[Plication of the common femoral artery, a differential diagnosis with endofibrosis of the external iliac artery in racing cyclists].
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Biomedical subjects
Publications and source records attributed to J Pillet.
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The study of 44 patients treated with intra-arterial fibrinolysis is reported. All these patients had an impending subacute ischemia of the lower limbs, a major complication of atheromatous disease. The criteria for patient selection were clinical, hemodynamic and radiological. The procedure of the treatment associating Urokinase, Heparin and Naphthidrofluril are defined, as well as its follow-up. The results have been evaluated according to the clinical and radiological improvement. 2 patients died when the treatment ceased and 10 were amputated, ie 27% of failures. The fibrinolytic treatment allowed identifying the patients who might quickly receive an additional treatment. In our experience, this treatment seems to improve the prognosis of impending subacute ischemia.
The study of numerous dissections, sections and X-rays of the lumbar spine has enabled us to clarify the connections of the lumbar spinal nerves at their emergence from the intervertebral foramen and in the lateral vertebral groove. This work naturally leads to the study of the extra foraminal herniated disc by an extra isthmian approach or to percutaneous surgery of thoracolumbar discs.
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The psoas major m. has a complex arterial supply, derived from the lumbar, iliolumbar, obturator, external iliac and common femoral a. The branches arising from the external iliac a., though quite often multiple and slender, are represented in 75% of cases by a single large-caliber vessel. This principal artery of the psoas m. is probably responsible for the curves of the external iliac a. in the aged and also in certain competitive athletes.
Carotid-anterior cerebral artery anastomosis constitutes an anomaly of the anterior part of the arterial circle of the brain. The anterior cerebral a. arises a few millimeters above the emergence of the internal carotid from the cavernous sinus, at the usual level of origin of the ophthalmic a. It travels medially, beneath the optic n., and then describes a curve with a superolateral concavity to arrive at the anterior part of the optic chiasma, where it anastomoses with the anterior communicating a. This asymptomatic variant of course is often associated with other cerebral vascular anomalies, especially arterial aneurysms. On the basis of 2 new cases discovered by chance, together with a review of the literature, various hypotheses capable of explaining the embryologic origin of these anomalies are discussed.
UNLABELLED: A controlled trial of Ginkgo biloba extract in injectable form (Tanakan 50 mg, a lyophilizate for parenteral use) was carried out versus a placebo as a preoperative medical treatment of stage III (Fontaine classification) chronic occlusive arterial disease of the lower limbs (with pain in decubitus). The 64 men and women patients in this multicenter study (32 in each group) were over 18 years of age and had a cultural and intellectual level as well as a physical condition allowing them to play an active role in the experiment (self-evaluation of pain). During 8 days they received two daily infusions of 500 cc of normal saline solution containing either 100 mg of Ginkgo biloba extract or a placebo of identical appearance. During this period, anticoagulants were authorized; hemodilution, vasoactive drugs and platelet anti-aggregates were forbidden; pentazocine (Fortal, 50-mg tablets) was allowed at the patient's request. Pain was rated according to a visual scale, with each patient marking a point between two extremes ("maximum imaginable pain" and "total absence of pain") 100 mm apart. A questionnaire based on that of Melzack (McGill Pain Questionnaire) completed this qualitative as well as quantitative self-evaluation of pain. The results of these questionnaires were assessed on the basis of 4 scores, each determined by the patient's choice among 3 evaluation figures. The chi square, Student and Wilcoxon tests were used for statistical analysis. RESULTS: The two randomly-composed groups with Ginkgo biloba extract and a placebo were comparable (Table I). Analysis was based on 55 observations (26 in the extract group and 29 in the placebo group).(ABSTRACT TRUNCATED AT 250 WORDS)
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.
To facilitate the interpretation of the scanographic findings in fractures of the calcaneus, the authors have achieved an anatomo-radiologic correlation in terms of the classical coronal, sagittal and horizontal planes. Clinically, the sagittal plane can be obtained only by reconstruction. The 2 other planes permit study of the sustentaculum tali and posterior talar surface only in different sections, without their respective relationships. The authors therefore suggest a new double-oblique view, practicable in the injured patient, with a forward tilt of 20 degrees and medial rotation of 35 degrees, perpendicular to the sinus tarsi. This serves for anatomo-radiologic correlation and shows both anatomic structures together. By itself, it provides as much information as the three classical views and appears adequate for the assessment of fractures.
Ischemia occurring during hyperextension of the upper limb in a 25-year-old woman led to the discovery of a supracondylar spur responsible for compression of the brachial artery with anomalous insertion of the pronator teres muscle. Resection of all abnormal structures provided immediate relief of symptoms. When atypical arterial symptoms of thoracic outlet syndrome occur in the upper limb, the brachial artery entrapment syndrome should be considered.
Over the last two years, 15 patients have undergone revascularization surgery to a total of 17 distal extremities at the level of or distal to the last phalangeal joint. Operations were performed by three surgeons trained in microsurgical techniques, making the series a homogeneous one. Results were analyzed using Tamai and Nakamura's scores. Determinant factors, social and economic costs and effects on occupation are emphasized. The mean success rate of 65% is influenced by the total or partial nature of the section, its localization to the thumb or long fingers and the mechanism of section. The good functional results obtained were due to distal forms of amputation, recognized despite the technical difficulties as being an indication of choice for this reimplantation surgery. All patients in this group were able to return to work, with or without adaptation, within a variable lapse of time.
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Since December 1985, we have operated upon seven bicycle racers for endofibrosis of the external iliac artery. In all instances, the athletes had started cycling early in life and were engaged in top level competition by the age of 17. The principal complaint was intermittent claudication of one lower limb at "near-maximal" exercise. Pain could be reproduced by exertional tests on an ergometric bicycle, and in all cases except one, measurement of ankle systolic pressure of that limb compared with the opposite side and brachial pressures showed a marked decrease on the involved side. Arteriography, performed with multiple views and positions, documented a 5 to 6 cm moderately stenotic (less than 40% diameter) segment, associated with arterial lengthening. Surgical treatment consisted of endarterectomy and shortening of the artery. Four patients were able to return to competition. The origin of this pathology is discussed, based on gross and histologic findings. Under certain predisposing anatomic conditions, abnormal hemodynamics, probably due to a high flow arterial state and an aerodynamic position on the bicycle, provoke repeated trauma which eventually produces the lesion. Practically unrecognized until now with only two previous publications on the subject in the literature, this entity is probably not uncommon.
The extrinsic arterial supply to the great saphenous vein was studied by dissection following latex injection, diaphanisation and contrast roentgenograms. Arterial supply arises from the external pudendal, superficial femoral, superior genicular and posterior tibial arteries. These branches ensure the irrigation of the vasa vasorum. The role they play in the outcome of bypass with the great saphenous vein is a further argument pleading in favor of the in situ technique.
The isolated azygos continuation of the inferior vena cave is a very rare variation of this organ. It is accompanied by the absence of the retrohepatic segment of the vena cava with two new observations, the literature is revised and the origin discussed.
An anatomic study was conducted on 100 specimens. Investigation of vascularization involved various techniques to avoid pitfalls inherent in each method. Injections, radiographs, microdissection, corrosion and transillumination allowed establishment of groups to describe variations in palmar, dorsal, pulpal and ungual artery distribution. Vasculo-neural relations are described and practical applications envisaged as a function of vascular anatomy.