[Quality of life after primary parotidectomy for benign tumor]. / Parotidectomie conservatrice pour tumeur bénigne: résultats sur la qualité de vie à long terme.

INTRODUCTION: Parotidectomy is commonly performed for various indications, including benign tumors of the parotid region. Esthetic or functional sequels of various importance and lasting effects may occur, as after any surgical procedure. These disorders may impact the patient's quality of life. The authors retrospectively evaluated the long-term outcome of patients having undergone conservative primary parotidectomy for a benign tumor, with a minimum follow-up of 10 years. PATIENTS AND METHODS: A hundred and twenty-six superficial conservative primary or secondary parotidectomies were performed during 5 years, 94 (74.6%) of which for benign tumors. A flap of the sternocleidomastoid muscle (SCM) was inserted between the skin and facial nerve branches to prevent Frey's syndrome and alleviate surgical site depression according to some criteria. Questionnaires were completed at least 10 years after surgery. RESULTS: The data of 53 patients was analyzed. 88.7% of patients had undergone a superficial parotidectomy and 11.3% a total one. The average histological tumor size was 3.3 cm (2.6 to 6.3 cm). The tumors were distributed as follows: pleomorphic adenoma in 79.4% of patients, cystadenolymphoma in 15.1%, oncocytoma in 3.7%, and basal cell adenoma in 1.8%. Twenty-six SCM flaps (49.1%) were performed. No patient presented with facial paresis or facial paralysis at the end of the study. The average follow-up was 10.4 years (10-11 years). Overall, social, psychological, and professional implications were reported by 7.5% of patients, and in 1.8% of cases the impact was significant. The use of a SCM flap seemed to prevent Frey's syndrome (Fischer test P=0.00001) and improved cosmetic results (Fisher test P<0.00001). DISCUSSION: Conservative parotidectomy for primary benign tumors has a limited impact on the quality of life in the long run. This impact concerned 7.4% of patients. There was a significant impact in 2% of patients. We recommend filling the surgical site to improve functional and esthetic results and decrease long-term effects on the patient's quality of life.

[Globulomaxillary cyst]. / Kyste globulomaxillaire.

Globulomaxillary cysts are located in the globular and maxillary process fusion area; they are not of odontogenic origin. Their etiology is similar to oral and facial clefts, which explains why they are classified as ontogenic fissural cysts. However, some clefts are not localized precisely on the premaxillary and maxillary process fusion area and their etiology as globulomaxillary cysts is questioned. In fact, those lesions could actually be of odontogenic origin.

[Hemophilic pseudotumors of the jaws]. / Pseudotumeurs hémophiliques maxillomandibulaires.

Hemophilic pseudotumors are observed in 1 to 2 % of severe hemophilia cases. They are very rare in the maxilla and mandible. Traumatic etiology is the most frequent. Osteolysis is the main radiological aspect. The treatment is usually enucleation, curettage, or intralesional fibrin glue injection.

[Dynamic bimaxillary osteotomy: the new occlusal base]. / L'ostéotomie bimaxillaire dynamique: "la nouvelle donne occlusale".

The authors present an ortho-surgical method which unites occlusion and aesthetic without compromise and without stopping orthodontic work during the immediate post-operative period. The occlusal preparation permits us a global and simultaneous mobilisation of the two maxillars which are ostesynthezed in posterior skeletal disclosing. This disposition allows a lingual replacement and gives more facility to an eventual immediate post-operative occlusal replacement. The stiff osteosynthesis with immovable plates realize a therapeutic dissociation between the skeletal stage and the basal alveolo-dental stage. The "proprioceptive amnesia" and the "muscular sideration" permit a proprioceptive reorganisation and a new neuro-muscular fonctionnement elaborated from a new occlusal base. The free movements of the T.M.J. facilitate these acquisitions and allow a perspective supervision of the occlusion in a dynamic perspective.

