Anatomical description of the umbilical arteries and impact of their ligation on pelvic and perineal vascular supply after cystectomy in women.

OBJECTIVE: In radical cystectomy, the surgeon generally ligates the umbilical artery at its origin. This artery may give rise to several arteries that supply the sexual organs. Our aim was to evaluate pelvic and perineal devascularisation in women after total cystectomy. PATIENTS AND METHODS: We carried out a prospective anatomical and radiological study. We performed bilateral pelvic dissections of fresh adult female cadavers to identify the dividing branches of the umbilical artery. In parallel, we examined and compared the pre- and postoperative imaging investigations [magnetic resonance imaging (MRI) angiography] in patients undergoing cystectomy for benign disease to quantify the loss of pelvic vascularisation on the postoperative images by identifying the occluded arteries. RESULTS: The anatomical study together with the radiological study visualised 35 umbilical arteries (n = 70) with their branching patterns and collateral arteries. The uterine artery originated from the umbilical artery in more than 75% of cases (n = 54) of the internal pudendal artery in 34% (n = 24) and the vaginal artery in 43% (n = 30). The postoperative MRI angiograms showed pelvic devascularisation in four patients. Devascularisation was dependent on the level of surgical ligation. In the four patients with loss of pelvic vascular supply, the umbilical artery had been ligated at its origin. CONCLUSION: The umbilical artery gives rise to various branches that supply the pelvis and perineum. If the surgeon ligates the umbilical artery at its origin during total cystectomy, there is a significant risk of pelvic and perineal devascularisation.

Is it useful to repeat an adrenal venous sampling in patients with primary hyperaldosteronism?

UNLABELLED: Adrenal venous sampling (AVS) is a challenging technical procedure and few patients had AVS procedure twice. AIM: To evaluate the reproducibility of the AVS, why AVS were repeated and the conclusions drawn from them. PATIENTS AND METHODS: From 1997-2012, 12 patients underwent two AVS. A cortisol level in the adrenal vein greater than or equal to 1.1 to inferior vena cava defined a successful catheterization and a lateralization of secretion corresponded to an aldosterone-to-cortisol vein ratio greater than or equal to 2 between the one side to another. RESULTS: The same side of lateralization of secretion was found in 75% of them. The second AVS were due to technical failure (n=4), unproven lateralization (n=2), a lateralization opposite to the main nodule and ipsilateral to hyperplasia (n=4) on first AVS. For two patients, as the CT was normal, AVS was required again. The second AVS was successful in all patients, including those with an initial technical failure but only patient with technical failure underwent surgery, as BP and kaliemia were controlled. Lateralization on the side of hyperplasia or opposite to the biggest nodule was confirmed in two of four cases. CONCLUSION: When AVS is unsuccessful for technical reasons, it is worth doing it again but after being sure that surgery is still possibly indicated.

Radiological anatomical study of the origin of the uterine artery.

PURPOSE: To clarify the origin of the uterine artery and quantify its anatomical variants. MATERIALS AND METHODS: We carried out a study based on dissections, intraoperative findings and retrospective analysis of arteriograms. Thirty female cadavers were dissected and bilaterally observed, with a total of 60 origins visualised. Fifty laparotomies were carried out during the treatment for pelvic neoplasms (100 origins observed) and 34 arteriograms performed for uterine fibroid embolisation were studied (58 origins visualised). RESULTS: In total, 218 origins of the uterine artery were visualised. The uterine artery originated from a common trunk with the umbilical artery in 80.7% of cases. It arose separately from the internal iliac artery in 13.16% of cases and directly from the superior gluteal artery in 3.51% of cases. It branched from a common trunk with the internal pudendal artery in 1.75% of cases, whereas arose separately from the obturator artery in 0.88% of cases. CONCLUSION: The uterine artery arose from a common trunk with the umbilical artery in the majority of the Caucasian population. Surgeons and radiologists should be aware of this mode of branching to facilitate surgery and interventional radiology and improve the safety of these procedures.

[In utero fetal death in pregnancy complicated by Takayasu's arteritis: case report and review]. / Mort foetale in utero durant la gestation compliquant une maladie de Takayasu : à propos d'un cas et revue de la littérature.

Takayasu's arteritis is a non-specific chronic vasculitis mainly involving the aorta and its main branches. A 37 year-old patient was diagnosed a Takayasu's arteritis during her last pregnancy. Her new pregnancy was characterised by a preeclampsia and an intrauterine growth restriction complicated by an intrauterine fetal death during the second trimester. Takayasu's arteritis is at risk of life-threatening complications for both the mother and the fetus. A multidisciplinary survey is recommended. Currently, management of this disease is unclear and no consensus is available during pregnancy. Trials testing antiplatelet agents and corticosteroids are now needed.