[Calcanear fractures. Advantages of horizontal tomography in exact diagnosis of the type of injuries (author's transl)]. / Fractures articulaires du calcanéum. Intérêt des tomographies horizontales pour un diagnostic radiologique exact des lésions.

The usual radiographic projections do not enable to do a complete diagnosis of the pattern of the calcanear fractures. Horizontal tomograms, performed since 1975 by the authors with a complex movement tomographe show the superior surface of the calcaneus. Compared with the sagittal and frontal tomograms, they are absolutely necessary to know the shape of the fractured calcaneus and to precise the anatomical basis of its treatment.

[Surgical treatment of calcanear fractures (103 cases). Reconstruction-arthrodesis, or reconstruction (author's transl)]. / Traitement chirurgical des fractures articulaires du calcanéum: reconstruction ou opération de Stulz? A propos de 103 cas opérés.

In a twelve-year period, 103 calcanear fractures (thalamus) were operated on, either by the Stulz procedure (calcanear Reconstruction-subtalar Arthrodesis [83 cases]), or by Reconstruction (20 cases). During the first seven years, the Stulz procedure had been performed systematically. During the following five years, indications were shaded between 28 reconstruction-arthrodesis and 20 reconstructions. A complete preoperative radiological study, including especially horizontal calcanear tomography enables to precise what type of injuries affects the four different parts of the calcaneus, and to choose between either procedure.

[Results of primary reconstructive arthrodesis of the calcaneus (study of a homogenous series of 55 fractures of the medical surface of the calceneus)]. / Résultats de la reconstruction-arthrodèse primitive du calcaneum. (ètude d'une série homogène de 55 fractures thalamiques)

55 cases of calcanear fractures (thalamus) have been treated with the Stulz procedure (early subtalar arthrodesis and calcanear reconstruction), associated with a repair of the great apophyse. All the cases are comparable and the results are considered as good or excellent in 93,8 p. 100 of them. The results are interpreted accordingly to subjective and objective tests. The result is depending of the type of the lesion, the patient's profession and the nature of the trauma. The result obtained at the time of fracture uniting will stay stable, will never deteriorate and sometimes improve. The early arthrodesis and reconstruction remains a good procedure for the comminutive fractures of the thalamus, which are considered as the most difficult to correct perfectly. For this reason, the simple reconstruction is often responsible of secondary subtalar arthrosis.

[Treatment of post-operative ventral hernia: elementary biomechanical basis. Report of 51 cases treated by mersilene mesh (author's transl)]. / Traitement des éventrations abdominales post-opératoires: bases biomécaniques élémentaires. A propos de 51 cas traités par treillis de mersilène.

Elementary functional anatomy of the normal abdominal wall and following incisional hernia are described. The treatment of postoperative hernia should be based on this: its object is to restore the morphology and functions of the abdominal wall, in particular its respiratory function. It may be necessary to carry out gradual pneumo-peritoneum before parietal repair. A mersilene mesh was used by the authors in 51 cases. Certain rules should be observed when this prosthesis is placed in position so that the abdominal muscles find the conditions closest to their normal function.

[Ruptures and "spontaneous" perforations of the rectum and sigmoid: a report on two cases and review of the published literature (author's transl)]. / Les ruptures et les perforations "spontanées" du rectum ou du sigmoïde. A propos de deux observations et d'une revue de la littérature.

Though ruptures and "spontaneous" perforations of the rectum and sigmoid are sometimes confused they are very different affections. Ruptures of the rectum or the rectosigmoid junction are lesions due to effort in chronically constipated subjects, frequently having rectal prolapses. They are due to a particular type of trauma. Perforations of the rectum, rectosigmoid junction, or the sigmoid loop arise from a previous acute ulceration of the intestinal wall. Systematic histological examinations may confirm the etiology. A case is reported of rupture of the rectum due to effort. The second case was a double perforation, of the rectum and the rectosigmoid junction, due to a non-specific acute rectocolitis.

