[Pelvic embolization in uterine cervix carcinoma (author's transl)].
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Biomedical subjects
Publications and source records attributed to D Doyon.
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Popliteal phlebography by puncture of the popliteal vein anables direct opacification to be obtained of the deep venous trunks of the knee and the thigh. This simple technique can be used for precise evaluation of valvular incompetence. Normal and pathological findings after 50 popliteal phlebographies are described.
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Catheterization of the portal system by transhepatic percutaneous puncture may be difficult when atrophy of the liver, severe ascites, or thrombosis of the intrahepatic portal branches exists. It could be useful, in these cases, to employ "real time" ultrasonography to assist puncture of an intrahepatic portal branch. A case is reported in which this method was used to obtain percutaneous puncture of a left portal branch during obliteration of esophageal varices.
The successful treatment of a congenital vertebral fistula with the balloon catheter occlusion technique is reported. A new approach is presented (the occipital approach), based upon the pathological enlargement of the second intervertebral space anastomosis between occipital and vertebral arteries.
Two successive hepatic arterial embolizations were performed in a patient with hypercalcemia secondary to hepatocellular carcinoma. The first procedure was performed on an emergency basis due to a cardiovascular episode and was immediately beneficial. The second procedure, performed five months later for a recurrence, was effective in 3 days; 13 months later, there had been no recurrence.
The functional anatomy of the facial artery consists of a group of constant arterial pedicles nourishing a specific territory and supplied by a variable facial trunk. There is a hemodynamic balance with other variable connecting trunks such as the transverse facial and internal maxillary arteries. Every type of variant, irrespective of its origin, may be understood based on the constant relationships and anastomoses involved. Knowledge of this functional anatomical system is crucial to an understanding of the blood supply to the face.
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Signs of a fracture of the mandible and a submaxillary hematoma were present in a patient wounded by a bullet. Selective carotid arteriography by femoral catheterization revealed the presence of sectioning of the facial artery at its origin and underlying external carotid stenosis. Hemorrhagic complications or aneurysm formation could have occurred if the lesion had not been demonstrated. Though arteriography is not without risks, it is irreplaceable for investigating cervicofacial injuries when a vascular lesion is suspected.
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The authors report their procedure of angiographic localization of endocrine tumors of the pancreas: arteriography and subselective pancreatic phlebography (by transcutaneous transhepatic route) with intrapancreatic venous hormonal assays. This technic is the only one able to localize microscopic secreting tumors (under 2mm diameter in 3 cases on 20 examinations). Interpretation of hormonal data is discussed.
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Early experimental studies have shown that it is possible to obtain vascular obliteration and clot formation using monopolar direct current electrocoagulation. There is a major risk of rupture of blood vessels if alternating current is used. Using a co-axial bipolar electrode and high frequency alternating current it was possible to obtain valid, reproducible, and safe vascular obliteration in the distal digestive tract arteries in dogs. The obliteration is due to lesions of the intima and the formation of a clot in situ.
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Thirty five cases of hepatic arterial embolisation are reported. The analgesic effect in association with tumour pathology (27 cases) was virtually constant (80% of cases). Arterial embolisation should thus replace surgical disarterialisation in the management of malignant tumours of the liver. It improves the quality of survival in painful tumours, above all when they are hypervascularised. Two fatal complications as a result of the technique emphasise the absolute need to respect its contraindications: portal thrombosis, even segmental, or hepatic failure. Two cavernous haemangiomas and one angioma with arterioportal fistula complicated by haemobilia were also successfully embolised. Five traumatic vascular lesions, two of which resulted in severe haemobilia, also benefited from superselective embolisation.
The normal development of the hyoidostapedial system and its branches and anastomosis are outlined. The intrapetrous facial nerve receives its arterial suplly from the network. The arterial arch of the facial nerve is seen more frequently in angiograms of infants than in those of adults. The fact that the same vessel supplies the VIIth and the Vth nerves suggests that an ischemic mechanism may frequently be involved in Bell's palsy. The facial nerve from the point of view of its arterial supply must be considered as a nerve of the middle fossa and represent the major risk of embolization in the propinal middle meningeal artery.
Since Parkinson's original description, the C5 collaterals are always presented as originating from a common trunk (meningo-hypophyseal). This is the least frequent anatomical variation. In fact, the posterior (C5) group of collaterals corresponds to the remnant of two transient embryonic vessels (primitive maxillary and trigeminal arteries), branches of which will give rise to the two main groups of collaterals originating from this area: medially, the inferior hypophyseal and the medial clival arteries; laterally, the basal tentorial and lateral clival arteries, which are constantly anastomosed with the ascending pharyngeal artery. Only in some cases (10%) do these two groups arise in common from the C5 carotid siphon. Apart from these branches the so-called Bernasconi's artery may originate from eight different pedicles, the C5 siphon representing only one of them.
The middle meningeal artery can sometimes supply the complete vascularisation of the posterior fossa, i.e., the dura mater of the cerebellar fossa and the tentorium cerebelli. The authors present an anatomic and radiologic correlative study based upon an unusual case where the middle meningeal artery arose from the ascending pharyngeal artery and vascularised the entire posterior cerebellar fossa.