[Encapsulating peritonitis. Etiology and current treatments. Apropos of 4 new cases].
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Biomedical subjects
Publications and source records attributed to J Hureau.
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Two characteristics of the ultrasonic image, that it is rebuilt and non figurative in its details, led us to establish specific relationships between anatomic structures and their ultrasonic images. The anatomic study was made on fresh, injected, frozen, livers, sectioned along the classical echographic planes. The echographic study was conducted in healthy patients, without any hepatic lesions. The results fall under three heads: analysis of the basic structures (portal vein, hepatic vein, and bile ducts) enables to establish perfect relationship between the anatomic and echographic features; the echo-anatomic study of the echographic planes pertaining to percutaneous examination of the liver provides a satisfactory correlation between the anatomy and the ultrasonogram; analysis of the hepatic vascular arrangement enables to define a sectorial systematization of liver structure. Segmental systematization of the right side of the liver is more difficult to define because of the virtual limits of the upper and lower segments of the right paramedian and lateral sectors. This study leads to better echographic understanding of the liver and to a tentative systematization essential to the localization of focal hepatic lesions.
The authors describe in detail the position of greatest stability of the shoulder joint. They review the mechanical importance of this position in the overall physiology of the shoulder-girdle and stress the essential role of two articular ligaments of the shoulder joint (the coracohumeral and inferior glenohumeral ligaments) in arrival at this reference position. There thus exists a passive control, of ligamentous origin, of movements of the shoulder-girdle. The position is essential if the shoulder is to benefit from the full range of movement and full stability which it needs in every day functioning.
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The caudal lobe of liver is an independent sector astride the right and left liver regions. It is formed of two parts, right and left, distinguished exteriorly by the caudal and papillary processes, and can now be explored (ultrasound and CT imaging) allowing its surgical removal (tumoral lesion of the superior biliary confluent).
The present work studies the atrioventricular (AV) junctional area in 15 hearts of P. cynocephalus perfused with phosphate-buffered formal 10%; 12 hearts were studied by gross anatomy and mesoscopic dissection, 3 hearts were serial sectioned in frontal plane (10 micron) and stained by trichromic method. The results show that the junctional AV area in P. cynocephalus is approximately similar to the same region in M. fascicularis and also in the human heart (Mandarim-de-Lacerda et Penteado in press, Mandarim-de-Lacerda et Hureau in press). It was impossible to dissect the AV node and AV bundle while the left bundle branch was easily identified as a calibrous fan-like fashion on the left side of the interventricular septum. The right bundle branch left the AV bundle and penetrated the myocardium of the trabecula septo-marginalis (moderator band).
The arterial blood supply to the sino-atrial (S-A) and atrio-ventricular (A-V) nodes was studied in 63 baboon hearts (Papio cynocephalus and Papio hamadryas). The arterial coronary injection was made with latex neoprene (23 hearts), a latex and lead oxide mixture (30 hearts) and polyester resin (10 hearts) for dissection, radiographic and corrosion cast studies, respectively. The S-A artery is a long recurrent left coronary branch (92.1%) or an ascendant less long right coronary branch (7.9%). The A-V arteries were 2 or 3 small branches of the interventricular posterior artery originating from the right or the left with the same frequency as in man. The percent distribution of the other coronary branches was similar to that observed in man.
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The authors studied the structure and disposition of the tissue components of the tunicae of the superior cerebral veins at the levels of the subdural space and of the superior sagittal sinus. It was observed that, at the level of the transition vein-sinus, the tunica adventitia is formed by numerous and voluminous fascicles of collagenic fibers and thin elastic fibers, which describe system spirals more opened distant to the superior sagittal sinus. The tunica intima of these vascular segments exhibits an endothelium resting on a network of elastic fibers, which may play the role of an internal elastic lamina. From the lateral, superior and inferior walls of the sinus, there originates a connective system whose fascicles of collagenic and elastic fibers incorporated to the vascular walls after describing a stretch in spiral around the vascular lumen. The authors admit that this dispositive connective collagenic-elastic, more the presence of the septums fibrous of the venous walls, give to the superior cerebral veins one property of the lengthening and of the shortening of the walls, in order to regulate the blood debit to the sinus. Also, ist was noted that, at the level of the subdural space, vascular walls exhibits a fibrous structure similar to that of the sinus, and are fixed to the interne face of the cranial dura-mater, to the lateral wall of the sinus and to the falx cerebri. These adherences contribute to preserve the integrity of the walls and even of the resistance during the elevation of the venous pression, preventing to the collapsus of these veins.
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The authors describe the anatomical basis of splenorenal anastomosis via the retroperitoneal approach. This technique can be used in cases where the transperitoneal approach is contraindicated.
The authors report an anatomical, morphological and functional study on the diaphragmatic passage of the esophagus. This study allows to conclude that the anatomical structures of the region play an important role in gastroesophageal continence. The idea of "physiological sphincter" must be broadened and take into account the crura of the diaphragm which from a true extrinsic anatomic sphincter. The authors also insist on the dynamic aspect of this region and on the variations of pressure related to the respiratory movements. From a practical standpoint, the conclusions of this study should permit the surgeon to make a dynamic investigation of gastroesophageal reflux and adapt treatment to a more precise physiopathological mechanism.
The use of a floating graft is proposed in order to attempt resolution of surgical problems raised by distal internal carotid artery lesions located high in the neck. Surgical treatment is essential, but vascular suture is impossible below the petrosa and ligature of internal carotid artery is often the only solution. The floating graft, which is fixed proximally only and is allowed to float in the circulation, allows exclusion of the lesion and maintenance of the carotid vascular axis. Preliminary experimental studies in the rat have provided satisfactory results and research should be continued in larger animals prior to possible clinical use.
The authors describe the number, courses, fixations and dispositions of the superior cerebral veins at the levels of the subdural space and of the superior sagittal sinus. It was observed that the superior cerebral veins have different courses to the superior sagittal sinus, and that these vascular walls are fixed to the intern face of the cranial dura-mater and to the lateral wall of the sinus. Frequently, the wall of the posterior vein adheres to the falx cerebri, presenting ascendant trajet to the inferior wall of the sinus. It was noted that the anterior veins open into the superolateral angle of the superior sagittal sinus, forming an acute forwards and right angle with it; the middle veins open near to the inferior angle of the sinus, with which they form an acute forwards or a right angle; the posterior veins enter the inferior angle of the sinus, forming an acute forwards angle with it. The authors confirm the superior cerebral veins draining into the superior sagittal sinus in sense favorable the current of the blood within it.
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One hundred hearts of baboons were studied (P. hamadryas and P. cynocepahlus). The weight and the volume of the hearts were measured by Scherle method (1970). The other measurements were: oblique diameter right "atrium" - apex cordis", right and left free ventricular thickness and the inner aorta diameter. The hearts were also studied by gross dissection and anatomical sections. The morphology of the heart of the baboon proved to be similar to the human heart morphology. Probably it is a good model to the cardiovascular research and may be surgical applications.