Biomedical subjects
Publications and source records attributed to O Heymans.
Maxillo-mandibular myxomas are rare lesions and their pathogeny remains unclear. The poor clinical picture and the absence of pain makes the diagnosis difficult. Because of the long lasting course, the tumor is usually large at the time of diagnosis. Although this tumor is benign, the local aggression and the high rate of recurrence dictate a radical treatment.
Despite recent advances in automobile safety, facial trauma remains a common event. Cranio-facial trauma, which usually occurs within a context of multiple trauma, can, in some patients, lead to serious life-threatening vascular complications. Such injury usually involves the carotid system (hemorrhage, aneurysm, dissection). Management of these vascular injuries must be given the same priority as other multiple trauma injuries. We present few typical cases illustrating carotid-cavernous or vertebro-vertebral fistulae, false aneurysms, arterial dissections or oro-facial bleeding. Bleeding is generally controlled by ligation or compression, other lesions being diagnosed secondarily by arteriography depending on the particular clinical situation. Treatment may involve endovascular procedures to achieve intravascular embolism or vascular occlusion.
OBJECTIVE: We examine geniopexy efficacy in OSAS treatment. STUDY DESIGN: Seven patients, aged 36 to 61 years, were studied. The mean body mass index was normal. RESULTS: Surgical late complications (modified symphysis proprioception) occurred in 4 patients. No patient was improved in sleep problems. Retromaxilly and retromandibuly were found in all patients by cephalometric study. DISCUSSION: Our results are quite different from these described successfully by other centers. Geniopexy do not move maxillar and mandibular skeletal bones, which are retruded in our serie. This explains maybe our bad results. Actually, we propose for this patients maxillo-mandibular advancement.
This case study describes a 61-year-old patient who had previously undergone sigmoid polypectomy. A follow-up colonoscopy revealed a polyp prolapsing into the colonic lumen through the base of the appendix. A laparoscopic-assisted appendectomy was performed, in which the cecum was exteriorized through the trocar hole so that a wide excision of the base could be performed. Fifty-eight polyps were observed in the appendix, but the base was free of polyps. Histologic studies reveal well-differentiated villous adenomatous polyposes. The patient was symptom free four years after surgery.
Leg coverage remains a difficult challenge for plastic surgeon, especially in certain areas. Although treatment of osteomyelitis is well established, coverage of bone, tendinous or hardware exposure remain controversial. In these selected cases, adiposofascial pedicled flaps should constitute a interesting solution. The multiples vascular supplies to the adiposofascial tissue of the medial side of the leg constitute de basis of this flap family. These condition allows an extreme adaptability to a wide range of defect with maximal satisfaction.
Scuba diving is an occupation with a still growing expansion. Like every sport it has its own specific pathologies. Some accidents can be very serious and life-threatening. We discuss the 3 main groups of accidents: barotraumatism, gas toxicity and accidents related to aquatic environment. The knowledge of the mechanisms underlying these accidents leads to a less risky approach of scuba diving.
Vascular anomalies can be classified as hemangiomas or vascular malformations. Hemangiomas are benign neoplasms, frequently diagnosed in infancy. The vast majority of these anomalies are totally harmless and spontaneously regress, although they often worry the parents because of esthetic reasons. Only a few (1/4), however, are endangering and will require therapy. Vascular malformations are rather vessel abnormalities which, unlike hemangiomas, persist. They require a thorough evaluation and most will benefit from an intervention. The recent development of informative imaging techniques (ultrasonography, Dopplerflow imaging and magnetic resonance) has permitted significant advances in the etiology and therapy of these vascular anomalies. All too often, these patients shuffle from physician-to-physician seeking help. Thus the authors recommend a multidisciplinary approach. This team should include a plastic surgeon, a radiologist and a paediatrician.
The hypothenar hammer syndrome is an uncommon but underestimated lesion of the cubital artery caused by repetitive trauma at the level of the hamate bone. It characteristically occurs in patients with a history of manual work as metal workers, carpenters and motor mechanics. We present a case of a patient who developed this syndrome following intensive use of a dig. Clinical finding, diagnosis and treatment are discussed.
Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.
Fractal geometry has become very useful in the understanding of many phenomena in various fields such as astrophysics, economy or agriculture and recently in medicine. After a brief intuitive introduction to the basis of fractal geometry, the clue is made about the correlation between Df and the complexity or the irregularity of a structure. However, fractal analysis must be applied with certain caution in natural objects such as bio-medical ones. The cardio-vascular system remains one of the most important fields of application of these kinds of approach. Spectral analysis of the R-R interval, morphology of the distal coronary arteries constitute two examples. Other very interesting applications are founded in bacteriology, medical imaging or ophthalmology. In our institution, we apply fractal analysis in order to quantitate angiogenesis and other vascular processes.
