Modified anterior intercostal artery perforator flap (AICAP) for autologous breast volume restoration after explantation.

Explantation of breast implants has become increasingly common. This study aimed to analyze breast auto-augmentation following implant explantation (using a laterally designed anterior intercostal artery perforator [AICAP] flap) in patients who did not need new implants and required volume preservation. Twenty-four patients (48 breasts) aged 31-67 years (mean, 52.4 years) with body mass index (BMI) between 24.43 and 29.34 (mean, 27.32) kg/m2 underwent this procedure. All patients had implant-related problems, such as recurrent capsular contracture (n=11), seroma (n=2), animation deformity (n=3), rupture-induced bleeding (n=5), and breast implant disease (n=3). Sizes of implants removed ranged from 215 to 355 ml. The mean flap size was 23.9 cm × 7.5 cm, and the average flap thickness was 2.3 cm (range, 2.0-3.2 cm). Flap survival was clinically examined postoperatively by ultrasonography. Pre- and postoperative final breast volumes were compared by direct patient observation and independent photograph observation by three plastic surgeons according to a 4-point scale (bad=1, regular=2, good=3, and excellent=4) and the brassiere size. All flaps were completely viable after harvesting. No postoperative signs of fat necrosis were observed, and independent plastic surgeon evaluation revealed good and excellent results in all cases. Patient satisfaction evaluated by BREAST-Q data was >90%. This new design, AICAP flap (with a lateral thoracic extension), can be safely used for breast volume restitution after breast implant explantation with high patient satisfaction. This flap exhibited reasonable potential of providing additional volume in patients who undergo implant explantation and require the preservation of similar volume.

[Traumatic dissection of the internal carotid artery: malignant supratentorial infarction and decompressive treatment]. / Dissection traumatique de la carotide interne cervicale: infarctus malin supra-tentoriel et traitement décompressif.

We present a case report of a thirty-six-year-old right-handed female. She suffered with a malignant space-occupying supratentorial ischemic stroke caused by a traumatic cervical internal carotid artery dissection. She had a car accident and, initially, presented with a normal examination. In two days, she became comatose (Glasgow Coma Scale score was 5) with complete left hemiplegia, right mydriasis and required respiratory assistance despite the medical treatment. It was decided to perform a large right frontotemporoparietal bone flap with large dural plasty. Eighteen months later, with intensive rehabilitation, the results of neuropsychological testing were normal, and the Barthel Index score was 90. The indications for decompressive surgery in malignant space-occupying supratentorial ischemic stroke remains controversial. The age, general condition, neurological examination (consciousness, pupils, deficit), extent of parenchymal hypodensity and attenuated corticomedullary contrast on the brain CT, degree of midline shift, presence of uncal hernation, disparition of the visibility of the mesencephalic cisterns and third ventricle, high level of the intracranial pressure, and perhaps the results of the perfusion-and diffusion-weighted MRI, are the elements to decide (or not decide) decompressive surgery.

[Hemostatic embolization of hepatocellular carcinoma complicated by hemoperitoneum. Apropos of 2 cases and review of the literature]. / Embolisation hemostatique de carcinome hepatocellulaire complique D'hemoperitoine. A propos de deux cas et revue de la littérature.

Rupture of hepatocellular carcinoma is a severe complication that occurs in about 10% of patients. It may occur as a terminal event in patients with advanced disease or it may be the first presentation in a healthy individual. Various treatment options have been proposed, which include conservative treatment, transarterial embolization and operative hemostasis or liver resection. We report intraperitoneal hemorrhage and hypovolemia in two patients with spontaneous rupture of an hepatocellular carcinoma treated successfully by transarterial hepatic embolization. On follow-up, these patients died 7 and 8 months after this treatment respectively.

[Endoscopic evaluation of chronic human immunodeficiency virus-related diarrhea]. / La place de l'endoscopie dans le diagnostic etiologique des diarrhées chroniques des sidéens.

Chronic diarrhea is an important clinical problem in patients infected with HIV. Data assessing the diagnostic yield of upper and lower endoscopy are limited. We reported 10 cases of HIV-infected patient referred to our hospital for chronic diarrhea from March 1995 to June 1999. 60% of the pathogens were identified obviously by stool studies. Cryptosporidium and Mycobacterium avium intracellulare (MAI) were the most common organisms. In this study, endoscopy identified 2 additional cases of MAI and one of 5 cryptosporidia detected in stool. Immunologic test identified a CMV infection in one case. Stool tests and endoscopy identified obviously 80% of the pathogens. Most investigators and us agree that stool studies should be the first diagnostic test. In patients with negative stool studies, lower endoscopy is more cost-effective than upper endoscopy and indicated as an initial exam.

[24-hour esophageal pH monitoring in adults. Apropos of a series of 116 patients]. / La pH-metrie oesophagienne de 24 heures chez l'adulte. A propos d'une série de 116 malades.

Between June 1994 and June 1996, we performed a 24-hour oesophageal pH monitoring in 116 adult patients. A retrospective analysis of the data is hereby presented. The principal indications include a chronic cough, recurrent laryngitis and noncardiac chest pain. In 65.5% of our cases, a pathological gastroesophageal reflux was found during pH monitoring. The symptom-index (SI) concerning the digestive and ENT symptoms did correlate in 1/3 of the cases while it was significant in only 15% of the cases with pulmonary and cardiac symptoms. 24-hour pH monitoring remains the method of choice for the study of gastroesophageal reflux and analysis of the SI is indispensable to evaluate the correlation of symptoms with episodes of reflux.

