Biomedical subjects

J F Chassagne

Publications and source records attributed to J F Chassagne.

At least 19 recordsLinked to original sources

PubMed2006

[Contribution of the pathology examination in the operating theatre in patients with skin cancer: retrospective analysis of 388 patients].

INTRODUCTION: Pathological examination in the operating theatre in patients undergoing resection of a skin cancer is one of the most adapted therapeutic approaches. We present our experience with 388 patients, comparing the rate of recurrence with or without operating-theatre pathological examination. MATERIAL AND METHOD: The study population included 388 patients, mean age 69.5 years (28-98 years) who underwent resection of 544 skin tumors (520 primary and 36 recurrent), 76.6% unique tumors. The pathological examination of the surgical specimen was performed immediately after removal. This method was systematic procedure for spinocellular carcinomas, was not performed for basocellular carcinomas measuring less than 1 cm when well circumscribed and not peri-orifice, and when reconstruction was not planned. RESULTS: The pathological examination was not performed in the operative theatre for 76 tumors; for 470 examinations performed in the operative theatre, at least one surgical margin was positive in 93 (19.8%). Anatomic regions concerned most were the tip of the nose and the eyelids. Recurrent tumors (5.0% of resections) accounted for 27% of the positive pathological results. Thirty-one patients had to have revision surgery, four after a false negative on the pathological examination performed in the operative theatre, four patients for a healing problem and 23 because of tumor recurrence (4%). DISCUSSION: Pathological examination in the operative theatre can help decrease the rate of recurrence in comparison with classical surgery using empiric margins. This method is reliable if performed by an experienced pathologist so that reconstruction can be undertaken before the definitive pathological results are obtained, improving patient comfort. These therapeutic options have a cost however in terms of equipment and personnel. Indications should be well chosen and balanced against the advantages of a two-phase classical procedure.

Adult↗

PubMed2004

Microsurgical lip replantation: evaluation of functional and aesthetic results of three cases.

Lip amputations are rare, and microsurgical replantation must be systematically tried to restore form and function in one step. The authors present a series of three cases. Revascularization of the amputated segment was obtained by arterial anastomosis with the corresponding labial coronary artery. No venous anastomosis was carried out, because no vein could be identified. Venous drainage was obtained by inducing bleeding and by postoperative application of leeches for 6 days. Anticoagulant therapy and antibiotherapy were used for 10 days. With this approach, two lip amputations were completely saved, and a third amputation only suffered partial necrosis. Aesthetic and functional results were evaluated as being good, with reestablishment of labial continence and recovery of protective sensitivity.

Adult↗

PubMed2004

[Principles of treatment of total unilateral cleft lip and palate. Suggested protocol].

Complete uni-lateral cleft palates resulting from failed union between internal and external nasal buds cause an imbalance of both superficial and deep nasal structures. After summarizing the principles that should guide the care of these anomalies, the authors present their therapeutic procedure, in which orthopaedic and surgical treatments are intimately associated. They conclude their presentation by emphasizing the difficulty of predicting the definitive result because of the extreme diversity of the sequellae that always accompany the treatment of cleft palates.

Alveolar Process↗

PubMed2001

[Orthopedic treatment of labio-maxillo-palatal clefts: our approach].

Many authors use a preliminary orthopedic procedure before cleft lip and palate surgical closure in order to prevent possible bone distortion following the rupture of the muscle belts resulting from the cleft. Actually, this is generally not only an orthopedic treatment but rather a surgical orthopedic step which includes lip adhesion before the surgical closure of the clefts. Following the procedures proposed by Georgiade and Latham, we have used since 1996 a treatment based on traction applied with an elastic chain on splints attached by transmaxillary pins for certain types of clefts, namely unilateral complete clefts with endognathy of the small fragment, unilateral complete clefts larger than 7 mm, bilateral wide complete clefts with premaxilla protrusion, and bilateral wide complete clefts with collapsus and premaxillary protrusion. Technical procedures vary with the type of cleft. Standard procedures with or without jacks are used for the other types of complete clefts. These orthopedic procedures with elastic traction are performed between the 3rd and 6th week, before lip adhesion of the upper part of the lip (combined with release of skin and subcutaneous tissues from the underlying alar cartilage). A palatine plate with or without a jack, fitted most of the time with a spring for nostril support, is then inserted until surgical closure.

Bone Nails↗

PubMed2000

Postoperative brachytherapy alone for T1-2 N0 squamous cell carcinomas of the oral tongue and floor of mouth with close or positive margins.

