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.

[Pelviperineoscopy. Preliminary study of feasibility on cadavers]. / Pelvipérinéoscopie. Etude préliminaire de faisabilité sur cadavre.

OBJECTIVE: The traditional access of perineum for the treatment of the pelvic organ prolapse by vaginal route is probably responsible for the risk of mesh exposure and a longer convalescence. So, endoscopic access to perinemeum needs to be evaluated. PATIENTS AND METHODS: Feasibility study on cadavers. Details of the procedure: opening of the pararectal space by digital dissection first after incision on the level of the posterior commissure. Introduction of an optical trocart to the level of the perineum incision; dissection of pararectal space with optics and CO(2); individualization of the various elements; installation of a transobturator trocart and a transgluteal trocart; dissection of the rectovaginal septum and visualization of the sacrospinous ligament and pudendal nerve. The measured variables were: operational incidents, possibility of creation of working space, dissection of the rectovaginal septum; finally, visualization of the sacrospinous ligament and pudendal pedicle. RESULTS: On the 4 studied cadavers, we could carry out a dissection of pelvirectal space in all the cases. On the 8 pararectal fosses, in all the cases we could carry out a cavity of dissection and to open the recto vaginal septum, visualization of the sacrosciatic ligament and pudendal pedicle was possible in 6 cases out of 8. There were one rectal injury, two vaginal injuries and one lesion of the pudendal pedicle. DISCUSSION AND CONCLUSION: This endoscopic access allows in the majority of cases to see the structures necessary to the realization of a vaginal sacrospinofixation or the installation of posterior mesh without a colpotomy and a traumatic exposure. The incidents are probably due to our inexperience and should disappear in time. The pelvi-perineoscopy is an endoscopic access of perineum which should be evaluated.

[Study of 3 white matter fiber trackings using MRI diffusion]. / Etude de 3 faisceaux de substance blanche en IRM de diffusion.

UNLABELLED: The aim of this study is to evaluate the interest of diffusion weighted MRI for the study of white matter fiber tracking. METHODS: Fifteen subjects having undergone diffusion weighted MRI have been included. Three white matter fiber trackings have been studied for each subject: interhemispheric transcallosum, optic radiations and pyramidal tracts. The results were compared to an atlas of human anatomy. RESULTS: All the white matter tracts studied have been visualized. The morphology of the three white matter tracts was similar to standard anatomy. The orientation of the three white matter tracts was determined in 100% of the cases. CONCLUSION: diffusion weighted MRI allowed the morphological study of all the analyzed white matter tracts. This technique might, therefore, help to evaluate nerve fiber tracts and guide neurosurgical interventions.

[Increase neuroanatomic definition of nervous central system structures by addition on slices of ferric chloride]. / Rehaussement des structures du système nerveux central par traitement des coupes anatomiques avec le chlorure ferrique.

The authors have described a new method of coloration on anatomic slices of the central nervous system realised on formolated subjects. They have presented their first results on their experiences carried out on the different levels of the brain, and this simple method of proceeding shows how interesting it could be for all practicians of Neurosciences and for the teaching of Neuroanatomy.

Assessment of the main pancreatic duct using computed tomography with multiplanar reconstructions.

UNLABELLED: The aim of this study was to assess the morphology of the main pancreatic duct (MPD) using multiplanar reconstructions and to compare this with the morphology of the MPD of anatomic subjects. MATERIALS AND METHODS: The morphology of the MPD was studied by means of multiplanar reconstructions obtained on the one hand from thin tomodensitometric slices and on the other hand from the dissection of anatomic subjects. This study involved 15 subjects in each group. RESULTS: Full multiplanar reconstruction was obtained in 13 cases. In 2 cases, the isthmus did not appear in the reconstructions. The morphology of the MPD was similar in both groups. The length of the MPD was identical at the head and isthmus of the pancreas in both groups but was greater in the dissection group than in the reconstruction group in the body and tail areas of the pancreas. The diameter of the MPD was greater at the head of the pancreas in the dissection group and was identical in both groups for the other segments of the MPD. CONCLUSIONS: Multiplanar tomodensitometric reconstruction of the main pancreatic duct is feasible. This new technique, currently under evaluation, could allow the study of canalar pathologies of the pancreas through tomodensitometry.

