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Biomedical subjects

J Moscovici

Publications and source records attributed to J Moscovici.

At least 37 records · Page 2Linked to original sources
PubMed1998

Microsurgical anatomy of the internal vertebral venous plexuses.

Few studies have been done about the venous vascularization of the spine since neuroradiologic studies in the 1960s and 70s. The aim of this study was to clarify the topography of the internal vertebral venous plexuses in relation to the posterior longitudinal ligament and the dura. The relationships of the vv. were studied at different levels of the spine. The internal vertebral venous system of seven cadavers was injected with a blue bicomponent silicon rubber. It consisted with an anterior and a posterior venous plexus. At the cervical level, the anterior longitudinal vv. are located in a dehiscence of the periosteal layer, in the lateral part of the spinal canal. At each level, they joined the contralateral one at the midline by a retrocorporeal v. located behind the posterior longitudinal ligament. No vv. were found in the epidural space. There was a major development of the retrocorporeal v. of the axis, but it did not receive any venous drainage from the vertebral body. At the thoracic and lumbar levels, the anterior venous plexuses remain within a dehiscence of the periosteal layer, which is thinner. The retrocorporeal vv. become pre-ligamentous. We did not find any posterior venous plexuses at the cervical level, but they were evident at the thoracic level and became more voluminous and sinusoidal in the lumbar region.

Adult↗
PubMed1998

[MRI study of the arterial ligament and the left pulmonary artery in the preoperative staging of left upper lobe bronchial cancers].

PURPOSE: To demonstrate that the ligamentum arteriosum is visible by precisely-oriented MRI. To demonstrate the predictive value of the ligament involvement for left upper lobe cancer surgery. MATERIAL AND METHODS: Fifteen controls, age-matched with bronchial cancer patients, were studied to establish how the ligamentum arteriosum could best be visualized on MRI. Visibility was optimal on RASE T1-weighted sequences on the frontal and sagittal oblique planes (aorto-pulmonary window). Acquisitions were performed with a body coil, 7 mm slices, 480 mm Fov, on a Magnetom Expert, 1T Siemens machine. Forty five patients with left upper lobe cancer underwent MRI investigation after CT had shown mediastinal proximity of the left pulmonary artery and the tumor. They underwent surgery with manual localization of the ligament at the beginning of the procedure. Findings and operative decisions were compared with those of MRI, establishing its predictive value. MRI defined the tumor-ligament and tumor first centimeters of the left pulmonary artery (LPA) relationships. RESULTS: MRI ligamentum visibility was about 87%. Ligament non-involvement on MRI (n = 23) was confirmed at surgery in all cases (100% concordance). Involvement suggested on MRI was confirmed in 18 cases and surgery was impossible or unsatisfactory. There were four false-positives with successful surgery (8% false positives). CONCLUSION: When CT shows left lobe cancers extending in the mediastinum towards the LPA, precisely-oriented MRI assesses surgical difficulty and resectability by demonstration involvement of the ligamentum and the first two centimeters of the LPA.

Adult↗
PubMed1997

[Urination disorders revealing posterior urethral valve: urodynamic aspects].

Urodynamics include several investigations of the bladder-sphincter complex. Uroflowmetry is easy to perform but interpretation might be hazardous in very young children: in urethral obstruction, it shows a decrease in the maximal flow rate and an increase in the voiding time: such an investigation has no specific value in case of posterior urethral valves since it can be even normal in case of obstruction. Nevertheless, uroflowmetry is of great interest with respect to postoperative follow-up. Other investigations of the bladder and of the urethra are more aggressive and not so helpful in diagnosing obstruction: they might be helpful in understanding and managing persistent voiding disorders after posterior urethral valves section.

Child↗
PubMed1997

[Utilization of thermosettable compounds in anatomic research].

The authors described a method of vascular injection with a coloured silicon rubber. The injected material was a biocomponent silicon elastomer, with ambiant temperature room vulcanizing. It was supple, easily dissequable and diffuse well into all small caliber vessels. The soft pressure injection did not cause neither material collection by vessels rupture nor anatomic structure distortion. This material could constitute an excellent alternative to coloured latex injection.

Anatomy↗
PubMed1996

Abdominal cystic lymphangioma in children: benign lesions that can have a proliferative course.