[The cysticohepatic duct and the subvesicular duct. Apropos of 2 types of bile ducts of different significance]. / Conduit cysto-hépatique et conduit sous-vésiculaire. A propos de deux types de conduits biliaires de signification différente.

A cysticohepatic duct drains a particular region of the liver. It represents an anatomical variation of the biliary tree. On the contrary, a subvesicular duct represents an abnormality of the biliary ducts development. It belongs to aberrant biliary ducts (vasa aberrantia) and has all their morphologic characteristics.

[Variations of division of the extrahepatic bile ducts: significance and origin, surgical implications]. / Les variations de division des voies biliares extrahépatiques: Signification et origine, conséquences chirurgicales.

As opposed to congenital anomalies, the anatomical variations, as well as the modal type, are issued from a normal morphological development. The variations of division of extra-hepatic biliary ducts are very frequent. They are clearly explained by the sequence of embryological development in man, and also by compared anatomy. Lots of variations occur, some of them being more frequently encountered than others during cholecystectomy for gallbladder lithiasis. A cysto-hepatic duct draining a large hepatic territory is the most dangerous variation. As a matter of fact, it can look as if the junction between the cystic duct and the common biliary duct was of the modal type. In surgical practice, the dissection of cystic duct must never go over the right side of the common biliary duct in order for it never to be injured. Radiological exploration of biliary tree during cholecystectomy for gallbladder lithiasis has to be routine, in order to discover the obviously unpredictable individual variations of division of extra-hepatic biliary ducts.

[Interest and limits of arteriography in one case of abdomino-pelvic trauma (author's transl)]. / Intérêt et limites de l'artériographie dans un cas de traumatisme abdomino-pelvien

Hepatic and pelvic arteriography were carried out in one case of trauma of the liver and pelvis. Initial hepatic arteriography did not give more information than per-operative cholangiography. Secondary hepatic arteriography suggests the presence of lesions which, in fact, do not exist. Pelvic arteriography permitted us to localise on one obturator artery, the origin of a voluminous retroperitoneal hematoma. We were able to stop the hemorrhage by embolisation and this facilitated surgical removal of the hematoma.

[Pancreatic injuries. Report on 42 cases (author's transl)]. / Les traumatismes du pancréas. A propos de 42 observations.

Between 1975 and 1980, 42 pancreatic injuries have been managed, they represented 9.5 per cent of abdominal injuries. Nine patients received penetrating trauma and thirty three patients sustained blunt trauma, the majority of them was a road accident. Associated and concomitant injuries of abdominal organs were present in 81 per cent of cases with the pancreatic trauma. More than 66 per cent have multiple brain, thoraco, abdominal, and bones injuries. Thirty two patients have been treated before the sixth hour. The emergency surgical treatment has been conservative in twenty six patients and a primary resection has been performed in twelve patients, (with eleven partial pancreatectomy and one pancreatoduodenectomy). But four patients died on the operating table because they have extensive injuries to several abdominal organs. Postoperative complications were present in 66 per cent of cases. They obliged the drainage of abscesses, three distal pancreatectomy and one pancreatoduodenectomy. The global mortality is 31 per cent, the secondary mortality is 21.4 per cent. The authors conclude thanks to the study of this series and of literature that the frequency of pancreatic trauma increased, and that its gravity is directly related to the number of other organs damages, missed or delayed diagnostic and to an inappropriate emergency treatment, which let necrosis and infection making their deadly evolution.

[Treatment of fractures of the humerus by intramedullary fixation]. / Traitement des fractures de l'humérus par "l'embrochage en bouquet"

The Hackethal's technique of intramedullaring wiring for humeral fracture represents the immobilisation procedure particularly convenient for this bone. This procedure can be realised without special instrumentation with Kirschner's wires and image intensifior. To allow the approach of the fracture, the patient's position is choosed upon the topography of the lesion. The intramedullaring wiring is always done from down to up. Indications for this procedure are: humeral shaft fracture, humeral neck fracture, and fractures of the shaft and of the neck. During the reduction of the fracture, the immoderate use of a image intensifior seams to be the major risk. Hackethal's technique for medullary wiring was used in 21 patients, only one pseudarthrosis was noted. The fonctionnal recovery of the arm is usually realised in three months.

