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Biomedical subjects

A Pech

Publications and source records attributed to A Pech.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Acoustic neurinoma. Otoneurosurgical approach].

From 1973 until November 1984, 224 cerebello-pontine angle tumors, 180 of them isolated neurinomas, were operated on. In a large majority of cases (160) through the widened trans-labyrinthine approach, advocated by House and Hitselberger was used. Despite advances in diagnostic procedures two out of three of these neurinomas were discovered only when they were already quite big. The post-operative overall death rate was 5 p. 100, tumor removal was complete in 96 p. 100 of cases and the facial nerve continuity was respected in 87 p. 100 of cases. These overall results can be still improved because in the last 50 cases, no death occurred, the removal was always total and the facial nerve continuity was respected in 96 p. 100 of cases. The problem of hearing preservation, impossible by this approach, is discussed. The necessity of facial nerve preservation and total removal, in order to prevent recurrence, is emphasized. It often seems very difficult to preserve hearing and to completely remove the tumor and at the same time, have the highest chance of saving the facial nerve.

Adult↗
PubMed1987

[Spheno-ethmoidectomy in recurrent nasal polyposis. Technic, indications, results].

Spheno-ethmoidectomy can be legitimately included within the therapeutic schema for nasosinusal polyposis causing incapacity and resistant to medical treatment. Benefiting from recent technical progress, a very precise medical therapeutic framework and improved knowledge of ethmoid surgical anatomy, a marked reduction in complications of this operation has been observed. Results of a series of 175 ethmoidectomies performed in 90 patients confirm the good results reported in the literature, even though follow up is still insufficient.

Ethmoid Sinus↗
PubMed1986

[Tumors of the cerebellopontile angle, with the exception of acoustic neuromas].

Based on a review of 38 cases of tumors of pontocerebellar angle, excluding acoustic neurinoma, and a literature review, clinical, radiologic and therapeutic characteristics of these lesions are described. Diagnosis depends on accurate pre-operative identification of the type of tumor. Based on frequency data it can be estimated that tumors of pontocerebellar angle are nearly always acoustic neurinomas : this infers that these other tumors of the angle represent a differential diagnosis where major orientation signs are radiologic. This is fundamental, since when considering all tumors of pontocerebellar angle those requiring a totally different approach to treatment than that for acoustic neurinomas must be distinguished from those for which inability to identify them is not of marked importance since their operatibility is identical.

Adult↗
PubMed1986

[Venous and meningeal prolapse during enlarged trans-labyrinth approach].

One hundred consecutive operations using the enlarged trans-labyrinthic (ETL) approach for acoustic neurinoma performed by the same surgeon were analyzed to determine incidence of venous and/or meningeal prolapses. Findings showed that ETL approaches were normal in 51 cases : normal superficial sinusodural space--external auditory canal and on deep dissection a superior petrous sinus and jugular space separated from the internal auditory canal. Prolapse was observed in 49 approaches : 30 very narrow sinusodural spaces due usually to temporal meninges prolapse (76%) associated in 25% of cases with a prolapse of lateral sinus; 29 prolapses of jugular space and 10 of superior petrous sinus, detected mainly in the narrow sinusodural spaces. In these cases, superficial displacement of the temporal meninges and lateral sinus appears indispensable in order to recover normal operating conditions towards the labyrinth and pontocerebellar angle.

Ear, Inner↗
PubMed1986

[Requisite selection of surgical technics in the treatment of cancer of the larynx].

Rules for functional surgery of cancer of larynx are defined by means of a detaited analysis of results of 43 cases of reconstructive anterior frontal laryngectomy, 17 cases of crico-hyoide-epiglottopexy and 32 cases of crico-hyoidopexy. The carcinologic features of this surgery are discussed, and emphasis placed on the importance of the paraglottic space and its functional conditions in the light of recent physiologic data. Surgical procedures used are outlined with, for each of them, the neoplastic localization suitable for treatment and a critical analysis of postoperative functional results. Carcinologic follow up is still insufficient for several techniques used, preventing any precise conclusions to be drawn, but the authors consider it is justifiable to perform 66% of partial as against 34% of total laryngectomies.

