The pectineal ligament: anatomical study and surgical applications.

The aim of this study was to reinforce the importance of the pectineal ligament in laparoscopic surgery for groin hernia and female urinary incontinence, particularly its anatomical importance in the myopectineal region. A morphologic study was conducted on 44 pectineal ligaments from 23 embalmed and one fresh human cadavers, together with a radiological study on four volunteer patients. Anatomical and histological findings confirm the fact that the ligament of Cooper represents a thickening of the pectineal fascia rather than a thickening from the periosteum. The pectineal ligament provides a landmark in each approach, open or laparoscopic, anterior or posterior surgery.

A prospective radiological anatomical study of the variations of the position of the colon in the left pararenal space.

Percutaneous puncture of the kidney allows direct access to the pyelocalicial cavities. The posterior approach of this retroperitoneal organ can be complicated of transcolic punctures due to the postrenal position of the colon. A prospective radiological anatomical study of the relationship between the left kidney and the descending colon was undertaken. One hundred computed tomograms of adult subjects were obtained from which the anatomy of the left perirenal area was determined: the descending colon is more frequently behind the kidney in the young females. Two main factors determinants of this situation are: 1) colon ontogenesis in relation to the attachment of the primitive mesocolon, permitting a 'fixed' left colon, or 'moving' left colon at the end of a long mesocolon, allowing it to pass behind the kidney; 2) a mechanical factor whereby the accumulation of perirenal fat with increasing age may be a limiting factor in lateral displacement of the colon.

[Intra-uterine artificial insemination. Indications, techniques, results; 83 cases]. / Inséminations artificielles intra-utérines. Indications, techniques, résultats; à propos de 83 observations.

OBJECTIVES: Retrospective study of results after intra-uterine artificial insemination performed in the Poitiers University Hospital. MATERIAL: There were 95 infertile couples who benefited from intra-uterine artificial insemination. Indications involved pathology of the cervix in 53% of the cases and male infertility in 30%. Another cause of infertility was found in 5% and no cause could be identified in 12%. METHOD: The technique was as follows. Ovary stimulation using clomifene and hMG, sonographic monitoring with oestradiol assay, hCG for triggering ovulation, 2 inseminations at 24 and 48 h after swim-up sperm preparation and luteal phase supplementation. RESULTS: The overall success rate was 32.6% with a mean success rate per cycle of 11.1%. The best results were obtained in couples with unexplained infertility and cervix-related infertility (42 and 32% respectively). These results are comparable to those in the literature. CONCLUSION: The results of this series and the data reported in the literature demonstrate the interest of intra-uterine artificial insemination in cases of cervical sterility where it is indicated as first intention treatment. In case of impaired ejaculation, unexplained sterility and certain other causes of male infertility, intra-uterine artificial insemination can be useful but requires further study in order to determine the criteria for indications and the techniques to be used. Associating ovary stimulation increases the probability of success, especially in cervical sterility. Finally, more than 4 to 5 attempts do not increased success rate.

[Functional anatomy of the pelvic veins in women]. / Anatomie fonctionnelle des veines pelviennes chez la femme.

Pelvic veins and lower extremities veins form a functional unit resulting in the interaction of their pathology. The intrapelvic venous system consists of two independent networks, under physiological conditions: the parietal and the visceral networks. The main collectors are the internal iliac veins, the ovarian superior rectal veins. The original venous plexi, located in the sub-peritoneal pelvic connective tissue, remain open because of the adhesion of their wall to the parietal pelvic fascia. The parietal venous network, abundant and supplied with valves, includes the retro-public and sacral plexi. The usual venous drainage is encouraged by abundant anastomoses, the decrease or even the absence of valves and the abdominal pressure. When this pressure increases, especially during walking, this encourages pelvic drainage. Occasional venous drainage is observed in case of obstruction of the usual collectors. Anatomical obstacles to the drainage, besides thrombosis and tumors, are essentially: compression of the left common iliac vein by the right common iliac artery, and direct compression of the inferior vena cava by the uterus during pregnancy which compresses it against the spine. It is responsible for gravidic postural shock, and an increased abdominal pressure, exceeding 20 mmHg. The main supply pathways are the ovarian veins and the vertebral plexi. This large, low-pressure avalvular plexus may function easily in both directions caudo-cranial and cranio-caudal. The relationship of this plexus with the roots of the sciatic nerve explain certain sciaticas during pregnancy. Dilatation of the ovarian veins during pregnancy cause a so called syndrome of the ovarian vein. Various venous compressions during pregnancy are responsible for some hematurias, increased collateral abdominal circulation, and turgescent haemorrhoids and vulvar varicose veins.