[The repair of recurrent postoperative incisional hernias. Objectives and therapeutic indications (68 cases)]. / La cure des éventrations abdominales post-opératoires récidivées. Objectif et indications thérapeutiques (68 cas).

Among 327 surgical repairs of incisional hernias done between 1974 and 1989, 68 repairs (21%) were performed because of a primary treatment failure. Failed primary attempts of cure had been unique in 71%, and multiple in 29% of cases; their procedure had been essentially suture or herniorrhaphy. Site of recurrent incisional hernia (R.I.H.), was midline or lateral incision in respectively 84% and 16% of cases. Size of R.I.H. was considered as large in two third of cases. Operation was performed electively in majority of cases (93%). More than half of the patients were "prepared" by preoperative pneumoperitoneum and/or weight reducing regimen. Mersilene* mesh was used in 81% of cases. Results of treatment of R.I.H. are reported, depending on procedure. Among 55 cures by use of Mersilene* mesh, 1 patient died (from myocardial infarction), and 5 recurrences occurred, 4 of which from sepsis. Study of complications and failures suggests: 1) careful attention to indications, 2) advantages of a large size Mersilene* mesh, 3) attention to preoperative treatment, especially weight loss regimen and progressive pneumoperitoneum.

[Synthetic prostheses used in surgery to repair abdominal wall defects (excluding groin hernias). Characteristics, in situ behaviour and applications]. / Les prothèses synthétiques dans la chirurgie réparatrice de la paroi abdominale (hernies de l'aine exceptées). Caractéristiques, comportement in situ et applications.

This study is an updating on synthetic prostheses used today to repair incisional hernias, eviscerations and abdominal wall defects due to a severe infection or a parietal excision of malignant tumours. The present prostheses are the fruits of the constantly developing plastic industry. Their characteristics and types (mesh or patch), together with the materials they are made of, are studied taking this development into account. The tissular reactions caused by prostheses are different depending on whether the material they are made of is an absorbable one or not. Published data on animal experimentation are largely used in this part of the study. A significant part is also allocated to the pathobiology of prostheses infection on which is based prevention of risk infection in the surgical practice. A synthetic prostheses has to be chosen depending on its characteristics and the tissular reactions it generates. In a septic environment, only absorbable prostheses can be used without risk. As for incisional hernias, which allows the authors to refer to their own expérience, the choice also depends on both the surgeon's own conception of the treatment and its purpose. The defect recovery after parietal excision of malignant tumours is eased by the use of a synthetic prostheses. In the future, synthetic prostheses will be even more used than today in the repair of abdominal wall. A present, the materials they are made of keep on being developed.

[Verifying the function of hepaticojejunostomies by scintigraphy of the bile ducts]. / Contrôle du fonctionnement des hépatico-jéjunostomies par la scintigraphie des voies biliaires.

Thirty six hepatobiliary scintigraphies with 99mTc-Dimethyl IDA were performed in thirty patients with an hepaticojejunostomy one month to ten years after surgery. Twenty patients underwent surgery for biliary disease and ten for duodenal or pancreatic disease. In most cases (twenty three), the radionuclide study has been systematically performed to assess the scintigraphic pattern of a normal hepaticojejunostomy. In seven cases this pattern was abnormal. Four times the biliary enteric anastomosis was involved. Three times it showed an abnormal liver morphology. After an hepaticojejunostomy, hepatobiliary scintigraphy seems to be the only examination providing dynamic information for the biliary enteric anastomosis and the intestinal loop. But it sometimes is difficult to analyse in all cases, it must be the screening test in patients when symptoms occur after hepaticojejunostomy; but a percutaneous transhepatic cholangiogram cannot always be avoided.