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Saint-Sauveur-en-Rue, France

Ho Quoc C.,Center Regional Leon Berard | Ho Quoc C.,Lyon University Hospital Center | Mojallal A.,Lyon University Hospital Center
Annales de Chirurgie Plastique et Esthetique

Introduction: Gluteal augmentation is a consultation request for many patients. The most common surgical techniques performed for gluteal augmentation employ gluteal implants. However, the results can be frustrating. Liposuction is one of the most common surgical procedures in aesthetic surgery. This surgical procedure can provide some complications. Fat grafting is an effective and predictable way to remodel the buttocks. To get better results, it's important to understand gluteal compartments with a descriptive study. The aim of this study is to describe gluteal semiology for buttocks remodeling with fat grafting. Methods and technique: We have described gluteal semiology with our review of literature. We have analyzed fat compartments of gluteal region: volume, links between every compartments, connections with major gluteal muscle and with the skin. We have also analyzed shape and volume of the buttocks. Results: We have described 11 aesthetic subunits, the volume and the shape of the buttocks, and the skin laxity. We did an important literature review to understand the most important gluteal zones to improve for patients' satisfaction. Conclusion: Our gluteal semiology description is very useful to understand liposuction/lipoinjection of gluteal areas. Fat grafting may be a reliable technique, simple and safe procedure. Surgery for correction of the buttocks may involve more than projection and volume. However, these must be in a balanced proportion with the rest of the body. © 2012 Elsevier Masson SAS. Source

The publication by the French National Health Authority in March 2012 of a recommendation that " excludes" psychoanalysis in the treatment of autistic children is paradigmatic of the evolution of medicine today. This development, based on positivist thinking, only takes account of empirical facts. The HAS recommendation raises important questions about " truth" and " meaning" in the care relationship, notions which may also exist outside Evidence Based Medicine (EBM). Two other concepts which have stood the test of time longer than either science or scientific language are everyday language and the imagination. Indeed, these concepts help us to define two routes for clinical studies: the short route which EBM is taking and the long route that leads us along the winding roads of the patient's narration and how to interpret it. This article describes the need to rethink a health policy that does not favor one route over the other, but which is guided instead by the tools of both medical evidence and those of sensory care. © 2012 Elsevier Masson SAS. Source

Ho Quoc C.,Center Regional Leon Berard | Chaput B.,Service de chirurgie plastique reconstructrice et esthetique | Grolleau J.-L.,Service de chirurgie plastique reconstructrice et esthetique
Chirurgie de la Main

Radiographic contrast medium extravasation in the upper extremity is not rare. It can be responsible for functional (compartment syndrome) and cosmetic sequelae. It is very difficult to predict the degree of final tissue injury in emergency. Currently, there is no consensus of emergency treatment. However, liposuction and saline washout as described by Gault is the usual treatment. We report the case of 42year-old woman with radiographic contrast medium extravasation in the arm (120cm3) with neurologic complications involving median nerve and medial cutaneous nerves of arm and forearm. Emergency conservative surgical washout with saline solution was performed under local anaesthesia. Drainage was realised by lipoaspiration cannula and arm massages. Clinical and radiological results were estimated. Ultimately, the patient has retained no sequela. Contrast medium extravasation in the arm with tissue complications is exceptional. We think that saline washout and lipoaspiration cannula drainage are an emergency useful treatment for radiographic contrast medium extravasation with tissue complications. Tolerance of the management was quite good. Postoperative X-rays are useful to assess treatment efficacy. © 2013 Elsevier Masson SAS. Source

Royer B.,Center Hospitalier University Amiens | Merlusca L.,Center Hospitalier University Amiens | Abraham J.,Limoges University Hospital Center | Musset L.,Laboratoire dImmunochimie | And 20 more authors.
American Journal of Hematology

POEMS syndrome is a rare disorder characterized by polyneuropathy, monoclonal gammopathy, multiorgan involvement, and elevated vascular endothelial growth factor levels. Localized bone lesions require irradiation, whereas young patients with disseminated disease receive intensive treatment with stem cell support. Treatment of older and non responding patients is not yet standardized. We report the use of a combination of lenalidomide and dexamethasone in 20 patients with POEMS syndrome. Four patients were newly diagnosed, and 16 had relapsed or progressed after treatment. All but one of the patients responded: clinical improvements were noted in neuropathies (16/20) organomegaly (13/13), peripheral edema (14/15), and pulmonary hypertension (5/5). At least a very good partial response was noted in 68% of patients, with partial responses in 26%. Serum VEGF levels fell markedly in all 17 patients with available values. Twelve patients had 18-FDG-PET/CT at diagnosis (11 with positive findings), and nine patients during follow-up. The number of lesions fell markedly in five cases and remained stable in two cases, while two patients became negative. During a median follow-up of 22 months, four patients relapsed. Toxicity, predominantly hematological, was mild and manageable. Lenalidomide thus appears to be effective in POEMS syndrome, inducing high rate of clinical and biological responses. © 2012 Wiley Periodicals, Inc. Source

Delay E.,Center Regional Leon Berard | Sinna R.,Center Regional Leon Berard | Ho Quoc C.,Center Regional Leon Berard
Aesthetic Surgery Journal

Introduction: Tuberous breast is a rare malformation that has negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context, including a combination of skin plasty and mammary gland remodeling, as well as prostheses and locoregional flaps. The authors have used fat grafting as a complementary technique to correct tuberous breasts since 1998. Objectives: The authors discuss application of their lipomodeling technique for correction of tuberous breast deformity. Methods: The charts of tuberous breast patients treated consecutively over an 11-year period (n = 31) solely with fat grafting (ie, without using an implant) were retrospectively reviewed. Each breast deformation was graded according to the Grolleau classification. The number of sessions and the mean transfer of fat volume by lipomodeling session were recorded. Patient and surgeon satisfaction were evaluated. Results: Of the 31 patients in this series, 18 had bilateral formations and 13 had unilateral malformations. The mean patient age was 23 years, and the mean body mass index was 21.9. A single session (mean transfer volume, 158 mL; range, 90-253 mL) was required in 14 (45%) cases. A second session (mean transfer volume, 226 mL; range, 100-316 mL) was necessary in the remaining 55% of cases. Mean follow-up period after the last fat transfer session was 6.5 years (range, 1.5-11 years). Patients were very satisfied in 94% of cases (n = 29) and satisfied in 6% (n = 2). The surgical team rated 94% of cases as being successful or very successful. No complications were observed. One patient developed hypertrophy of the treated breast following weight gain and thus required breast reduction. Imaging performed preoperatively and 1 year postoperatively did not reveal any anomalies other than oil cysts. Conclusion: Fat grafting is a reliable technique that produces excellent results and high levels of patient satisfaction for the treatment of tuberous breast. The aesthetic outcome is natural, implant free, and long lasting. © 2013 The American Society for Aesthetic Plastic Surgery, Inc. Source

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