RESUMEN
INTRODUCTION: The dermatofibrosarcoma protuberans (DFSP) is a rare but not exceptional tumour. Surgical treatment should contain a wide excision to avoid local recurrence. MATERIAL AND METHOD: We report a retrospective study of 34 cases treated by the same team from 1994 to 1999. In this series, only 4 cases (12%) presented recurrences after previous treatment by the other teams. In all cases, surgical resection was performed with 3 cm lateral margin and a disease free anatomic layer removed with the tumour. RESULTS: The mean of follow up was 60 months. There was no recurrence case in our 34 patients during this period. We compare our results with those, from others teams described in international literature since 1951. Margins and results are similar with some teams who practice the Mohs surgery. CONCLUSION: These data are in favour of a reduction of the lateral margins in classical surgical procedure of DFSP. They should be consolidated by a follow-up in longer term with a prospective study.
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Dermatofibrosarcoma/cirugía , Recurrencia Local de Neoplasia/prevención & control , Neoplasias Cutáneas/cirugía , Adolescente , Adulto , Anciano , Niño , Dermatofibrosarcoma/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/patología , Resultado del TratamientoRESUMEN
PURPOSE: Elevated intraocular pressure and systemic hemodynamic changes are main risk factors in primary open-angle glaucoma (POAG). Sleep-disordered breathing (SDB) characterized by snoring, excessive daytime sleepiness and insomnia is accompanied by large swings in blood pressure and repetitive hypoxic periods during sleep. The aim of this study was to evaluate whether there is any relationship between SDB and POAG. METHODS: Consecutively, 212 outpatients with POAG and 218 outpatients without POAG were recruited. Both eyes were examined. An interviewer-administered semi-structured questionnaire was used to collect SDB-related symptoms. RESULTS: After controlling for age, relative to control group, POAG patients showed a high prevalence of snoring (47.6%, p=0.04), snoring plus, excessive daytime sleepiness (27.3%, p=0.01) and snoring plus, excessive daytime sleepiness, plus insomnia (14.6%, p=0.01). CONCLUSION: We found a high prevalence of SDB in patients with POAG. Chronic hemodynamic changes and recurrent severe hypoxia resulting from SDB may contribute to anoxic optic nerve damage, implicated in glaucoma.
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Glaucoma de Ángulo Abierto/complicaciones , Síndromes de la Apnea del Sueño/etiología , Anciano , Presión Sanguínea , Femenino , Glaucoma de Ángulo Abierto/epidemiología , Humanos , Presión Intraocular , Masculino , Prevalencia , Síndromes de la Apnea del Sueño/epidemiología , Encuestas y CuestionariosRESUMEN
The communication of data through telecommunication networks between Healthcare professionals and particularly Hospitals and family doctors is a fundamental challenge for the next decade. Some experiences are demonstrating the feasibility of this approach and give clear insight of the potentials, difficulties and constraints of the problem. Different technical solutions are proposed following a centralised or a distributed architecture, security and confidentiality obligations, and the users requirements. We propose an original solutions based on the principle of inter-mediation to provide intelligent treatments and services on the messages that are exchanged between the network participants. This approach proved to be successful in the experimental field of Armentières (France) where more than 30,000 messages were exchanged between the hospital and the General Practitioners during 1999. Following this experimental phase, the prototype is currently customised and industrialised to fulfil the requirements and needs of an healthcare sector.
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Redes de Comunicación de Computadores , Sistemas de Registros Médicos Computarizados , Planificación de Atención al Paciente , Grupo de Atención al Paciente , Recolección de Datos , Francia , Humanos , Derivación y Consulta , Programas InformáticosRESUMEN
The CATCH 22 association (Cardiac defect, Abnormal facies, Thymic hypoplasia, Cleft palate, Hypocalcemia) combines certain signs common to various syndromes (Di-George syndrome, velocardiofacial syndrome, etc.) in combination with a 22q11 chromosomal microdeletion. Velopharyngeal insufficiency can be a complementary sign, or even a presenting sign of this chromosomal anomaly. After clinical examination of these patients, velopharyngeal insufficiency appeared to be due to a deep nasopharynx rather than to a short soft palate. We therefore reviewed 11 patients with teleradiography. We studied the length of the soft palate, the depth of the nasopharynx, the ratio of the depth of the nasopharynx over the length of the soft palate, and we compared our results with those observed in reference populations. The results demonstrate nasopharyngeal disproportion with a normal length of the soft palate and increased depth of the nasopharynx. This anatomical finding therefore encourages us to propose sphincteroplasty rather than velopharyngoplasty.
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Anomalías Múltiples , Cefalometría/métodos , Aberraciones Cromosómicas , Trastornos de los Cromosomas , Cromosomas Humanos Par 22 , Fisura del Paladar/genética , Cara/anomalías , Cardiopatías Congénitas/genética , Hipocalcemia/complicaciones , Cráneo/diagnóstico por imagen , Timo/anomalías , Insuficiencia Velofaríngea/cirugía , Adolescente , Factores de Edad , Niño , Preescolar , Fisura del Paladar/complicaciones , Femenino , Cardiopatías Congénitas/complicaciones , Humanos , Masculino , Radiografía , Insuficiencia Velofaríngea/diagnóstico , Insuficiencia Velofaríngea/etiologíaRESUMEN
OBJECTIVE: The aim of this study was to present a measuring tool, in the form of a dual-rating grid, for preoperative appearance and postoperative results in the treatment of labionasal clefts. METHODS: This study was carried out on 43 children with partial unilateral clefts, operated on using a derivation of Millard's technique. The preoperative initial severity score (ISS) was the sum of points each corresponding to a precise anatomic anomaly. A severe cleft was given a rating of 6, and a mild cleft a rating of 1. The postoperative results score (PRS) was the sum of points corresponding to residual or acquired anatomic anomalies: a good result was given 0.5, and a poor result 3.5. Each score was a mark given separately and agreed on by two surgeons. To compare the rating grids, the correlation between the ISS and the PRS was calculated. RESULTS: Twenty-four patients had an ISS less than 5; 19 patients had an IGS more than or equal to 5. Marks for the PRS were between 0.5 and 3.5 with the majority at 1 to 1.5. CONCLUSION: This study demonstrates the coherent connection between these two pre- and postoperative rating grids.
