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Biomedical subjects

J Hureau

Publications and source records attributed to J Hureau.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Prefabricated free grafts and neovascularized free grafts. 150 cases in rats].

The use of vascularized, composite and prepared free transplants is a recent technique. Two types of transplants were grafted in rats (150 operated cases). For the prefabricated free transplants, each component remains vascularized by rami of the main pedicle: vessels, nerves, bone, periosteum, cartilage, muscle, skin (50 cases). The graft is transplanted immediately. Neovascularized free transplants are quite different, the various components being laid around the vascular pedicle (100 cases). Neovascularization revascularizes the components. The free graft is transplanted 5 weeks after being prepared. The period of observation ranges from 3 to 12 months. Observation includes macroscopy, arteriography, histology and intravascular dye injections. The results with prefabricated free transplants show normal vascularization of soft tissues. There is bone in all cases, it is normal in 80% of cases. In neovascularized transplants, the bone is normal in 33% of cases only, and totally resorbed in 46%. Prefabricated free transplants produce better results than neovascularized free transplants and must be preferred. The merit of these composite free transplants is that they produce free transplants selectively, using various tissues and chosen vascular pedicles. These transplants are a useful and futuristic alternative for highly sophisticated reconstructive surgery.

Animals↗
PubMed1991

[Free forearm flap used in the reconstruction of the cervico-cephalic region. 43 cases].

The free neurovascular antebrachial transplant was described by Yang-Guofan in 1978. In 1981, we brought the description of this free transplant to Europe. Forty-three antebrachial grafts were made to reconstruct the cervicocephalic extremity. We had various indications: floor of the mouth and base of the tongue: 18 cases, facial structures: 7 cases, posterior wall of the pharynx: 9 cases, rescue surgery for esophagoplasty: 6 cases, mandible: 2 cases (using a bone rod taken from the radius), internal aspect of the cheek: 1 case. All grafts were revascularized. In 41 cases, the indications were carcinological, the last 2 cases being benign lesions. The early postoperative mortality included 1 case, not related to the nature of the operation (neoplasm). There was no failure of free transplants. Surveillance was ensured every half-hour during 12 hours, then every 3 hours. Discriminating sensation was recovered in 39 of 43 cases. Mandibular bone reconstructions were knit at the 3rd month. The main disadvantage of removing this graft is esthetic, as it leaves a considerable scar on the forearm. The free antebrachial transplant provides an effective solution to the reconstructions of the cervicocephalic extremity, when a narrow, thin, supple, reinnervated, compound transplant is needed.

Adolescent↗
PubMed1991

[Mandibular reconstruction using free vascularized fibula transplant].

Free revascularized fibular transplants have been used in surgery for the reconstruction of long bones since 1973. The reconstruction of the mandible using a free fibular transplant has been published in 1989 only by Hidalgo. The mandible and the fibula have little in common, except for their length and a similar structure in section. The anatomical study of the free osteofasciocutaneous fibular graft included 20 fresh subjects. The vascularization of the fasciocutaneous plate is either grouped or, more frequently, tiered (2/3 of cases). The technique to remove this graft is specified. Four clinical cases are reported, including three cases of neoplasm of the floor of the mouth invading the mandible, and one case of traumatic amputation of the lower part of the face. A free composed transplant taken from the fibula has been used in all four cases. The postoperative period was normal, and the grafts were completely successful. The main indications of free transplants made of fibular bone are: extensive (more than 8 cm) or compound losses of bony substance from the mandible. The richly vascularized transplant take from the fibula is very sophisticated and performant. The length of bone that can be removed is 25 cm; the bone may be osteotomized in 2 to 4 fragments retaining their vitality. Other tissular structures such as the skin, fascia, muscle, are removed with the bone. The independence in space is threefold and regards the bone, the teguments and the vascular pedicle. The microsurgical qualities of the vascular pedicle are considerable. These free transplants improve the quality of survival (endosseous implants in one case). The morphological, functional and esthetic result is good as a rule.

Adult↗
PubMed1991

[Surgical risk. A developmental concept].

