[Multiple ossifying trichilemmal cysts of the scalp: a familial case]. / Kystes trichilemmaux ossifiants multiples du cuir chevelu : un cas familial.

INTRODUCTION: The trichilemmal cyst, also called pilar cyst, is a dermal epithelial cyst originating from the pilar follicle. It usually occurs in the scalp. Hereditary and ossifying cases are rare. CASE REPORT: We report the case of a 61-year-old woman presenting with familial multiple trichilemmal cysts, located in the scalp. The histological examination after surgical exeresis confirmed the diagnosis. The trichilemmal cysts featured intra-cystic ossification. The wide dimension of the lesions dimension imposed an extensive surgical scalp exeresis. Reconstruction was performed with a flap after skin expansion. DISCUSSION: The trichilemmal cyst is a benign tumor of skin appendages with a slow outcome. Multiple locations may require an extensive surgical scalp exeresis and lead to a problematic reconstruction. Hereditary cases require familial follow-up to prevent such problems.

[Sentinel node procedure in head and neck cutaneous melanoma]. / Ganglion sentinelle dans les mélanomes cutanés de l'extrémité cervicocéphalique.

INTRODUCTION: Sentinel lymph node (SLN) biopsy is frequently discussed in the management of cutaneous melanoma, especially in head and neck localizations where SLN biopsy is much more demanding. The benefits of SLN protocol are not proved yet. The aim of our study was to present our experience of SLN biopsy in head and neck cutaneous melanoma. PATIENTS AND METHODS: This retrospective study included all patients managed for head and neck malignant melanoma from 2002 to 2006. We reviewed the technique, implementation and difficulties of the procedure, postoperative outcome, and complications. RESULTS: Nineteen patients were included. An average of 2.2 lymph nodes were localized per patient using lymphoscintigraphy. Biopsy was impossible for one patient because the deep spinal node was not found. An average of 1.2 nodes was biopsied per patient. One patient presented with micrometastases. Another presented with lymphorrhea. DISCUSSION: Sentinel node biopsy is widely performed in the management of cutaneous melanoma but remains an option for these indications in the last update of the French Society of Dermatology. SLN biopsy is difficult to implement because of the complexity of head and neck lymphatic system.

[Isolated mandibular B-cell lymphoma revealed by inferior alveolar nerve anesthesia]. / Lymphome B mandibulaire isolé révélé par une anesthésie du nerf alvéolaire inférieur.

INTRODUCTION: Mandibular lymphomas are rare and most often revealed by painless swelling. The authors report the case of a mandibular lymphoma revealed by an isolated lesion of the inferior alveolar nerve evolving for eight months. CASE REPORT: A 41-year-old male patient was followed for left mandibular pain, with progressive hypoesthesia of the left inferior alveolar nerve. The radiological assessments remained normal during eight months. Then a vestibular tumor developed in front of tooth 34. The biopsy revealed a B-cell lymphoma. No other localization was found. The patient was in complete remission two years after polychemotherapy. DISCUSSION: Our observation is unusual in its clinical presentation. Mandibular lymphomas most often present as a painless swelling, sometimes ulcerated in the mouth. They are very rarely diagnosed after an isolated hypoesthesia of V3. Lymphomas are the second most frequent head and neck lymphomas after epidermoid carcinomas, but the frequency seems to be increasing. In almost all the cases, they present as B-cell tumours of the DLBCL subtype in the WHO classification. Mandibular localizations account for only 0.6% of the cases. They are often misdiagnosed as a dental problem. The complete remission rate after chemotherapy ranges from 60 to 80% at one year. Nevertheless, the prognosis remains bad with a survival rate of only 50% at five years.

[Contribution of the posterior auricular artery in the vascularization of the facial nerve in prestylian space: anatomical study and surgical applications]. / Contribution de l'artère auriculaire postérieure à la vascularisation du nerf facial dans l'espace préstylien : étude anatomique et conséquences chirurgicales.