[Cecal volvulus: anatomical bases and physiopathology]. / Volvulus du caecum: bases anatomiques et physiopathologie.

UNLABELLED: The aim of this study was to report on 7 cases of cecal volvulus and to evaluate anatomical variations allowing this pathology. METHODS: 7 consecutive patients (4 women) treated for cecal volvulus were included. The clinical and paraclinical parameters, the management of patients, were studied through an analysis of medical histories. Contributing factors for cecal volvulus were analysed by an anatomical study and literature analysis. RESULTS: all patients complained about abdominal pain associating or not to acute intestinal obstruction. The diagnosis was radiographically carried out for 3 patients. All patients were treated by surgical procedures (right colectomy: n = 6, cecopexy: n = 1). The mortality and morbidity rates were 0 percent and 28 percent. Fifteen anatomical subjects had complete dorsal fixation (75 percent). Seven out of them had retrocecal recessus. Five subjects (25%) had a non fixed cecum, according to the literature relating a non-fixation of ascending colon to parietal peritoneum in 11 to 25 percent of the cases. The main factor of risk is the female gender. CONCLUSION: cecal volvulus can be advocated for patients having abdominal pain. The diagnosis is rarely based on an only clinical examination or abdominal radiographs alone. Tomodensitometry is most performing examination for diagnosis. An early and appropriate management of patients is necessary to avoid significant morbidity and mortality rates.

Anatomic bases of graciloplasty using end-to-side nerve pudendal anastomosis.

The objective of this study was to evaluate the possibilities of reinnervation of the gracilis muscle, transposed around the anus, by the pudendal nerve using an end-to-side nerve anastomosis. This study was carried out in 14 cases (7 adult human cadavers bilaterally). The gracilis muscle and its vascular-nervous bundle have been dissected and the nerve innervating the gracilis muscle has been cut at its origin. The gracilis muscle, accompanied by its nerve, has then been transposed around the anus. The pudendal nerve has been dissected from its extrapelvic part. The reinnervation using an end-to-side nerve anastomosis has been considered as feasible when the proximal ending of the nerve of the gracilis was put into a tension-free contact with the extrapelvic part of the pudendal nerve. The extrapelvic part of the pudendal nerve has a common trunk in 12 cases. The width of the extrapelvic part of the pudendal nerve was 2.6+/-0.7 mm, range 1-3.5. The width of the proximal endings of the nerve innervating the gracilis muscle was 2.3+/-0.5 mm, range 2-3. The reinnervation of the gracilis muscle by the pudendal nerve has been possible in 14 cases. An average supplementary length of 17.4+/-15.4 mm was available (range 5-52). These results suggest an eventual practical aspect of this technique for the reconstruction of a functional sphincter using the gracilis muscle transposed around the anus.

The anatomical relationship of the iliocava junction to the lumbosacral spine and the aortic bifurcation.

This study dissected 42 cadavers to investigate the level of the iliocava junction and the relationship with the lumbosacral spine and the aortic bifurcation. The iliocava junction was between L4 and S1, most often at the level of L5 (64%) and on the median third of the spine (55%). The average height of the iliocava junction was 15.5 mm. The mean interiliac angle was 69 degrees . It was not related to the width of the iliocava junction. The iliocava junction covered the whole of the L5-S1 disc in 12% of cases. The iliocava junction was located above the aortic bifurcation only in 1 case. The mean distance between iliocava junction and aortic bifurcation was 19 mm. The variability of the iliocava confluence is high and complicates the anterior approach to the lumbosacral spine.

[Study of ilio-cava confluence and its relations with the lumbo-sacral spine]. / Etude de la confluence ilio-cave et de ses rapports avec le rachis lombo-sacré.

Dissection of 35 human cadavers was performed to assess the variability in the vascular anatomy of ilio-cava confluence and to define the relations with the lumbo-sacral spine and the aortic bifurcation. The ilio-cava confluence was between L4 and S1, most often at the level of L5 and on the median third of spine. The mean height of the ilio-cava confluence was 14mm. The confluence covered the whole of L5-S1 disc in 14% of cases. The main collateral branch was the medial sacral vein. The variability of ilio-cava confluence is great and complicate the anterior approach of lumbo-sacral spine.