The word risk has several senses. Whether in civil, penal or administrative law, it supposes the notion of liability. Liability too often leads to decide in advance that there has been a fault. The corollary of fault is repair. One condition for this is that there is damage, a cause-effect relationship and evidence. Then what about liability without fault, with the notion of burden of the proof, of compensation for damage, in the ill-defined context of presumed fault? There is a praetorian law about medical liability. It is an adaptation, with the passing years, of common law to the specific issues of medicine. Surgery is a profession with risks and duties. The reasonable liability of the surgeon represents his claims for fame. The surgeon must neither be released of any liability nor assumed to be guilty a priori. There is enough matter for a wide ethical and legal debate about a concept-risk-that has undergone many vagaries.

Ethics, Medical↗
PubMed1991

[The posterior interparietoperitoneal spaces or retroperitoneal spaces. 1: Normal topographic anatomy].

The posterior spaces between the wall and peritoneum or extraperitoneal spaces are located between the visceral retrocolic and retro-duodenopancreatic fascias anteriorly and the parietalis fascia posteriorly. They were studied using an anatomic and computed tomographic comparison. The propria fascia (lateroconal fascia) divided into the anterior and posterior layers of the perirenal fascia. The fascias delimitate two anterior and posterior pararenal spaces around the kidney compartment and two anterior and posterior perirenal spaces in the compartment itself. These spaces extended above and below the renal compartment from the diaphragm to the pelvis. These large spaces composed of fat and organs can assume the guided migration of pathologic processes or their spread according to the importance of the fascias barriers. They below to the genito-urinary region. The extraperitoneal spaces are related anteriorly to the retroperitoneal alimentary organs: duodenum, pancreas, ascending and descending colon depending of the alimentary region. They are related posteriorly with the abdominal wall and its own fat. The individuality and the interdependance of these three territories (alimentary, genito-urinary and abdominal wall) and their consequences for pathologic CT scan imaging will be discussed in the second part of this paper.

Humans↗
PubMed1991

[The posterior interparieto-peritoneal or retroperitoneal spaces. 2: Pathological x-ray computed tomographic image].

The old reports about the interparieto-peritoneal spaces described particularly the renal space and its environment. The CT scan has modified the in vivo study of the extraperitoneal spaces (E.P.S.) and brought the question of the acquired knowledge up again. An anatomical research was performed in the first part of this study which describes the structures limited between the parietalis fascia and visceral peritoneal fascias. These are the true EPS which the main element is the propria fascia of Sappey (lateroconal fascia) and its anterior and posterior renal double layers. All these lamellar structures limits spaces variably infiltrated with fat tissue: the anterior pararenal space almost virtual, the posterior pararenal space which continues till the Bogros space and the anterior and posterior renal spaces of the renal compartment which the fat continues till the bladder and accompanies the ureter. The second part of this study precises some notions of general topography which are necessary for reading abnormal CT scan images. This part reminds the aortic and arterial general organization of the vertebrates as described by Mackay. It underlines the architectural importance of the three areas so defined: parietal or peripheral, intermediate or mesoblastic genitourinary and deep lateral or digestive endoblastic. These three areas corresponds to the three vascular aortic circles. It emphasized the importance to accept in practice the notion of visceral joining fascia which has been proved in adult people. The longitudinal architecture of the compartments is precise with respect to their appartenance to one among the three arterial arches of Mackay. What the anatomy suggest, the pathology can prove. Several pathological processes are studied on CT scan: large hemorrhagic or necrotic collections in acute pancreatitis, abnormalities or diseases of renal or adrenal compartments, extraperitoneal mesenchymomas, diseases of the psoas compartment. All these observations are analysed in order to explain anatomical and CT scan findings. This study refers not only to the oldest researches which are still valuable but also to the most recent controversies. All the questions are not solved using the clearest schemes.

Abdomen↗
PubMed1990

Arterial vascularization of the operated stomach: highly selective vagotomy, anterior lesser curve seromyotomy, esophageal replacement by transposed stomach after esophagectomy or circular pharyngolaryngectomy.

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.

Arteries↗
PubMed1990

[Auto-transplantation of small intestine, an emergency salvage procedure after failure of esophagoplasty].