INTRODUCTION: The aim of our study was to establish a systematization of collateral branches originating from posterior auricular artery to facial nerve in prestylian space. MATERIALS AND METHODS: Thirty posterior auricular arteries were studied on 15 fresh cadavers after selective patent blue injection. We observed subsequent colouration of facial nerve. Number and topography of collateral branches were highlighted. RESULTS: Posterior auricular artery supplied facial nerve in 67%. Collateral branches dedicated to facial nerve could be classified into three types: type 1 corresponded to one artery in prestylian space, type 2 to several branches in prestylian space; finally type 3 featured several branches originating from posterior auricular artery in prestylian space on the one hand, in superficial retroauricular area on the other hand. CONCLUSION: Posterior auricular artery is the main blood supply to facial nerve in prestylian space. In most of the cases, branches to facial nerve originate deeply in parotid space. Nevertheless nervous branches may originate from superficial retroauricular segment of posterior auricular artery. Their damage during surgical procedures as bat ear surgery can cause definitive facial nerve palsy.

High flux of relativistic electrons produced in femtosecond laser-thin foil target interactions: characterization with nuclear techniques.

We present a protocol to characterize the high energy electron beam emitted in the interaction of an ultraintense laser with matter at intensities higher than 10(19) W cm(-2). The electron energies and angular distributions are determined as well as the total number of electrons produced above a 10 MeV threshold. This protocol is based on measurements with an electron spectrometer and nuclear activation techniques, combined with Monte Carlo simulations based on the GEANT3 code. The method is detailed and exemplified with data obtained with polypropylene and copper thin solid targets at a laser intensity of 2x10(19) W cm(-2). Special care is taken of the different sources of uncertainties. In particular, the reproducibility of the laser shots is considered.

[Third molar surgery under general anesthesia: a review of 180 patients]. / Extraction des dents de sagesse sous anesthésie générale : à propos de 180 patients.

BACKGROUND: Third molar surgery is an important part of the activity in a maxillofacial surgery department. This common activity is often under-evaluated by patients who forget its surgical aspect. The aim of this study was to evaluate our practice, and especially complications, with special consideration given to medicolegal aspects. MATERIALS AND METHODS: All the patients operated between September 2004 and July 2006 were enrolled in a retrospective study. This population is described, with the indications, follow-up, and complications. RESULTS: One hundred and eighty patients were reviewed (sex-ratio 1, mean age 27 years). The most frequent indications were impaction and pain. The mean duration of hospitalization was 1.7 days and temporary disability, one week. Local infection occurred in 8%; there was neurological complication in 2% for the inferior alveolar nerve, and 1% for the lingual nerve. These were all transient cases. DISCUSSION: Third molar surgery is an important and profitable part of the activity in a maxillofacial surgery department. Standardized information is necessary even if the rate of complications remains low.

Untreated growth hormone deficiency with extremely short stature, bone dysplasia, cleft lip--palate and severe mental retardation in a 26-year-old man with a de novo unbalanced translocation t(1;12)(q24;q24).

We report on a 26-year-old patient presenting with extremely short stature (height 72cm, weight 6.5kg, OFC 42.5cm), facial dysmorphism, cleft lip--palate, severe mental retardation and de novo 1q24.2--q25.2 and 12q24.31 interstitial deletion. He was the only child of non-consanguineous parents and his birth length was 43cm. He had severe feeding difficulties and required enteral nutrition until the age of 3 years. Standard cytogenetic analysis showed an apparently balanced de novo translocation t(1;12)(q24;q24). Endocrine studies at 11 years of age for severe growth retardation revealed multiple pituitary hormone deficiency with severe growth hormone deficiency, but the child was untreated because of associated mental retardation. At 26 years of age, he could not walk or speak and had no signs of puberty. Investigations revealed spondylo-epi-metaphyseal dysplasia with severe osteoporosis, enlarged aorta when compared to the patient's size and apparently normal pituitary development. High resolution karyotype showed a 1q24-q25 deletion, and comparative genomic hybridization studies confirmed the 1q interstitial deletion. FISH studies of both breakpoints using PACs and BACs enabled us to further characterize the 1q interstitial deletion (1q24.2-1q25.2) and also revealed a 12q24.31 interstitial microdeletion. This case is compared with previously reported patients with similar deletions, but the untreated pituitary deficiency could also be responsible in part for the severity of the growth deficiency. This observation is of interest for two reasons. First, these deletions could be a clue in the search for a gene responsible for growth hormone deficiency/midline defects. Second, it shows the importance of molecular cytogenetics in the study of de novo apparently balanced translocation with abnormal phenotype.

