Biomedical subjects
Publications and source records attributed to P Trouilloud.
The incidence of lipoma in the parotid gland is very low, and lipomas in the deep lobe of the parotid are extremely rare and seldom considered in the differential diagnosis of deep lobe parotid gland tumours. A deep lobe parotid gland lipoma is presented and discussed.
INTRODUCTION: The authors present early results of the treatment of interphalangeal fractures with external dynamic distractor and early reeducation. PATIENTS AND METHODS: Fifteen proximal interphalangeal fractures were treated with a "do-it-yourself" external distracter. Distraction was performed with rubber band or steel stitches. Patients sustained immediate self-mobilization and physiotherapy. Total duration of the treatment was 45 days. RESULTS: Thirteen patients had good results with normal mobility after three months and recovered 80% of their controlateral force. Algodystrophia occurred in one case with poor functional results. One late management led to severe interphalangeal rigidity. CONCLUSION: External distraction is a safe and economical treatment providing good early results with few complications. Long-term follow-up is necessary to make this procedure a standard-of-care in the management of proximal interphalangeal fractures.
Calciphylaxis presents like subcutaneous lesions with livedo reticularis leading to necrotic and painful ulcers, predominantly in the lower limbs and the abdomen. They initially simulate dermohypodermitis. Biology reveals secondary hyperparathyroidism, phosphocalcic metabolism abnormalities and state of hypercoagulability. Histological signs are constant: calcifications in the media of small and sub-cutaneous arteries, intimal hyperplasia and intravascular thrombosis. This complication occurs in 4% of end-stage renal disease patients. Its prognostic is awful with a rate of mortality of 60% due to sepsis. Treatment is based upon the normalization of phosphocalcic rates and local debridement.
After a total proctocolectomy, ileoanal continuity is achieved by an ileal pouch-anal anastomosis. This anastomosis is not possible when the ileum cannot reach the anus. To avoid definitive ileostomy in this circumstance, we devised a gastric pouch, taken from the left half of the vertical portion of the stomach, vascularized by the right gastroepiploic pedicle, then interposed it between the ileum and the anus. The aim of this anatomical study on seven cadavers was to estimate the capacity of this gastric pouch to reach the anus. The distance between the caudal edge of the pubic symphysis and the apex of the pouch was measured. It is accepted that an ileal pouch always reaches the anus without tension if it comes down 6 cm below the caudal edge of the pubic symphysis. The apex of the gastric pouch reached a mean of 13.3 cm (range 10-18 cm) below the caudal edge of the pubic symphysis. This technique was then performed on four patients. The apex of the gastric pouch reached a mean of 12.5 cm (range 10-14 cm) below the caudal edge of the pubic symphysis and always reached the anus. These findings emphasize that a gastric pouch interposed between the ileum and the anus after a total proctocolectomy has an excellent capacity to reach the anus without tension.
We report a case of crural tumefaction becoming rapidly painful revealing a synovial cyst of the hip. Literature data concerning differential diagnosis, pathogenesis, clinical varieties, diagnosis and treatments of this rare pathology are emphasized.
Lower gastrointestinal bleeding after aspirin intake was reported in a 64-year-old woman. Gastroscopy, colonoscopy and selective mesenteric angiography failed to reveal the source of hemorrhage; only a midgut malrotation was suggested by angiography. Small bowel enema finally demonstrated a blind sac on the antimesenteric border of the ileum, corresponding to a Meckel's diverticulum. This embryological remnant of the vitelline duct was associated with a mesenterium commune. Laparoscopy confirmed the small bowel study, and resection of the diverticulum was easily carried out. It is, to our knowledge, the first time that these developmental abnormalities have been preoperatively diagnosed together.
