[Use of ultrasound for the removal of cement in hip prosthesis reoperations]. / Utilisation des ultrasons pour l'ablation du ciment dans les reprises de prothèses.

PURPOSE OF THE STUDY: One of the challenges facing the surgeon during revision procedures is the harduous task of complete acrylic cement removal while leaving the surrounding cortical bone intact. A set of ultra sonic driven instruments has been evaluated revisions of total hip and total knee prosthesis. The principle is to convert standard electrical energy into mechanical energy via an ultrasonic transducer. MATERIAL: 10 revisions of cemented hip prosthesis and one of a total knee prosthesis (Guepar Howmedica) have been performed with success easily and safely. RESULTS: The ultra-sonically driven tools used have reduced the incidence of perforation (1 cases), with no need to cut cortical windows to remove the distal plug, and have also reduced the time for cement removal and the intra-operative blood loss. CONCLUSION: The author thinks that this technique provides a great facility in revision surgery. A larger study will be done soon.

Fractures of cervical spine with neurological lesion treated by reduction and fixation with plates.

A series of 61 cases of cervical spine fracture and dislocation with neurological deficit treated operatively were reviewed. All were reduced and internally fixed with plates and screws. The operative technique was not easy and required a great deal of care and experience. Surgery did not significantly alter the neurological recovery in 12 cases with root involvement and 23 cases with complete tetraplegia. Neurological recovery seemed to be better after surgical intervention in the case of incomplete tetraplegias; 18 out of 26 being able to walk eventually. The main value of surgical fixation of these injuries was to allow early rehabilitation without any external cervical support. However, intensive care of the neuro-cardio-respiratory complications in the post-operative period was necessary to evert the high risk of mortality and morbidity from surgery.

[Total hip prosthesis. Current indications (author's transl)]. / Prothèses totales de hanche. Indications Actuelles.

The various problems posed by total hip prosthesis are first described. The authors then analyse the various parameters which should guide the choice of this technique which must be used only when all other solution have failed. The recent development of prostheses without cement has made it possible to widen the application of this surgery to younger patients. Two special cases are finally reported: the role of total prostheses in the treatment of sequelae of fractures of the acetabulum, and in disarthrodesis of the hip with insertion of a total prosthesis.

Comparision of low dose heparin and low dose heparin combined with aspirin in prevention of deep vein thrombosis after total hip replacement.

In a prospective randomised trial, two groups of 20 patients each were compared. The first group received low dose heparin (t.i.d.) and the second group received low dose heparin (t.i.d.) combined with aspirin. The incidence of deep vein thrombosis (DVT) were determined using both radioactive fibrinogen uptake test and venography. The correlation between the two methods of diagnosis was better than 90%. There was no significant difference in the incidence of DVT between the two prophylactic regimen. A significant tendancy towards increased bleeding in observed with the combination of low dose heparin and aspirin.

[Vascularization of the transverse colon]. / Vascularisation du colon transverse.

Results of 21 injections of the transverse colon with coloured latex. The superior and inferior mesenteric arteries are separately injected. Dissections allowed the study of the topography and width of the colic transverse vessels. Collateral circulation is also described. A middle colic artery is present in 85% of the cases. The length of transverse colon vascularized by each arterial system is related with accuracy to the number of arcades issued from each system. The superior mesenteric artery prevails in the blood supply of the transverse colon (70% of its length).

[Arterial vascularization of the 3rd and 4th portions of the duodenum. Recent acquisitions]. / La vascularisation artérielle des troisième et quatrième portions du duodenum. Acquisitions récentes.

New knowledge on arterial blood supply of the 3rd and 4th parts of theduodenum. Injection of the digestive arterial system in 15 adult subjects allows the study of the blood supply of the 3rd and 4th parts of the duodenum. Although the duodeno-pancreatic arches are constantly found, the authors showed that the branches to the duodenum have a variable layout. On the right of the superior mesenteric artery, the distribution of the branches is always regular on both sides of the 3rd part of the duodenum. On the other hand, on the left of this artery, there is sometimes a vascular hiatus which may extend to the duodeno-jejunal angle. Although in 60 per cent of the cases, this part of the duodenum is well supplied with blood on both surfaces, in 40 per cent of the cases on the other hand, there exists an avascular area on both sides. This lay-out is not favorable for division and anastomosis of this segment of the digestive tract.

