Search PubMed⌕ Search

Biomedical subjects

M Stricker

Publications and source records attributed to M Stricker.

At least 37 records · Page 2Linked to original sources
PubMed1997

Distribution of physicians in Ontario. Where are there too few or too many family physicians and general practitioners?

OBJECTIVE: To assess the regional distribution of family physicians and general practitioners in Ontario after adjusting for practice intensity and the population's patterns of health care use. DESIGN: Analysis of administrative data. SETTING: Ontario. MAIN OUTCOME MEASURES: Intensity of patient use of GP services, GP practice density, and physician density for each Ontario county (measured as the ratio of practice-intensity equivalent GPs to use-intensity equivalent inhabitants). RESULTS: Despite adjustment for practice intensity and use patterns, wide variations exist in GP densities. chi 2 tests identified counties that consistently reported GP densities significantly different (P < 0.001) from the provincial average. Four of the five counties with health science teaching centres had densities significantly higher than the provincial average, while 10 other counties had significantly lower densities. CONCLUSIONS: Results of this study provide useful information for physician resource planning and might inform debate concerning proposals to restrict physician billing numbers and practice locations to rectify perceived maldistribution of physicians.

Adult↗
PubMed1997

[Unusual facial clefts].

After briefly review facial morphogenesis, the authors define facial clefts, distinguishing primary clefts, secondary clefts, and residual clefts. They discuss the uncertainties surrounding the embryology and clinical features of palpebral colobomas. The various pathogenetic concepts are analysed: amniotic hypothesis, vascular hypothesis, fusion defect. The various classifications of rare facial clefts are reviewed, with particular emphasis on Tessier's classification and the so-called Milan classification. The general principles of surgical treatment are described together with the various skeletal and soft tissues procedures.

Craniofacial Abnormalities↗
PubMed1996

[The coral orbital floor. Its value in traumatology. The results of a multicenter study of 83 cases].

A madreporic coral graft was used for orbital floor reconstruction following facial trauma. This report presents a multicentric study of 83 patients with a follow-up period of 15 to 24 months. The results of this study indicate no significant rejection or infection opposed to so many synthetic implants outcome. The radiological follow-up demonstrates a partially resorption of the implant within about 2 years and its replacements by new bone. Coral implant was used to correct enophthalmos or diplopia due to enlarged orbital dimensions. It was technically easy to insert and its anatomic shape does not require to be fashioned before use. Its inflexibility allows to bridge large bone defects and this implant should be considered as an attractive alternative to autogenous grafts, avoiding a second surgical site, in reconstructing orbital floor fractures.

Adolescent↗
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

[The posterior part of the skull. Classification of dysmorphism. Original treatment: turned biparietal flap transposition].

The deformation of the posterior part of the skull (occipito-vertebral region), induced directly or indirectly, occurs in numerous pathological situations. Its significance is frequently overlooked. Lesions of the cranial content, alterations of the lambdoid suture or other premature synostosis, abnormal constraint related to posture or to muscular activity can modify the posterior curvature of the skull, generally flattening it. The authors propose a classification based on three points: -Intracranial pathology: alterations of the brain or CSF fluid can induce either insufficient (microencephaly) or excessive (hydrocephalus, Dandy Walker or Arnold Chiari malformations) expansion. -Bone pathology: craniosynostosis: sagittal synostosis (scaphocephaly) induces a bulging and coronal synostosis a flatness of the posterior skull. Bilateral premature lambdoid synostosis (pachycephaly) produces total flatness of the back of the skull. -Extrinsic pathology: dysmorphism is often asymmetrical and results from extracranial mechanical application dysfunction such as inborn torticollis, cervical spine pathology (Klippel-Feil syndrome), or prolonged decubitus during the first year of life. The authors describe a personal technique for correcting this dysmorphism: the turned biparietal flap transposition. The back of the skull is remodelled (either asymmetrical or bilateral flatness), and patients with no need for a helmet can lie on their backs immediately after the operation.

Child↗
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

[Triangular skull. Apropos of trigonocephaly].

The authors present 87 patients with trigonocephaly who were operated on. They take an interest in the consequence of the early synostosis of the metopic suture. The metopic suture combine with the sagittal sutural system, but his spot of manifestation is unambiguous. Its manage the dimension of the frontal bone which himself has repercussions on the set of the orbits. Thereby the fronto-orbito-facial dysmorphy has two component parts. One direct with little frontal bone and a thick sutural spot which extend more or less to the bregma and a second indirect with early deformation of the orbits and late deformation of the parietal bones. Three clinical patterns are described: micro-frontal shape, medio-frontal shape and orbito-frontal shape. In the pure shapes there is no direct impact on the encephalon but the venous stasis is high and probably liable for the encephalic damage when they exist. A single surgical proceeding does not meet the many varieties of deformations. Resection of fused metopic suture from a bifrontal flap; confection of orbito-fronto-nasal band which is opened by greenstick fracture on the metopic site; transposition of an hemicoronal suture between the two hemifrontal valves lateraly translated; foreward mobilisation and interventing temporal flaps. To finish the modeling it is necessary to open the periosteum sheet in order to translate temporal muscles then to overlay with interparietal pedicularly periosteum the anterior step. Metopic synostosis is ordinarily only an aesthetic deformity infrequently associated with intracranial pathology. The treatment must be required for pronounced deformities to prevent significant psychosocial consequences.

Abnormalities, Multiple↗
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↗
PubMed1993

[Meaning of the form and facial dysmorphism].

Face morphogenesis and its troubles disturb always the patient and its family. Why? Among the ways of research about these problems the Catastrophe Theory of R. Thom is helpful. In another way the terms and words used to explain the lesions and the troubles of self-perception are examined.

