The recurrent laryngeal nerve (RLN): application to transhiatal oesophagectomy.

To emphasize the risks of recurrent laryngeal nerve lesions during transhiatal oesophagectomy an anatomical study of the course of the recurrent laryngeal nerve (RLN) was performed. Twenty RLN were dissected in their thoracic portion. This work showed the constancy of the low origin of the nerve in the adult under the aortic arch, and its course in the tracheal angle. It confirmed the close connections of the nerve with the posterior mediastinal viscera. Lastly, it displayed oesophageal nerve branches arising from the RLN and a few anastomoses between them and the tracheal nerve branches. This anatomical disposition resulted into the difficulty of transhiatal oesophaphagectomies and the risk of injury of the recurrent laryngeal nerve. The possibility of nerve lesions can explain the respiratory complications of this surgical approach.

Anatomic and MRI study of the subtalar ligamentous support.

The diagnosis of subtalar instability remains difficult both clinically and radiographically. The authors present an anatomic and MRI study of the subtalar ligamentous support. The anatomic study has consisted in dissections and sections of cryoconserved hindfeet (15 cases) which precises the organisation of ligamentous bundles in the lateral (sinus tarsi) and central (canalis tarsi) subtalar compartments, mainly represented by the trilayered inferior extensor retinaculum, the cervical talo-calcaneal ligament and the interosseous talo-calcaneal ligament. MRI study (1.5 tesla) of anatomic specimens was performed according to defined types of sections: sagittal, coronal, coronal oblique, axial transverse. The correlations of anatomic and MRI sections allowed a precise interpretation of the subtalar ligamentous support as anatomically described. A complementary clinical MRI study was performed which allowed the validation of "the inversion test": this test optimizes the visualization of the different ligamentous structures. Relative to the difficulties of conventional imaging procedures, MRI appears of clinical relevance in the diagnosis of subtalar instabilities. This technique allows direct visualization of ligaments (or their rupture) and therefore a better evaluation of subtalar involvement in ankle sprain. This paper present a functional concept in MRI articular ligamentous restraints concern.

[The lateral retromalleolar groove: a radio-anatomic study]. / La gouttière rétromalléolaire latérale: étude radio-anatomique.

The anatomy of the malleolar peroneal groove is presented. The results are based on a coupled osteological and CTscan study of 20 samples of fibulae. The average distal fibular torsion was 64 degrees. The peroneal groove was oriented posteriorly (mean value: 78 degrees). Three types of morphological variations were found: concave, flat, convex (the convex shaped groove was the most frequent one: 70%). The average width of the groove was 9 mm. These morphometric results were compared to "clinical" ones performed on patients with a peroneal tendons dislocation syndrome: CTscan study showed an osseous dysplasia concerning the groove depth (flat or convex) and/or a torsional insufficiency. Hypothesis of a bone dysplasia in peroneal dislocation syndrome is discussed.

The sacroiliac joint: anatomical study in the coronal plane and MR correlation.

The current clinical imaging technique applied to the sacroiliac joint (SIJ) is coronal Computed Tomography (CT). The aims of this study were: 1) to section the cartilage, the ligaments of the SIJ, and their relations to adjacent organs, in a coronal plane; 2) to correlate anatomical and magnetic resonance (MR) sections; 3) to extend these data in vivo. A topographic dissection of a 52 year-old female specimen was performed to identify the various components, and spatial relationships of the SIJ. Another fresh frozen 50 year-old female cadaver was chosen on CT criteria of normality, and examined with a high resolution (HR) T1-weighted spin echo sequence, in a plane parallel to the ventral limit of the first two sacral vertebrae. This cadaver was then sliced with a sliding gauge device (slice thickness: 5 mm, and device thickness: 1 mm). The SIJ of a 28 year-old nulliparous volunteer, were examined in HR MR imaging, and with a faster sequence, for comparison with the post mortem data. The slice study was correlated with conventional dissection. The continuity and thickness of the auricular cartilage, the complex fascicles of proximal ventral and dorsal sacroiliac ligaments, and distant sacrotuberous and sacrospinous ligaments, were studied. In each plane, coronal HR MR imaging studies were correlated with anatomical sections. The clinical relevance of this comparison was to extend these data in vivo. The auricular cartilage and the ligaments of the SIJ are clearly analyzed by MR imaging, which could contribute to the study of sacroiliitis.

[Study of morphometric and anatomo-densitometric correlations of the normal pancreas. Apropos of 28 cases]. / Etude des corrélations morphométriques anatomo-scanographiques du pancréas normal. A propos de vingt-huit cas.

The authors report morphometric mensurations from axial features on CT scan of twenty eight cases of normal pancreas. A review of the literature corroborates the value of anatomic correlations of computerized axial tomography in the morphometric study of the pancreas.

Anatomic basis of tracheobronchial reconstruction by intercostal flap.

