Tomographic diffractive microscopy and multiview profilometry with flexible aberration correction.

We have developed a tomographic diffractive microscope in reflection, which permits observation of sample surfaces with an improved lateral resolution, compared to a conventional holographic microscope. From the same set of data, high-precision measurements can be performed on the shape of the reflective surface by reconstructing the phase of the diffracted field. Doing so allows for several advantages compared to classical holographic interferometric measurements: improvement in lateral resolution, easier phase unwrapping, reduction of the coherent noise, combined with the high-longitudinal precision provided by interferometric phase measurements. We demonstrate these capabilities by imaging various test samples.

[Diagnostic methods for obstruction of the upper urinary tract: which tests are available in 2001]. / Méthodes diagnostiques de l'obstruction de la voie excrétrice supérieure (VES): quels sont les examens disponibles en 2001?

The presence of upper urinary tract obstruction, its site and its nature can be determined and the most appropriate treatment can be defined in the majority of clinical cases. However, in some circumstances, non-invasive or minimally invasive methods, such as ultrasonography, intravenous urography, urography with diuretic test, conventional and diuretic nephrography and MR urography, are unable to confirm the presence of obstruction, requiring assessment of the upper urinary tract by antegrade pyelomanometry. This investigation measures the pressure in the upper urinary tract perfused at a constant rate by a percutaneous catheter and allows evaluation of the obstruction. The authors discuss the place of the various upper urinary tract investigations to confirm the definitive diagnosis of upper urinary tract obstruction.

Variations of the radial artery in man.

Variations of the radial artery are common in man. A high origin, due either to precocious bifurcation or to persistent duplication of the brachial artery, and the presence of a superficial dorsal ramus in the forearm suggest hemodynamic insufficiency of the axial vascular network allowing persistence of certain portions of the superficial system of the upper limb. Confusion of these unusual arteries with the subcutaneous veins may explain the accidental injection of drugs and distal necrosis of the limb. Knowledge of these variations may facilitate ascending catheterization of the cardiac cavities.

[Right aortic arches: anatomic and embryologic classification]. / Les arcs aortiques droits: classification anatomique et embryologique.

Right aortic arches are rare but non exceptional abnormalities of embryonic aortic system. Sometimes responsible for tracheal or esophageal compression, they may be totally asymptomatic and fortuitously discovered. They have to be preoperatively identified in order to modify the procedure of an eventual mediastinal surgery. In this review, we describe the embryonic events which lead to these anatomical variations and the anatomosurgical classification used to precisely define their type. This anatomical definition is indispensable to adjust the surgical procedure to the consequent modification of anatomical relationships.

Urodynamics in patients with pheochromocytoma: a peri-operative study of 10 cases.

Alpha receptors have been demonstrated in the bladder neck, and urinary retention may be the presenting symptom in an occasional pheochromocytoma patient. This prompted us to define the urodynamic profile in pheochromocytoma patients. Ten patients were studied. Except for 2 patients, all tumors secreted norepinephrine either alone (n = 4) or mixed (n = 4). Urodynamic studies (uroflowmetry, cystometry, profilometry, response to alpha-adrenergic agents) were performed with Urodyn 5000 chain (DANTEC) connected to a water perfused Bohler's catheter. Profilometry was done according to the Brown and Wickham technique. Normal values were those of the International Continence Society. Alpha blocker test was done by intravenous injection of thymoxamine (0.5 mg/kg) and was considered as positive if urethral closure pressure (UCP) decrease was greater than 30% after 10 minutes. Ten patients had a pre-operative study, omitting alpha-blocker test in 1 patient; 5 patients consented a postoperative study. Pre-operatively we could demonstrate: 1) Increased UCP in 8 of 10 patients, regardless of the secretory pattern; 2) Response to alpha-adrenolytic agents in 7 of 9 patients; and postoperatively: 3) Good correlation between a positive alpha-blocker test and a decrease in urethral pressure in 3 of 5 patients. Urodynamics in pheochromocytoma patients show a typical alpha-adrenergic pattern and may explain bladder dysfunction as a presenting symptom.