The colon or stomach is generally used for extended oesophagoplasty. These pediculated plasties may be complicated by necrosis or stenosis and require total or partial resection at a later stage. We report such an outcome in this case report: failure of left coloplasty, partial failure of right coloplasty and stomach then rendered unusable. The cervico-thoracic oesophagus was reconstructed using a free revascularised small bowel transplant, re-establishing the continuity between the cervical oesophagus and the retrosternal right colon. This case presents several particularities: semi-emergency salvage procedure, use of a saphenous vein graft to revascularise the intestinal artery using the lingual artery as nutrient artery, venous drainage of the transplant via the intrathoracic left brachiocephalic vein, necessity for resection of the left half of the manubrium sterni and the head of the left clavicle.

Colon↗
PubMed1990

[Pharyngoesophageal reconstruction using a vascularized free jejunal graft. Indications--technique and surveillance. Report of 90 cases].

Several procedures have been proposed for pharyngoesophageal reconstruction. The use of a revascularized free jejunal graft currently appears to be a method of choice for anatomical, physiological and technical reasons. The authors currently look back on a series of 90 patients having received a revascularized free jejunal graft between 1978 and 1989 inclusive. The indications predominantly include cancer of the pharynx invading the posterior wall and preserving the cervical esophagus, requiring total circular pharyngolaryngectomy (77 cases). Some benign lesions involve reoperated patients (13 cases). The technique for obtaining the jejunal graft is accurately codified: use of the 3rd jejunal loop in isoperistaltic conditions, refrigeration during the period of ischemia, revascularization by the cervical vessels. If a salvage operation is needed, it is necessary to prepare a saphenous venous graft at the beginning of the operation (3 cases). These grafts must be observed daily. Early negative signs include unexplained epistaxis, blood in the saliva, cervical skin suffering. Emergency fiberscopy must be performed with a bronchoscope or a rhinofiberscope. In case of suffering or necrosis of the graft, the patient must be reoperated immediately and a second free jejunal graft must be placed. The absence of postoperative mortality, low morbidity and good functional results obtained in the series are convincing reasons for using this procedure.

Emergencies↗
PubMed1990

[Vascular problems in gastric esophagoplasty after esophagectomy or circular pharyngolaryngectomy].

Gastric oesophagoplasty (GOP) after total oesophagectomy or circular pharyngolaryngectomy is complicated by an average anastomotic breakdown or fistula rate of 15%, and a stenosis rate of 8%. Ischemia related to the actual procedure itself undoubtedly plays a role in the production of such complications in spite of the rich vascular supply to the stomach. The authors report the results of an anatomical study involving 24 stomachs from non-embalmed adults studied by various forms of arteriography depending in the GOP technique employed. For healthy normotensive gastric arteries, they demonstrate the principal elements likely to influence the vascularisation of the graft and propose a provisional vascular score for ischemia. Based on this, they discuss the vascular risks associated with GOP techniques in general.

Adult↗
PubMed1990

[Comparative study of vascularization of the stomach after hyperselective vagotomy and anterior seromyotomy].

Based on a Micropaque arteriography study of 21 stomachs from non-embalmed adults, the authors compare the ischemic consequences of highly selective vagotomy (HSV) with those of anterior seromyotomy (ASM) combined with posterior trunk vagotomy. HSV inevitably produced an avascular band 2-4 cm wide in the lesser curve region. ASM, to be total and effective, needs to produce hemostasis of the submucosal plexus thereby also producing ischemia of the denuded mucososubmucosal band. It is however possible to avoid the submocosal plexus by remaining more superficial; however, it is then necessary to combine an additional neurotomy otherwise the procedure is likely to fail. In any event, the partial ischemia associated with ASM is much less serious than that noted after HSV.

Adult↗
PubMed1988

A study in organogenesis: the arterial supply of the anorectal region in the human embryo and fetus. Anatomic and embryologic bases of anorectal malformations.

The development of the anorectal region is based on differentiation of the terminal portion of the hindgut. The origin of anorectal malformations is still unknown but seems to occur very early in the embryologic period. To gain a better understanding of their development, a study of the arterial supply of the anorectal region was made in 26 embryos and 50 fetuses.

Anal Canal↗
PubMed1988

The caudate lobe of the liver.

The caudate lobe of the liver is an independent segment straddling the right and left lobes of the liver. It is divided into 2 parts, right and left, indicated externally by the caudate and papillary processes. It is now possible to unvestigate it by ultrasonography and computed tomography, allowing its surgical excision for tumoral disease of the superior biliary confluence.

Humans↗