[Reconstruction of the anus by the gracilis muscle reinnervated by the pudendal nerve. A preliminary anatomical study]. / Reconstruction du sphincter de l'anus par le muscle gracile réinnervé par le nerf pudendal. Etude anatomique préliminaire.

UNLABELLED: The aim of this study is to evaluate the possibilities of reinnervation of the gracilis muscle, transposed around the anus, by the pudendal nerve with an end-to-side nerve anastomosis. METHODS: This study was carried out in 10 cases. The gracilis muscle and its vascular-nervous pedicle have been dissected. The nerve of the gracilis muscle has been cut at its origin. The gracilis muscle was transposed around the anus. The nerve of the gracilis muscle was transposed in the gluteal area. The pudendal nerve has been dissected from its extra-pelvic part. The reinnervation with an end-to-side nerve anastomosis has been considered as feasible when the proximal ending of the nerve of the gracilis was put into a tension free contact with the extra-pelvic part of the pudendal nerve. RESULTS: The reinnervation of the gracilis muscle by the pudendal nerve has been possible in all cases. The extra-pelvic part of the pudendal nerve has a common trunk in 8 cases. The width of the extra-pelvic part of the pudendal nerve was 2.8 +/- 0.8 mm (1-3.5). The width of the proximal endings of the nerve innervating the gracilis muscle was 2.5 +/- 0.5 mm (2-3). After transposition of the nerve of the gracilis muscle in the gluteal area an average supplementary length of 20.9 +/- 16.8 mm was available (range 5-52). CONCLUSIONS: These results suggest that a reconstruction of the anal sphincter with a gracilis muscle transposed around the anus and reinnervated by the pudendal nerve with end-to-side nerve anastomosis is possible.

Left subpancreatic transplexus exposure of the proximal abdominal aorta.

The authors report their experience based on the anatomical study of the celiac region and on the practice of abdominal multiorgan removal for transplantation. They particularly concentrate on the limits and the content of the celiac region of Luschka and particularly: -the position of the celiac axis in relation to the median arcuate ligament of the diaphragm, -the relations of the collateral branches of the abdominal aorta, -the place being taken by the celiac plexus and its situation in relation to the left renal v. From these elements, they describe an original transplexus surgical exposure of the origins of the celiac axis and of the superior mesenteric a. They show the importance of this approach in abdominal vascular surgery and during abdominal multiorgan removal in transplantation.

Histoenzymatic study of human renal tissue preservation: II--Catalase activity in proximal tubular cells is uncorrelated with transplant evolution.

Enzyme histochemical activity of catalase, a peroxisomal enzyme involved in cellular antioxidant systems, was studied in proximal tubular cells of human renal transplants as a marker of ischemia-reperfusion injury in the prediction of the evolution of renal transplants. A low enzymatic activity was observed in all renal biopsies performed at 30 min. reperfusion with no difference between the several evolution types of renal transplants. Reduced catalase activity due to ischemia-reperfusion injury could not be correlated with renal function or used as an index of renal function recovery.

Histoenzymatic study of human renal tissue preservation: I--Proximal tubular glucose-6-phosphatase is correlated with transplant evolution.

Glucose-6-phosphatase was tested histochemically as a gluconeogenesis marker of ischemia-reperfusion injury of proximal tubular cells in human renal transplants. Histochemical enzyme activity, histology and transplantation conditions (preservation solution, cold and warm ischemia time, donor age), were compared to renal transplant evolution. Neither histology nor transplantation conditions were correlated with renal transplant evolution. Only glucose-6-phosphatase activity was significantly correlated with transplant evolution and could be used as a more sensitive marker than histology for the detection of ischemia-reperfusion injury of proximal tubules.

[The so-called "celio-mesenteric button-hole" region, an anatomico-surgical study]. / La région dite du "bouton coelio-mésentérique", étude anatomo-chirurgicale.