[Catheterization of the jugular vein (vena jugularis interna). The advantage of Boulanger's technic]. / Katheterisierung der Drosselvene (Vena jugularis interna) Vorteil der Technik nach Boulanger.

The present study was designed to emphasize the technical accuracy of the percutaneous internal jugular vein approach in operative reanimation (Boulanger Technik). In 18 specimens with hyperextended neck, the cannulation of the internal vein was achieved from a puncture point situated 7.3 cm lateral to the sternoclavicular joint, at level of the top of the thyroid cartilage; then the catheter was pushed slanting downwards an laterally by 50 degrees with respect to the inner border of the sternomastoid muscle toward the union medial third-middle third of the clavicle. The acknowledge of the distance between the puncture point and the right auricle allows to ascertain the proper location of the catheter. The use of the internal jugular vein can be recommended in operative reanimation because its cannulation is harmless and easy to carry out and both its large size and deep situation lower the usual risks of more distal venous catheterizations.

[The Whitaker test. Apropos of an obstacle not to be ignored]. / Le test de Whitaker. A propos d'un obstacle à ne pas méconnaître.

Since 1980, 35 pyelomanometric procedures have been performed in the Department of Clinical Urology for dilatations of the upper urinary tract of uncertain etiology. During two recent procedures, pressure measurements were modified by an extra-urinary obstacle caused by the patient's position. Our experience confirms the value of the Whittaker test as well as the need for a faultless technique.

Comparative investigations in 26 impotent and 26 nonimpotent diabetic patients.

To determine the causes of diabetic impotence the same investigations were performed in 26 impotent and 26 nonimpotent diabetics. The rates of abnormalities found were almost identical in the 2 groups in regard to Doppler examination of the penile arteries, conduction velocities of the median nerves, latency times of the bulbocavernosus reflex and cystometrograms. Conversely, urine flow rates (24 of 25 versus 2 of 26 patients) and Minnesota Multiphasic Personality Inventory (14 of 23 versus 0 of 14 patients) were almost exclusively abnormal in the impotent diabetics. In addition, inadequate sex-specific attitudes were found in 60 per cent of the impotent diabetic men, which was the proportion found in a carefully selected sample of psychogenically impotent nondiabetic men. The distribution of the abnormalities found suggests that in most diabetic patients impotence results from the addition of a subtle abnormality of the autonomic nervous system in almost every case or psychological and arterial factors.

Organization of the extensor complex of the digits.

On the basis of 150 dissections the authors show that, on the back of the hand, the tendinous formations ensuring the extension of the fingers can be arranged in four groups of a least two tendons for each finger, excepting the thumb. In the little finger the group comprises a constant tendon, the extensor proper, and two variables, the common extensor and the expansion of the extensor carpi ulnaris. In the index finger the extensor proper and the common extensor nearly always coexist. In the middle finger the great common extensor, sometimes divided, can be accompanied at depth, by an extensor tendon. Finally, in the ring finger, two or three more or less intricate slips are found forming the common extensor. The presence of anastomoses and the numerous slips originating in the tendon-forming band can reduce functional deficiency following the section or rupture of a tendon. On account of these variations the surgeon should operate with caution in tendon transplantations.

[Factors in the stabilization of the ulnar head]. / Les facteurs de stabilisation de la tête ulnarienne.

The authors studied the stability of the ulnar head by dissections of the radio-ulnar joint and experimental ligamentous removals in 150 specimens. They emphasize the importance of the tendon of the extensor carpi ulnaris and medial collateral ligament tightened by Kuhlmann's sling which firmly apply the ulnar head against the anterior edge of the sigmoid potch of the radius. Transsection of the separate fibro-osseous tunnel of the extensor carpi ulnaris with forward creeping of the tendon out of its groove enlarges the size of the gap between extensor carpi ulnaris and extensor digiti quinti; if in addition both fibro-cartilaginous disk and medial collateral ligament are torn, the ulnar head dislocates dorsally. Such a displacement can be obtained by full supination following forced pronation. The volar dislocation of the ulnar head occurs more rarely; it might be caused by insufficient extensor carpi ulnaris and ruptured fibro-cartilaginous disk and yielded by shallow sigmoid notch and blunt anterior border. So muscular structures avoid dorsal displacement of the ulnar head actively whereas only fibro-osseous structures passively prevent from anterior displacement.