Humans↗
PubMed1985

[The external fronto-ethmoidal approach].

A lateral fronto-ethmoidal approach simultaneously exposing the frontal sinus and the nasal fossae appears to be a necessity for the surgical treatment of fronto-ethmoidal pathology. It is possible to fashion an osteo-plastic flap in the fronto-naso-maxillary region. The technique of the approach is described. The operation leaves no ocular functional sequelae and the scar is minimal. Twenty one operations by fronto-nasal flap approach are described, 10 for benign tumours of the fronto-ethmoidal system and 11 with the aim of re-aerating the frontal sinus for cases of complicated or iatrogenic serious sinusitis. The results are studied. The indications of the fronto-nasal flap are described: In tumour pathology, this technique must be used for osteomas and mucoceles of the fronto-ethmoidal system as soon as the ethmoidal component reaches or goes beyond the middle ethmoid. If the fronto-ethmoidal lesion only involves the anterior ethmoid, it is then accessible via simple frontal flap. Inverted papillomas which require wide exposure should also be treated via this approach. In infectious pathology, the fronto-nasal flap offers the possibility, after eradication of fronto-ethmoidal lesions and calibration of the naso-frontal canal, of re-aeration of the frontal sinus which seems preferable to its exclusion. The possibility of re-aeration of the frontal sinus by an osteo-plastic procedure is progress in comparison with lost bone craniotomy procedures.

Craniotomy↗
PubMed1985

[Vestibular neurectomy in Ménière's disease. Results and comments apropos of 77 cases].

The authors report 77 cases of vestibular neurectomy performed between 1972 and 1984 (40 male and 37 female) for incapacitating Meniere's vertigo. Neurectomy was via a sub-petrous (S.P.) approach in 55 cases, by posterior trans-labyrinthine (P.T.L.) approach in 9 and anterior trans-labyrinthine (A.T.L.) in 13 cases. A.T.L. was abandoned because of the frequency of leaks of CSF and of meningitis. The P.T.L. approach did not result in any facial paralysis, even transient. There were 2 CSF leaks, without meningitis and one of which required reoperation. For the 55 S.P. cases, hearing worsened in 22.2% with 8 cases of deafness, including three appearing secondarily. There were two transient auditory improvements. Vertigo was cured in 73 cases (94.8%) with 25.9% instability after several months. The authors stress the frequent bilateralisation of the disease and the need to reserve vestibular neurectomy for cases of longstanding incapacitating vertigo, resistant to all other treatment, as well as the value of surgery on the endolymphatic surgery provided that the criteria of indication are complied with. Medical treatment remains the essential basis, including the analysis and, where applicable, treatment of psychosomatic factors by a trained psychiatrist. Finally, when vestibular neurectomy is indicated, the S.P. approach is otologically most suitable, the P.T.L. being reserved for deaf ears or the elderly.

Aged↗
PubMed1985

[Cholesteatoma of the ear. Experience with an eclectic therapeutic attitude].

In the light of 702 cases of cholesteatoma seen over a 20 year period, the authors report the experience of a hospital team based upon analysis of the last 517 cases. 322 patients were treated by a conservative attitude to the bony meatus, including 120 undergoing routine revision between 14 and 24 months. 195 cases were treated by an open technique, either primarily or following massive recurrences despite the use of closed techniques. In 33% of cases, patients had already undergone at least a tympanoplasty. The authors discuss the indications of the treatment of cholesteatoma. Each patient must be considered as an individual case and whilst our preference would be for conservation of the bony meatus, certain anatomical and functional conditions make a so-called open technique necessary in 1/3 of cases.

Adolescent↗
PubMed1985

[Rare cervicofacial cysts and fistulas in children].

