patrick chaynes

Introduction Les voies lymphatiques et les territoires de drainage de l’ovaire sont mal connus alors qu’ils sont directement concernes dans le traitement chirurgical du cancer de l’ovaire. Buts de l’etude L’objectif principal de notre travail anatomique etait de mettre en evidence les territoires et les voies physiologiques de drainage lymphatique de l’ovaire. L’objectif secondaire etait d’etudier la faisabilite d’une technique inedite d’injection et de visualisation des vaisseaux lymphatiques. Materiel et methodes Vingt-six ovaires de cadavres frais ont ete injectes a l’aide de bleu patente. Les vaisseaux lymphatiques colores ont ete reperes et disseques, apres observation puis selon les territoires de lymphadenectomies pelvienne et lombo-aortique recommandees. Resultats Nous avons retrouve une coloration lymphatique du territoire lombo-aortique dans 35 % des cas, du territoire iliaque commun dans 35 % des cas, du territoire ilio-obturateur dans 81 % des cas et du territoire inguinal dans 4 % des cas. Le territoire lombo-aortique semble se drainer via le ligament suspenseur de l’ovaire, colore dans 77 % des injections. Le ligament large, colore dans 69 % des cas, semble etre un veritable carrefour lymphatique anastomotique, entre l’ovaire, l’uterus et la trompe. L’atteinte du territoire inguinal pourrait se faire via les vaisseaux lymphatiques du ligament large puis du ligament rond. Nous n’avons pas observe de drainage controlateral dans les territoires de lymphadenectomie. La faisabilite de notre methode est probante, 92 % de nos injections ont permis la coloration d’au moins un territoire lymphatique. Conclusion Notre etude contribue a une meilleure comprehension du drainage lymphatique de l’ovaire. Celle-ci est indispensable au developpement de techniques orientees de prelevement ganglionnaire, plus contributives dans la stadification et moins morbides que les lymphadenectomies etendues recommandees.

ObjectiveTo investigate predictors for improvement of disease-specific quality of life (QOL) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) with early motor complications.MethodsWe performed a secondary analysis of data from the previously published EARLYSTIM study, a prospective randomized trial comparing STN-DBS (n = 124) to best medical treatment (n = 127) after 2 years follow-up with disease-specific QOL (39-item Parkinson's Disease Questionnaire summary index [PDQ-39-SI]) as the primary endpoint. Linear regression analyses of the baseline characteristics age, disease duration, duration of motor complications, and disease severity measured at baseline with the Unified Parkinson’s Disease Rating Scale (UPDRS) (UPDRS-III “off” and “on” medications, UPDRS-IV) were conducted to determine predictors of change in PDQ-39-SI.ResultsPDQ-39-SI at baseline was correlated to the change in PDQ-39-SI after 24 months in both treatment groups ...

Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outc...

We report the case of a young patient, presenting with total bilateral vulvar necrosis after reduction of a femoral neck fracture. This report describes the management of this complication, its mechanism of injury and the associated means of prevention.We present an investigation of the vulvar vasculature in order to understand the mechanism of injury.The study of the vulvar vasculature rejects the anatomical hypothesis of selective damage to the internal and external arteries. Instead, it suggests intraoperative impingement of the terminal blood vessels caused by compression against the perineal post prompting discussion on the use of moulded countertraction posts during orthopaedic surgery.

The increasing trend toward performing minimally invasive neurosurgery may benefit from recent progress in using neuroendoscopic techniques to reduce trauma in patients who have undergone operations. Arterial and venous vessels, especially loops, may compress the central segment and cause hyperactive dysfunction of the nerves. Relationships of the anterior inferior cerebellar artery to the facial and vestibulocochlear nerves and the anterior inferior, and superior cerebellar arteries to the trigeminal nerve were studied. The authors report findings from an endoscopic study performed in cadaver heads via the retrosigmoid and retrolabyrinthine approaches. Arteries and veins were colored by injection of red and blue silicon rubber. The cerebellopontine angle (CPA) was examined using 2.7-mm and 4-mm-diameter rigid endoscopes at viewing angles of 0š, 30š, and 70š. Well-known structures could be identified endoscopically without prior dissection, and the entire CPA could be explored. Howe...

