between 1984 and 2001. The material consisted of 5 infants with natal teeth, identified by the pediatrician. We analyzed the family history, the pregnancy history, the gender, the etiology, the complete examination of the infant, the clinical, the structural characteristics, the complications and the management of the teeth. RESULTS: We found 4 boys and 1 girl, 2 of the newborns were premature, all of them observed to have natal teeth. The incidence was 1: 3,400 births. There were 14 natal teeth, 10 incisors (70%) and 4 canines (30%), no molar was found. Nine of the teeth (6 incisors and 3 canines) were maxillary (65%) and 5 (4 incisors and 1 canine) were mandibular (35%). No morphological syndrome was discovered. Most of the teeth were mobile in all directions and were extracted because of the possibility of aspiration, the difficulty in feeding and the ulceration of the ventral surface of the tongue. DISCUSSION: According to the literature, this phenomenon is rare and the incisors are the teeth most commonly involved. Natal teeth are more common than neonatal teeth and nearly 90% of these teeth are the normal primary teeth. The presence of natal teeth is due to several factors related to an unknown cause of disturbed biological chronology. There is no conclusive evidence of a correlation between early eruption and systemic disorders, but some investigators suggest that natal teeth may be associated with certain syndromes. We must keep in mind that radiographic examination is essential for the differential diagnosis between supernumerary and normal primary teeth. The supernumerary teeth should always be extracted but the decision to extract a normal mature natal tooth should be done according to scientific knowledge, mobility of the tooth, local or general complications and parental opinion.

Diagnosis, Differential↗
PubMed2004

[Social adjustment in French adults from who had undergone standardised treatment of complete unilateral cleft lip and palate].

France has a population of about 60 million peoples and each ten years data about the standard of living are collected by the central bureau of statistics, we considered the collection of data on 5000 households in 1999 in our geographical area would afford a unique opportunity to compare the equivalent status of French adults with repaired cleft of the lip and palate (CLP). Aspects of social adjustment were investigated in a sample of 82 French adults 18-35 years old with repaired complete unilateral cleft of the lip and palate (CLP). All subjects received a standardized regimen of care from the Burgundy cleft palate team of Dijon. The investigation, based on response to a questionnaire, partly replicated a national survey of social and economic life in the population (Standard of living survey Burgundy, INSEE France 1999), so that adults with complete clefts could be compared with a large control sample of the same age. The control group was constituted by subjects between 18 and 35 years in the standard of living survey Burgundy 1999, INSEE France, they were taken from a regional probability sample of households. This report covers education, employment, and marriage. The significant difference between groups was assessed by: Student's t-test or analysis of variance for continuous variables and chi2 test for categorical variables. The results demonstrated that there are significant differences in educational attainment and employment between adults with cleft of the lip and palate and other people. Fewer with cleft of the lip and palate marry, and when they marry they do so later in life, scholarship history showed significant delay in the cleft of the lip and palate group, independence regarding housing was lower in the cleft of the lip and palate group. If cleft of the lip and palate adults functioned within normal limits with regard to employment. However, levels of income were substantively lower than control groups. It would appear that cleft subjects experience some limitation in their ability to secure vocational and economic rewards from society. As a conclusion we can say regarding our results that the cleft of the lip and palate group, even with the smallest degree of malformation (unilateral without associated malformation), showed a significant delay in the independence process.

Adaptation, Psychological↗
PubMed2004

[Tumoral calcinosis of the plantar forefoot: a case report and review of the literature].

Tumoral calcinosis of the plantar forefoot is an uncommon benign condition resulting from deposits of hydroxyapatite crystals in periarticular soft tissue. The pathogenic mechanism remains to be clarified. This condition is generally observed in young subjects and a hereditary pattern is often discovered. We report the clinical, radiological, and biological findings in a case of right forefoot tumoral calcinosis observed in a sixteen-year-old girl and describe the surgical treatment and pathology results. Based on this case and a review of the literature, we discuss the different pathogenic hypotheses as well as the appropriate diagnostic and therapeutic approach.

Calcinosis↗
PubMed2004

[Correlation between the real cost of an intervention and cost factors in France: example of removal of jaw fixation material in mandibular fractures].

