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  • Surgery  (16)
  • 1
    ISSN: 1279-8517
    Keywords: Coronary a ; Myocardial bridge ; Myocardium ; Cardiac circulation ; Anatomy ; Surgery ; Cardiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les auteurs rapportent un rare cas de pont myocardique sur le tronc de l'a. coronaire droite chez un adulte brésilien, caucasien, décédé dans un accident d'automobile. Après une brève revue de la littérature, le cas est décrit et illustré. Ce même cœur présente d'autres ponts: sur le segment initial de l'a. du bord droit; sur une branche ventriculaire antérieure droite, et sur l'a. interventriculaire antérieure. Suit une discussion sur le siège et la signification de ces ponts myocardiques.
    Notes: Summary A rare case of myocardial bridge over the trunk of the right coronary a. is described in the heart of a male, adult, Caucasian, Brazilian, whose death occurred after an automobile accident. After a review of the literature, the unusual finding is described and illustrated. Other bridges on the beginning of the right marginal a.; the right anterior ventricular a.; and on the anterior interventricular a. (left anterior descending) a. were observed. The location and significance of myocardial bridges over coronary a. are discussed.
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  • 2
    ISSN: 1279-8517
    Keywords: Vertebrae ; Anatomy ; Spinal cord ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Treize sujets ont été tirés au sort et embaumés selon la technique de Winckler. Après prélèvement de la colonne vertébrale et du segment céphalique en monobloc, les pièces furent congelées et des coupes horizontales pédiculaires pratiquées en C6, T1, T6, L1, L3 et L5. Après photographie et agrandissement, la surface du foramen vertébral et des différents éléments contenus fut mesurée sur ordinateur grâce au programme Canvas et analysée grâce au programme Statview. Le pourcentage d'occupation du foramen vertébral par la moelle est en moyenne de 30,5 % en C6, 26,1 % en T1, 21,4 % en T6, 12,7 % en L1, et 0,08 % en L3. Le pourcentage d'occupation du foramen vertébral par les filets radiculaires est en moyenne de 3,9 % en C6, 3,3 % en T1, 1,6 % en T6, 14,2 % en L1, 17,5 % en L3, et 12,2 % en L5. Le pourcentage d'occupation du foramen vertébral par l'ensemble des éléments nerveux est en moyenne de 34,4 % en C6, 29,5 % en T1, 23 % en T6, 26,9 % en L1, 18,9 % en L3, et 19,3 % en L5. Le pourcentage d'occupation du foramen vertébral par le liquide cérébrospinal est en moyenne de 25,2 % en C6, 30,7 % en T1, 31,6 % en T6, 43 % en L1, 43,5 % en L3, et 28,1 % au L5. Dans l'ensemble les éléments nerveux ne dépassent pas le 1/3 de la surface du foramen vertébral. Ces notions doivent être connues par les chirurgiens qui pratiquent des laminectomie ou corporectomie décompressives dans le cas des traumatismes vertébraux et des sténoses congénitales ou arthrosiques.
    Notes: Summary Thirteen subjects were randomly selected and embalmed according to Winckler's technique. After removal of the vertebral column and the head in one block the specimens were frozen. Transverse transpedicular cuts were performed at C6, T1, T6, L1, L3, and L5. After enlargement photography, the surface area of the vertebral foramen and its various contents were measured on a computer using the Canvas programme and analysed using the Statview programme. The mean area of the vertebral foramen occupied by the cord was 30.5% at C6, 26.1% at T1, 21.4% at T6, 12.7% at L1, 0.08% at L3. The mean area occupied by the nerve roots was 3.9% at C6, 3.3% at T1, 1.6% at T6, 14.2% at L1, 17.5% at L3, 12.2% at L5. The mean area of all the nervous tissue was 34.4% at C6, 29.5% at T1, 23% at T6, 26.9% at L1, 18.9% at L3, 19.3% at L5. The cerebrospinal fluid occupied a mean area of 25.2% at C6, 30.7% at T1, 31.6% at T6, 43% at L1, 43.5% at L3, and 28.1% at L5. The total neural tissue did not occupy more than a third of the vertebral foramen. These facts should be considered by surgeons who perform laminectomy or decompression in cases of vertebral trauma or congenital and osteoarthritic stenoses.