[Peri-implantitis or squamous cell carcinoma?]. / Péri-implantite ou carcinome épidermoïde?

INTRODUCTION: Squamous cell carcinoma developed around dental implants has seldom been described. It simulates peri-implantitis. The authors present two cases and a literature review. CASE REPORTS: A 70 year-old woman presented with an exophytic tumor developed around dental implants placed in the anterior part of the mandible. Panoramic X-rays showed major osteolysis, especially around the distal abutment implants. A 72 year-old patient, smoker, presented with chronic lichen planus; he was carrying two implants supporting an overdenture with ball-attachments, placed 15 years before. He presented with an ulcerated symphyseal tumor, bone loss around implant in position 43. The implant had been spontaneously pushed out. In both cases the diagnosis was squamous cell carcinoma. DISCUSSION: Few cases of squamous cell carcinoma developed around dental implants have been reported. They initially mimic peri-implantitis. The carcinogenic role of the implant has never been established. Another hypothesis is the migration of malignant cells, originating from a mucosal tumor, through the sulcus. Risk factors for squamous cell carcinoma (smoking or alcohol consumption, precancerous lesions) are an indication for a permanent follow-up. Biopsies will prove the diagnosis.

[Lymph node clearance: is surgical practice homogenous?]. / La pratique des curages ganglionnaires est-elle harmonieuse? Analyse rétrospective de 330 cas.

AIM: The aim of our study was to make evident the huge variability in lymph node dissection practice. MATERIAL AND METHODS: Therefore a retrospective study was conducted on 330 patients assessed for cervical, axillary or groin dissections. In each case the authors collected the primary diagnosis and clinical stage indicating lymph node clearance, identity of the surgeon and the pathologist, surgical technique including skin incision and landmarks of tissue removal, size of the clearance, and number of lymph nodes removed. Correlations between diagnosis, surgeon's or pathologist's identity, size of the clearance and number of nodes were analyzed using non-parametric tests. RESULTS: Standardized procedures as axillary dissections occurred few differences between surgeons. In groin or cervical dissections statistical differences were made evident with great technical variability. There was a positive correlation between size of the piece of lymphadenectomy and number of lymph nodes removed. CONCLUSION: Standardized procedures as axillary dissections provide few variations. Cervical and especially groin dissections should be harmonized, published and taught harmoniously in schools of surgery. So the expression "regional lymph node clearance" would mean.

[What determines the sick leave of repair and rehabilitation of the hand flexor tendons injuries]. / Recherche sur les facteurs influençant la durée de l'arrêt de travail dans les réparations des tendons fléchisseurs de la main.

OBJECTIVES: The purpose of this study is to analyse the relationship between the social and economical consequences, after repair and rehabilitation of the hand flexor tendon injuries, and to prove that it is not related to local factors. METHOD: All the patients who underwent surgery for at least one flexor tendons injury of one or several long fingers, between the years 2003-2004 were included in this study. Information regarding the data was taken from the patient file. Statistical tests were used for analysing these data. RESULTS: Significant first rate factors related to the length of sick leave are the chaotic professional history (P=0.03), the type of occupation (P=0.01) and the age (P=0.0002). A significant second rate factor is represented by the type of mobilization/retraining (P=0.04). Sex, side of injury, finger injured, zone of injury, associated damages, did not significantly influence the results of this study. CONCLUSION: The environmental factors determine the length of sick leave more than the characteristic of injury in hand flexor tendons surgery.