[Treatment of idiopathic retroperitoneal fibrosis: ureterolysis of corticoid therapy?]. / Traitement de la fibrose rétro-péritonéale idiopathique: urétérolyse ou corticothérapie?

Steroid therapy has been used as a treatment for idiopathic retroperitoneal fibrosis for the past ten years and more. In 14 out of a series of 19 patients, this treatment was well-tolerated and successful. It acts quickly. The results of medical treatment compare favorably with those of surgical ureterolysis. In the authors' view, steroid therapy is therefore the treatment of choice for this complaint, and surgical management should be confined to the relatively rare setbacks of medical treatment, and to patients who do not tolerate steroids.

[Pyelomanometry in obstructions of the upper urinary tract. Apropos of 26 cases]. / La pyélomanométrie dans les obstructions du tractus urinaire supérieur. A propos de vingt-six observations.

Pyelomanometry can be used in cases of ambiguous dilatation, to measure the pressure in the upper urinary tract during constant-flow perfusion through a percutaneous catheter (Whitaker's test). After recalling the principles of this method, and the technical procedure, the authors go on to discuss twenty six cases, analyzing the results, and comparing the advantages of this procedure with other methods of exploration.

[Descriptive and topographical anatomy of the dorsal artery of the foot]. / Anatomie descriptive et topographique de l'artère dorsale du pied (pédieuse).

The authors studied the course of the A. dorsalis pedis in 67 specimens cleared up with formalin and injected with terpentine and minium. The classical statement was found in 44 cases (2/3): the A. dorsalis pedis following the course of the A. Tibialis arise in front of the upper edge of the retinaculum extensorum, ran through the first intermetatarsal space and anastomosed with the A. plantaris lateralis. In 15 cases, it divided into 2 terminale branches - A. dorsalis medialis and lateralis - at 2-3 cm cm beyond its origin. In 6 cases, the artery was tiny and the arterial supply of the dorsum of the foot was mainly provided by both the lateral malleolar and the fibular arteries. Twice, the A. dorsalis pedis ran down into the second intermetatarsal space. The knowledge of these individual variations is to be pointed out by arteriography before using either M. extensor digitorum brevis or skin of the dorsum of the foot as flaps for covering cutaneous defects at the bindfoot.

[The arterial blood supply of the skin flap of the dorsal foot]. / Contribution à l'étude de la vascularisation artérielle du lambeau du dos du pied.

The dorsal foot skin supplied by the arteria dorsalis pedis the dorsal venous arch, the peroneal sensory nerves and the musculus extensor digitorum brevis is a very good myocutaneous flap. The material on which the study was carried out, consisted of 20 feet from standard cadavers, injected with a mixture of terebenthene and minium through the arteria tibialis anterior. The m. extensor digitorum brevis is 6.1 cm long, 1.7 cm wide, 3.9 mm thick. It is mainly supplied by the a. dorsalis pedis and its branches: the a. tarsea dorsalis (constant) and the a. metatarsea dorsalis (12 of 20 specimens). The average diameter of the a. dorsalis pedis at the upper limit of the m. extensor retinaculum was 2.14 mm and this was chosen as the most proximal limit of the dorsalis pedis flap. The a. tarsea dorsalis was present in all the specimens, with a diameter of 0.95 mm at its origin and a length of 35 mm. On average, this artery divided into four branches to the m. dorsalis pedis. The a. metatarsea dorsalis was present in 12 of 20 specimens, with an average diameter of 0.53 mm and a length of 22 mm. On average, this artery divided into three branches to the m. dorsalis pedis. We drew three lines in the proximal, middle and distal third of each flap design and calculated the sum of arterial branch sections with our lines. We think this provides a reasonable indication of the comparative richness of the cutaneous blood supply in the flap. The mean number of cutaneous branches was 10 in the proximal third, 6.7 in the middle third (13 if branches supplying the m. extensor pedis brevis are included) and 5 in the distal third. The myocutaneous dorsalis pedis arterialized flap can be safely used as an island flap to cover the ankle or heel and as a free flap for palm defects.