This study was conducted to evaluate the activity of the Erector Spinae and four other muscles of the lower limb during the 1500 first milliseconds of the sitting movement. Electromyographic activities of the Soleus, Tibialis Anterior, Biceps Femoris, Vastus Lateralis, and Erector Spinae muscles were recorded together with cinematic and kinematic data. An inhibition of the Erector Spinae activity was found at the beginning of the movement. It preceded the displacement of the first mobile kinematic marker in 8 of 15 trials. This muscular inhibition created a postural forward movement before the voluntary backward movement. This inhibition of the Erector Spinae could be considered as an anticipatory adjustment movement because of its postural function and its precocity. These results, obtained in healthy young people, should be compared with results in old people, especially with people who suffer from psychomotor dysadaptation syndrome, in whom this inhibition of the Erector Spinae seems to be absent.
The authors report a rare anomaly of portal vascularization which was detected by CT-scan and MRI and then confirmed surgically. There was no portal bifurcation at the hilum of the liver. After giving off its right dorsal branch, the portal vein entered the right liver and divided in the parenchyma into the right ventral and left branches. The arteriobiliary distribution was normal. Only a few similar cases have been reported. The left branch of the portal vein is reported to have few variations in contrast with the right one, which has many. The venous structure of the liver varies increasingly with the distance from the left umbilical vein. During a right hepatectomy, the possibility of such a vascularization makes it necessary to ensure that the left branch of the portal vein starts upstream before dividing a portal branch entering the right liver.
The authors report a tubular duplication of the thoracic esophagus in a 17-year-old male. This anomaly, rare in the adult, can be explained either by a failure of esotracheal compartmentalisation, or a notochordodysraphy or more probably by an error during vacuolisation of the esophagus. The anatomical characteristics of the duplication were clearly seen on MRI. This investigation showed the intramural duplication, with only a thin barrier without muscle, between the esophageal lumen and the duplication channel: two communications were present between the esophageal lumen and the duplication. The esophagus was accessed by right thoracotomy. The close contact between the duplication and the esophagus did not allow them to be separated. A subtotal esophagectomy was necessary, with digestive continuity being restored by coloplasty after a left cervicotomy and a laparotomy. The anatomy seen on the MRI should have predicted that an esophagectomy was necessary and that a thoracotomy could have been avoided by performing the procedure with a closed thorax.
Retrosternal dislocation of the clavicle is a highly uncommon lesion. Diagnosis may be delayed with the risk of discovery after severe complications resulting from the protrusion of the medial part of the clavicle into the anterosuperior mediastinum. Currently, diagnosis is based on computed tomographic findings. We report a case of retrosternal dislocation of the clavicle complicated by subclavian venous thrombosis and review the therapeutic indications proposed in the literature.
Our interest was stimulated by the uncommon case of a 4-year-old girl who presented a Sprengel deformity associated with two omovertebral bones on the same side. The first omovertebral bone was situated in the levator scapulae muscle and the second omovertebral bone was lying in the rhomboid muscle. The removal of these two bones was combined with a Woodward procedure to obtain a good correction.
PURPOSE OF THE STUDY: Video assisted thoracic surgery (VATS) is a new modality which allows visualization of, and access to the intrathoracic organs without thoracotomy. Recently, this technique has been used for anterior thoracic spine approach to perform surgery which previously required standard postero-lateral thoracotomy. The authors report their initial experience of anterior spinal fusion using thoracoscopy and give a detailed description of their surgical procedure. MATERIAL AND METHODS: This technique, started on June 1993, was performed only in one level 1 in 10 patients who had thoracic spine trauma with fracture or luxation. The procedure was performed in the lateral decubitus position. The patient was prepared in the standard manner for a full thoracotomy. Surgical instruments that are needed for conversion to an open procedure must be in the operative room. Ventilation was stopped to the ipsilateral lung. Lung's collapse of the surgical side was obtained with a double lumen tube. Carbon dioxide (CO2) insufflation was used to further collapse. The first thoracoscopic portal was placed through the sixth or seventh intercostal space in the posterior axillary line, which