[Surgical management of mandibular condylar fractures in adults in France, 2005]. / Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005.

INTRODUCTION: The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005. MATERIAL AND METHODS: One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery. RESULTS: The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability. DISCUSSION: This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.

[Evaluation of a method to reduce the number of sentinel nodes removed in melanoma patients: prospective study]. / Vers une meilleure sélectivité dans la technique de prélèvement du ganglion sentinelle: étude prospective.

INTRODUCTION: Since 1992, sentinel node (SLN) biopsy was generally applied to melanoma for carcinologic staging. Literature points out an increase of nodes removed for each procedure. It means to a high cost for this procedure and it wanders from the defining concept of SLN. The aim of our study was to evaluate whether, we can minimize number of SLN removed, without influencing the reliability of carcinologic staging. MATERIAL AND METHODS: We conducted a prospective study about 50 patients with stage one melanoma. For each patient, the SLN was identified with hand-held gamma probe technique. We removed only the hottest and all nodes greater than 70% of the hottest. We analysed the characteristics of melanoma, the success rate of this procedure, how many nodes have been removed and how many have had micro-metastases. This result was compared to two main studies with chi(2) test. RESULTS: The success rate of this technique was 100%. We dissected 1,3 SLN for each patient, with 22% positive SLN. Statistical analyse pointed out a better selectivity of our study, rate of pathological positivity and recurrence was alike. DISCUSSION: Our technique decreasing number of removed SLN is reliable. A minimal number of nodes doesn't distort sensitivity of carcinologic staging, and reduce cost of the procedure.

[Boxer's fracture: Cost evaluation orthopaedic or surgical treatment]. / Evaluation du coûit des fractures du col du cinquième métacarpien traitement orthopédique et chirurgical.

UNLABELLED: Many methods of treatment have been proposed for fractures of the neck of the fifth metacarpal ranging from early mobilization to various surgical techniques. The aim of this retrospective study was to evaluate the functional results and the costs of closed as opposed to open treatment (Foucher's K-Wire technique). MATERIALS AND METHODS: We conducted a retrospective study on all fractures without rotational deformity and with a palmar angulation less than 40 degrees C. Details of the patients, the fractures, functional results and the cost of management were analyzed. RESULTS: The functional results were similar between the two groups, but surgical treatment increased the cost of treatment to 1100 euros. CONCLUSIONS: We advocate the use of closed treatment for these fractures. The functional results are the same as with surgical management, but the costs are much reduced.

Reducing the number of sentinel nodes removed in melanoma patients: a prospective study.

CONTEXT: Since 1992, sentinel lymph node (SLN) biopsy was generally applied to melanoma for tumor staging. As the literature points out, an increasing number of nodes are being removed for each procedure, driving up the cost for this procedure and wandering away from the defining concept of sentinel lymph node. AIMS: The objective of the current study was to show that the number of sentinel lymph node s removed can be minimized without influencing the reliability of tumor staging. MATERIALS AND METHODS: We conducted a single-arm prospective study in patients with stage I melanoma. For each patient, the sentinel lymph node was identified using the hand-held gamma probe technique. We removed only the hottest nodes as well as the nodes with radioactivity greater than 70% compared to the hottest. We analyzed the characteristics of each melanoma, the success rate of this procedure, how many nodes were removed and how many had micro metastases. STATISTICAL ANALYSIS: The results were compared to those of the literature, previously published Porter study using the chi-square test. RESULTS: We included 90 patients. The success rate of this technique was 100%. We dissected 1.3 sentinel lymph nodes for each patient, with 22% positive SLN. Statistical analyses point out a better selectivity of our study for a similar rate of pathological positivity and recurrence compared to the literature. CONCLUSIONS: Our technique for decreasing the number of sentinel lymph nodes removed is reliable. The removal of minimal number of nodes doesn't compromise the sensitivity of tumor staging, while it does reduce the cost of the procedure.