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  • 3
    ISSN: 1279-8517
    Keywords: Lung ; Lymphatic ; Bronchial carcinoma ; TNM classification ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La confrontation anatomochirurgicale de 360 cadavres et de 260 patients opérés de cancers bronchiques permet de constater que les lymphatiques du poumon rejoignent le médiastin homolatéral parfois directement et parfois par des sites qui ne correspondent pas au niveau anatomique de l'injection ou du cancer pulmonaire : ceci implique la nécessité de faire des curages systématiques de l'ensemble des lymphonoeuds du médiastin homolatéral lors de la chirurgie du cancer bronchique. En cas d'atteinte tumorale (N2), le pronostic est d'autant meilleur qu'un seul site est atteint, que l'atteinte nodale soit microscopique, uni ou plurinodale, avec ou sans rupture de la capsule et quel que soit le traitement réalisé, du moment que la résection semble macroscopiquement complète au chirurgien. Ceci s'éclaire à la lumière de l'étude anatomique qui montre que la chaine lymphonodale est une unité fonctionnelle qui déverse la lymphe dans la grande circulation soit au niveau des conflluents veineux du cou, soit dans le conduit thoracique au médiastin. En cas d'atteinte isolée d'une chaine, il y a plus de 70 % de chance pour que des métastases systémiques soient déjà présentes, 90 % quand N2 touche deux chaines et en cas de N3 (passage de la lymphe à des chaines controlatérales), cette fréquence atteint pratiquement 100 %. Mais, l'exérèse macroscopiquement satisfaisante permet de régler le problème local et l'atteinte des noeuds du médiastin, même avec rupture capsulaire ne peut pas être considére comme une contre-indication en l'absence de métastases systémiques cliniquement décelables.
    Notes: Summary Correlation of the anatomic and surgical features in 360 cadavers and in 260 patients operated for bronchial carcinoma reveals that the lymphatics of the lung reach the ipsilateral mediastinum, sometimes directly and sometimes by sites which do not correspond to the anatomic site of the injection or of the pulmonary lesion. This implies the need for systematic eradication of all the lymph nodes of the ipsilateral mediastinum during surgery for bronchial carcinoma. In cases of tumoral lesions (N2), the prognosis is better when only one site is involved, whether the nodal disease is microscopic, uni- or multiglandular, with or without rupture of the capsule and whatever treatment is carried out, even when resection seems macroscopically complete to the surgeon. This is explicable in the light of the anatomic study, which shows that the lymph node chain is a functional entity which channels the lymph into the systemic circulation, either at the venous confluence of the neck or into the thoracic duct in the mediastinum. When only a single chain is affected, there is a greater than 70% chance that systemic metastases are already present, 90% when N2 affects 2 chains, while in N3 cases (lymph passage to contralateral chains) the incidence reaches virtually 100%. However, macroscopically satisfactory excision allows management of the local problem, and involvement of the mediastinal nodes, even with capsular rupture, cannot be considered as a contraindication in the absence of clinically detectable systemic metastases.
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  • 4
    ISSN: 1279-8517
    Keywords: Lung ; Lymphatics ; Thoracic duct ; Surgery ; Carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'extension lymphatique des cancers du poumon au médiastin est le facteur essentiel du pronostic. L'étude anatomique des lymphonoeuds du médiastin a été menée sur 360 cadavres de sujets adultes à partir de l'injection du segment pulmonaire. Onze sites anatomiques sont concernés. La lymphe rejoint ces sites sans faire relais dans les lymphonoeuds intra-pulmonaires dans 20 à 40% des cas. Au sein de ces sites le courant lymphatique se poursuit vers la grande circulation en traversant un nombre variable de lymphonoeuds ou parfois aucun. Le courant lymphatique rejoint la circulation veineuse au niveau cervical mais plus d'une fois sur dix la lymphe a déjà rejoint le conduit thoracique au médiastin et dans un nombre intermédiaire de cas les sites du médiastin contro-latéral.
    Notes: Summary Lymphatic spread of carcinoma of the lung to the mediastinum is an essential factor determining prognosis. An anatomic study of the mediastinal lymph nodes was made on 360 cadavers of adult subjects based on injection of the pulmonary segment. Eleven anatomic sites were involved. In 20 to 40% of cases the lymph reached these sites without any relay in the intrapulmonary lymph nodes. Within these sites the lymph flow continued towards the systemic circulation by traversing a variable number of lymph nodes, or sometimes none. The lymph flow reached the venous circulation in the neck, but in more than one case in ten the lymph had already entered the thoracic duct in the mediastinum, and in an intermediate number of cases the sites in the opposite mediastinum.