PURPOSE: To evaluate the efficacy of postoperative brachytherapy alone (brachy) for Stage T1-2 squamous cell carcinomas (SCC) of the floor of mouth (FM) and the oral tongue (OT) with close or positive margins. METHODS AND MATERIALS: Between 1979 and 1993, 36 patients with T1-2 N0 (24 T1, 12 T2) OT (19), and FOM (17) SCC with close or positive margins following surgery underwent postoperative brachy. Mean patient age was 56 years (range 37-81) and sex ratio was 3.5:1 male:female. Mean surgery to brachy interval was 36 days (range 16-68). The technique used was interstitial Iridium-192 ((192)Ir) brachytherapy with plastic tubes and manual afterloading. Mean total dose was 60 Gy (range 50-67.4) at a mean dose rate of 0.64 Gy/h (range 0.32-0.94). Mean patient follow-up was 80 months. RESULTS: The 5-year actuarial overall and cause-specific survivals of the entire group were 75% and 85%, respectively. The local control was 88.5% at 2 years, with a plateau apparent after 23 months. Of the 4 local relapses, 2 were salvaged with surgery and external beam radiotherapy (EBR). No tumor or treatment factors, including tumor size, margin status, disease site, or radiation dose, were correlated with local control. The 2 head and neck second primaries underwent curative treatment on nonirradiated tissue. One patient developed a grade 3 sequelae (bone and soft tissue necrosis). Grade 2-3 chronic sequelae were seen in 7 of 17 and 3 of 19 FOM and OT tumors, respectively (p = 0.09). CONCLUSION: Postoperative brachy is a promising approach in T1-2 N0 OT and FOM SCC with close or positive margins. This approach is associated with high rate of locoregional control and low risk of chronic sequelae, obviates major surgery, avoids potential sequelae of EBR (xerostomia, dysgueusia, fibrosis), and avoids treatment of second head and neck primary on nonirradiated tissues.

Adult↗

PubMed1999

[The value of sialo-MRI in the study of salivary gland duct pathology].

Usual imaging diagnostic for salivary glands is sialography. Sialography is not stripped of disadvantages and failures. The MRI-sialography is an examination which is carried out without any injection of contrast's product (without catheterization or intravenous injection). It is thus noninvasive and painless. The complete study of salivary gland and its ducts is always possible and could not be blocked by local or loco-regional conditions. It allows exploration of several salivary glands in the same time. We think that the MRI-sialography must find its place in the diagnosis arsenal for salivary pathology in spite of its current handicaps represented by its cost and the difficulty of access to the apparatuses.

Contrast Media↗

PubMed1999

[Rapid prototyping and bone reconstruction].

The authors describe the main techniques for rapid prototyping used in the medical field, with particular emphasis on Laser stereolithography. They describe the basics of the technique as well as the procedures they currently use to construct anatomic specimens from scanned images. For more than 10 years, the targets of researchers in the field of bone reconstruction in craniofacial surgery have been: to design a system to acquire data directly from CT-scans, to optimize modelling, processing and materials, to verify the possibility of producing prefabricated prostheses with data from preoperative models (22 cases). The target of integrating this technique into therapeutic protocols has been reached. The current trend in research is to produce prostheses from biocompatible materials directly from CT scan data by Laser stereolithography.

Computer-Aided Design↗

PubMed1997

Post-operative brachytherapy: a prognostic factor for local control in epidermoid carcinomas of the mouth floor.

The aim of this study was to analyse the role of post-operative brachytherapy (BT) in a group of patients with a high risk of local relapse (positive or narrow surgical margins) for squamous cell carcinoma of the mouth floor (SCCFM). A comparison with post-operative external beam irradiation (EBI) in a group of patients with standard risk of local relapse for SCCFM with free margins is performed to estimate the benefit of BT. From 1979 to 1992, an initial group of 32 patients with SCCFM (12, T1-2; 20, T3-4x) received an Ir 192 low dose rate BT using plastic tubes (+EBI for 20 patients) after surgery with positive or close margins. BT was applied in one or two planes to the surgical scar. The mean dose of BT was 57 Gy (range: 50-60) for exclusive BT and 22 Gy (range: 15-30) when a boost was applied (mean EBI dose = 50 Gy). During the same period, 36 patients had post-operative external irradiation alone after satisfactory surgical resection. Excluding the post-operative margin, these two groups were comparable for other prognostic factors. The mean follow-up was 46 months (range: 5-145) with a minimum follow-up of 2 years. For BT and EBI groups, the 5-year results (Kaplan-Meier) were, respectively, overall survival 62% and 43%, local control 81% and 60% (P = 0.09) (log-rank) and severe complications 4/32 and 1/36. Post-operative BT achieves good local control for patients with narrow or positive margins by increasing the dose to the surgical scar, with good tolerance. Given these encouraging results, we confirm this treatment for these patients.

