Biomedical subjects
Publications and source records attributed to J Pillet.
Femoro-popliteal bypass is difficult to perform when the posterior tibial artery originates at a high level in the lower limb. The problems arising from this anatomical variation, in which the tibio-peroneal trunk is, at least classically, anterior to the popliteal muscle, can be overcome by the technique described.
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A comparative study was conducted on three micrografts of 2 mm diameter: a frozen umbilical artery, a bovine heterograft and an inert P.T.F.E. material graft. These were implanted in the infrarenal aorta of 158 Wistar rats. Each graft was examined on eight occasions: after 4, 24 and 48 hours, one and two weeks, and 1, 2 and 6 months. Excluding 46 animals that died within 24 hours, the overall permeability rate for all grafts was 87.7% (88.9% for umbilical arteries, 82.8% for bovine heterografts and 85.4% for P.T.F.E.). All grafts were examined by optical and electron microscopy. The inert material showed excellent parietal stability. In contrast, alteration and resorption of the primary matrix were moderate in extent for bovine heterografts, and major for frozen umbilical arteries which appear to be a very unstable grafts.
A rarely reported method for revascularization of lower limbs is the use of descending thoracic aorta and a prosthesis passing through the subpleural and subperitoneal tissues. It is nevertheless a valuable procedure in patients in good general condition in whom there is a local contraindication to the abdominal approach. It appears to be more reliable in the long term than a conventional axillofemoral shunt.
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Pancreatography using fibroscopy is current practice in medicine and contributes to the diagnosis of diseases of the pancreas. The radiographic images obtained generally represent oblique projections which have little in common with classic anatomical diagrams. An analysis of 60 pancreatographic investigations considered normal (out of a series of 400 investigations made on various diseases of the pancreas) has been followed by a comparison between these radiographic results obtained in vivo with diverse anatomical classifications in current use. The conclusion is reached that pancreatography is morphologically reliable and that there is no correlation between the mode of ramification of the ducts and pathological conditions (with the exception of the pancreas divisum and the annular pancreas).
A rare case of thrombosis of the popliteal artery due to an exostosis of upper end of tibia is reported. It is rare for exostoses to develop at the upper metaphysial region of the tibia, rare fore vascular complications to develop and particularly rare for these to consist of thromboses. This lesion is a differential diagnosis in young adults with lower limb ischemia. Follow up of these exostoses should be by Doppler, after dynamic arteriography to serve as a reference. Surgical treatment should be adapted to the degree of functional disability and the course of the exostosis or the complications it provokes.
Crossed shunts between the two femoral axes constitute a useful safeguard in unilateral iliac occlusions when the abdominal approach is contraindicated. Hemodynamic considerations suggest the need for iliac implantation from the donor side. This simple technique does not complicate the operation and provides a more satisfactory result than the interfemoral shunt.
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The arterial vascularisation of the anterior loge of the leg is supply by the anterior tibial artery. Three muscles are contained in an inextensible space. Each of this muscles received an arterial supply proportional to his volume. The fragility to ischemy of the extensor hallucis longus is not explained by insufficiency of this arterial branches.
Despite recent advances in the treatment of vascular injuries, the prognosis of injuries to the popliteal vessels is still poor with an incidence of 10-40 p. 100 of amputations recorded in the literature. Mortality rate is 4 p. 100. The authors have seen 13 cases and have studied seven factors influencing the prognosis - the duration of ischaemia, the general condition of the patient, the type of lesion, the state of the veins, the severity of the ischaemia, the level of the lesion and associated soft tissue injury and wounds. Each of the parameters has been assessed with a grade proportional to its severity. The summation of the grades leads to a division into three degrees of increasing severity and allows an early prognosis to be made. In the most severe degree of the lesion, amputation should be performed immediately. Twenty-one attempts at conservative surgery resulted in success in only four cases, with 17 amputations and four deaths among these.
A series of arteriographies of the internal thoracic arteries was performed by the authors. By superimposing the tracing of 55 thoracic walls thus obtained, the authors were able to observe a preferential pathway. This pathway is located at a rather precise distance of the manubrio-corporeal angle and of the median axis. 22 parasternal chains were dissected. The lymphatic chains appeared closely linked with the arteries. An irradiation field covering all the parasternal nodes was thus precisely defined.
From a theoretical study combined with dissection of twelve joints and the building of a mechanical model, the authors describe the contact zones between capitulum and conoìdal zone of the humerus on one hand, and cupule and radial bevel-edge on the other, and this, during the various phases of pro-supination. In supination, the contact is essentially forward. In pronation, it is mostly backward. In each position, it is approximately the same area of the cupule which is in contact with the capitulum. The best fit is in the functional position. Major displacement occurs with almost flat cupules, displacement is minimal with hollow cupules which correspond to rounder heads.
The construction of an extra-anatomical femoropopliteal shunt resulted in the saving of a lower limb following a gunshot wound to the upper third of the thigh involving vascular lesions and extensive tissue loss. By applying this technique it was possible to obtain revascularization of the limb without the septic risks of reconstruction in situ, with the attendant difficulty of initial skin coverage of the wound.