To evaluate the efficiency of emergency suction in extravasation injuries of contrast medium, records of 11 patients treated for extravasation injuries with a combination of suction and saline washout were reviewed. All of the patients were treated in the first 2 hours after injury. The mean extravasated volume was 55 cc. There were no surgery-related complications, and all the patients experienced a relief of their preoperative pain. Except for two patients with blisters at admission, none of them suffered skin or soft-tissue necrosis. Mean time to complete healing was 9 days. Emergency suction therapy is safe and effective in preventing the skin and soft-tissue necrosis associated with extravasation injuries of hyperosmolar contrast medium.
Although pressure sores occur frequently during the evolution of paraplegic patients, they can present in patients confined to bed or in casts. Ischiatic, sacral and trochanteric sores are the most frequent. For stade III & IV lesions surgical excision followed by a coverage with healty tissue remain the only right principle. Usually, flap transfert meats these requirements. However, the selection of the surgical procedure and the post-op care are the main factors for a successful treatment.
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Surgically assisted rapid maxillary expansion is an accepted method for correction of transverse skeletal and dental discrepancies. The surgical technique includes a Lefort I osteotomy with medial palatine osteotomy. The maxillary must be totally released to achieve the desired expansion. There are several advantages: bone apposition in osteotomy sites, reduced risk of dental version or extrusion compared with orthopedic care, secondary surgical cure of complex dysmorphism requiring fewer segmentary osteotomies. Finally, we examined skeletal side effects induced by surgically assisted rapid maxillary expansion in the vertical and sagittal dimension of the face.
Endoscopic surgery is slowly becoming an increasing part of plastic surgical practice. Besides its most obvious advantages, related to small incisions, the endoscope provides excellent magnification of the operative field. We thus decided to investigate the possibility of using the endoscope as an alternative to the operative microscope for performing microsurgical procedures. Before starting a clinical investigation, digital artery, nerve, vein microsutures, and neck dissections were performed in fresh human cadavers. Magnification, working distance, depth of focus, diameter and temperature of the operative field, and resolution were measured using either the operating microscope or the endoscope. Working conditions were compared. The advantages of the endoscope as compared to the microscope were: less bulk, sterility, mobility, versatility and cost-effectiveness. The disadvantages were: short working distance, inferior resolution and two-dimensional images. Overall, the endoscope was found to be an interesting alternative to the operating microscope. We are now using the endoscope routinely in the clinical arena, and we believe that it has a great potential and a promising future as a microsurgical tool.
Facial wounds are frequently associated with bone fractures and multiple trauma; however, disruption of the parotid gland or Stensen's duct is rare and is often associated with facial nerve palsy. Lesions are often undiagnosed on first assessment of the multiple trauma patient. If microsurgical repair of Stensen's duct provides good functional results, ignoring such lesions often leads to later complications such as fistulae and sialocoeles. Although simple ligation of Stensen's duct has been reported to give satisfactory results, the authors prefer a more anatomic reconstruction of this structure whenever possible. A case of Stensen's duct microsurgical repair using a vein graft are reported.
The historical background of solitary and multiple myxoid tumors of the dermis is accompanied by a confusing conglomeration of names. We report a case whose histologic features do not fit exactly with previous classifications. It appeared as a solitary angiomyxoma of the face containing stellate pleomorphic cells and exhibiting a locally infiltrative behavior with tendency for recurrences over more than 25 years. This recurrent pleomorphic solitary angiomyxoma appears to be distinct from cutaneous myxomas that exhibit a very low local recurrence rate and from malignant tumors with myxoid deposits. The treatment consisted of a wide surgical excision.
BACKGROUND: Recent advances in angiogenesis research have led to the introduction of new prognosis factors. Although the vessel count is effective in breast cancer, the prognosis of primary cutaneous melanoma (PCM) does not seems to be directly influenced by this parameter. However, the microscopic examination of PCM suggests variability in the repartition of the microvasculature. OBJECTIVE AND METHOD: To explore the possibility of extracting information about the vessel distribution by performing a textural analysis on the grey level of histological sections by means of fractal characterization by both Fourier spectrum and multifractal analysis. RESULTS: Three different patterns of vasculature were identified according to the vessel density and distribution. CONCLUSION: It is possible to differentiate and quantify clearly the differences in the microvessel profile organization using the fractal and multifractal methods.