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  • 5
    ISSN: 1279-8517
    Keywords: Middle rectal arteries ; Anatomy ; Surgery ; Surgical Anatomy ; Rectal resection ; Anatomical nomenclature
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'étude des artères rectales moyennes porte sur 30 cadavres de sujets adultes (29 blancs, 1 noir) des deux sexes (15 hommes, 15 femmes). Les artères rectales moyennes sont retrouvées dans 56,7% des cas, bilatérales (36,7%) ou unilatérales (20%). Leur origine se situe au niveau de l'artère honteuse interne (40%), de l'artère glutéale caudale (26,7%), de l'artère iliaque interne (16,8%) et plus rarement des autres branches pelviennes. Leur calibre extérieur mouen est de 1,7 mm, pour une longueur de 7 cm, et un point de pénétration sur la paroi rectale, à une distance de 6 cm de l'anus. La pénétration artérielle se situe au niveau des parois antérieure (50%) ou postérieure (45%) du rectum, isolément ou conjointement (43,3%). Ces données anatomiques justifient la conservation des artères rectales moyennes dans la chirurgie colorectale dans la mesure du possible. Le terme d'artères rectales moyennes, dans la nomenclature anatomique, devrait être modifié au profit de celui d'artères rectales inférieures issues de l'artère honteuse interne. De même, le terme d'artères anales devrait être substitué à celui, classique, d'artères rectales inférieures, pour être en accord avec la division de l'intestin terminal en rectum et canal anal.
    Notes: Summary The middle rectal arteries were studied in 30 cadavers of adult and older individuals (29 Caucasians and one Negro)_of both sexes (15 males and 15 females). The middle rectal artery was present in 56.7% of the cases, bilaterally (36.7%) or unilaterally (20%), originating from the internal pudendal (40%), inferior gluteal (26.7%), internal iliac (16.8%), and less frequently from other pelvic branches. The average external diameter of the middle rectal artery was found to be 1.7 mm, its average length about 7 cm, and the point of penetration in the rectal wall about 6 cm (average) superior to the anus. The most frequent sites of the rectal wall pierced by the middle rectal arteries were the anterior (50% of the cases) and posterior (45%) quadrants of the rectum, whether isolated or combined (43.3%). These anatomical features justify, when needed and possible, the preservation of the middle rectal artery in surgical interventions on related organs. The term middle rectal arteries in Nomina Anatomica should be changed to inferior rectal arteries and indented under internal pudendal artery; the current term inferior rectal arteries should be changed to anal arteries to follow the already adopted division of the terminal intestine into rectum and anal canal.
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  • 6
    ISSN: 1279-8517
    Keywords: Stomach ; Vascularisation ; Surgery ; Complications ; Vagotomy ; Esophagoplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La richesse de la vascularisation de l'estomac est bien connue et la grande tolérance de l'organe aux ligatures vasculaires soulignée. Cependant, des faits cliniques ainsi que des études anatomiques de plus en plus fines invitent à nuancer quelque peu cette conception classique, surtout lorsque l'on intervient chirurgicalement sur le viscère. L'objectif de ce travail est d'évaluer plus particulièrement l'importance de l'ischémie pariétale qu'entraînent la vagotomie hypersélective et la plus récente séromyotomie antérieure d'une part, la gastrolyse préalable à l'œsophagoplastie gastrique après oesophagectomie ou pharyngo laryngectomie circulaire d'autre part. 40 estomacs de sujets adultes non embaumés ont été étudiés par artériographie selon des modalités techniques variables en fonction de l'intervention à tester. Il en ressort que la vagotomie hypersélective crée constamment une bande avasculaire de 2 à 4 cm de large sur toute la hauteur de la petite courbure intéressée par l'intervention, que la séromyotomie antérieure, sous réserve de quelques précautions techniques, n'entraîne presque pas d'ischémie pariétale, et qu'enfin l'importance de l'ischémie inhérente à l'œsophagoplastie gastrique est sensiblement variable selon les modalités techniques. Les conclusions pratiques appuyées sur une riche iconographie permettront de mieux cerner les impératifs vasculaires au moment du choix des techniques opératoires en tenant compte, bien entendu, du contexte clinique.