OBJECTIVE The veins draining the posterior wall of the third ventricle and its adjacent structures and the posterior part of the midbrain have been the most neglected of the intracranial vascular structures in both the anatomic and neurosurgical literature. During our dissections of the pineal region and the quadrigeminal cistern, we did not always encounter topographic anatomy as described in previous articles. The purpose of this study is to describe the topographic anatomy and normal variations of the specific veins that drain the collicular plate and the pineal body and their adjacent structures with a view to better defining neurosurgical approaches to the pineal region. METHODS The deep cerebral veins draining the pineal body, the collicular plate, and their surrounding neural structures were examined on both sides of 25 adult cadaveric brains. In all specimens, the carotid and vertebral arteries and the jugular veins were perfused with red or blue silicone, respectively, to f...

Neurenteric cysts are cystic masses lined by a columnar epithelium of endodermal origin. They are rare in the central nervous system. We report two neurenteric cysts in the posterior cranial fossa and describe their neuroradiological features. The lesions were of low density on CT and more accurately delineated on MRI. They gave the same signal as cerebrospinal fluid on all sequences. There was no contrast enhancement.

✓ Extramedullary hematopoiesis (EMH) is a compensatory mechanism occurring in patients with chronic anemia, which occurs most frequently with thalassemia. The authors report the case of a 57-year-old man, with no history of clinical or hematological disease, presenting with spinal cord compression. Magnetic resonance (MR) imaging demonstrated a homogeneous posterior epidural mass extending from T-3 to T-6. Following decompressive surgery, the patient's symptoms improved. Histological analysis showed features consistent with a diagnosis of EMH. Subsequent workup was remarkable for an asymptomatic spherocytosis without anemia. There was no family history of anemia. An EMH-related presentation of mild spherocytosis has been described in the literature, but its epidural location led to spinal cord compression. The MR imaging features were suggestive of EMH, but in the presence of spinal cord compression and in the absence of a history of chronic anemia, the authors did not believe t...

In this cadaveric study we assessed the level of the emergence of the musculocutanous nerve (MCN) relative to needle insertion site during infraclavicular block. Forty brachial plexi from 20 embalmed adult cadavers were dissected. The MCN was exposed from its origin on the lateral cord to its penetration into the coracobrachialis muscle. The point of emergence of the MCN from the lateral cord relative to a line drawn directly caudad from the anteromedial tip of the coracoid process was measured. A needle was placed predissection using our previously described technique, and the distance from the needletip to the emergence of the MCN was measured. MCN often emerged distal to the coracoid process. At the needle insertion site, 80% of MCN had already emerged from the lateral cord. The distance of emergence ranged from 8.5 cm proximal to 12 cm distal to the coracoid process. This anatomical study suggests that MCN may be one of the factors explaining MCN block failure for the single-injection technique of infraclavicular block using lateral needle trajectory.

Neurenteric cysts are cystic lesions lined by a columnar epithelium of endodermal derivation. They are rarely located in the central nervous system. We describe the case history of two recurrent neurenteric cysts located within the posterior fossa: one in the 4th ventricle and the second in the cerebellopontine angle. The literature is reviewed and the follow-up and recurrence of such cysts are discussed.

Object. The deep cerebral veins may pose a major obstacle in operative approaches to deep-seated lesions, especially in the pineal region where multiple veins converge on the great cerebral vein of Galen. Because undesirable sequelae may occur from such surgery, the number of veins and branches to be sacrificed during these approaches should kept to a minimum. The purpose of this study was to examine venous drainage into the vein of Galen with a view to surgical approaches. If a vein hampering surgical access must be sacrificed, it can therefore be selected according to the smallest draining territory. Methods. The deep cerebral veins and their surrounding neural structures were examined in 50 cerebral hemispheres from 25 adult cadavers in which the arteries and veins had been perfused with red and blue silicone, respectively. Special consideration was given to the size and location of drainage of the vein of Galen and its tributaries. Conclusions. When a surgeon approaches the pine...

