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Hubert J.,Center Affilie niversite Of Montreal | Landes G.,Center Affilie niversite Of Montreal | Tardif M.,Center Affilie niversite Of Montreal
Journal of Plastic Surgery and Hand Surgery | Year: 2013

A schwannoma is a benign tumour of Schwann cells that presents as a palpable and painless mass on the volar aspect of the hand and wrist. A 44-year-old, right-handed woman, presented for a volar swelling of her right hand. On examination she had a non-pulsatile mass with no fluctuation at the radiopalmar aspect of the right hand, and a soft mass on the volar aspect of the right palm. There was no pain on palpation. An excisional biopsy specimen showed an encapsulated and extrafascicular tumour that originated in the median nerve fascicules. Histological examination showed a median nerve schwannoma measuring 4.0 × 1.5 × 1.2 cm. Differential diagnosis of hand tumours is divided into three categories: tumours of the soft tissue, bone, and skin. Schwannomas of the median nerve make up 0.1%-0.3% of all hand tumours. Symptoms are caused by an entrapment syndrome resulting from the growing tumour. Pain is the most common complaint of schwannomas distal to the wrist. Imaging studies include computed tomography (CT) and magnetic resonance imaging (MRI). It is difficult to differentiate schwanommas from neurofibromas solely on the basis of an MRI. Neurofibroma grows intraneurally and infiltrates the nerve; it has the potential to require resection of all or part of the nerve, leaving a consequent functional deficit. Tumours of the hand are diagnostically challenging and median nerve shwannomas are rare. © 2013 Informa Healthcare.

Georgescu M.,Center Affilie niversite Of Montreal | Tanoubi I.,Center Affilie niversite Of Montreal | Fortier L.-P.,Center Affilie niversite Of Montreal | Donati F.,Center Affilie niversite Of Montreal | Drolet P.,Center Affilie niversite Of Montreal
Annales Francaises d'Anesthesie et de Reanimation | Year: 2012

Objective: The impact of non-invasive positive pressure ventilation (NIPPV), which is a combination of inspiratory positive airway pressure (IPAP) and positive end expiratory pressure (PEEP), on the effectiveness of preoxygenation in obese patients was evaluated. Design: Randomized, controlled, double blinded, crossover study comparing NIPPV vs. tidal volume breathing (TVB) with regard to the expiratory O2 fraction (FeO2). Patients and methods: Thirty participants with body mass index (BMI) greater or equal to 30kg/m2 scheduled for elective surgery were included. Patients with facial hair, and airway anomalies were excluded. Each patient underwent 3 minutes 100% O2 preoxygenation with the two following methods in a random order: 1: TVB; 2: NIPPV (4 cmH2O IPAP+4 cmH2O PEEP). Primary outcome was FeO2 after 3minutes. Secondary outcomes were the number of patients reaching FeO2 greater or equal to 90%, tidal volume, respiratory rate, and patient comfort on a 4-point scale. Results: No differences between methods were found regarding the FeO2 change with time or after 3minutes (89±6% with TBV vs. 91±4% with NIPPV). FeO2 greater or equal to 90% was reached more frequently with NIPPV (80%) than with TVB (60%) (P=0.008). Tidal volume (m±SD) was larger throughout preoxygenation with TBV (837±440mL) than with NIPPV (744±368mL), (P=0.0005). Respiratory rate did not differ between regimens. Patient comfort was good and similar. Conclusion: This study suggests that providing a positive pressure of 4 cmH2O throughout inspiration and expiration during preoxygenation in obese patients provided benefits with regard to the FeO2. © 2012 Société française d'anesthésie et de réanimation (Sfar).

Hathout L.,Center Affilie niversite Of Montreal | Hijal T.,McGill University | Theberge V.,University of Quebec | Theberge V.,Center des Maladies du Sein Deschenes Fabia | And 10 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2013

Purpose Conventional radiation therapy (RT) administered in 25 fractions after breast-conserving surgery (BCS) is the standard treatment for ductal carcinoma in situ (DCIS) of the breast. Although accelerated hypofractionated regimens in 16 fractions have been shown to be equivalent to conventional RT for invasive breast cancer, few studies have reported results of using hypofractionated RT in DCIS. Methods and Materials In this multicenter collaborative effort, we retrospectively reviewed the records of all women with DCIS at 3 institutions treated with BCS followed by hypofractionated whole-breast RT (WBRT) delivered in 16 fractions. Results Between 2003 and 2010, 440 patients with DCIS underwent BCS followed by hypofractionated WBRT in 16 fractions for a total dose of 42.5 Gy (2.66 Gy per fraction). Boost RT to the surgical bed was given to 125 patients (28%) at a median dose of 10 Gy in 4 fractions (2.5 Gy per fraction). After a median follow-up time of 4.4 years, 14 patients had an ipsilateral local relapse, resulting in a local recurrence-free survival of 97% at 5 years. Positive surgical margins, high nuclear grade, age less than 50 years, and a premenopausal status were all statistically associated with an increased occurrence of local recurrence. Tumor hormone receptor status, use of adjuvant hormonal therapy, and administration of additional boost RT did not have an impact on local control in our cohort. On multivariate analysis, positive margins, premenopausal status, and nuclear grade 3 tumors had a statistically significant worse local control rate. Conclusions Hypofractionated RT using 42.5 Gy in 16 fractions provides excellent local control for patients with DCIS undergoing BCS. © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

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