[Evolution of salivary estradiol levels during the spontaneous menstrual cycle. Correlation between saliva and plasma]. / Evolution des taux d'estradiol salivaire au cours du cycle menstruel spontané. Corrélation salive-plasma.

The measurement of steroid concentrations is recommended in the exploration of the different endocrine functions. The salivary concentrations are the reflect of the free biologically active fraction in the plasma. In this study we have used a sensitive and specific method that can be routinely applied in salivary extradiol (SE2) RIA, using a 3 CMO 125I histamine derivative as a tracer. This study related to 12 normal spontaneous menstrual cycles and two abnormal spontaneous cycles. Saliva samples were collected daily throughout the menstrual cycle. Plasma samples were collected simultaneously to compare the salivary and plasma patterns. In the follicular phase SE2 was low: M +/- SD = 9.4 +/- 2.4 pmol/l. During the periovulatory period, the mean level of SE2 the day of the preovulatory peak was 27.6 +/- 8.6 pmol/l. In the luteal phase the SE2 levels fluctuated in a serrated manner with a mean of 11.7 +/- 3.4 pmol/l. The difference between the different phases is significant at the probability threshold 0.01. We have compared the salivary and plasma patterns during the different phases. At the beginning the salivary/plasma ratio was 3.4 +/- 0.9%. During the periovulatory period this ratio was only 2.5 +/- 0.6% and the end of the cycle 2.8 +/- 1%. The statistic study showed that these differences were significant at the probability threshold 0.01.

[Support and suspension of the pelvic viscera in women. Functional and surgical anatomy]. / Soutènement et suspension des viscères pelviens chez la femme. Anatomie fonctionnelle et chirurgicale.

This work is an attempt to settle the semantics of the pelvic connective tissues based on the international nomenclature (Nomina Anatomica) on the one hand on the other following a study of the macroscopic anatomy together with the microscopic appearances and a functional study together with a radiological study which includes in particular tomodensitometry. The Pelvic viscera are held in position by visceral fasciae which are continuous with the parietal pelvic fascia and the retro peritoneal connective tissue. This connective tissue, which is moderately loose, is arranged around the blood vessels as visceral ligaments. These are more obvious when traction is exerted during surgical operations and it resembles the way strands of a net come together when they are being stretched. It is essential to ligate and cut these ligaments if the viscera are to be freed. The surfaces which join the viscera together (the septum and the retro-pubic and retro-rectal spaces) are very important and from the biomechanical point of view resemble bonds that are stuck together. In fact, their resistance has the effect of interlocking neighbouring surfaces, and so effects a better distribution of pressures that are exerted and of their absorption. The changes that take place at rest and at movement of the pelvic organs during the menopause and during pregnancy and the puerperium have been studied. The role of episiotomy in particular as a step towards preventing urinary incontinence is emphasized. In fact, it lessens the pull on the external fibres of the sphincter muscle of the urethra which are bound up with the tissues of the vaginal wall. We have found in 140 women who have been operated on for stress incontinence that 62% had a tear or an episiotomy that was carried out late and that was insufficiently large; 13.9% had a tear: and 11.4%, on the other hand, had an episiotomy without a tear. On the other hand, in another group of similar women over the age of 45 who had had an episiotomy, 16.17% had stress incontinence.

[Development of the curvature of the cervical spine in utero. Attempted interpretation]. / Evolution de la courbure du rachis cervical in utero. Essai d'interprétation.

It is conventional saying that the fetal rachis shows only one ventral concavity. An echographic study allowed to observe in utero the rachis of more than a hundred live fetuses. The radius of this curvature gradually increases according to the development, revealed by the disappearance of the cervical curvature under the influence of the weight of the head and the uterine constraints. The sagittal curvatures of the vertebral column explains mans adaptability to the erected position. The authors think that the conventional conception, in which ontogenetic development is comparable with phylogenetic development, needs to be reconsidered: the cervical curvature is a prime curvature setting the evolutionist question about the origins of the rachidian curvatures.