Average biometric values of the abdominal aorta and its collaterals, together with their variations, were studied during 80 multiple organ biopsies and 60 cadaver dissections. Two morphotypes were detected raising technical and tactical problems during multiple organ biopsies, particularly since this region includes the origin of the renal arteries. The left transplexic approach provides enhanced safety during control of arterial ostia.

[Non-invasive dynamic studies of the cervico-thoraco-brachial pathway. Anatomo-clinical correlative study]. / Explorations dynamiques non invasives de la traversée cervico-thoraco-brachiale. Etude corrélative anatomo-clinique.

Based on a computer assisted analysis of the anatomic and biomechanic features of 200 subjects, the authors propose a dynamic approach to the exploration of the cervico-thoraco-brachial pathway. Results are given for 70 healthy and diseased subjects. Ultrasonic evaluations of the arterial component, dynamic echography of the axillo-subclavian venous component, electrophysiology including conventional electromyography, somesthesic and motor evoked potentials, and advanced imagery provide a panel of complementary diagnostic techniques.

Intestinal absorption of drugs: digitalis binding and transport by brush-border membrane vesicles from human duodenum.

The intestinal epithelial cell layer is the first major barrier to absorption encountered by xenobiotics. An understanding of the mechanism and sites of drug absorption and metabolism is thus a critical first step in developing orally active compounds. In this context human brush-border membrane vesicles obtained from multi-organ donor intestines have been purified. This model has been validated and used to investigate the duodenal absorption of drugs "in vitro", namely digitalis. It is well established that digitalis compounds present great variability in their respective "in vivo" bioavailability in human (60-90% for digoxin, 0% for ouabain). These particular characteristics prompted us to determine whether this membrane model constitutes a suitable tool in predicting the bioavailability or intestinal transport processes of these molecules. The uptake of [3H] digoxin and [3H] ouabain by membrane vesicles incubated in media of increasing osmolarities demonstrated that: i/two factors are involved in the uptake processes of digoxin: membrane binding and intravesicular transport (osmotic sensitive), ii/ for ouabain, no osmotic sensitivity was observed, indicating that no transport process occurred, but only membrane binding processes. These results are in complete agreement with the absolute bioavailability data reported for man "in vivo". This human brush-border model constitutes an interesting approach to the intestinal absorption phenomena which are known to be among the factors influencing the bioavailability of orally administered drugs.

[Anatomic basis of the harvest of abdominal organs for organ transplants]. / Bases anatomiques des prélèvements d'organes abdominaux en vue de transplantations d'organes.

The abdominal organs removals, with a view to transplants, are complex surgical operations which require a perfect knowledge of visceral vascular anatomy. The common point of these removals is the "birenal en bloc excision", whose we have codified the development. This removal has induced us to revise many points of surgical anatomy and particulary: the connections between the liver and the right kidney; the importance of the mesoduodenum; the relative orientations of the portal vein and inferior vena cava axis; the ureteral vascularisation; the topography and the number of renal arteries; the connections between renal arteries orifices and superior mesenteric arterial orifice. When we have to remove, besides the kidneys, the liver or the pancreas or even the small intestine, surgical problems are the same, but then, the dissections concern also the celiac axis and the superior mesenteric artery. These multiple removals raise also many questions to the anatomist, the most interesting concerning: the multiple hepatic arteries; the connections between celiac branches of the abdominal aorta. All these notions are envisaged not only by the light of the anatomical preparations but also by reference to the clinical experience of the authors.

Macroscopic study of the adult thymus.

The dissection of 48 cadaveric specimens has been compared with operative findings for a review of the shape, size and site of this gland in the adult. The structure of the thymic compartment and the relations of the thymus, particularly with the vessels of the superior mediastinum and the base of the neck, were studied. The relative positions of the inferior parathyroid glands and the thymus were identified, with respect to the influence of this topography on the surgery of these glands. The arterial suply to the thymus, which is still very abundant in the adult, presupposes a functional organ whose physiologic involution is slow.

From classical to modern anatomy or computer-assisted biomechanics.

The authors describe their methodology - dissection, photography, informational - permitting a biomechanical approach together with the study of the changes in the topographic anatomy of a region during movement.