[The blood supply of the semitendinosus, gracilis and sartorius muscles and surgical applications (author's transl)]. / La vascularisation des muscles de la patte d'oie et ses applications chirurgicales.

The vascular pedicles of the semitendinosus, gracilis and sartorius muscles were identified by the authors. Although devascularisation of the tendons is of no importance in plastic operations, any technic using the fleshy part of these muscles should take care to preserve the blood supply. It is therefore important to know their anatomy.

[New acquisitions on the arterial vascularization of the 3d and 4th portions of the duodenum. Surgical applications]. / Nouvelles acquisitions sur la vascularisation artérielle de la 3e et la 4e portion du duodénum. Applications chirurgicales.

The authors studied the blood supply of the 3rd and 4th parts of the duodenum in 15 adult subjects. Although the duodeno-pancreatic arches are constantly found, the branches to the duodenum have a variable lay-out. On the right, the superior mesenteric artery, the distribution of which is always regular on both sides of the 3rd part of the duodenum. On the other hand, on the left, the superior mesenteric artery, there is sometimes a vascular hiatus which may extend to the duodeno-jejunal angle. Although in 60 p. cent of cases this part of the duodenum is well supplied with blood on both surfaces, in 40 p. cent of cases on the other hand, there exists an avascular area on both sides. This lay-out is not favourable for division and anastomsis of this segment of the digestive tract.

[Does the phrenico-gastric ligament exist?]. / Le ligament phrénico-gastrique existe-t-il?

On thirty cadaveric dissections, we studied the so-called "phreno-gastric" ligament. In fact, it appears that there is an adhesion between the fundus and the posterior wall in only 60 % of the cases. This adhesion is always very loose, easily cleaved and in no case is there a real fibrous suspensory ligament. Moreover, in 40 % of the cases, the posterior surface of the fundus is entirely covered by peritoneum and is free in the bursa omentalis. In that case, the posterior surface of the stomach is connected with the diaphragm by a very short meso extending on the right to the meso esophagus and on the left to the gastrosplenic ligament.

[Anatomic variation of the aortic coronary openings (apropos of 80 dissections)]. / Variations anatomiques des orifices coronariens aortiques (a propos de 80 dissections).

A series of 80 heart dissections, compared with a survey of the literature shows that:--both coronary ostia are usually in the right anterior and in the left posterior position, in the commissural plane, at the level of the corresponding sinus of Valsalva (the left one being often superior in size to the right one).--anatomic variations of the coronary ostia (especially variations of the left coronary ostium) may be summed up into 3 patterns: Variations in number : sometimes, there is only one aortic coronary ostium, usually owing to a left coronary artery originating from the pulmonary artery; a common aortic ostium for a single coronary artery is not frequent. Multiple ostia are the most common variations : an accessory artery may arise from a separate ostium (often the "third coronary artery" from the right aortic sinus; sometimes the anterior descending and the circumflex arteries may originate from separated orifices). Variations in origin remain few, affecting most often the left ostium. Variations in size reflect the corresponding coronary plexus preponderance.

[Anatomic variations of the common trunk of the left coronary artery (apropos of 80 dissections)]. / Variations anatomiques du tronc commun de l'artère coronaire gauche (a propos de 80 dissections).

An anatomic study of the main left coronary artery is reported : important anatomic variations may occur:--sometimes, the main left coronary artery is missing (1 % of the cases),--its origin may be unusual (from the pulmonary artery),--its average length is 11 mm; but, it may be longer (35 mm) and sometimes very short (less than 8 mm in 15 per cent of the cases) : this last aspect has to be taken in account by the surgeon during aortic valve surgery if a coronary perfusion has been decided.--At last, its division into two branches (anterior descending and left circumflex) is the most usual (65 or 70 per cent of the cases). A third branch of division may exist (diagonal or lateral branch) in about 20 to 30 per cent of the cases. The left coronary artery may also divide into four (or even five) branches in 5 to 10 per cent of the cases.