[Medical demographics and plastic surgery in France: current situation and projections].
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Demography↗
Biomedical subjects
G Magalon
Publications and source records attributed to G Magalon.
[Geographic distribution and density of plastic surgeons in France].
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France↗
[Pseudo-paralysis of the brachial biceps in obstetrical brachial plexus lesions (OBPL):concerning the "overly optimistic" EMG in OBPL].
In birth palsy of the brachial plexus, the mixed interference pattern recorded for the brachial biceps on the electromyogram often conflicts with the muscle's inability to flex the elbow. We report our observations of a six-month-old infant who presented paralysis of the upper and medial elements of the brachial plexus, in whom we demonstrated early biceps-triceps co-contractions, which may explain this discrepancy and 'pseudo-paralysis' of the biceps. We analyse and discuss the practical consequences of these findings, and notably the possible therapeutic use of triceps-to-biceps surgical transposition.
Brachial Plexus↗
PAI-1 produced ex vivo by human adipose tissue is relevant to PAI-1 blood level.
Human adipose tissue has been shown to produce plasminogen activator inhibitor type 1 (PAI-1). However, the importance of adipose tissue in the regulation of the PAI-1 plasma level is not known. The aim of this study was to investigate the relation between the production of PAI-1 by adipose tissue, plasma PAI-1 level, and variables related to the insulin resistance state. The link between the production of PAI-1 inducers such as tumor necrosis factor-alpha and transforming growth factor-beta and the production of PAI-1 by adipose tissue was also evaluated. Blood samples were obtained as soon as possible to the induction of anesthesia from 30 patients undergoing elective abdominoplasty. PAI-1 antigen levels measured in conditioned media after a 19-hour incubation period of adipose tissue explants were significantly correlated with plasma PAI-1 antigen levels (r=0.54, P=0.004) and with systemic lipid parameters such as triglycerides and high density lipoprotein cholesterol (r=0. 46, P=0.014; r=-0.50, P=0.01, respectively) but not with insulinemia and body mass index. PAI-1 production by adipose tissue was correlated with those of TNF-alpha (r=0.5, P=0.01) and TGF-beta (r=0. 53, P=0.007). These results emphasize the role of adipose tissue in determining plasma levels of PAI-1, with a local contribution of TNF-alpha and TGF-beta in PAI-1 production by adipose tissue.
Adipose Tissue↗
[Use of skin expansion in resurfacing defective amputation stumps of the lower limbs. 6 case reports].
Better procedures and materials have enabled us to improve the results of skin expansion under knee level and extend its indications. We have used such procedures to cover defective amputation stumps in the lower extremity. When the local conditions are suitable, skin expansion permits the use of healthy skin from the lateral sides of the stump to provide coverage for the ulcerated areas, thus fulfilling the main goals which are to keep the bone shaft as long as possible and cover the stump with sensitive skin, so that a prosthesis can be fitted. In two cases, we also performed skin expansion at a distance to reduce the residual scar at the donor site (expanded flap from the other leg, expanded full-thickness skin graft) when the amount of healthy skin available around the stump was insufficient; the functional results were satisfactory. Skin expansion has become a choice strategy for this type of indication, but it must be performed perfectly to avoid complications or failures (our two first cases). It is important to take precautions at various stages of the operation which must be carefully staged.
Accidents, Traffic↗
[Esthetic surgery: where should we draw the line between information and publicity?].
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Adolescent↗
[Who are the French plastic surgeons?].
Based on data from the national advice of the Conseil National de l'Ordre des Médecins (French Medical Board), the author found 654 plastic surgeons in France and classified them into five categories, demonstrating the increasing proportion of females in this specialty.
Female↗
Pilomatrixoma of the head and neck in children: a study of 38 cases and a review of the literature.
OBJECTIVES: To describe the clinical presentations and discuss the guidelines for surgical management of pilomatrixoma involving the head and neck in children. DESIGN: Retrospective study. SETTING: A tertiary care center. PATIENTS: Thirty-three patients, with a mean age of 4.5 years, underwent surgical treatment for pilomatrixoma (n = 38) between 1989 and 1997. INTERVENTION: All patients were treated surgically. In 34 cases, a direct approach was used to achieve complete removal of the lesion with (n = 11) or without (n = 23) skin resection. In the remaining 4 cases, an indirect approach via a parotidectomylike incision was used. RESULTS: In 88% of cases, the presenting symptom was a hard, slow-growing, subcutaneous tumor. The lesion was associated with pain and inflammation in 7 cases (18%) and abscess or ulceration in 4 cases (11%). Twenty-nine patients presented with single nodules and 4 presented with multiple occurrences. The lesions were located on the face (cheek, eyelid, or forehead) in 20 cases (53%), on the neck in 8 cases (21%), in the parotid region in 8 cases (21%), and on the scalp in 2 cases (5%). CONCLUSIONS: Pilomatrixoma is a rare, benign skin tumor, but practitioners should be aware of its clinical features. Diagnosis is usually easy based on clinical findings, but computed tomographic scan is helpful, especially in cases involving tumors located in the parotid region. Spontaneous regression is never observed. Complete surgical excision, including the overlying skin, is the treatment of choice.
Adolescent↗
Early curettage of giant congenital naevi in children.
Early curettage of giant congenital naevi in new-born infants, if performed during the first few weeks after birth, can have a substantial effect on the pigmentation of the lesions, reducing the number of pigmented cells and leaving only moderate scars. We describe our experience in a series of nine congenital naevi treated by curettage between the first and seventh week after birth. Histological changes that occur in the naevus during the first few days after birth mean that early treatment is needed to obtain a cosmetic improvement. Curettage as an early treatment for giant congenital naevi in new-born infants provides cosmetic improvement and might decrease the risk of malignancy; however, the lesions are not cured. Naevus cells persist in the deep dermal layers and may come to the surface, such that close monitoring is needed long after curettage. The cosmetic improvement is likely to benefit the child's psychological development.
