[Chronic volvulus of an ectopic spleen with subcapsular hematoma. CT x-ray aspect]. / Volvulus chronique d'une rate ectopique avec hématome sous-capsulaire. Aspect TDM.

The authors present a case of ectopic spleen complicated by chronic torsion and subcapsular haematoma in an asymptomatic patient. The value of ultrasonography and computed tomography in the diagnosis of these complications is discussed.

[Peroperative autotransfusion]. / La transfusion autologue peropératoire.

Between April 1976 and December 1984, 297 patients underwent major elective and emergency surgery using intraoperative autotransfusion (Bentley ATS unit). An amount of 732 l of blood was reinfused, representing 61% of the total intraoperative blood transfusion. Thanks to this method, an average 2.46 l of blood per patient was spared, with a range of 0.9 to 6 l according to the type of surgery (elective or emergency). Twelve accidents are reported, including four bradycardias (less than 45 b X min-1), two air emboli and six haemorrhages due to an excess of anticoagulation. These complications were related either to poor technique (too great a transfusion output) or insufficient blood anticoagulation control. Simplicity of use and high transfusion output of the device adapted to the blood loss are the advantages of intraoperative autotransfusion.

[Traumatic hepaticoportal fistula. Apropos of a case]. / Fistules hépatico-portales traumatiques. A propos d'un cas.

A case of post-traumatic hepaticoportal arteriovenous fistula between common hepatic artery and portal vein is reported. This localization of the lesion is exceptional, and early, marked clinical manifestations allow rapid diagnosis and treatment before the development of a portal hypertension.

[Duodenopancreatic injuries. Diagnostic and therapeutic considerations apropos of 25 cases]. / Traumatismes duodéno-pancréatiques. Considérations diagnostiques et thérapeutiques à propos de 25 cas.

A review of a homogeneous series of 25 cases of duodenopancreatic injuries emphasizes the serious nature of the lesions operated upon at the acute pancreatitis stage. An early diagnosis of these duodenopancreatic lesions is essential since they are often included in the context of multiple injuries. Principal diagnostic difficulties arise in lesions due to contusion without associated intra-abdominal injuries. In these cases ultrasound and CT scan imaging provide valuable data, particularly the latter exploration which is 89% reliable in demonstrating pancreatic morphology. Treatment differs as a function of presence of isolated or combined duodenal and pancreatic lesions and of lesional type. It should be as conservative as possible, although exeresis for lesions of body and tail of pancreas is currently performed more frequently.

Anatomical and roentgenological basis for the study of the lumbar spine with the body in the suspended position.

Roentgenological investigation of the lumbar spine was done in the standing and suspended position in 100 healthy adult male volunteers. Spinal and external morphology were studied. The aim of this work was to identify eventual correlations between the modifications of shape and size of the suspended lumbar spine and external morphology. Such correlations were sought to establish a functional approach to anthropometry. The results of this study demonstrated that the suspended position led to lengthening of the spine in 70% of the subjects examined, shortening of the spine in 22% and mainly straightening of the spine in 8%. Extension of the lumbar spine resulting from the suspended position is dependent upon tonic muscle activity and the relations between the observed spinal modifications and external morphology are difficult to establish. Nevertheless, anthropometric profiles and spinal features allow identification of certain influential external morphological parameters. Furthermore, the results of this study confirm those of others devoted to elongation of the lumbar spine under horizontal traction or suspension and lead to practical conclusions.

Morphologic and functional anatomy of the subclavian veins.

50 jugulo-subclavian venous junctions were removed to study the endovenous structures of the subclavian vein and of this junction. The diameter of the subclavian vein is always less than that of the internal jugular vein. Valvules were constantly found, whereas endovenous structures such as those found in the ilio-caval junctions were very rare. In view of these findings, these structures may be regarded as of embryologic origin.

Adventitial cysts of the popliteal artery.

Adventitial cysts of the popliteal artery are rare. Their pathogenesis is debated. In one of the two cases reported here, there was a communication between the arterial cyst and the articulation of the knee. This supports the embryonic theory that the articular synovium and adventitial cysts have the same mesenchymal origins. Treatment is surgical, with simple evacuation of the contents of the cyst in uncomplicated cases, excision and reconstruction in the others.

Treatment of deep venous thrombosis with a very low molecular weight heparin fragment (CY 222).

Thirty patients presenting with phlebographically confirmed deep venous thrombosis were treated with a very low molecular weight heparin fragment (CY 222) in an open and prospective phase-2 trial. A uniform dosage of 750 IC anti-factor Xa units/kg/day was administered subcutaneously for 10 days or more to patients whose thromboses were categorized as postsurgical (17 cases) or medical (13 cases). The clinical symptoms of venous thrombosis diminished in 93% of the patients overall. The extent of vascular clearing was assessed by an original scoring system which compared the pre- and posttreatment phlebographies. The effect of treatment was globally rated 'very good' (more than 75% lysis) in 37% of the patients, 'good' (about 50% lysis) in 40% and 'poor' (0-25% lysis) in 17%; the phlebographic thrombosis worsened in 6.6%. Little change occurred in laboratory tests exploring thrombolysis, but a strong anti-factor Xa activity was detected.