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Labio Leporino/cirugía , Fisura del Paladar/cirugía , Evaluación de Resultado en la Atención de Salud , Cirugía Bucal/normas , Cara/anatomía & histología , Humanos , Lactante , Recién Nacido , Pronóstico , Valores de Referencia , Índice de Severidad de la EnfermedadRESUMEN
People suffering from AIDS are subject to frequent hospitalisations. In some cases, they cannot go back home after hospitalisations, due to severe illness, family or sociologic problems. This is the reason why some therapeutic flats are at their disposal to make easier their medical follow-up after the hospital's discharge. In these Therapy Accommodation, they are treated by trained GP who often suffer from lack of information and lack of expertise in difficult cases. For this purpose we included these flats in the regional Telemedicine AIDS network to give these physicians free access to the computerised multimedia medical record of their patients and to provide them with synchronous co-operation facilities.
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Síndrome de Inmunodeficiencia Adquirida/terapia , Cuidados Posteriores , Telemedicina , Cuidados Posteriores/métodos , Redes de Comunicación de Computadores , Sistemas de Computación , Conducta Cooperativa , Medicina Familiar y Comunitaria , Humanos , Sistemas de Registros Médicos Computarizados , MultimediaRESUMEN
PURPOSE OF THE STUDY: The authors investigated the application of life-sized bone models obtained by stereolithography in orthopaedics. MATERIALS: The method was applied to planify correction of a severe femoral bone deformity secondary to fibrous dysplasia in a 27 years old man. This deformity was responsible for abnormal hip range of motion 70 degrees/-10 degrees (flexion-extension), -20 degrees/60 degrees (abduction-adduction), -30 degrees/60 degrees (external-internal rotation), and restricted walking ability because of lack of abduction and external rotation. A "shepherd-cross" deformity was identified on X-rays. A correction osteotomy was considered but we were unable to planify the angle of osteotomy on plain X-rays. CT scan identified 100 degrees of varus cervical deformity and 90 degrees of cervical antetorsion, but CT scan was helpless to choose the position for the osteosynthesis device. METHODS: 2D pictures obtained by CT scan were introduced and treated on a Silicon Graphics Indigo2 hardware. Mimics software authorized 2D and 3D views of bone which were separated of soft tissue by color separation process. CTM software authorized the 3D bone surface reconstruction (3D files). The 3D files were used to obtain life-sized bone model in 6 hours by stereolithographic process (scale 1/1). RESULTS: We planified a 70 degrees valgus and 40 degrees derotation and chose the best location for osteosynthesis device considering the fibrous dysplasia (best location was the posterior and superior aspect of the femoral neck). The planified osteotomy was performed and we obtained the stability of a nail-plate in the femoral neck. During surgery, we observed the bone model and the deformed femur had the same shape. Likewise, the model strongly indicated the inside bone structure (ie distribution of fibrous dysplasia tissue). Bone healing was obtained after 5 months with improvement of range of motion [(70/0) (20/30) (30/20)]. Histologic examination diagnosed fibrous dysplasia without malignancy features. CONCLUSION: Computer-generated life-sized bone models are available from computer tomographic data by means of stereolithographic process. This technic was helpful to improve planification of this complex proximal femoral osteotomy. Obtaining life-sized bone models could improve preoperative planning in case of multidirectional deformity, unusual site for osteotomy, or severe deformity impairing the choice for fixation device or its position into bone extremities. The indications for this method should be restricted to unusual and severe bone deformities, with inadequate preoperative assessment by standard X-rays or CT scans. Likewise, this method could be indicated for preoperative planning of technically demanding osteotomies such as oblique plane.
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Simulación por Computador , Fémur , Displasia Fibrosa Poliostótica/diagnóstico por imagen , Osteotomía/métodos , Adulto , Displasia Fibrosa Poliostótica/cirugía , Estudios de Seguimiento , Humanos , Masculino , Modelos Anatómicos , Rango del Movimiento Articular , Tomografía Computarizada por Rayos XRESUMEN
Although sutures have been identified as being important growth sites of the craniofacial complex, some points are still debated. The aim of our work was to analyze coronal suture response after immobilization in 24 New Zealand White rabbits. This immobilization was induced by an adhesive that bridged the coronal suture under investigation. Contrary to the reports of several authors, our procedure did not promote craniostenosis. The sutural space remains present even if it appears considerably reduced. Our cytometric examination clearly demonstrates that growth reduction localized on the external cortex of the calvaria whereas the internal cortex have a subnormal evolution. These findings favor a different evolving profile of both tables of the calvaria. They also suggest that one should be very careful before considering this procedure, as it may induce craniostenosis.