Biomedical subjects
Publications and source records attributed to X Nelissen.
The observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or myocutaneous flaps.
The purpose of this study was to assess the relevance of the tip of the greater horn of the hyoid bone (THB) in the localization of the carotid bifurcation, the superior thyroid and lingual arteries, and the hypoglossal and superior laryngeal nerves. Measurements of these structures with respect to the THB were also made. Thirty perfusion-fixed human cadavers (60 specimens) were studied. Sharp measurements were made along two orthogonal axes crossing exactly on the THB. The vertical axis was parallel to the craniocaudal axis of the body. Taking the THB as a landmark, the five structures were identified in all the specimens. The mean value, standard deviation, and range of measurements for each structure studied are given in the text. This study shows the THB to be a useful landmark which is an aid to locating the aforementioned structures with confidence, and concludes that knowledge of this landmark would be beneficial for the surgeon dealing with the mid neck area.
Diabetic patients, presenting with both peripheral vascular disease and large soft-tissue defects, are too often treated by primary amputation. A combined revascularization and free-tissue transfer procedure can extend limb salvage in these patients. The authors report their experience over 4 years with 19 diabetic patients with peripheral vascular disease and large soft-tissue defects of the foot requiring free-tissue transfer. Although there was a 100 percent flap survival, early local wound problems occurred in three patients (16.6 percent). The recurrence rate was about 18.7 percent, but no complementary flap procedures were mandatory. With a mean follow-up of 38 months (range: 23 to 55 months), the limb salvage rate was 94.4 percent. Although there was one limb loss and one patient with ambulation difficulties, 16 patients (84.2 percent) were fully rehabilitated and were able to function independently. Despite a rather small series, this study confirms that in selected diabetic patients, a combined approach of vascular and reconstructive surgeons can reduce the limb amputation rate with acceptable complication rates. This combined approach offers major benefits to these patients, especially stable coverage and preservation of ambulation, and should always be considered before amputation.
The total homograft replacement of the left AV valve and subvalvular apparatus constitutes a delicate operation, which may prove beneficial in young patients with extensive bacterial endocarditis. The case of a staphylococcal endocarditis in a young drug addicted patient, operated three years previously of mitral valve repair for the same pathology, is presented. In addition to the complete excision of infected tissues and valvular substitution with biological material, this technique has the advantage of avoiding long term anticoagulation. The history, technical key points, and current indications of mitral homograft in the surgery of the left atrio-ventricular valves are reviewed.
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.
Since a few years, more and more papers are published in the international literature about nasal anatomy, probably because of the growing popularity of the open rhinoplasty. So, new concepts, new anatomic entities have been established without equivalent in the French literature. The authors review the most recent notions of the surgical anatomy of the nose and propose a french terminology for several concepts developed in the international literature (e.g. supratip breakpoint). The surgical anatomy of the external nose is described.
Over recent years, an increasing number of papers are published in the international literature about nasal anatomy, probably because of the growing popularity of open rhinoplasty. New concepts and new anatomical entities have been established without any equivalent in the French literature. This paper reviews the most recent concepts of surgical anatomy of the nose and proposes a French terminology for several concepts developed in the international literature (e.g. supratip breakpoint). In this second part, the surgical anatomy of the nasal cavities is analyzed together with a glossary including the main concepts, some of them unpublished in the French literature.
Nasal obstruction is a major epidemiologic medical problem. The cost of its medical and surgical treatment is considerable. The frequency of the symptoms and their usual benign course often lead the physician to pay little attention to them. Occasionally, life-threatening problems, such as Wegener's granulomatosis may first present as nasal obstruction. Frequently, nasal obstruction deteriorates the quality of life by causing serious discomfort and by altering with the sense of smell and taste.
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Superficial papillary adenomatosis of the nipple is a benign tumor of the ductal epithelium that clinically resembles Paget's disease. Unilateral serous, bloody, or serosanguinous discharge with crusting is most commonly present. Symptoms include tenderness or pruritus. Histologically, the tumor is characterized by proliferating ductal structures lined by a double layer of columnar epithelium. The lesions are focally eroded. Keratin cysts and apical intraluminal projections are commonly found. The original description was reported in 1954 in the english language literature. Just a few cases have been reported in the french literature. These cases are reviewed and two classic examples are reported; their therapeutic options are discussed.