Brachytherapy↗

PubMed1995

A new three-dimensional treatment algorithm for complex surfaces: applications in surgery.

PURPOSE: Recent advances in computer technology enable automatic reconstruction of surface models using digitized contour lines and three-dimensional (3D) representation on a graphic terminal. This work was aimed at obtaining 3D reconstructions of facial bones to help guide oral surgery and complex dental implantology procedures. MATERIAL AND METHODS: The starting point was a computed tomographic examination. The limits of the cortical bone were automatically outlined and then digitized using a special computer program. The resulting data were then compiled for computer-aided design (CAD) purposes, and a virtual 3D model of the bone was mathematically computed. This model was next transferred to a computer program that piloted a CAD/computer-aided manufacture (CAM) machine that guided a laser stereolithography process. RESULTS: The early results of the use of 3D images, as well as solid models, for clinical and surgical purposes, indicate a high degree of reliability in morphologic diagnosis, determining the surgical procedure, and establishing the subsequent prognosis.

Algorithms↗

PubMed1995

[Surgery and curietherapy of keloids].

Postoperative irradiation of keloids allows a decrease of the recurrence rate by about 50%, compared to surgery alone. A review of the literature illustrates the benefits due to the irradiation, and describes the techniques available. The Iridium 192 interstitial brachytherapy, with per-operative implantation of the plastic tubes and immediate irradiation of 20 Gy at 5 mm depth, is detailed as used by French teams. The analysis of the published results allows to recommend this technique which is tailored to each clinical situation, safe, and easy to perform by the surgeon.

Brachytherapy↗

PubMed1995

[Temporomandibular joint luxation and Ehlers-Danlos disease. Apropos of a case].

First described by Tschernogobow in 1981, Ehlers-Danlos syndrome is usually observed in white males. Symptoms results from defective collagen synthesis. Diagnosis is based on clinical presentation. There are 9 different clinical groups. Maxillofacial manifestations are usually seen in type VIII Ehlers-Danlos syndrome. The clinical case presented here illustrates the problems involving the temporomandibular joints and focuses on an assessment of proposed therapeutic options.

Adolescent↗

PubMed1994

[Total reconstruction of the nose by osteocutaneous preformed forearm flap. Apropos of a case].

The authors report the case of a 28-year-old woman in whom multiple surgical reconstructions were performed to cure an extensive radiation necrosis of the nose. In 1980, after the failure of a dorsalis pedis free flap and of a free groin flap, success was obtained with a free lateral mammary flap. But defatting, bone grafting and modelling produced partial necrosis of the flap. Finally, total nasal reconstruction was achieved in 1983 with a pedicled osteocutaneous forearm flap. To secure the transfer, the flap was first modelled by folding directly on the donor site. The advantages of this procedure are a lower risk of postoperative infection and a fewer number of secondary surgical stages needed to achieve the reconstruction. The reliability of the forearm flap and the simplicity of the procedure advocate its use in difficult reconstructions of the nose, when others techniques could not give better results.

Adult↗

PubMed1992

[Bone substitutes and infection in maxillofacial surgery].

Bony substitutes are in fashion in maxillofacial surgery. They are used to fill bony cavities, in bony reconstruction to give shape-lines and re-create area of support or to fill bony defects. Then their use is frequently crowned by success in general surgery, it is not the same thing in maxillofacial surgery because of the usual impossibility to fulfil a requirement to biomaterial utilisation: the watertight. Furthermore, they don't have yet, for the most part, an essential quality: malleability. In our experience, their use are frequently disappointing because of postoperative infections and we stay faithful to the autograft bone. However it is highly probable that these biomaterials will take an importance more and more considerable when these problems will be overcame.

Biocompatible Materials↗

PubMed1992

[Traumatic rupture of the levator tendon of the upper eyelid].