Body Image↗
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↗
PubMed1991

Postaxial acrofacial dysostosis (Miller) syndrome: a new case.

We describe a new case of postaxial acrofacial dysostosis (Miller) syndrome. This syndrome consists of mandibulofacial dysostosis, similar to that seen in Treacher Collins syndrome, and postaxial limb deficiency. The mode of inheritance remains uncertain.

Abnormalities, Multiple↗
PubMed1990

[Role of micro-anastomosed muscular transplantation in corrective surgery of permanent facial paralysis].

Vascularized and reinnervated transfer of a muscle from the body to the face is never a simple procedure. It is important to evaluate the pre-operative state of facial muscles. It is difficult to define the correct indications for the various surgical techniques proposed: muscle selection, selection of recipient vessels, selection of a reinnervation method, the positioning of the transferred muscle. The authors present a series of 12 cases of long standing facial paralysis for more than 3 years. Results are presented. The authors think that the ideal muscular transfer is still unknown. In principle, nothing can replace facial muscles except facial muscles. Currently, the authors prefer the latissimus dorsi flap with partial transfer. For reinnervation, the facial nerve must take the priority, while all other reinnervation technics should take second place. In all cases, great attention must be paid to the positioning of the muscle, the usefulness of conventional palliative procedures and the continuous moral support to all of these patients.

Facial Paralysis↗
PubMed1990

[Entropion: therapeutic indications].

The severity of entropion depends on trichiasis which is perpetuated by orbicularis spasm, creating a vicious cycle. The therapeutic approaches are based on the aetiopathogenesis. Congenital entropion is essentially treated by infraciliary cutaneomuscular resection. The various components of involutional (senile) entropion, horizontal and vertical retraction, orbicularis dyskinesia, are treated respectively by tissue reduction, reinforcement of retractore and myoplasties. In cicatricial entropion, chondro-mucosal or fibromuscular graft is the technique of choice for correcting insufficiency of the tarsoconjunctival plane or its curvature. It is also the best solution for the correction of trichiasis or distichiasis.

Burns, Chemical↗
PubMed1990

[A complete intermediate temporomandibular joint prosthesis. Evaluation after 6 years].

Since 1983 we have inserted more than 100 temporomandibular joint prostheses. A review after 6 years allows the respective indications to be listed and the complications to be studied in 72 insertions involving 62 cases suitable for analysis. The prosthesis is a total intermediary prosthesis forming an unsealed cupula composed of 2 halves--a mandibular portion and a temporal portion. Insertion of the prosthesis requires preliminary facial nerve dissection then osteotomy of the mandibular condyle and its subsequent drilling to allow the screwing in of the prosthesis. The prosthesis was used in traumatology, in condylar and high sub-condylar fractures, in the event of failure of functional treatment, in malformation syndromes, in tumors and, finally, in degenerative pathology. 13 prostheses were removed. A study of the probable causes of complications shows a predominance of technical problems related to inaccurate positioning of the prosthesis, in that it was not placed in the axis of the condyle, or that inadequate bicortical support was present. In our opinion, these complications do not question the conception of the prosthesis but rather indicate that it is necessary to perfect the insertion technique while taking advantage of improvements in the prosthesis which are currently under study.

Ankylosis↗
PubMed1990

[Repair of mutilations of the lacrimal apparatus].

Repair of mutilated lacrimal passages should be adapted to the anatomy and physiology. Whenever possible, this should be performed as an emergent operation and come in as part of an overall therapeutic strategy. Repair methods used are simple end-to-end approximation of permeable segments, in case of limited lesions, and use of arterial grafts or of adjacent, nasal or saccular mucous flaps, in case of extended lesions. When reconstruction is not feasible owing to the extent of the lesions or to failure of the repair methods, tear derivation is carried out directly via the lacrimal sac or nasal fossa, by means of intermediate flaps (primarily nasal mucosa) or indwelling drains. Objectively, the functional outcome of repair is hard to assess, as tearing can, by no means, be considered a clinical criterion of obstruction, in the same way as lack of tearing is not a criterion of permeability. Only dacryography or, when possible, postoperative scintigraphy of the lacrimal passages allow for an objective evaluation of the results. Thus, although satisfactory results are the rule, long-term objective observation often leads to mitigating feelings.

Dacryocystorhinostomy↗
PubMed1990

[Reconstruction of the temporomandibular joint and its alternatives].

Reconstruction of the temporomandibular joint is always quite problematic. --Use of a prosthesis. Many prostheses have been propounded to deal with the operational problems. As, in our opinion, these seem not to meet the usual orthopaedic surgery requirements, we developed a totally intermediate prosthesis with non-sealed cupula. The use of this prosthesis, whenever feasible, provides the solution for the problems with which we have to contend during reconstruction surgery in traumatology and degenerative or tumoral disease. Nonetheless, its use remains limited to adults. --Utilization of biological material: following numerous attempts made with the conventional osteocartilagenous grafts (metatarsal, rib), we believe that the proper orientation, walking in Chang's footsteps, is toward the use of the head of the second metatarsal bone as a microanastomotic transfer. It seems to us that this technique must be used in children, particularly those with malformation syndromes or ankylosis.

Bone Transplantation↗
PubMed1989

[Posterior cranial dysmorphy. Classification and an original technic of correction: parieto-occipital transposition].

The posterior part of the skull, frequently overlooked, is altered directly and indirectly in numerous pathological situations. Lesions of the cranial contents, alteration of the lambdoid suture, abnormal constraints related to posture or to muscular activity modify the posterior curvature of the skull, generally in the form of flattening. Examination of the posterior part of the skull is essential in the context of neurosurgery and craniofacial malformations. The dysmorphy can be corrected by an original, personal technique of biparieto-occipital transposition restoring a harmonious curvature allowing immediate weight-bearing.

Brain↗