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Biomedical subjects

P Fleury

Publications and source records attributed to P Fleury.

158 records · Page 9Linked to original sources
PubMedDate not supplied

[Exenteration: taboo of cholesteatomatous chronic otitis. Opinion based upon personal experience (author's transl)].

The authors recall that in cholesteatomatous chronic otitis exenteration should be performed only as a last resort. This accepted, to wish to present it as an opprobious operation responsible for all evils is excessive. In 288 cases of cholesteatomatous chronic otitis treated between 1971 and 1978 (out of 433 cases of progressive otitis) 241 were treated surgically by the technique involving destruction of the osseous meatus. Amongst these 241 exenterations, there were 106 (i. e. 40%) in which the indication was absolute since they involved ears which were either cophotic or had already undergone exenteration. Reviewing a recent study of the local appearance in 225 cases of exenteration including 198 for cholesteatoma, they find 84% of ears perfectly dried up and healing in the long term. With regard to the restoration of healing, this problem arose, later, in only 6% of cases.

Cholesteatoma↗
PubMedDate not supplied

[The contribution of standard views of the mastoids in the treatment of cholesteatoma (author's transl)].

The authors consider than standard films of the mastoid (bilateral Schüller, mastoid tips displaced) are essential in all cases of chronic cholesteatomous otitis since they frequently provide the surgeon with useful information concerning appropriate management. Their opinion is illustrated by very convincing cases. Furthermore, they form part of personal hypotheses concerning the course and the interpretation of certain aspects.

Cholesteatoma↗
PubMedDate not supplied

[Severe epistaxis caused by carotid artery rupture].

Epistaxis due to rupture of the carotid, usually occurs as a result of cranial or closed cranio-facial traumatism. Heamorrhage is secondary to the formation of post-traumatic arterial aneurysms or arterio-venous fistulas. Frequently, the lesion is along the intra-cavernous pathway of the internal carotid. Rupture of a spontaneous arterial aneurysm in the sphenoidal sinus is, however, extremely rare. Carotid arteriography is the main method of investigation, and this method alone is capable of detecting the carotid lesion. In addition to obvious cases, it should be requested in cases of severe, copious and recurrent epistaxis when interrogation of the patient reveals the merest hint of trauma, often a long time previously. Immediate treatment consists of anterior bilateral and naso-pharyngeal tampnage. This allows enough time for arteriography to be carried out under the most favourable conditions and also testing for carotid substitution. In order to ensure permanent thrombosis of the aneurysmal pocket or the arteriovenous fistula, most methods resolve themselves into occlusion of the carotid axis. Cervical ligature of the carotid on its own, and isolated trapping have given way to techniques employing either a combination of trapping and embolization, or the placing of a balloon probe without trapping. At present, Serbinenko is advocating using balloons released when arteriography is carried out, obliterating the fistula and left in position permanently. Finally, there is the method by which the sphenoidal sinus is approached para-lateronasally after ethmoidectomy: this is an effective method which is much less incursive than the endo-cranial approach.

Aneurysm↗
PubMedDate not supplied

[Management of severe epistaxis caused by so-called vascular or hypervascular tumors].

The authors begin by recalling the various tumoral conditions responsible for severe epistaxis. They differentiate between: angiomas and pseudo-tumoral angiomatous formations, vascular or so-called vascular tumours and hypervascularized tumours. In an emergency, immediate tamponage is essential. Treatment is also preventive: a gentle clinical examination and biopsies in the operating theatre. Particular stress should be laid on the contribution of super-selective arteriography which enables embolization to be carried out during the investigation. Embolization is particularly advocated, notably in cases of naso-pharyngeal fibroma, when there is a tumoral projection obstructing the pterygo-maxillary fossa or when there is considerable vascularization stemming from a branch of the external carotid other than the internal maxillary. Whatever the situation, any embolization, if it is to be permanently effective should be followed within 48 to 72 hours by surgical excision.

Embolization, Therapeutic↗
PubMedDate not supplied

[Current treatment of Rendu-Osler disease, excluding radiation].

All the methods available to O.-R.-L. practitioners for the treatment of epistaxis in Rendu-Osler disease are reviewed. In an emergency, gentleness is essential. Over the long term, procrastination for as long as possible is advisable. Super-selective arteriography and embolization are of great value in an emergency and can give some good long-term results. In fact, there is not one exclusive curative therapy. Estrogenotherapy has its advocates. Saunder's dermoplasty gives variable results, but these can be improved upon if a broad access route is used and dermoplasty extended to above and behind the nasal fossae. Because of its aggressive nature, irradiation must be kept as a last resort.

Blood Transfusion↗