Search PubMed⌕ Search

Biomedical subjects

J M Chevallier

Publications and source records attributed to J M Chevallier.

At least 19 recordsLinked to original sources
PubMed1992

Anatomic and radiologic bases of surgery of the thoracic aorta.

Lesions of the thoracic aorta create problems related to their site and relations with the main aortic branches. The aim of surgery must be to treat the lesion while ensuring perfusion of the tissues excluded by clamping during the operation. Anatomic study of the aortic lesions is based on imaging. Angiography is still often the basic examination though it shows only the lumen and course of the aorta. However, CT and MRI visualise the aortic wall and especially the relations of the aorta to the mediastinal structures. A comparison of anatomic and imaging studies was made on 10 fresh subjects coming from the anatomy department of the Saints-Pères and from the school of surgery of Fer à Moulin. Sections were made every 3 to 5 mm in 3 planes (sagittal, coronal and axial) after CT localisation of the plane of section. This anatomic study was correlated with CT and MR images made on healthy volunteers. The choice of surgical management of a lesion of the thoracic aorta is based on preoperative anatomic assessment by imaging applied not only to the aorta but also to its branches and the territory supplied.

Aorta, Thoracic↗
PubMed1992

[Is facial nerve visible on magnetic resonance imaging?].

The internal architecture of the parotid gland was studied by nuclear magnetic resonance (NMR) imaging, particular attention being paid to the intra-parotid portion of the facial nerve. Currently available apparatuses provide high resolution images of previously poorly elucidated anatomic details. Certain authors consider that images in the axial plane in T1 allow direct visualization of the facial nerve and its branches in the form of low frequency linear signals within the gland. The present study, based on radio-anatomic correlations and date determined in a healthy volunteer, demonstrated that these structures correspond in fact to segments of the excretory canal tree, the facial nerve and its branches being invisible on NMR imaging. It is not possible, therefore, to determine the location of a parotid tumor in relation to these nerve elements using this imaging technique.

Facial Nerve↗
PubMed1992

[Pancreas divisum, chronic pancreatitis and diabetes mellitus. Improvement by pancreaticojejunostomy].

The relationship between pancreas divisum and chronic pancreatitis is controversial. We report the cases of two patients aged 40 and 53 years suffering from recurrent pancreatitis and known to have histologically proven idiopathic chronic pancreatitis. One patient had insulin dependent diabetes. Pancreatography demonstrated in these two cases a pancreas divisum with a dilated dorsal pancreatic duct. A pancreatico-jejunostomy was performed, associated in one case with splenopancreatectomy for pseudo-cyst. With a follow-up of 32 and 78 months, both patients were free of symptoms and the diabetic patient had normal blood glucose levels with diet alone. The clinical history of the patients suggests a relationship between pancreas divisum and chronic pancreatitis and that pancreatico-jejunostomy may improve pancreatic pain and pancreatic function.

Adult↗
PubMed1991

Hepatic trauma: experience with 135 consecutive liver injuries (1982-1989) and arguments for conservative surgery.

Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Anatomic bases for liver transplantation.

This study gathers the anatomic implications for a good liver transplantation. During hepatic removal a left hepatic a.exists in 20% of cases; a right hepatic artery originating from the superior mesenteric a. (SMA) can be the only arterial supply in 9% of cases; the whole lesser omentum has to be removed and the SMA from 6 cm to its origin. The SMA must be freed from the celiac ganglia and its ostium removed with the celiac trunk in an aortic patch cut on the anterior side in order to avoid the renal ostia. During total hepatectomy, dissection of the portal triad is often difficult because of portal hypertension dilating accessory portal veins (parabiliary arcade) and pedicular lymphatics. Nerve plexuses are thick in front of the hepatic artery or behind the portal triad. Transection of triangular ligaments leads to the retrohepatic inferior vena cava (IVC) that must be freed from its posterior tributaries (right suprarenal vein and inferior phrenic veins flowing either into the IVC or into the hepatic veins). One big problem during hepatic replacement is the biliary anastomosis which must be well irrigated. In the recipient, dissection up to the hilum preserves hepatic and pancreatico-duodenal pedicles. The biliary tract of the graft must be cut low, behind the pancreas, and several centimeters of the gastroduodenal artery must be preserved to save hepatic and gastroduodenal pedicles.

Hepatectomy↗
PubMed1991

The thoracic esophagus: sectional anatomy and radiosurgical applications.

The relationships of a tumor of the thoracic esophagus to the adjacent mediastinal structures are currently studied by means of computed tomography (CT), magnetic resonance imaging (MRI) and, more recently, by echoendoscopy. However, the assessment of axial mediastinal CT and of MRI in the coronal and sagittal planes calls for some degree of experience. To further this training a sectional anatomy is proposed in correlation with imaging of the thoracic esophagus and the posterior mediastinum. Ten fresh subjects whose vascular networks had been previously injected with colored resin were sectioned along the three planes of space after positioning under CT monitoring. The axial sections were compared with the CT images made with a GE 9800 Quick scanner. Three frontal and sagittal sections were compared with the MRI images made with a GE Signa apparatus using a high magnetic field. The relations of the esophagus were studied at three levels: the supra-azygo-aortic segment, where it is related to the left subclavian artery; the inter-azygo-aortic segment, where access to the esophagus is barred on the left by the aortic arch and on the right by the arch of the azygos vein, section of which provides ample access; and the sub-azygo-aortic segment, where the esophagus passes behind the left main bronchus and to the right of the descending aorta, two organs whose invasion contraindicates excision of a tumor of the esophagus but is difficult to assess by current thoracic imaging techniques. The esophagus then descends behind the left atrium; the investigation of the kinetics of the heart cavities by transesophageal echocardiography is an application of this anatomic relationship.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophagus↗