[Contribution to the study of the vascularization of the fascia lata tensor muscle]. / Contribution à l'étude de la vascularisation du muscle tenseur du fascia lata.

The tensor fascia lata is a short flat muscle arising from the anterior superior iliac spine and inserting into the fascia lata at mid thigh. It is supplied by three arterial pedicles of unequal importance, branching from the external iliac, gluteal and deep femoral arteries. The 'dominant' blood supply is carried by the lateral circumflex femoral artery which comes from the deep femoral and enters the muscle, approximately 8.8 cm beneath the anterior superior iliac spine. This vessel varies in size from 2 to 3.5 mm; it is 8 cm long but can be lengthened by ligating the branch for the vastus lateralis. On the deep sheath of the iliotibial tract it gives off three branches which supply each third of the fleshy body. The upper branch runs vertically to the iliac insertion of the muscle but not so far as the iliac crest and provides no cutaneous twig. On the contrary, the mid branch runs transversally through the muscle and sends perforating vessels to the skin overlying the fascia lata 6--7 cm below the anterior superior iliac spine. The descending branch runs parallel to the muscular fibers of the muscle and supplies the skin of the lateral lower thigh down to 8 cm above the knee. So the pedicle supports an area of the skin which is double the length (22 cm) and triple the width (9.5 cm) of the fleshy body. The tensor fascia lata including the two layers of the iliotibial tract but excluding its upper insertion, together with the skin of the lateral aspect of the thigh can be safely used as a myocutaneous flap for covering defects of the trochanteric, ischial and sacral areas.

[Fibrous polyp of the posterior urethra. 3 cases (author's transl)]. / Le polype fibreux de l'urètre postérieur. A propos de 3 observations.

The authors report 3 new cases of fibrous polyps of the posterior urethra, all implanted very high on the posterior surface of the posterior urethra either on the veru montanum (1 case) or immediately below the bladder neck. Histologically, the benign lesion consisted of a connective tissue axis, fibrous and vascular, surrounded by a transitional type epithelium. Dysuria, bloody urethrorrhagia, initial haematuria, bladder retention and infections were the presenting features of the lesion which can be diagnosed only by urethrographic films before endoscopy. The characteristic picture is a filling defect, sometimes cervico-urethral and sometimes purely urethral, within in the most typical cases the outline of the pedicle visible. The authors treated 3 cases by opening the bladder and drawing the polyp through the bladder neck, sectioning it and ensuring haemostasis of the base. Encouraged by these good results, the authors now prefer this method to endoscopic resection. This is followed by a review of the literature and an extensive bibliography.

The dorsal arterial network of the wrist with reference to the blood supply of the carpal bones.

The gross examination of 50 minium injected specimens showed us the various patterns of the posterior arterial network of the wrist. This is chiefly provided by the radial artery which gives off a constant dorsal carpal branch over the posterior aspect of the trapezium. This vessel crosses the carpus transversely to the inner border of the hand and is joined in half of the cases by the interosseous artery; contribution of the posterior carpal branch of the ulnar artery was more rarely found than usually described (25%). From the arch thus formed are given off short branches which run upwards along the intercarpal joints and enter the posterior aspects of the proximal carpal bones whose lower halves seem to be the most favorably supplied. On the contrary, the distal carpal bones receive several short twigs which penetrate their posterior surfaces. Although the arrangement of the pedicles may undergo many a variation, attention must be drawn to the fact that the dorsal arteries are smaller but denser than the volar, except for the hamate. Therefore 2 different patterns of arterial supply can be described at the carpus: the blood supply of the outer and axial bones--scaphoid, trapezium, lunate, capitate--derives from the radial and the interosseous arteries and is probably shared equally by volar and dorsal branches; the inner bones--triquetrum, hamate--are primarily supplied by volar or medial branches coming almost exclusively from the ulnar artery.