Twenty-one pediatric cases of abdominal cystic lymphangioma (CL) treated in the past 20 years are reviewed. To date, this is the largest reported series. CL is a rare congenital malformation that presents either with chronic abdominal distension (and is detected by palpation of a cystic mass) or acutely with bowel obstruction or signs of peritonitis. It is more common among boys and most often occurs in children under 5 years of age. Abdominal ultrasonography is the procedure of choice for establishing the diagnosis. Acute cases with intracystic hemorrhage are more difficult to diagnose. Computed tomography and celioscopy may be useful. With these techniques, a correct diagnosis should be achieved in nearly every case. Enucleation (when feasible) or segmental intestinal resection (when the cyst is intimate to the bowel) is effective treatment. In a few cases the malformation is diffuse, and extensive bowel resection is necessary, with the risk of short bowel syndrome.

Abdominal Neoplasms↗
PubMed1996

Artificial urinary sphincter implantation for neurogenic bladder: a multi-institutional study in 107 children.

OBJECTIVES: To evaluate the outcome of implantation of the AMS 800 artificial urinary sphincter in children with neurogenic bladder. PATIENTS AND METHODS: The records of 107 children (74 boys and 33 girls) treated for neurogenic urinary incontinence by implantation of the AMS 800 artificial sphincter between 1983 and 1993 were reviewed retrospectively. The underlying cause of incontinence in 92 patients was spina bifida, the mean age at implantation was 13.7 years and 30 patients had undergone previous bladder neck surgery. Implantation was carried out in combination with another surgical procedure in 24.3% of patients. The mean follow-up was 61 months (minimum 12). RESULTS: The mean operational life of the sphincter was 56 months. No deaths occurred but removal of the artificial sphincter was necessary in 20 patients (19%). Surgical revision was not required in 44 patients (41%) but at least one revision was performed in 63 and more than one in 42. There were 21 mechanical failures, 40 surgical complications and 39 cases involving changes in the dynamics of bladder function. Of the 87 children (81%) in whom the device is still in place, 72 are completely continent (83%), 10 are slightly wet, and five are incontinent. The overall success rate was 77%. CONCLUSIONS: The results emphasize that for successful implantation of an artificial urinary sphincter in children, the pre-operative bladder capacity must be sufficient and previous surgery should not have been performed on the bladder neck, the site of choice for implantation in children. Sphincterotomy is not always necessary in paediatric patients. Children and parents should be informed of the high complication rate and the need for long-term follow-up.

Adolescent↗
PubMed1996

[Decisional criteria in the management of vesico-ureteral reflux in children with congenital neurogenic bladder].

OBJECTIVES: To determine, in the particular case of neurogenic bladder, the best criteria for selection and grading of the modalities available for the treatment of vesicoureteric reflux, which is often associated. METHODS: 194 patients with congenital neurogenic bladder, including 76 cases with vesicoureteric reflux were retrospectively reviewed. The various treatments applied, their results and their complications were reviewed. Conclusions are drawn and proposals are made for the optimal management of vesicoureteric reflux in the particular context of congenital neurogenic bladder. RESULTS: This series included 8 grade I, 28 grade II, 49 grade III and 23 grade IV and V. In more than 50% of cases, reflux was detected on during routine assessment of congenital neurogenic bladder, demonstrating the value of this assessment (25% of cases of reflux were detected before the age of one year). Management initially consisted of vesical drainage, often by intermittent catheterization, from the age of 2 to 3 years and antibiotic prophylaxis. This treatment was sufficient to correct reflux in 9 cases and to control it in 16 cases (no urinary tract infection, no deterioration of the upper tract). An elective anti-reflux operation was decided in 69 cases of VUR (1 grade I, 15 grade II, 38 grade III, 16 grade IV or V). Cohen's technique was performed in 3 cases and endoscopic injection of PTFE was performed in 3 cases. Most of these refluxing bladders were hypertonic and/or presented an abnormally high closing pressure. The operative criteria were: symptomatic reflux; persistent reflux; renal deterioration; non-compliance with treatment. Several complications were observed and are described. CONCLUSION: Vesicoureteric reflux in the context of congenital neurogenic bladder plays a major role in the deterioration of renal function. These forms of reflux usually occur in hypertonic bladders. Urodynamic studies appear essential before deciding treatment. Intermittent catheterization is able to control or even correct a certain number of these cases of reflux and should be introduced by the age of 2 or 3 years. When surgery is required, Cohen's operation is the easiest to perform, but is associated with an increased complication rate. Injection of PTFE or macroplastic could constitute a good indication.