[Effect of information by images on patients' anxiety and comprehension before esthetic surgery on the abdominal wall: a prospective randomised trial with 60 patients]. / Impact de l'introduction d'images sur l'anxiété et la connaissance des patientes avant une abdominoplastie esthétique. Une étude prospective randomisée incluant 60 patientes.

Informed consent is a legal and ethical requirement before every surgical procedure especially when it comes to esthetic surgery. Obtaining a satisfactory understanding of the risks and benefits of the operation by patients remains a critical problem. This trial aimed to assess the value of visual information. Patients scheduled to undergo abdominoplasty were approached during the first preoperative consultation. All patients were given an information leaflet about the procedure and completed a Spielberger state trait anxiety inventory (state-trait inventory, STAI form Y-1): questionnaire to assess baseline anxiety. The patients were then randomly assigned to watch or not watch the information CD-Rom during the second preoperative consultation. The day before surgery the patient completed a second anxiety questionnaire and a knowledge questionnaire. 67 patients were screened, 2 declined to participate and 5 were unable to complete the form. Of the remaining 60 patients 30 were assigned to look at the CD-Rom and the remaining 30 not. The groups were similar in regards to age, sex, education and initial anxiety score. Patients who watched the CD-Rom were significantly less anxious before a esthetic surgery than those who did not (Mean STAI 45 for the "image group" [38.2-46.3] vs 55 for the "no image group" [49.9-63.8]). Furthermore they also scored higher in the knowledge questionnaire than the "no image" group as far as the purpose and the procedural details of the surgery were concerned. However statistical difference of knowledge regarding the potential complications of the procedure was not found.

[Deep lobe parotid gland lipoma: an extremely rare entity. A case report]. / Lipome du lobe profond de la glande parotide: à propos d'un cas rarissime.

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.

[Risk estimation in aesthetic surgery: a national study in French]. / Etude de l'estimation du risque en chirurgie esthétique: enquête nationale auprès des chirurgiens.

AIM: The aim of this study was to establish the status of the means of information and to search for the variability in risk estimation. MATERIALS AND METHODS: A questionnaire has been mailed to a hundred plastic surgeons randomly sorted among the habilitation list to be returned in an anonymous enclosed envelope. This random sample comprised 50 liberal practioners and 50 plastic surgeons working at hospital. The first part of this questionnaire dealed with basic data such as the type of activity (reconstructive or aesthetic), years of experience and means of information. The second part dealed in seven items with the most important preoperative information to be given to the patient and the most feared complications according to each surgeon before a reduction mammaplasty and abdominoplasty. RESULTS: A total of 50 (50%) of the 100 questionnaires were returned. Years of experience influenced significantly the importance given to information and the way of transmitting it. Important variability existed between the surgeons' answers. Moreover, current complications were in many cases never mentioned. Risk estimation depended on the experience of the surgeon and the information procedures were influenced by the surgeon's type of activity. CONCLUSION: Important variability in risk estimation exists among the plastic surgeons leading to an important variability in the kind and way of delivering information.

[Aesthetic surgery and quality of life before and four months postoperatively]. / Chirurgie esthétique et qualité de vie subjective avant et quatre mois après l'opération.

AIMS: To evaluate the improvement in the subjective quality of life and mental health after Aesthetic surgery on the basis of indices of patient satisfaction. METHOD: The population consisted of 25 women who had requested cosmetic surgery (mean age: 34.76) including 19 for breast augmentation and 6 for abdominal plastic surgery. After giving their written consent, the subjects took part in a psychological evaluation conducted at two different times: the first at the time of the second medical consultation and the second 4 months after surgery. In each case, the psychological evaluation consisted of a clinical interview and two questionnaires: the subjective quality of life profile (SQLP) and the general health questionnaire (GHQ12). RESULTS: The results of the study revealed the benefits of cosmetic surgery for the patients' subjective quality of life. The subjects' mental health and quality of life improved on a number of dimensions: physical health, pain, physical appearance, social life and inner life. Improved physical health during the postoperative period was associated with the quality of the relations with the doctor whereas deterioration in health was associated with excessively high initial expectations concerning the relations with doctors and physical health.