[Radiation-induced esophageal cancer. Presentation of a case and review of the literature]. / Cancer de l'oesophage radio-induit. Présentation d'un cas et revue de la littérature.

Esophageal cancer induced by radiation is uncommon. Irradiation of the head, the neck, the chest and the abdomen may cause an esophageal cancer several years later. Therefore, regular gastroscopy and biopsy of esophageal mucosa are strongly recommended in symptomatic patients. Surgery combined or not with radiotherapy seems to be the most effective treatment for this kind of cancer. We report a case of squamous cell carcinoma of the esophagus diagnosed 13 years after chemotherapy and radiotherapy for Hodgkin disease stade IIIb.

Functional parathyroid cyst and hypocalciuric hypercalcemia.

Parathyroid cysts are uncommon. They can be divided into functional and nonfunctional cysts depending on whether or not they are associated with hypercalcemia. Functioning cysts are very rare, with fewer than twenty reported cases. We report a case of functioning parathyroid cyst associated with hypocalciuric hypercalcemia. We have been unable to find a similar case previously reported in the literature.

Functional parathyroid cyst and hypocalciuric hypercalcemia.

Parathyroid cysts are uncommon. They can be divided into functional and nonfunctional cysts depending on whether or not they are associated with hypercalcemia. Functioning cysts are very rare with less than twenty reported cases. We report a case of functioning parathyroid cyst associated with hypocalciuric hypercalcemia. We have been unable to find a similar case previously reported in the literature.

[Detection of Helicobacter pylori by the urease test in 244 patients]. / Recherche d'Hélicobacter pylori chez 244 patients par le test à l'uréase.

The authors report the results of the detection of Helicobacter Pylori (HP) in gastric mucosa by the urease test, in 244 patients between January 1989 and August 1991. The overall prevalence of HP was 38.1%. It was 19.5% in patients with normal upper gastrointestinal endoscopy (UE), 61% in duodenal ulcer (p < 0.001) and 68.7% in congestive antritis (p < 0.001), significantly higher than in controls. There was no significant difference between controls and patients with erosive antritis or healed duodenal ulcers. The prevalence of HP rises with age in all patients and in those with lesions at UE but not in those with normal UE. A rise of this prevalence seems to exist in the months of June and December. The authors conclude by pointing out the rise of the overall prevalence of HP in congestive antritis compared with erosive antritis, the similarity of prevalence in normal subjects and those with healed ulcer and the lack of influence of age on this prevalence in subjects with normal UE. These conclusions are in need of confirmation by further studies on much more longer series.

[A case of trichinosis revealed by a protracted diarrhea and neurologic manifestations]. / Un cas de trichinose révélé par une diarrhée prolongee et des signes neurologiques.

We report a case of trichinosis presenting with a subacute persistent diarrhea and neurologic complications. Gastrointestinal endoscopic as well as digestive and neurologic radiologic signs were observed. The mainstay of treatment was glucocorticoids associated with thiabendazole. The patient responded well to this regimen. A literature review to explain the gastrointestinal and neurological manifestations of trichinosis as well as their management was done.

Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume.

Lithium carbonate is known to alter calcium metabolism by lowering urinary calcium excretion and increasing serum calcium concentrations. Several investigators have reported increases in serum immunoreactive PTH (iPTH) values after a few weeks or months of lithium treatment, and several cases of primary hyperparathyroidism developing during lithium treatment have been reported. To determine whether the increases in serum iPTH might be the result of increased renal retention of inactive PTH fragments rather than stimulation of parathyroid function, we measured plasma intact PTH by immunoradiometric assay and estimated parathyroid size by ultrasonography in men who had received short term (less than 6 months) or long term (greater than 3 yr) lithium treatment and in normal subjects. Serum ionized calcium was higher by 0.03-0.04 mmol/L in subjects treated short term (mean, 1.7 months) with lithium than in normal subjects, but plasma intact PTH and serum midregion iPTH values were not different. The absence of a reciprocal decrease in PTH values is compatible with a lithium-induced shift in the set-point for the inhibition of PTH secretion by calcium toward a higher calcium value. Both plasma intact PTH and serum midregion PTH values were higher in subjects during longer term (mean, 103 months) lithium treatment, and estimated parathyroid volume was 3-fold higher. Serum phosphate was lower, and serum chloride and plasma 1,25-dihydroxy-vitamin D values were higher in those treated with lithium long term, probably from the biological action of the increased PTH. We conclude that long term lithium treatment increases circulating biologically active PTH and causes parathyroid enlargement. Whether this chronic stimulus to parathyroid growth might lead to adenoma formation in certain susceptible individuals and whether a PTH-induced increase in skeletal remodelling occurs that might hasten the appearance of osteopenia remain to be determined.

Rapid correction by 1-alpha-hydroxycholecalciferol of hemichorea in surgical hypoparathyroidism.

A 45-year-old woman with long standing surgical hypoparathyroidism presented with right hemichorea of three months' duration. She had profound hypocalcaemia and hyperphosphataemia and extensive cerebral, cerebellar and basal ganglia calcification. Correction of the chemical abnormalities with 1α-hydroxycholecalciferol, calcium supplements and aluminium hydroxide resulted within 10 weeks in complete disappearance of the abnormal movements.