Objectifs.-Utiliser l'IRM afin d'évaluer le rôle des mesures anatomiques postopératoires à propos de la récupération de la continence dans les néovessies iléales après cystoprostatectomie pour cancer de vessie. Méthodes.-Cinq cas de patients nécessitant des cathétérismes propres intermittents (CPI) et 38 patients contrôlés qui ont eu une IRM dynamique de leur néovessie ont été évalués dans une étude prospective monocentrique. Tous les patients inclus avaient eu une néovessie iléale après cystoprostatectomie pour cancer de vessie. Trente-deux mesures anatomiques des os du bassin et des tissus mous ont été réalisées sur les IRM dynamiques. Une analyse mul-tivariée ajustée selon l'âge après des comparaisons de moyennes a été réalisée pour évaluer l'association des variables au mode de continence et à sa sévérité. Un modèle de Cox uni-et multivarié ajusté à l'âge a été utilisé pour évaluer l'association des variables avec le délai de récupération de la continence. Résultats.-La continence diurne des patients contrôlés était par-faite dans 73,7 % et satisfaisante dans 94,7 %. L'épaisseur du Levator ani au niveau de l'anastomose entre la néovessie et l'urêtre pré-disait le mode de continence urinaire diurne (RRR = 2,14 par mm, parfaite contre imparfaite, 95 % IC [1,16, 3,97], p = 0,015), la sévé-rité de l'incontinence (Rapport de cote ordinal = 2,08 par mm, 95 % IC [1,27, 3,93], p = 0,007) et le délai de récupération de la conti-nence diurne (ratio du hazard [HR] = 0,82 par mm, 95 % IC [0,68, 1,00], p = 0,046). Chez les patients qui avaient l'anastomose entre le néovessie et l'urètre au niveau de l'épaisseur maximale, l'urètre membraneux était sous la ceinture du muscle Levator ani. Conclusion.-Ces données suggèrent l'existence d'un défaut de soutènement de l'urètre membraneux quantifiable. Ainsi la préser-vation des structures péri-sphinctériennes au cours de la chirurgie est recommandée. http://dx. Objectifs.-Les descriptions anatomiques de l'artère vésicale infé-rieure sont variables. Il est admis classiquement qu'elle assure la vascularisation artérielle de la partie inférieure et latérale de la vessie, et qu'elle naît directement de l'iliaque interne, parfois de l'artère glutéale inférieure. Elle est pour certains auteurs spécifique à l'homme, pour d'autres présente dans les 2 sexes. Nous avons voulu savoir si elle pouvait être identifiée chez la femme. Méthodes.-Dissection des artères à destinée vésicale de 12 cadavres frais. L'artère vésicale inférieure était recherchée dans les branches issues du tronc antérieur de l'artère iliaque interne et identifiée par le territoire qu'elle vascularisait. Résultats.-La population étudiée était composée de 6 hommes et de 6 femmes. L'artère vésicale inférieure a été mise en évidence Figure 1. Vue supérieure de la pièce de cystoprostatectomie totale d'une dissection d'un homme de 84 ans. 1. Aorte abdominale. 2. Artères iliaques communes droite et gauche. 3. Artère iliaque externe. 4. Tronc de division antérieure de l'iliaque interne. 5. Tronc de division postérieure. 6. Artère ombilicale et artères vési-cales supérieures. 7. Artère vésicales inférieures droite et gauche. 8. Trigone vésicale et barre inter-trigonale portant les orifices uré-téraux qui sont en position orthotopique. 9. Veru montanum. 10. Canaux déférents. 11. Uretère droit. 12. Artère obturatrice gauche. chez 92 % des sujets de sexe masculin et chez 33 % des sujets de sexe féminin. Chez les hommes, elle naissait directement de l'iliaque interne dans 72 % des cas et de l'ombilicale dans 27 % des cas (Fig. 1). Chez les femmes, elle naissait, dans les cas rencontrés, directement de l'iliaque interne. Conclusion.-L'artère vésicale inférieure ne semble pas être propre au sexe masculin même si elle est beaucoup plus fréquemment ren-contrée chez ce dernier. C'est sans doute le caractère quasi constant chez l'homme, le grand nombre de variations anatomiques dans la vascularisation pelvienne humaine et les rapports étroits entre vascularisation vaginale et vésicale chez la femme qui explique qu'elle ne soit décrite pour certains auteurs que chez l'homme. On la rencontre toutefois chez 1 femme sur 3 dans cette série. http://dx.