Olivier Heymans

Fractal Quantification of the Microvasculature Heterogeneity in Cutaneous Melanoma

Background: Recent advances in angiogenesis research have led to the introduction of new prognosis factors. Although the vessel count is effective in breast cancer, the prognosis of primary cutaneous melanoma (PCM) does not seems to be directly influenced by this parameter. However, the microscopic examination of PCM suggests variability in the repartition of the microvasculature. Objective and Method: To explore the possibility of extracting information about the vessel distribution by performing a textural analysis on the grey level of histological sections by means of fractal characterization by both Fourier spectrum and multifractal analysis. Results: Three different patterns of vasculature were identified according to the vessel density and distribution. Conclusion: It is possible to differentiate and quantify clearly the differences in the microvessel profile organization using the fractal and multifractal methods.

Liposuction : Review of the Techniques, Innovations and Applications

Abstract Liposuction is currently the most frequently performed aesthetic operation in the world. Despite its widespread popularity, it should nevertheless be stated that it is not trivial surgery, not always benign and not as safe as intimated in the glossy office brochures. Since the initial description of liposuction, numerous changes have taken place. Today, surgical indications are well defined and the liposuction procedure is well codified. However, several surgeons and manufacturers have developed new equipment and techniques. We propose to survey all the techniques showing the real place of each of them. Their advantages and disadvantages will be discussed. The various techniques dealt with are: the wetting solution techniques, standard liposuction or Suction-Assisted Lipoplasty (SAL), internal Ultrasound-Assisted Liposuction (iUAL), VASSER assisted liposuction, external Ultrasound-Assisted Liposuction (eUAL), Laser-Assisted Liposuction (LAL), Power-Assisted Liposuction (PAL) and Vibroliposuction (VL). On the basis of this review of the literature and of our clinical experience, we conclude that VL is the safest, most effective and precise surgery that can be used in any of the modern indications for liposuction. We concluded that VL seems to have all the advantages and none of the disadvantages associated with iUAL.

Cutaneous psammomatous melanotic schwannoma: non-recurrence with surgical excision.

AbstractBackground: Melanotic schwannoma is a pigmented nerve tumor that may be located in the skin and express local aggressivity. This tumor may occur singly. It may also be part of the Carney complex which consists of various, but specific, tumors. Objective: We report two cases of subcutaneous melanotic schwannoma localized on the trunk in two men aged 37 and 45 years. Methods: Conventional histology and immunohistochemistry were performed. Results: One melanotic schwannoma was associated with a cutaneous atypical myxoma and multiple melanocytic lesions, all being part of the Carney complex. The other case had no associated signs. In both cases, the melanotic schwannoma was completely excised and did not recur. Conclusion: Melanotic schwannoma is rare and curable by surgery. It must not be confused with malignant melanoma and other pigmented neoplasms. The Carney complex should be carefully ruled out.

Breast implants. A review.

Abstract Breast implants have been used for about four decades for both reconstructive and aesthetic purposes. In 1963, the quality of the artificial implants was revolutionized by the introduction of the silicone gel-filled implant. Since, this modern prosthesis has gone through an evolution of change and improvement with several types of devices with many variations and styles within each class. Actually, for the last three decades, approximately one million women have received silicone breast implants in the USA. But, in 1992, the American FDA banned silicone from the market, leaving saline implants as the only product generally available as an alternative until now. Other filler materials were introduced, but have never progressed beyond the experimental stage in the USA (in contrast with Europe). The evolution of the different implants through time, with their advantages and disadvantages will be discussed, but also the controversy on silicone implants in the USA and their suspected association with systemic diseases.

Invasive Tricholemmal Carcinoma of the Nose

Tricholemmal carcinoma is a rare entity. It must be distinguished from the benign proliferating variant of the tricholemmal cyst. We report a case of tricholemmal carcinoma massively invading the nose. The neoplasm was excised surgically with a satisfactory outcome.

Accidental radiogenic ulcer of the fingers in an industrial setting.

Radiations are responsible for distinct types of lesions in the skin. They largely depend on physical parameters. Thanks to technical improvements, the risk of acute and chronic radiation injuries is better controlled without, however, being abolished in many settings. Despite well-established security rules, accidental radiogenic damage may occur particularly in the industry using powerful radioactive sources. We report such a case that was successfully treated by surgery. Case Report An otherwise healthy 47-year-old man presented with a 6-month history of ulceration on the right index following a burn which failed to heal. The ulceration on the radial pulp of the index finger measured 2 ! 5 mm (fig. 1). The depth reached the bony phalanx but without any changes disclosed at the X-ray examination. One year before the thermal injury, his right hand had been exposed to short but high-dose Á-rays (Co: 300 Ci) resulting from a close contact of the hand with the radioactive source. Surgical excision followed by coverage with a thenar flap was performed under intravenous locoregional anesthesia. Three weeks later, the base of the flap was sectioned and no ischemia was observed on the transferred tissue. However, the time to complete healing lasted 6 weeks because of the unfavorable local conditions. Six months later, the flap integrity looked perfect and only hypersensitivity to cold persisted. The index and thumb exhibited normal functions. Two years after the initial accident, a painful ulceration measuring 10 ! 5 mm developed on the ulnar pulp of the right thumb (fig. 1). It showed no trend to spontaneous healing. Excision was performed under intravenous locoregional anesthesia. Coverage was secured by a Moberg advancement flap. Despite the apparent viability of the flap, healing of the margins lasted about 4 months. Normal function of the thumb was restored after 8 months. Currently, 4 years after the initial injury, the two sites do not show any sign of recurrence or tissue dystrophy.