A feasibility study was carried out to standardise the use of the intercostal muscle flap (ICF) for reconstruction of the posterior wall of the trachea and bronchi. The program consisted of two stages. Morphologically, in anatomic specimens, intercostal muscle flaps were dissected that could be used whatever the morphotype of the subject. Ten human cadavers were dissected after a right thoracotomy in the 6th right intercostal space, providing flaps 12 to 18 cm long and 1.5 to 3 cm wide. Experimentally, studies were made on 7 dogs of the functional and anatomopathologic aspects of the reconstruction at the 20th postoperative day. The results showed impermeability and rapid healing at endoscopy on the 10th postoperative day in every case as well as regeneration of ciliated epithelium in 6 of the 7 cases. The ICF may therefore be considered for losses of tracheobronchial substance, whether accidental, spontaneous (fistulae) or deliberate (surgery for malignant or benign lesions).

Ultrasonographic anatomy of the liver.

Two characteristics of the ultrasonic image, that it is rebuilt and non figurative in its details, led us to establish specific relationships between anatomic structures and their ultrasonic images. The anatomic study was made on fresh, injected, frozen, livers, sectioned along the classical echographic planes. The echographic study was conducted in healthy patients, without any hepatic lesions. The results fall under three heads: analysis of the basic structures (portal vein, hepatic vein, and bile ducts) enables to establish perfect relationship between the anatomic and echographic features; the echo-anatomic study of the echographic planes pertaining to percutaneous examination of the liver provides a satisfactory correlation between the anatomy and the ultrasonogram; analysis of the hepatic vascular arrangement enables to define a sectorial systematization of liver structure. Segmental systematization of the right side of the liver is more difficult to define because of the virtual limits of the upper and lower segments of the right paramedian and lateral sectors. This study leads to better echographic understanding of the liver and to a tentative systematization essential to the localization of focal hepatic lesions.

Study of the experimental biomechanics of tendon repair with immediate active mobilization.

The authors present a biomechanical study of tendon behavior after primary suturing and early active mobilization. In this animal study (23 specimens), three types of sutures are compared using 2 biomechanical parameters: the load at rupture (R), and Young's modulus of elasticity (E). The authors show that early mobilization does not compromise the final strength of a tendon. Moreover, early mobilization confers the biomechanical characteristics of resistance and elasticity more closely akin to those of the normal tendon. Pathoanatomical examinations confirm the fibroelastic reaction of cicatrization and the mechanical role of mobilization in the orientation of newly formed tendon fibers.

Anatomical basis of the microsurgical approach to the pineal gland.

The microanatomic study of the pineal region was made from 18 cadaver brains. The purpose of this paper is to describe the surgical anatomy needed to approach this area, which is deeply located and in the midline, by analysing the different methods of approach.

The muscles of the abdominal wall: a new functional approach with anatomoclinical deductions.

The basic functional anatomy of muscle can be investigated by histochemical analysis of the muscle fibers and kinesiologic electromyography. The results of these techniques lead to anatomoclinical deductions based on the structure of muscle. Histochemical analysis of the striated fibers of a given muscle shows the existence of three functionally different populations of fibers. The relative abundance of each category of muscle fibers (expressed as a percentage) demonstrates the basic function of the muscle. The investigation of muscle function by kinesiologic electromyography shows that there are three categories of motor activity in the course of movement. These different types of motor activity are dependent upon the muscle fibers which display different physiological features, especially with respect to their contraction time. These two investigative techniques, the overall results of which are concordant, were applied to the study of the function of the muscles of the abdominal wall and led to the following anatomo-clinical deduction: tonico-postural motor activity is predominant in the rectus abdominis and flat abdominal muscles. Kinesiologic electromyography also allowed to demonstrate the functional development of these muscles according to the age, sex, corpulence and physical activity of the subjects studied.

[Cancer of the lower oesophagus. One-stage subtotal oesophagectomy without thoracotomy and retrosternal gastroplasty (author's transl)]. / Cancer du bas oesophage. Oesophagectomie sub-totale sans thoracotomie et gastroplastie rétrosternale en un temps.

In the operation proposed the tumour is approached by the abdominal route after incision of the diaphragm. It is dissected and the overlying healthy oesophagus is stripped. Continuity of the digestive tract is re-established by tubular gastroplasty in which the stomach is brought up to the neck through a retrosternal tunnel. The operation is indicated for tumours of the lower and middle oesophagus.

[Double spontaneous viscero-renal fistula. A report of one case (author's transl)]. / Double fistule réno-digestive spontanée. A propos d'une observation.

The authors report one case of double spontaneous viscerorenal fistula on the right kidney. After consultation of the world literature, they expose the main character of this lesion. They insist on the transparietal pyelography in the diagnosis and on the surgical treatment.

[The primary neoplasm of the gall-bladder. Report of 55 cases (author's transl)]. / Le cancer primitif de la vésicule biliaire. A propos de 55 observations.

The authors report 55 cases of primary neoplasms of the bladder which represent 5,2 per cent of cholecystectomies, their study prove its very important deadly character. They insist on the necessity of the immediatly systematic examination. This examination permit a knowledge of the in situ stades and permit to make adapted surgical treatment. This treatment may be a cholecystectomy if it's a in situ type adenocarcinoma but it must be an enlarged cholecystectomy in all the other cases.