[Propofol and thoracic surgery]. / Propofol et chirurgie thoracique.

20 patients undergoing thoracic surgery were studied. Before anaesthesia either a catheter was placed in the intercostal space, at the same level as the thoracotomy (16 patients) or an epidural catheter was inserted if there was a contraindication of intercostal blockade (4 patients). Marcaine 0.5--was injected. Anaesthesia was induced with propofol 2.5 mg.kg-1, vecuronium 0.1 mg.kg-1, dextromoramide 50 mcg.kg-1. It was maintained with propofol 9 mg.kg-1.h-1 for 30 mn, then 4.5 mg.kg-1.h-1 for following hours (by a syringe pump) and vecuronium 0.1 mg.kg-1.h-1. Cardio vascular effects were studied only in the 16 patients with intercostal blockade: during induction bradycardia in 3 patients, and systolic arterial pressure (S.A.P.) decrease of 30% in 8 patients were observed. After the incision, heart rate and S.A.P. became steady. The average duration of anaesthesia was 214 min +/- 74. The time from the end of propofol infusion to the moment of extubation was 15.4 min +/- 33 and the time to recover all mental faculties was 46 mn +/- 11. 30 min after the end of anaesthesia the maxima minute ventilation was equal to the post operative value at 48 H. Propofol anaesthesia allows a fast awakening, without cumulative effects.

[Epidemiologic characteristics of 21 peranesthetic anaphylactoid accidents observed in a population of 12,855 surgically treated patients]. / Caractéristiques épidémiologiques de 21 accidents anaphylactoïdes peranesthésiques observés dans une population de 12 855 sujets opérés.

A study of anaphylactoid reactions (AR) observed between September 1982 and September 1983 was carried out in the surgical departments of a French regional hospital. The patients who had presented clinical symptoms suggesting an AR (bronchospasm, collapse, tachycardia, with or without skin rash) during a general anaesthesia were included in this study. A precise history of previous anaesthesias and allergy was taken; allergological testing was carried out six to eight weeks after the AR. It included intradermal skin tests (ST) and a human basophil degranulation test (HBDT) with the suspected drugs. Out of 12,855 patients operated on under general anaesthesia in the hospital, 21 AR were seen during the year under study, in 18 women and 3 men, of median age 27 years (extreme values: 11 and 62). The median number of previous anaesthesias was 2 (extreme values: 0--in 4 cases- and 22). Cardiocirculatory abnormalities were the most frequent clinical symptoms of the AR: they consisted of decreased arterial pressure in 13 cases, with 8 cases of vascular collapse. Respiratory symptoms were less frequent but severe bronchospasm was observed in 5 cases. Skin rashes were seen simultaneously in 13 out of the 21 observations. A history of allergy was found in 11 patients. Total IgE serum concentration averaged 134 kU X 1(-1) (extreme values: 32-378). Results of histamine-sensitivity skin tests were not significantly different from those observed in a control group. Calcemia and magnesemia were in the normal range. One to four drugs were tested in each patient: 41 tests combining ST and HBDT were carried out.(ABSTRACT TRUNCATED AT 250 WORDS)

[Choice of a central analgesic for anesthesia with spontaneous respiration]. / Choix d'un analgésique central pour l'anesthésie avec respiration spontanée.

The ventilatory effects of tramadol (T) and nefopam (N) are evaluated in anesthetized patients with enflurane in a closed circuit breathing system and compared with the effects of pentazocine (P). The following parameters tidal volume (VT), minute ventilation (V), CO2 (capnometry) occlusion pressure (OP), ventilatory response to hypercarbia are recorded after 30 minutes of anaesthesia, before and after repeated injections of the analgesics, P: 15 mg, N: 40 mg, T: 100 mg are injected I.V., and analgesics administration is repeated at 30 minutes interval, so that the patients receive a total P dose of 30 mg, a total N dose of 60 mg and a total T dose of 200 mg. The administration of 15 mg of P induces a change in VT (-24%), ventilatory frequency (-40%), OP (-18) OP only returns to basal values after a second dose. The ventilatory response to hypercarbie is indeed satisfying (increase of 61% in V). After N and T, ventilatory frequency is not disturbed. V increases of 16% and 11% respectively after the first injection, and of 31% and 2% after the second injection. OP increases by 39% and 56% respectively after the first injection and gets better over time with nefopam (+ 58%), 30 mg of P. 20 mg of N and 100 mg of T are equivalent for analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesia programmed by enflurane]. / Anesthésie programmée à l'enflurane.