Among the various congenital cervicofacial swellings observed in children, three types are rarely encountered in general practice: auriculobranchial cysts and fistulae, thymic cysts and cystic lymphangiomas. To resolve diagnostic and therapeutic problems related to these rare lesions it is essential that their etiopathogenic bases be understood. Auriculobranchial cysts and fistulae present clinical symptoms (cervical, parotid, auricular) that are only poorly evidenced and are related mainly to infection. Surgical excision requires a wide approach route of the parotidectomy type with preliminary isolation of the facial nerve. Thymic cysts result from embryogenic anomalies leading to remnants from the 3rd endobranchial pouch and/or degenerative disorders of Hassal's corpuscles. Of mainly perioperative detection their exeresis requires investigation of possible inferior mediastinal prolongations and preservation of healthy thymic parenchyma. Cystic lymphangiomas arise from dysembryoplasia of the lymphatic system, two opposing pathogenic theories existing to explain their origin. They are serious lesions because of their dissecting tendencies and their inexorable growth in the vast majority of cases. Two forms of lymphangioma, from the embryologic, diagnostic and therapeutic points of view, can be distinguished: those of extraparotid origin and those developing from the parotid.

Branchioma↗
PubMed1984

[Total circular pharyngolaryngectomy. A method of reconstruction with a free forearm skin flap].

The reconstruction of the digestive tube after total circular pharyngo-laryngectomy continues to pose a number of problems. Fistulae and delayed healing of the mucosa are common problems after musculo-cutaneous flaps. They are due, on the one hand, to a spring effect of the flap which interferes with tubulisation and, on the other hand, to the problematical suture of the thick thoracic wall skin to the fine oesophageal mucosa. Free visceral plasties give first intention repairs with rapid return of eating, but they carry a mortality of 10 to 15%. The free ante-brachial plasty with a radial pedicle seems to be a satisfactory alternative due to the quality of the oesophageal reconstruction and the absence of mortality. The technique of forming the flap and the operative procedure are described. Five cases are presented. There were no failures and oral feeding could be re-commenced by the 21st day, on average.

Colon, Sigmoid↗
PubMed1984

[Cholesteatomas of the fronto-orbital region].

Three cases of primary fronto-orbital cholesteatoma are reported and the relevant ORL and neurosurgical literature reviewed. Clinical diagnosis of this rare affection is not simple but is suggested by signs of infero-internal exophthalmus, an external orbital mass or exteriorized sinusitis after chronic headache. Two characteristic features are seen on radiology. The essential therapeutic problem is to prevent late recurrences, their frequency appearing to have been underestimated. Secondary cholesteatoma of iatrogenic or post-traumatic development is seen more rarely, and produces an endosinus disease treated surgically through a conventional para-lateronasal approach. Primary cholesteatoma, the more common variety, originates in the frontal diploë, is perisinusal in location and can extend into neighboring structures, particularly the external orbital apophysis. A CT Scan is essential in order to detect endocrine extension. A surgical approach adapted to the perisinusal localization of the lesion must be adopted, as for example the Cairns-Unterberger approach.

Adult↗
PubMed1984

[Role of musculocutaneous flaps in pelvibuccopharyngectomy].

Musculocutaneous flaps were used for reconstruction after excision of large base of tongue or lateral oropharyngeal wall tumors in 50 patients, the most frequently employed flap in both regions being one from pectoralis major. Results showed marked reliability for these types of flaps for repair in these two areas, and they have now supplanted conventional single pedicle skin flaps. Various flaps supplying different useful surfaces are required, the platysma or sternocleidomastoid muscles being used for small areas, the pectoral or trapezius muscles for medium sized gaps and the latissimus dorsi for extensive repairs. Postoperative and functional results were improved both after initial or repeat operations. The possibility of more extensive excisions should improve prognosis of these tumors, their severity being partly related to local recurrence. It is too early to conclude definitely in their use in initial surgery, but they are valid procedures following failure of radiotherapy, enabling certain patients to be treated again after 3 years in the absence of any other therapy.

Follow-Up Studies↗
PubMed1984

[Glottic reconstruction with a flap of thyroid perichondrium].

Laryngoplasty was performed using the perichondrium of the thyroid cartilage or a sternohyoid muscle flap. Techniques and results are described using this method, applied for glottic reconstruction after vertical partial laryngectomy of the frontolateral type and after cordectomy. Anatomic and functional results in 15 cases are described, ultrasound imaging showing in all cases an improvement in basic laryngeal function, and in the timbre and strength of the voice.

Female↗