Age Factors↗
PubMed1996

[Retro-iliac ureter. Report of a case lumbosacral agenesis].

The authors report a case of retro-iliac ureter associated with a lumbo-sacral agenesis. Retro-iliac ureter seems in relation with abnormal constitution of aortic division and/or ilio-cava confluence when the metanephros migrates. Lumbosacral agenesis is the most severe state of sacral agenesis and is a part of the syndrome of caudal regression. The association of the two malformations have never been described and could be fortuitous. Nevertheless, the vertebral malformation could induce a perturbation in the formation of vascular structures and so an abnormal migration of the metanephros.

Adult↗
PubMed1994

Contribution to the study of the tributaries and the termination of the external jugular vein.

The dissection of 100 external jugular veins in 50 cadavers was the object of this anatomic study. A certain number of notions concerning the afferent veins, the mode of termination and the valvular system of this vessel were defined. 1) Afferent veins. Along its pathway toward the deep venous system, the external jugular vein successively received: the transverse cervical vein in 88 cases (88%), usually opposite the intersection of the external jugular vein with the dorsal border of the sterno- cleidomastoid muscle; the suprascapular vein in 47 cases (47%); the anterior jugular vein in 46 cases (46%); the cervical vein or anastomosis with the latter in 13 cases (13%). 2) Mode of termination. Forty-three subjects presented a symmetric mechanism. 100 anastomoses can be classed into three types: in 60 cases (60%), the external jugular vein flowed into the jugulo-subclavian venous confluence; in 36 cases (36%), in to the subclavian vein at a distance from its junction with the internal jugular vein; in 4 cases (4%) in to the trunk of the internal jugular vein. 3) Study of the valves. There were studied in 25 subjects (50 external jugular veins). The valves were found in the ostial and paraostial position in 49 out of 50 veins.

Humans↗
PubMed1993

Anatomic basis for use of a gracilis muscle flap.

The aim of this study was to specify certain anatomic features of the gracilis m. with a view to the use of muscular or myocutaneous flaps. It was based on dissection of 84 gracilis muscles in 42 subjects as well as selective injection of the main pedicle of 20 muscles. This established the following points: 1) The arterial supply is abundant, consisting of several pedicles reaching the muscle on its deep aspect. The main neurovascular pedicle arises from the deep vessels of the thigh, via either the a. of the adductors (73%), the medial circumflex a. (19.2%) or as a double supply from both arteries (7.7%); 2) The cutaneous vascularisation over the gracilis m., derived from the solitary main pedicle, is inconstant. In 20 injections, it was satisfactory in 11 cases, poor in 5 and absent in 4; 3) The distal tendon of the gracilis m. is closely related to the posterior branch of the saphenous n. to the leg, which it crosses in an elongated X; 4) A simple method of calculation based on the distance between the upper border of the pubis and the medial femoral epicondyle allows quite precise determination of the point of entry of the main pedicle into the gracilis m. 5) Complete dissection of the main pedicle adds to the available length of the muscle flap.

Humans↗
PubMed1993

Increase in testicular temperature in case of cryptorchidism in boys.

Temperature of the undescended testis, measured in its cryptorchid location during surgical procedure for orchidopexy in 46 boys, 13- to 180-months-old, was significantly higher (34.4 +/- 0.9 degrees C) than that of the contralateral normally descended testicle (33.2 +/- 1.2 degrees C; P < 0.001). Temperature significantly declined from the Bogros' space (35.3 +/- 0.5 degrees C) to the inguinal canal (34.7 +/- 0.7 degrees C) and from the latter to the empty scrotal cavity (31.1 +/- 1.8 degrees C). The physiological descent of the testicle is associated with a marked cooling of its thermal environment. When this process is interrupted for any reason, temperature of the cryptorchid testis is significantly increased. This rise in temperature could be either a concomitant or a main factor for the impairement of testicular functions associated with cryptorchidism.