A microcomputer type 6502 is the central unity of a volatile anaesthetic injector for use in a closed circuit breathing system. Estimated calculations for quantity of anaesthetic liquid are done in agreement with the formula of J.W. Severinghaus and H. Lowe. Clinical assay is realised with enflurane. The syringe efficacy is controlled by permanent recorder of halogenate concentration in upper airways Fi-FA: infrared analysor cosma Rubis 3000).

[Technical aspects of reconstruction of the mandibular region using composite flaps of the latissimus dorsi]. / Aspects techniques de l'étage mandibulaire par lambeau composite du grand dorsal.

Anatomical data from 20 laboratory dissections are employed to describe a composite flap associating skin, the latissimus dorsi muscle, and ribs, important anastomoses existing between the intercostal and inferior scapula vascular systems. Two cases were treated by single-stage extensive reconstruction of the mandibular region employing this osteomusculocutaneous flap of the latissimus dorsi.

[Pulsed Brain-Spoerel system a new closed-circle system (author's transl)]. / Le montage de Bain-Spoerel pulsé. Adaptation à la technique du circuit fermé à l'éthrane (100 malades).

A pump is used to reinsert the expiratory gas of a Bain Spoerel system into the circuit. It delivers a 14 l.min-1 flow. The expiratory gas is drawn across a CO2 absorber and fresh gas flow is reduced to the patient's VO2. The technic cumulates the advantages of the closed system to the Bain Spoerel system: practical design for head surgery, no valve, then less energetic loss by the patient in spontaneous ventilation, convenient gas flow, adapted to the small child, because of small dead space, economy of drugs, ecology: no more pollution ! humidification and warming of inspired gas. A hundred patients have been so anaesthetized in head surgery without any problem.

[Comparison of halothane and enflurane on the pulmonary compliance (author's transl)]. / La compliance pulmonaire en cours d'anesthésie en circuit fermé. Effets comparés de l'halothane et de l'enflurane sur celle-ci.

The peroperative pulmonary compliance in spontaneous ventilation is studied in two series of ten anesthetized patients with halothane and enflurane, in closed system. The tidal volumes (inspiratory and expiratory at noflow point) are recorded by pneumotachograph (Godard 17212). The intrathoracic to mouth differential pressure is recorded by pressograph (Godard 17300). The measurements are simultaneously realized by linear recorder (Brush gould 2500) or by XY recorder (Bryans 26000 A4). At the second hour of anaesthesia with enflurane pulmonary compliance is not modified (non significant increase to 11,5 p. cent: 0,3 less than P less than 0,2) while with halothane it shows a very significant 25 p. cent decrease (0,001 less than P less than 0,01). The authors relate this difference to the specific feature of breathing in the course of such an anaesthesia with enflurane.

[The adaptation of the Bennett PR2 to intermittent mandatory ventilation (author's transl)]. / Adaptation du Bennett PR2 à la ventilation intermittente commandée.

This adaptation presents the following advantages over and above those already acknowledged for continuous IPP ventilation: conservation of respiratory muscle functions, autoregulation of ventilatory frequence, reduction of mean endothoracic pressure, thus dispensing with the necessity for negative-end-expiratory pressure. In addition: easy, effortless assembly, abolishes the defects of the Bennett PR2, gives the machine a good volumetric performance.