was the safest place. All subsequent portals were placed under thoracoscopic visualization, in a triangular way as recommended by Landreneau (1992). Only open trocars were used to avoid complication of CO2 insufflation. Once the target level has been defined, a needle was placed into the disc space and roentgenographic confirmation obtained. The parietal pleura was then divided using monopolar electrocautery. Segmental vessels of the operation field lied transversely across the midportion of the vertebral body. They were mobilised and systematically ligated with endoscopic clip to simplify the procedure. Then the intervertebral space was opened and bone and disc were removed, restricted to the anterior and middle third. The graft was placed into the thoracic cavity by using a high density calcium hydroxyapatite ceramic block. Peroperative radiologic control ascertained the good position of the implant. At the end of the procedure a chest tube was placed through the lower trocar site and the lung re-expanded. A post operative CT Scan controlled good position of the graft and complete lung expansion. Contra-indications for VATS are previous surgical procedures or empyema causing extensive pleural adhesions. Procedures not appropriate for VATS approach are some that require anterior instrumentation for stabilisation, burst fracture, or fracture with posterior wall involved. RESULTS: The planned procedure was accomplished in all but one patient who required conversion to an open procedure because of segmental artery bleeding. Mean operative time was 1 h 45 mm, and mean estimated blood loss was 650 cc. There was no complication from CO2 insufflation neither postoperative complication. With an average of 2 years follow up, anterior grafting is as good as an open technique, radiologic evaluation according to Uchida (1990) showed good incorporation of each block without any radiolucent line or displacement. DISCUSSION: According to literature this technique was performed safely in 10 cases, especially without any respiratory complications and chronic pain (impairement of pulmonary function, re-expansion failure, incisional complications, rib fractures, chronic pain and malfunction of the chest wall, limitation of shoulder girdle motion) which are considered to be the main disadvantage of traditional thoracotomy. Many authors previously used VATS for multi level thoracic discectomy for correction of spinal deformities (Mack 1995), spinal reconstructive surgery (Mac Afee 1995) or removal of protrude thoracic disc (Rosenthal 1994). CONCLUSION: This original technique demonstrates that thoracoscopy for anterior thoracic surgery is better for the patients, reducing surgical trauma of the chest wall and to the lung parenchyma (in term of post operative comfort, sh
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The orientation of the zygapophyseal joints at the thoraco-lumbar level is an important factor involved in the axial rotation of the human spine. The functional role of the Mamillary Processes (MP) is unknown. This study was carried out on 55 adult dried spines. The aims were 1) to record the interzygapophyseal joint angles. 2) to determine morphological and functional angle types. 3) to correlate the various types and the corresponding MP lengths. 4) to propose hypotheses about the MP role. There were 2 distinct morphotic types founded on 2 different populations of angles clearly visible on histograms at the T12 level and statistically detectable at the T11 and L1 levels. T11-T12-L1 realized an homogeneous anatomical unit with 2 separate groups depending on the zygapophyseal joint orientations. A functional classification was also possible depending on the location of the geometric axial center of rotation. The "thoracic" type which center was on vertebral body. 95% of T10 vertebrae and 88% of T11 vertebrae belonged to the "thoracic" type whereas 97% of L1 ans 98% of L2 belonged to the lumbar type. At the T12 level, we found 35% of "thoracic" type and 65% of "lumbar" type. Long MP were found on "lumbar" type vertebrae with little interzygapophyseal angles (p < 0.001). "Anatomical" types were not related to different MP lengths. On the contrary, the "functional" classification showed shorter MP on "thoracic" type vertebrae than on "lumbar" vertebrae (1.9 +/- 2.9 mm vs 4.5 +/- 3 mm, p < 0.03). A large interzygapophyseal angle is known to enhance the axial rotation of the thoraco-lumbar junction. We infer that MP also play a role in axial rotation.(ABSTRACT TRUNCATED AT 250 WORDS)