Body Temperature↗
PubMed1993

[Urodynamic studies in children].

Disturbances of micturition and continence in children are frequent and, in certain cases, urodynamic studies provide a major diagnostic contribution to the clinical and radiological assessment. Many investigation techniques are available, ranging from simple uroflowmetry to the most complex urodynamic study recording bladder pressure, urethral pressure and urethral sphincter electromyography. In children, it is essential to record abdominal pressure, to perfuse the bladder slowly and to be present during the examination in order to correctly detect any artefacts. The indication for urodynamic examination and its technique depend on the results of a thorough clinical assessment and useless or invasive examinations must be avoided. Urodynamic studies have an important role in the diagnosis, prognosis and treatment of neurological problems, but have a more variable role in functional disease, the most frequent and most extensively studied and in uropathies responsible for disturbances of micturition or continence.

Child↗
PubMed1992

[Gracilis muscle in man].

This study is based upon the dissection of 84 gracilis muscles in 42 cadavers. It allowed to emphasize the following features: 1-The proximal insertion of the muscle is a strong tendinous lamina arising from the anterior aspect of the pubis and from the ischio-pubic branch; the distal insertion to the tibia is common to both the gracilis and the semi-tendinous muscles. 2-The distal tendon of the gracilis is tightly connected to the posterior branch of the internal saphenous nerve which crosses the muscle behind the medial femoral condyle. 3-The arterial supply (52 dissections) appears to be very rich, consisting in various pedicles entering the muscle by is lateral side. The main neurovascular bundle is issued from the profound vessels of the thigh, coming either from the adductors artery (73%), either from the medial circumflex artery (19.2%), either from both networks (7.7%). The site of penetration of the vessels in the muscle is remarkably constant. The remaining pedicles (2 to 4, one of which is quite constant at the musculotendinous junction) arise from the muscular branches of the femoral artery. 4-There is a good correlation between the measured length of the muscle and the distance between the superior aspect of the pubic arch and the medial epicondyle. A 0.37 corrective factor applied to this latter distance allows to determine the exact sit of penetration of the main neurovascular bundle in the muscle.

Arteries↗
PubMed1990

[Non-palpable testes. Apropos of 161 cases].

A series of 161 boys with 178 impalpable testes is reviewed. Extended inguinal exploration was the main form of investigation and treatment. Hormone injections and studies were performed in bilateral cases. Sonography was unhelpful. Laparoscopy was not used. Impalpables testes account for 7% of all boys with an anomaly of testicular descent and 8.5% of operated boys. One hundred and twenty six testes were found, 58 in the abdomen, 68 in the inguinal canal. Thirty one nodular vestige were found and all 25 with histopathology were spermatic duct residue. In 21 boys no trace of testes or spermatic duct remnant were found. Ninety five testes were successfully brought to the scrotum with one (85) or two (10) stage procedure. Anomalies of the upper urinary tract in 13 of 21 cases without testes or spermatic duct remnant were very rare. In bilateral cases it looks better to search a testes whatever the biological responses to gonadotropin stimulation.

Abdomen↗
PubMed1990

[Management of a biliary cyst disclosed prenatally. Apropos of 2 cases].

Two cases of prenatal detection of congenital biliary cysts are reported. Prenatal and postnatal ultrasonography demonstrate a solitary sonolucent cystic lesion. The differential diagnosis in fetus and infant includes any abdominal cystic lesions: ovarian cyst, duplication cyst, cystic lymphangioma, choledochal cyst and other congenital cysts of the liver. In opposite to the difficulty of diagnosis, the choice for treatment is easy: surgery is the only way to allow histologic diagnosis and to avoid any relapse or complications.

Choledochal Cyst↗
PubMed1990

[Is early excision-graft justified in hand burns in children? Report of 201 cases].

The authors wish to show the difference between hand burns in children and adults. Throughout a group of 201 observations, they confirm the predominance in children of hands burns on palmar face. For them, the directed cicatrization by fat dressing associated with splints set in position of maximum cutaneous stretching is the first therapeutic. The early tangential excision and grafting is suitable only in rare indications, for instance in electric burns.

Adolescent↗