Biomedical subjects
Publications and source records attributed to R Sarrazin.
One case of electropharmaceutical anaesthesia for transcervical thymectomy in myasthenia gravis is reported. Easiness of procedure, slightness of pharmaceutical intoxication, quality of awakening, simplicity of postoperative course, illustrate the interest of trying this kind of anaesthesia, whenever tonic awakening is required.
Mediastinoscopy allows mediastinal examination through a cervical pathway. 17 mediastinoscopies were performed on 15 children with lymphomas (5 Hodgkin disease, 10 non Hodgkin malignant lymphomas). The diagnosis was assessed by mediastinoscopy on 10 patients which had only an abnormal mediastinal opacity and were free from extrathoracic localisation. This endoscopy was done on 5 children associated with a staging laparotomy to establish a prognosis and to investigate the spread of the disease before or during treatment. Diagnosis was obtained in 14 of the 15 patients. No surgical complications was observed. However, emergency care was necessary after two anaesthesical accidents in 2 children with malignant lymphomas. Mediastinoscopy is unfrequently required in children. Although in non surgical disease such as lymphomas, it may avoid an unnecessary thoracotomy and be repeated without damage.
A new case of asymptomatic thymolipoma in a 4.5 years old girl is reported. It was discovered during systematic medical investigation. Its radiological characteristics and the lack of evolutivity made the authors suspect the diagnosis before operating. A total surgical extraction of the 300 g weighing tumor was performed through a right thoracotomy. No complication occurred in the post-operative time. Others authors already indicated the scarcity of this affection (less than 10 cases in children) as well as the special radiological characteristics of this tumor and the noticeable clinical tolerance often despite a large bulk. Histologically the tumor is made of an infiltrating of the normal thymic tissue by proliferating adipose adulte cells, the benignity of which is demonstrated by the evolution. In this study a differential diagnosis between thymolipoma and other mediastinal tumors is made and also some pathogenic assessments. Surgery always is required for treatment.
The authors became interested in the lymphatic drainage of the stomach in order to attempt to determine for each region the type of drainage and the risk of cancer spread. They studied 132 dissections including 97 injections, 210 cases records of gastric carcinoma, 8 lymphographies by ultrafluid Lipiodol and 17 peroperative injections of vital staining. The system of drainage proposed by Rouvière was on the whole confirmed; however, one should emphasise the doubling of the hepatic chain, the existence of long collectors which bypass a relay in the left gastric artery, the importance of the posterior gastric artery which transmits the lymphatics of the splenic chain. Finally, the authors emphasise the existence of 3 longitudinal areas on the stomach where the presence or agsence of valvules in the subserous collectors orients the lymph towards the lesser or greater curvature of the stomach, which easily explains the onset of isolated carcinomatous adenopathy, situated on the curvature opposite the neoplasm.
The authors relate their experience on the investigation of the visceral lymphatic vessels. Their experience concerns the lung, the pancreas and essentially the stomach. This work has been carried out as well on the corpse using the technique of Papamiltiades as on the living. On the corps, only descriptive and topographic results may be taken into account; actually, to consider drainage in such a case seems to be a misinterpretation considering absence of lymphatic circulation and the importance of technique on the results. Only confrontation with results in vivo allows an interpretation.
This technique enables the exploration of the mediastinum by the cervical way, but remains an unfrequent examination in children. Among almost 1000 mediastinoscopies made by the authors, the indication concerned only 20 children aged less than 17. Made in a prognostical purpose in most of the cases (16 patients) it gave the diagnosis 14 times. In four cases the mediastinoscopy was carried out as a prognosis during a pre-therapeutics of some hematosarcomas. This method requires a general anaesthesia with intubation, but doesn't differ much from the technic for adults. Besides the supra-sternal way leading to the axial mediastinum (Carlens's technic) other ways are used, particularly the anterior mediastinoscopy--exploring the thymic lodge--and the antero-lateral way through an intercostal space. The mediastinoscope enable the visual control of the lesions, completed with biopsies of the tissues for an histological examination and puncture with a needle for the cytology study. The diagnosis was made in 90% of the cases, sometimes after repeat mediastinoscopy. The failures are due most often to an incertitude in the interpretation of the samples than a badly directed biopsy. There was no surgical incident in our serie. The general morbidity of the examination is 1,5% and the mortality is 0,1% according to the authors. But two anesthetic incidents were observed in children with malignant lymphomas and required the use of reanimation technics. The mediastinoscopy is useful in the tumors of the thymus (10 times), the tumors of the lateral mediastinum (8 times) an hematosarcomas or Hodgkin's disease.
The authors describe a new observation of a congenital aerobiliar fistula in a newborn infant showing choleptysies associated with a pulmonary obstruction. The most remarkable facts are the presence of a radiological pneumogallbladder, and the existence of a real trifurcation of the trachea on the bronchography, associated with a choledocal hypoplasia. The death having occured before the operation, the autopsy allowed the confirmation of the termination on the left hepatical duct and the duality of conformation of the fistula, respiratory and biliary. On the occurence of this 9th case, a review of the literature shows the stereotyped nature of the clinical signs and the course of the fistula which seems invariable. The different aspects of the malformation are considered as well as the treatment which necessitates an exeresis by thoracic pathway.
The central nucleus of the perineum. Having carefully studied the anatomy of the central nucleus of the perineum on 27 male pelvises, the authors discuss the fibromuscular nature of this structure which extends from the peritoneal cul-de-sac to the perineal fascia, between urogenital pathways in front and digestive pathways in back. The connections to all the pelvic-perineal organs are discussed. The middle perineal adoneurosis. A personal conception. The study of twenty seven male perineums has permitted the authors to formulate a personal conception of the anatomy of the middle perineal aponeurosis. It is made up of adjoining structures organized in front and in back of the urethrae; above all it includes a smooth fibromuscular part in back of this canal, whereas in front, it behaves as a vessel-carrying sheath, where the dorsal pack of the penis and the Santorini plexus pass.
Anatomo-radiological study of the thorax based on 110 lateral chest radiographs and 11 necropsies of normal adults. The authors show the interest of this lateral projection which has been too long considered as a simple contribution to the anterior-posterior projection. This incidence exhibits many anatomical details, which could not be seen on any other standard incidence.
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The authors describe a group of 9 resection anastomoses with end-to-end sutures of the cervical portion of the trachea after resuscitation. The operative results are analyzed first: in 8 cases the trachea recovered almost normal function in a very short time; one failure occurred : this was with a patient with considerable neuro-psychic sequelae following serious cranial traumatism. These results are then compared with 7 laryngo-tracheal plasties carried out according to the principles of Rethi's operation; it emerges from this study that circumferential resection followed by end-to-end anastomosis is still the ideal form of treatment for tracheal stenoses in view of the quality and consistency of the results. Operative technique is then described and, in giving their operative indication, the authors stress the need for medical and endoscopic treatment during the asphyxial crisis; this treatment is then suggested for removing the tube in open tracheal stenoses and in order to allow resection anastomosis with the trachea closed several weeks later.
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