Biomedical subjects
Publications and source records attributed to E Arnaud.
Treacher Collins syndrome is a complex congenital malformation. The most important manifestations of this syndrome are hypoplastic or absent malar bone, centrofacial over-projection, eyelid coloboma, and micrognathia. This article presents an approach to re-establish the right centrofacial proportions through "flattening osteotomies" of the maxilla, malar bone reconstruction, and other maxillo-mandibular osteotomies.
General considerations about frontal sinus development are discussed. This retrospective radiological study concerns 90 craniosynostoses among 850 cases operated in the Cranio-Facial Unit (1976-88, Hôpital Necker des Enfants Malades, Paris, France). The incidence of frontal sinus development is compared between a control group and the craniosynostoses group with a mean age at surgery of 3 years and a mean follow-up of 6.5 years. Pneumatization of the frontal bone seemed to vary according to the type of surgery and the age at review, but was not linked to sex and age at surgery. A classification of fronto-cranial remodelling is suggested.
This retrospective clinical and radiographic study concerns 75 cases of craniosynostoses among 850 cases operated in the Craniofacial Unit of Necker's Hospital for Sick Children (1976-1988, Paris, France). The correlation between frontal sinus development and glabellar morphology was analyzed. When there was a significant advancement of the supraorbital ridge the projection of the glabella was satisfactory without any frontal sinus. When no significant advancement was performed, the pneumatization of the frontal bone was as frequent as in the general population and was dependent upon the underlying frontal sinus.
General considerations about frontal sinus development are first discussed. We include retrospective clinical and radiographical studies dealing with 90 craniosynostoses among 850 patients operated in the Craniofacial Unit of Necker's Hospital for Sick Children (1976-1988; Paris, France). The incidence of frontal sinus development is analyzed: The pneumatization of the frontal bone seemed to develop according to the type of surgery and to the age at which review was realized, but was not linked to the age at which surgery was performed. The surgery consisted of fronto-orbital remodeling after supraorbital bar mobilization. The median age at surgery was approximately 3 years, and the median length of the postoperative follow-up was 6.5 years, depending on the type of pathology. The correlation between frontal sinus development and glabellar morphology are also analyzed: When there was a significant advancement of the supraorbital bar, the projection of the glabella was satisfactory without any frontal sinus. When no significant advancement was performed, pneumatization of the frontal bone was as frequent as in the general population and was dependent on the underlying frontal sinus. A classification of the different type of frontal advancement is proposed.
Surgical repair of craniosynostosis carries a high risk with large blood losses. Over a 2-yr period, we have managed 115 patients undergoing craniosynostosis repair with peroperative haemodilution to achieve a final PCV of 0.28-0.35. Measurements of PCV allowed calculation of estimated blood losses and transfused volumes in terms of red blood cell mass. Total estimated red cell volume lost was 91 +/- 66% of patient's estimated red blood cell volume during the peroperative period. The type of skull deformation and surgical procedure determined the extent of peroperative bleeding. Peroperative transfusion was satisfactory in 48% of patients and slight overtransfusion was noted in 32%. During the postoperative period, liberal administration of blood led to overtransfusion and possibly unnecessary transfusion in 74% of patients. Because of the well known risks of transmission of infectious disease, strict volume compensation with development of haemodilution and autotransfusion procedures should be used to limit these risks.
The purpose of this study is to demonstrate the development of angiogenesis spreading from a vascular pedicle stretched by an expander, and to determine its potential to supply blood to an adjacent skin area. In the pig model (9 animals), we inserted an expander under the saphenous vessels after interrupting all the connections between the pedicle and the related inguinal skin. The opposite side was used as a control with a non-expanded silicone sheet, 1 mm (2 animals) and 3 mm (7 animals) thick. After 6 weeks of expansion, vascular island skin flaps were elevated on the saphenous vessels. 6 out of 7 expanded flaps were totally successful. Of the 5 flaps elevated above the 3 mm silicone sheet, 1 flap was successful and 4 partially failed. The 2 flaps elevated above the 1 mm silicone sheet failed. An anatomical arteriovenous pedicle stretched by an expander can supply a skin area located distal to it. Angiogenesis also occurs in contact with a thick silicone sheet but the blood supply of the skin is less effective. The newly formed vascular network is visualized on the angiograms.
The authors report two cases of arteriovenous fistula due to spontaneous rupture of an aortic or iliac aneurysm into the iliocaval venous axis. This is a rare complication of atheromatous aneurysm (less than 4% of ruptured aneurysms), often difficult to diagnose as the clinical presentation may be obscure. Although aortography is the reference diagnostic investigation, color Doppler ultrasonography enabled visualisation of the arteriovenous communication and provided an accurate diagnosis in one recent case. Treatment of these aortocaval fistulae is always surgical. The prognosis and immediate operative mortality depend mainly on the presence of an associated retroperitoneal rupture.
The possible transformation of synovial osteochondromatosis into chondrosarcoma is rarely reported in the literature, as well as the coexistence of the two entities. The authors have observed two such cases. The first one was discovered by arthroscopy in the course of a synovial osteochondromatosis associated with a posterior tumour proved secondarily as being a chondrosarcoma. On the contrary, the second case presented as a destroying tumour invading the entire joint and proved secondarily as being a benign osteochondromatosis. Cartilaginous masses very important may lead to bone destruction in the course of benign osteochondromatosis. However, in such cases, the possibility of an associated or a secondary chondrosarcoma must be looked for using radiology, arthroscopy and microscope examination.
During ESWL, bacteria which may be contained in the stone gets disintegrated. This study evaluates the role of prophylactic antibiotherapy in preventing such complications. Fifty patients whose urine culture was negative were randomized into two groups: the first group (25 patients) received a placebo, the second group received Ceftriaxone 1 g I.V. as a single injection performed 1 hour previous ESWL. There was no positive blood culture and no positive urine culture in the placebo group arm as well as in the antibiotic group. In this study, the risk of infection induced by ESWL seems to be minimal, so that prophylactic antibiotherapy does not appear to be necessary when urine before ESWL is sterile.