Level and modalities of origin of the small saphenous vein: toward codification of the proximal approach level.

PURPOSE: The proximal approach to the small saphenous vein (SSV) must be performed according to precise anatomical landmarks to respect the esthetic profile of venous insufficiency surgery. In this work, we propose the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as palpable landmarks from which to easily identify the situation of this vein. METHODS: This was a cadaveric dissection study involving 62 members of fresh and embalmed anatomical subjects. We used a horizontal line passing through the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as reference marks. Once the origin of the SSV as dissected, the distances between the saphenous vein and the landmarks were measured. RESULTS: We found that the small saphenous vein was often unique. The origin of this small saphenous vein projected, on average, to 4.40 cm from the horizontal passing through the tip of the lateral malleolus and 1.2 cm from the lateral edge of the calcaneal tendon. CONCLUSION: These two measurements constitute the orthogonal coordinates for the situation of the small saphenous vein origin.

Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery.

OBJECTIVES: To specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC). MATERIALS AND METHOD: We injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects. RESULTS: At the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes. CONCLUSION: The variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections).

The variations in the emergence and distribution of the ilioinguinal nerve are the cause of the failures of the ilioinguinal block and the difficulties at interpreting the ilioinguinal nerve syndrome. In order to identify its variations and set reliable anatomical landmarks for performing the ilioinguinal block, we dissected 100 inguinal regions of 51 adult corpses. The nerve was absent in seven cases and double in one case. The ilioinguinal nerve emerged from the internal oblique muscle, passing at 1 +/- 0.8 cm of the inguinal ligament and 3.33 +/- 2 cm of the ventral cranial iliac spine. It appeared behind the inguinal ligament and/or the ventral cranial iliac spine in 19 cases and presented a common trunk with the iliohypogastric nerve in 13 cases. In 47 cases, the nerve appeared in the form of a single trunk. Sixteen modes of division and eight types of predominantly anterior scrotal topographic distribution could be noted. These results show the high variability of the emergence and the sensory distribution of the ilioinguinal nerve. They enable us to propose techniques for ilioinguinal block performance using more accurate anatomical landmarks formed by the inguinal ligament and the ventral cranial iliac spine and a better diagnostic approach of ilioinguinal neuropathies.

[Etiology and therapeutic aspects of generalized acute peritonitis of digestive origin. A survey of 207 cases operated in five years]. / Aspects etiologiques et therapeutiques des peritonites aiguës generalisees d'origine digestive. Une série de 207 cas opérés en cinq ans.

UNLABELLED: Generalized acute peritonitis is defined as a brutal and diffuse peritoneum inflammatory. AIM: To assess the organic aspects of acute peritonitis of digestive origin and to evaluate the results of their surgical treatment. MATERIAL AND METHOD: Between January 1997 and December 2001, 221 patients were operated for generalized acute peritonitis. Among them, 207 patients (93.6%) had a digestive aetiology and were included in this study. They were 188 men (91%) and 19 women (9%). The average age of patients was 31.1 +/- 10.1 years old with extremes of 16 and 74 years. The organic (aetiologies) and therapeutic aspects as well as the remote follow-up were studied. RESULTS: The following aetiologies were found: perforation of gastro-duodenal ulcer, 109 cases (52.7%), complicated appendicitis, 76 cases (36.7%), ileal perforation, 13 cases (6.3%), colic perforation, 5 cases (2.4%), jejunal perforation, 1 case (0.5%), rupture of liver abscess, 1 case (0.5%) and pyo-cholecyst, 2 cases (0.9%). Complications had occurred among 65 patients i.e. 31.4% of the cases and were distributed as follows: local wound abscess, 42 cases (20.3%); evisceration, 10 cases (4.8%); post-operative peritonitis, 6 cases (2.9%); digestive fistula, 4 cases (2%) and resumption of ileostomy, 3 cases (1.4%). Mortality concerned 19 patients and the rate was 9.1%. Aetiology of death was septic shock or multiorgan failure in most of cases. The average time in which the continuity of the digestive tract was restored after stoma was 36.3 +/- 10.7 days. The late complications were: incisional hernia in 7 cases (3.5%), small bowel obstruction in 3 cases (1.5%) and pylorus stenosis in 1 case (0.5%). CONCLUSION: The perforations of gastro-duodenal ulcers, in first, followed complicated appendicitis are the most frequent aetiology. Mortality and morbidity, especially in parietal peritonitis, are not negligible.