Back↗
[Prospective study of 100 cases of breast hypertrophy].
The authors performed a prospective study of 100 consecutive cases of mammary hypertrophy. Sixty were treated by McKissock's technique and forty by Thorek's technique. The patients were reviewed at the second and sixth postoperative months. A general study of the population was performed to specific their demand, which was functional in 90% of cases, and the various symptoms were quantified. 74% of cases presented with psychological problems and a desire for aesthetic improvement was expressed by 67% of cases. Postoperatively, a functional improvement was obtained in 99% of cases, while psychological disorders resolved in 100% of cases. The satisfaction rate was very high: 79% of patients were very satisfied and 20% were satisfied. Some defects observed by the patients or surgical team are analysed. The complications observed, always minor, are reported. Breast reduction provides an unquestionable benefit for patients with mammary hypertrophy. Two simple and perfectly defined techniques were used to treat all these cases with a maximal satisfaction rate and a minimal complication rate.
Adult↗
[Malignant melanoma in children. Apropos of 6 cases].
Six cases of malignant melanoma were observed in children aged 5-14 years, over a 14-year period: both sexes were equally affected. In three cases, the melanoma was a primary tumor, which indicates that this diagnosis should always be born in mind in children and any suspicious lesion should be biopsied and removed. Three cases had a family history: dysplastic naevus in two cases and malignant melanoma in one case, which confirms the increased risk in some families. Histologically, nodular forms were more frequent than those which spread superficially and the tumors were quite thick when diagnosed (mean thickness: 3.9 mm). Treatment includes wide excision and coverage with skin grafts associated with immuno or chemotherapy in some cases. Mean follow-up was 38 months and no death occurred during this period.
Adolescent↗
[What's new in upper limb skin expansion?].
The indications for skin expansion of the upper limb are now well defined. Based on a series of 56 cases, the authors confirm that a rigorous technique and good management of complications can minimize failures of the method. Technical progress and new biomaterials certainly allow further reduction of these complications and possibly the development of new indications.
Adolescent↗
Infantile digital fibroma--report on eleven cases.
Infantile digital fibroma is a benign lesion, but it is sometimes a locally aggressive proliferative lesion. After having examined the literature, we analysed 11 cases of infantile digital fibroma among children between 1 to 16 years, with a long-term follow-up (14 years). We had 4 recurrences. Treatment was surgical. The histological diagnosis has required special stains to put in evidence the typical cytoplasmic eosinophil elements. Surgery usually involved excision and grafting. We also discuss therapeutic measures.
Adolescent↗
[Surgical treatment of gynecomastia].
Surgical treatment of gynaecomastia is easy. When medical treatment is insufficient, surgery can improve the deformations with a minimal scarring. After morphological aspects and surgical objects description, the authors explain surgical techniques and indications.
Adolescent↗
[Use of "foot-bank" tissue to cover amputation stumps. Apropos of 4 cases].
PURPOSE OF THE STUDY: The authors report 4 cases of plantar skin free transfer to cover an amputation stump. MATERIAL AND METHODS: In two cases, operated as emergencies, a flap based on the posterior tibial pedicle was harvested from a non-reimplantable extremity. In one case the calcaneum was included in the flap to provide a stump wide enough to hold a prosthesis. The two others cases concerned planned amputation of non-functional extremities, with free transfer of the available plantar skin areas. RESULTS: All 4 patients healed well and the skin coverage provided a good quality stump which was rapidly equipped with prostheses. DISCUSSION: Covering amputation stumps with a free flap from the foot bank has proven to be a reliable procedure, economic for the patient, affording a good physiologic bearing surface. CONCLUSION: This method should proposed in emergency amputations according to local conditions, and may also be advantageous in some cases of secondary surgery.
Adult↗
[Plantar verrucous carcinoma. A case report and literature review].
The authors report a case of carcinoma cuniculatum plantar and review the literature on this rare tumour. The clinical features and course of this tumour. The clinical features and course of this tumour are successively described. Although associated with limited malignancy and almost exclusively local extension, progression of this disease may lead to amputation, which can be avoided by early diagnosis, especially based on precise histological examination of all tumours with a benign recurrent appearance after well conducted treatment.
Carcinoma, Verrucous↗
[Coverage flaps for loss of substance of the scalp. Our experiences apropos of 42 cases].
We report our experience with 42 coverage flaps for tissue loss involving the scalp. Malignant tumors of the scalp were the major cause of tissue loss. Repair modalites and outcome are reported. This series included 23 local flaps, one pediculated regional flap, and 18 free flaps associated with three cranioplasties and four dura mater plasties due to invasion of the subjacent tissues. We discuss therapeutic indications and insist on selection criteria which depend on etiology (localization, form depth), local factors (integrity of the pericranium and subjacent structures) and general factors (age, sex, physical and psychological status, socioprofessional context, patient expectations). In all cases, we opted for tissue repair which offers greater safety with minimum function and esthetic morbidity.
Adolescent↗
[Cutaneous expansion at the level of the lower limbs. Surgical technique, indications and complications].
Skin expansion in the lowers limbs has been described for a long time. The authors report their experience in this site. The operating technique is described in such a way as to limit complications to a minimum. The indications for this technique are recalled with particular emphasy on the use of expansion in preparation for a subsequent procedure. Lastly, the most frequent complications are discussed together with the methods of their prevention.
Adult↗