    Notes: Summary The rich vascularisation of the stomach is well known and the remarkable tolerance of the organ to vascular ligatures has been emphasised. However, some clinical observations as well as more and more detailed anatomical studies suggest some modification of this classical concept, especially when operating on the viscus. The aim of this work was to evaluate particularly the importance of parietal ischemia which follows hyperselective vagotomy and the more recent anterior seromyotomy, on the one hand, and the gastrolysis that precedes gastro-esophagoplasty after esophagectomy or circular pharyngolaryngectomy on the other hand. The stomachs of 40 unembalmed adult cadavers were studied by angiography in various ways, according to the operation which was being considered. The findings indicated that hyperselective vagotomy caused an avascular band 2 cm wide along that part of the lesser curve affected by the surgical intervention, and that anterior seromyotomy (allowing for some technical artifacts) caused almost no parietal ischemia, and lastly, that the ischemia from gastro-esophagoplasty varied according to the technique used. Useful conclusions, supported by numerous illustrations, will allow the surgeon to define better the vascular requirements when choosing the procedure to be used, taking account of the clinical situation.
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  • 7
    ISSN: 1279-8517
    Keywords: Pulmonary valve ; Pulmonary trunk ; Autograft ; Anatomy ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A pulmonary valve autograft may be proposed to replace diseased aortic valves. The explanted pulmonary valve is replaced with a pulmonary homograft with the inherent risk of calcified degeneration. A monocusp valve using the anterior pulmonary trunk has been proposed to reconstruct the right ventricular outflow tract. The aim of this study was to determine the feasibility of this technique. In hearts from 17 adult cadavers, we measured pulmonary trunk diameter at the leaflet tops (D1). H1 and H2 were respectively from leaflet top to lower and upper levels of the pulmonary trunk bifurcation. D2 = 1.4 D1 was calculated as the monocusp size allowing a 45∘ opening of the valve and thus permitting good valvular efficacy. G = H1-D2 determined the feasibility of the technique G greater than 10 mm, appeared the most favorable, G between 0 and 10 mm, appeared possible, and G less than 0, appeared to be impossible. Mean values of D1, H1 and H2 were respectively 20.19 mm, 37 mm and 57 mm. The technique was possible in 16 cases (94%) and impossible in 1 case (6%). Preoperative determination of these parameters, by echocardiography or magnetic resonance imaging, appears necessary before applying this new surgical technique.
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  • 8
    ISSN: 1279-8517
    Keywords: Pudendal nerve ; Surgery ; Infiltration ; Neurophysiology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Our anatomic findings have led us to define conflictual relations that may be encountered in their course by the pudendal n. and its branches. Starting from the clinical study of a group of patients suffering from chronic perineal pain in the seated position, we have defined, beginning with the cadaver, three possible conflictual settings: in the constriction between the sacrotuberal and sacrospinal ligaments; in the pudendal canal of Alcock; and during the straddling of the falciform process of the sacrotuberal ligament by the pudendal n. and its branches. Consequently, considering so-called idiopathic perineal pain as an entrapment syndrome, the clinical and neurophysiologic arguments and infiltration tests have led us to define a surgical strategy which has currently given 70% of good results in 170 operated patients. Earlier diagnosis should improve on this.
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  • 9
    ISSN: 1279-8517
    Keywords: Non recurrent inferior laryngeal nerve ; Retroesophageal subclavian artery ; Thyroid ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors report 17 cases of a right non-recurrent inferior laryngeal n. (NRILN) observed during 15 years of practice of thyroid and parathyroid surgery. In their last two cases, the existence of an aberrant right subclavian a., constantly associated with NRILN, was confirmed by MRI angiography. On the basis of the literature and their own experience, the authors review the incidence of this double anomaly, its embryologic explanation and its anatomic and surgical importance. They stress the diagnostic factors and the therapeutic implications, very different in children and adults, of a particular vascular anomaly whose outcome is little understood.
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  • 10
    ISSN: 1279-8517
    Keywords: Non recurrent inferior laryngeal nerve ; Retroesophageal subclavian artery ; Thyroid ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors report 17 cases of a right non-recurrent inferior laryngeal n. (NRILN) observed during 15 years of practice of thyroid and parathyroid surgery. In their last two cases, the existence of an aberrant right subclavian a., constantly associated with NRILN, was confirmed by MRI angiography. On the basis of the literature and their own experience, the authors review the incidence of this double anomaly, its embryologic explanation and its anatomic and surgical importance. They stress the diagnostic factors and the therapeutic implications, very different in children and adults, of a particular vascular anomaly whose outcome is little understood.
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