INTRODUCTION: Autologous tendon grafts still remain the best material for the reconstruction of the knee ligaments. They provide the most constant and durable results. For the cases of important postero-posterolateral instability, strong and biomechanically correct techniques of reconstruction exist, but most publications state the fact that laxities progressively reappear in the course of the rehabilitation, that is during the crucial period of fragility of the transplants due to remodeling. These grafts must therefore be protected without impinging on the functional therapy and without impeding the progressive introduction of the mechanical strains necessary for the metaplasia of the transplants. The authors present the biomechanical study of a protection system represented by a synthetic ligament placed between the posterior aspect of the fibular head and a point midway between the femoral insertions of the lateral collateral ligament and of the popliteus tendon. MATERIAL AND METHODS: Anatomical, radiological, mathematical studies and measures on cadaver knees were made. The antero-posterior laxity and the laxity in rotation were measured between 20 degrees and 120 degrees of flexion on 4 knees in the autopsy room and on 2 fresh frozen knees. 3 series of measures were made for each knee: firstly on intact articulations, secondly after cutting of each posterior and posterolateral ligamentary component successively, and finally after putting in place of the synthetic ligament, without any other reconstruction. Graphs showing the laxity in relation to flexion were established. RESULTS: The different studies confirm that the ligament does not significantly interfere with joint function, apart from reducing the automatic inwards rotation of the femur at the end of extension. The graphs concerning the intact knees are very similar to these established with the ligament in place. DISCUSSION AND CONCLUSION: Quasi normal function was restored by the protection ligament, after cutting of every posterior and posterolateral ligament, without any other reconstruction. This means that abnormal movements that could injure the autologous grafts were eliminated. Both posterior and posterolateral reconstructions should be therefore protected. We used this protection system for 12 cases since 1986. It definitely improved the results of our postero-posterolateral reconstructions.
The elongation nail was experimented on 10 pure-breed Romanov ewes aged 9 to 12 month-old. It was implanted in a randomly chosen femur, the other femur being used as a control. After a superior and lateral approach to the femur, drilling and initial distraction averaging 26 mm, the nail was inserted and locked at both ends. Lengthening began at D1 by alternate inward and outward rotation maneuvers exerted on the pelvic limb. One ewe presented an intraoperative hip dislocation, another one unlocked the upper lock, with secondary shortening. The other 8 ewes underwent successful lengthening without apparently suffering (63-mm gain, i.e. 37% at the end of lengthening). Two ewes died at 9 months and their femura presented with a space remaining to fill smaller than 3 mm. Five of the other 6 ewes were followed up for an average of 10 months after bone healing and nail removal, over a total follow-up of 2 years. The femur is modified all over its diaphysis and widened at the level of the regenerated tissue, where cortical bone is thinner but has a normal lamellar appearance. Bone marrow is replaced by trabecular bone filled with fatty marrow. The pathology study of the last of the 6 ewes followed up for 2 years showed a bridge between both sites of incipient regeneration, indicating bone healing. The final gain as compared to the non-operated side is 27%. Progressive lengthening can be performed with an internal fixator in animals. The clinical trial in progress with allow evaluating this technique and establishing its field of application.
The authors report their exploration's test of efferent pathway through the BERA with the wave one's surface... Thirty one subjects have been tested. If we can deduce through this study the interaction of the two cochlea by efferent pathway.
Two retrospective epidemiologic studies have examined the incidence and prevalence of significant lower limb-length discrepancy and the number of surgical corrections by lengthening in 1987 in France. The incidence of apparatus prescriptions for asymmetry correction filled was 2.16 per 100,000 population. The prevalence of people using a corrective apparatus was one per 1000 population. The male-to-female ratio was 1.95:1. Because of biases in the study population, the actual incidence and prevalence of significant limb-length discrepancies is likely to be considerably higher. A questionnaire administered to surgeons of the French Orthopedic Society revealed that the majority of surgical lengthenings were performed by large orthopedic teams. In the 418 procedures reported, the tibia was lengthened more often than the femur (ratio 1.1:1). Gradual distraction techniques were used in 89.4% of cases, with the Ilizarov apparatus used in 57.4%, the Wagner apparatus in 20.6%, and the Orthofix fixator in 11.2%. Immediate distraction techniques were used in 7.9% of cases, 85% of which were done on the femur. Average total lengthening was 51 mm for tibia and femur. Average lengthening was greater for methods of gradual distraction (53.5 mm) than for immediate distraction (31.4 mm).