The sulcus of the caudate process (Rouviere's sulcus): anatomy and clinical applications-a review of current literature.

The sulcus of the caudate process is a horizontal groove on the inferior face of the liver. Its prevalence has not previously been determined. Because of its location, it represents a helpful extra-biliary landmark that could be used in biliary surgery to decrease bile duct injury. The goal of this study is to determine the prevalence of Rouviere's sulcus and describe its anatomy and relevant surgical applications. We conducted a literature review on the various characteristics of the sulcus, selecting anatomical clinical studies and dissections. We performed 10 cadaveric dissections in the Laboratory of Anatomy at Purpan University to determine the contents. We selected 12 anatomical studies, conducted between 1924 and January 1st, 2020, which included 2394 patients. The prevalence of the sulcus is 78.24% ± 9.1. Classification of Singh was used to describe anatomical characteristics. Type I ("deep sulcus") was identified in 50.4% ± 9.8 of cases, mostly consisting of Type Ia (open). Type II ("slit-like") was estimated to account for 13.3% ± 13.2, whereas Type III ("scar") described 12.3% ± 8.0. Average dimensions were estimated for length (26 mm ± 5.7), width (6.5 mm ± 1.5), and depth (7.9 mm ± 1.75). The content of the sulcus consists of the right portal vein and its division, the right hepatic artery, along with the right hepatic bile duct. The sulcus determines the orientation of the common bile duct. The sulcus of the caudate process is a reliable extra-biliary landmark, which presents a useful tool for reducing bile duct injuries during hepatobiliary surgery.

Short-term autonomy and survival after hepatectomy in the elderly.

AIM: To study morbi-mortality, survival after hepatectomy in elderly patients, and influence on their short-term autonomy. PATIENTS AND METHODS: This is a retrospective study conducted between 2002 and 2017 comparing patients less than 65 years old (controls) to those more than 65 years old (cases) from a prospective database, with retrospective collection of geriatric data. Cases were divided into three sub-groups (65-70 years, 70-80 years and>80 years). RESULTS: Four hundred and eighty-two patients were included. There was no age difference in number of major hepatectomies (P=0.5506), length of stay (P=0.3215), mortality at 90 days (P=0.3915), and surgical complications (P=0.1467). There were more Grade 1 Clavien medical complications among the patients aged over 65 years (P=0.1737). There was no difference in overall survival (P=0.460) or disease-free survival (P=0.108) according to age after adjustment for type of disease and hepatectomy. One-third of patients had geriatric complications. The "home discharge" rate decreased significantly with age from 92% to 68% (P=0.0001). Early loss of autonomy after hospitalization increased with age, 16% between 65 and 70 years, 23% between 70 and 80 years and 36% after 80 years (P=0.10). We identified four independent predictors of loss of autonomy: age>70 years, cholangiocarcinoma, length of stay>10 days, and metachronous colorectal cancer. CONCLUSIONS: Elderly patients had the same management as young patients, with no difference in surgery or survival, but with an increase in early loss of autonomy.

[Comparison of treatment with griseofulvin, beta blockers and calcitonin in 55 cases of post-traumatic algoneurodystrophies]. / Comparaison du traitement par la griséofulvine, les bêtabloquants et la calcitonine dans 55 cas d'algoneurodystrophie post-traumatique.

A comparative study of three treatments of reflex sympathetic dystrophy (selected at random) was carried out on 55 cases : 20 patients were treated with calcitonin, 19 with beta-blocking agents, and 16 with griseofulvin. The delay in drug effect seems similar for the 3 drugs but griseofulvin is associated with a greater failure rate. The beta-blocking agents and calcitonin gave comparable results. beta-Blocking agents appear to obtain better results than other 2 treatments in patients with a psychological component to their disease.