INTRODUCTION: economic cost is a timely topic which will have to be taken in consideration more and more for determining the appropriate indication for surgical procedures. "Health has no price, but it has a cost" is a common proverb urging us to think in terms real cost of a surgical procedure. The purpose of this study is to estimate the real cost of a usual and frequent intervention: removal of osteosynthesis material in mandibular fractures. Real cost was compared with the cost charged by the French health insurance fund. MATERIAL AND METHODS: this retrospective study collected all the interventions concerning material removal after mandibular fractures performed in our department during 2002. The following parameters were retained: the number of consultations, the duration of occupation of the surgical unit and the recovery room, the list of materials and products used, the cost of the medical staffs and cleaning agents, the duration of hospitalization, other administrative loads and expenses. RESULTS: a series of 30 patients was found, each patient had had three consultations, the average duration of hospitalization was 36 hours, the time of occupation of the surgical unit was 100 minutes and occupation of the recovery room was 2 hours. The total real cost of this intervention was 510 Euros, the cost estimated by the health insurance fund was 110 Euros and the cost of hospitalisation charged was 997 Euros. CONCLUSION: these results show us the real cost of this intervention and the cost estimated by the French health insurance fund. It is highly noteworthy that the cost estimates were totally inadequate. This study leads to a discussion concerning a more global approach to the cost-benefit ratio of such an intervention as well as the indication for bioabsorbable material compared with titanium in facial traumatology.

Cost-Benefit Analysis↗
PubMed2003

[Complete chest wall reconstruction after en bloc excisions with Gore-Tex/Marlex/Flap sandwich. A retrospective study of 14 cases].

To assess the results of surgical resection and chest wall reconstruction we reviewed our experience with the complete chest wall reconstruction after en bloc excisions according to an original algorithm based on the location of the thoracic defect. The 14 reconstructions were performed by the senior author. We found 5 central, 6 lateral and 3 borders locations. In the central locations with a total resection of the sternum the reconstruction was realized by Gore-tex's mesh in depth, metal hooks (staples) and Marlex's mesh under a musculocutaneous flap of coverage. In case of lateral location the reconstruction was realized by Gore-tex's mesh covered with a musculocutaneous flap, the borders locations were reconstructed by Marlex's mesh and flap of coverage. The histological diagnoses were: one desmoid tumor, eight sarcomas, a recurrence of hepatocarcinoma and four recurrences of breast cancer. The superficial coverage performed by latissimus dorsis flap 12 for cases and rectus abdominis flap for two cases. All the patients were able to produce a spontaneous breath after surgery. Two deaths at distance and an infection were to regret. On the whole the algorithm of reconstruction according to the location of the defect allows a simplification of the indications.

Adolescent↗
PubMed2003

[Establishing a new severity score for EEC: ectrodactyly-ectodermal dysplasia-cleft lip and palate].

BACKGROUND: EEC (ectodactyly-ectodermal dysplasia-cleft lip and palate) is a rare disease transmitted by autosomal dominant inheritance with variable penetrance and weak expressivity. Clinical expression is thus very variable. Besides the three signs defining the syndrome, other manifestations include anomalous lacrimal ducts, urogenital malformations, transmission deafness, facial dysmorphism, and mental retardation. In 1995, Roelfsema and Cobben established a severity score on the basis of data in the literature. MATERIAL AND METHODS: We analyzed retrospectively the cases of 5 patients followed from 1980 to 2000 in two University Hospitals in France. Malformations were detailed and the Roelfsema and Cobben score was calculated. The real degree of disability was estimated from social activity level. We searched for a correlation between the Roelfsema and Cobben score and the real degree of disability. RESULTS: Our findings showed a poor correlation between disability and the Roelfsema and Cobben score. We proposed a new score which takes into account social disability. DISCUSSION: Our study revealed that the Roelfsema and Cobben score overly emphasizes anatomic malformations without taking into account natural adaptation to the social environment. Inversely, the Roelfsema and Cobben score gives little importance to invisible anomalies despite their invalidating effect.

Abnormalities, Multiple↗
PubMed2003

[Seip Berardinelli: the effect of the partial tongue resection].

The Seip Berardinelli or undiagnosed endocrine metabolic syndrome is a rare autosomal recessive pathology mainly described in families of Portuguese origins. This syndrome presents various metabolic disturbances responsible of various dysmorphies. We report the case of two brothers seen during their childhood for respiratory, speaking and feeding problems related to a class 3 of Angle and macroglossia. The object was to study the interaction between the size of the tongue, the prognathism and the disturbances presented in order to organize early surgery (partial glossectomy).

Child↗
PubMed2002

[Reconstructive surgery of the lower lip skin].

The reconstructive procedures of the lower lip skin are revised. We present the various possibilities of surgical reconstruction in a classic way, according to the size of the defect.

Dermatologic Surgical Procedures↗