We report on two cases of traumatic desinsertion of levator aponeurosis. After a blunt trauma diagnosis between levator aponeurosis desinsertion and neurogenic ptosis is important in planing the treatment: early surgery for the first and foregoing for the later.

Adult↗

PubMed1992

[The first- and second-arch syndrome. A treatment analysis and plan].

There is a very great lesion staging in these syndromes, and a great number of procedures have been described, according to the age and severity of the lesions. The initial assessment is therefore important, since it allows classifying these malformations according to their severity in key sectors. Scheduling the treatment in time must take account of: growth, the necessity to perform successive operations in one region, since no operation must hinder a subsequent one. It is essential to determine the optimum time for bone reconstruction. An early treatment with a conventional bone graft, without any intrinsic growth potential, condemns the reconstructed region to immobility, therefore to a progressive degradation of the result in time and to successive corrections. Early reconstruction is justified only if the available reconstruction means allow the reconstructed area to grow, either naturally or with the aid of orthopaedic stimulation. Some means seem to be available to date. A choice must therefore be made between: delayed morphological surgery, early functional surgery. Considering the extent of the means implemented, this is reserved for severe cases. The other great problem is the reconstruction of the auricle, which most often requires a series of operations scheduled over 2 years. The middle ear may not be operated if the lesions are unilateral. The other malformations, including macrostomia, muscular and neural abnormalities, involvement of the eyelids, sometimes require correction, which must fit in a repair schedule that must be established as soon as possible and must take account of the predictable procedures in order to prevent them from hindering each other.

Abnormalities, Multiple↗

PubMed1992

[Osteosarcomas of the mandible].

On the base of 3 cases of mandibular osteosarcoma, the current role of surgery is specified. The most often used procedure is Rosen's protocol, which includes: preoperative chemotherapy, radical surgery with reconstruction, and postoperative chemotherapy. The key element is the pathological study of the surgical specimen. This will determine the response of the tumor to preoperative chemotherapy and, by comparing the histology of the initial biopsy specimen to that of the surgical specimen, will be used as a basis to select the postoperative chemotherapy. For this type of tumor, chemotherapy has completely substituted for radiation therapy, which is no longer used in the initial treatment. Prophylactic lung radiation therapy has also been given up due to the risks of pulmonary fibrosis entailed by the effective doses. Surgery still has a role of choice in the therapeutic schedule, even if it cannot be contemplated as the sole treatment. Considering the usually young age of the patients, we currently think that reconstruction must be immediate and must resort to all the techniques likely to produce the best possible functional and morphological result.

Adolescent↗

PubMed1991

[Value of MRI in the visualization of the meniscus in temporomandibular joints].

Modern imaging techniques, among which nuclear magnetic resonance currently ranks first, have made it much easier to understand the internal disorders of the temporomandibular joint. While computed tomography still is the ideal technique for all bony affections in the articular region, especially for injuries. MRI now is an essential first-intention complementary examination. It allows assessing the location of the meniscus and very well defines the pathology being explored: reducible or irreducible dislocation of the meniscus, either purely anterior or anterolateral, the latter being better visible on coronal views (which are not systematically taken). The examination includes T1-weighted parasagittal views perpendicular to the axis of the condyle, taken with a surface coil (knee coil). Two sequences are performed, one with the mouth open and one with the mouth shut. The meniscus appears as a biconcave hypointense signal, which normally lies on the head of the condyle both when the mouth is open and when it is shut. T2-weighted sequences have the advantage of revealing possible effusion or intra-articular adhesion between the capsule and the synovial membrane. They may also better demonstrate a possible myxoid degeneration of the meniscus. The considerable increase in scanning time required for these sequences accounts for their unfrequent use. The condition of the bone can also be assessed, but we find MRI less accurate than direct sagittal CT scans. The future prospects include shorter imaging times owing to fast-imaging sequences (short T1 with partial flip angle).

Cartilage, Articular↗

PubMed1991

[Surgical problems arising from ethmoid adenocarcinomas].

Adenocarcinomas are the most frequent ethmoid tumors. The only curative treatment at present is surgery. Potential extensions of these tumors require a wide exeresis. This is best ensured with an approach that is cranial and of the Cairns type at first, then in some cases facial and patterned on the Moure-Sebileau course of approach. This procedure demands the immediate reconstruction of the 3 levels involved: the dura mater, the bone and the mucosa of the nasal fossae. We reconstruct the dura mater with a pericranial flap, the bone with bone grafts, and the mucosa with a flap from the galea.

Adenocarcinoma↗