Ciliary ganglion afferents and efferents variations: a possible explanation of postganglionic mydriasis.

PURPOSE: Ciliary ganglion is a pre-visceral vegetative ganglion, relay of ocular bulb vegetative pathways, concerning three types of fibers: parasympathetic, sympathetic and somatosensory. The objective of this study was to describe the different patterns of distribution of those fibers around the ciliary ganglion to explain rare post-traumatic or postoperative ocular symptoms. METHODS: Dissection of 20 orbits, from cavernous sinus to ocular bulb, after intravascular injection of colored latex. RESULTS: Concerning afferents, or roots, three dispositions have to be described: all of them were identified (55 %); parasympathetic root was absent and ciliary ganglion was attached directly to the inferior branch of the oculomotor nerve (25 %); sympathetic root was absent (20 %). Somatosensory root, coming from nasociliary nerve, was constant. Efferents (short ciliary nerves), including these three types of fibers, were variable in number but always constituted two bundles. CONCLUSION: The absence of identifiable parasympathetic root, resulting in a close relationship between ciliary ganglion and the inferior branch of the oculomotor nerve, could be a possible explanation of postganglionic mydriasis following blow-out orbital floor fracture or surgical repair of this type of fracture. The absence of sympathetic root is due to a forward retro-orbital connection between internal carotid plexus and ophthalmic nerve within cavernous sinus, corresponding to gray rami communicans.

The arterial supply of the coracoid process.

OBJECTIVE: The aim of this study was to describe the arterial supply of the coracoid process and to define its possible involvement in complications of Latarjet procedure. METHOD: Five shoulder dissections were performed to highlight the extraosseous blood supply of the coracoid process. Postmortem arteriographies of the upper limb were performed. Diaphanization of a scapula enabled to view its intraosseous blood supply. RESULTS: The vertical part of coracoid process was supplied by supra-scapular artery, and the horizontal part by branches of the axillary artery. DISCUSSION AND CONCLUSION: This anatomical study has shown that the coracoid process had its own blood supply. During the Latarjet procedure, vascular sacrifices are mandatory to allow coracoid process transfer to the scapular neck. Such sacrifices could explain lysis or non-union of the coracoid process after Latarjet procedure. Preservation of axillary artery branches supplying horizontal part of the coracoid process could be a possible solution to prevent non-union and lysis of the bone transfer.

Treatment of an aneurysmal bone cyst of the lumbar spine in children and teenagers, about five cases.

The aneurysmal bone cyst is a rare tumor. Its treatment is complex when localized to the lumbar spine, with neurological, mechanical, and tumoral complications. The aim of this study is to describe these tumors, their treatment, and their long-term evolution, as well as to define an appropriate therapeutic strategy. Four of the five cysts had anterior and posterior extension. Three patients had neurological symptoms at diagnosis and two of them presented with pathological fracture. Surgical treatment was performed by intralesional resection. Long-term progress was always favorable, without recurrence or functional limitation. Two patients had a stable, mild spine deformity.

Which are the ideal donor and recipient vessels for a whole ovarian transplantation?

OBJECTIVE: To compare deep circumflex iliac (DCI) and deep inferior epigastric (DIE) pedicles as potential recipient vessels for a whole ovarian microvascular transplantation. DESIGN: Anatomical study. SETTING: Laboratory of anatomy, university center. PATIENT(S): Ten fresh human female cadavers. INTERVENTION(S): Anatomical dissections, vascular injections, histologic analysis. MAIN OUTCOME MEASURE(S): Morphological analysis of the gonadic, DCI, and DIE pedicles; diameter of the vessels at regular intervals along their entire length. Comparisons of the caliber values between receiving (DCI and DIE) and gonadic pedicles aiming to determine the optimal size match. RESULT(S): We highlight a tortuous appearance of the gonadic artery. This morphology contrasted with the venous system that included two or three straight veins, one of them being wider than the others. The gonadic vessels converge into a wider artery and vein at 5 cm from the ovary. An optimal size match existed between gonadic and DCI arteries and veins sections, in 13 of 14 gonadic pedicles. CONCLUSION(S): A safe microsurgical whole ovarian transplantation is feasible if the gonadic pedicle is harvested with a minimal length of 5 cm from the ovary. The DCI pedicle seems to have the best size match with the ovarian vessels to perform a reliable end-to-end microvascular anastomosis.

New anatomical data on the drainage patterns of the uncinate process of the pancreas.

PURPOSE: Recently, progress has been made in the surgical management of benign pancreatic tumors sparing as much of the pancreatic parenchyma and pancreatic function as possible. However, the main complication of partial pancreatectomy is the disruption of pancreatic ducts ensuing leak of pancreatic secretion leading to the formation of pancreatic fistulae. In this study, we attempt to precisely define the anatomy of the branch duct draining the uncinate process which is of interest to the surgeons. METHODS: Seventeen formalin-fixed pancreases were taken and ducts were injected with a colored gelatin solution. Within the uncinate process of the pancreases, the branch duct was localized, measured and its anatomical drainage defined. Statistics were performed using Spearman's correlation test. RESULTS: The uncinate process was drained exclusively by the main pancreatic duct in ten cases, by the accessory pancreatic duct in three cases, and by both the ducts in four cases. All of the branches drained into the main pancreatic duct downstream to the junction between the main and the accessory pancreatic duct, except for one. CONCLUSIONS: We have precised the possibility of double drainage of the uncinate process, but this could not be correlated with simple anatomical or radiological landmarks such as the length of the main pancreatic duct or the patency of the minor duodenal papilla.

Intermittent active motion versus immobilization in the treatment of Staphylococcus aureus-induced arthritis in a rabbit model.

PURPOSE: This study has evaluated the effects of immobilization versus intermittent active motion on cartilage and on antibiotic efficacy in a rabbit septic arthritis model. METHODS: Rabbits were infected and assigned to one of four groups: group 1, no treatment without immobilization (allowing intermittent active motion); group 2, cast; group 3, oxacillin without immobilization; group 4, oxacillin and cast. Animals were sacrificed 21 days later. Bacterial counts and lateral radiograms were performed. A radiological score was calculated. RESULTS: Immobilization had no effect on oxacillin efficacy and a deleterious effect on the radiological score. CONCLUSION: Intermittent active motion has allowed a better cartilage healing during the treatment of septic arthritis.

Internal device decreases antibiotic's efficacy on experimental osteomyelitis.

PURPOSE: We have evaluated the effect of internal and external osteosynthesis devices on the efficacy of vancomycin treatment in a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA)-induced post-traumatic osteomyelitis. METHODS: Double tibial osteotomies in female New Zealand rabbits were performed, inoculated with a MRSA strain, then fixed with an intramedullary rod. A debridement was performed 4 days later for each rabbit, and a bacterial count in pus was determined (B1). In the first group (G1), the osteosynthesis material was removed and replaced by a new sterile nail. In the second group (G2), the intramedullary rod was removed and then replaced by an external fixator. Immediately after surgery, G1 and G2 rabbits were treated with vancomycin (60 mg/kg twice a day). The animals were sacrificed at the end of a 5-day period, and a bacterial count in pus was performed again (B2). RESULTS: The difference of log(10) colony forming units per milliliter (CFU/ml) (B2-B1) was -1.2 +/- 0.5 and -2.9 +/- 1.1, respectively, for G1 and G2. CONCLUSION: The efficacy of vancomycin treatment increased after removal of the internal osteosynthesis device.