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The arteries and veins of the left vagus (VN) and left recurrent laryngeal (RLN) nerves from the thoracic inlet to the subaortic region are described following vascular casting with red colored latex in 6 adult fresh non-embalmed cadavers. In all specimens the anterior bronchoesophageal artery supplied at least one vessel to the VN and RLN in the subaortic region. For the RLN other arterial sources were arteries arising from the aortic arch in 1 specimen, the subclavian artery in 3 specimens, the first intercostal artery in 1 specimen, and the inferior thyroid artery in all specimens. For the VN other arterial sources were arteries arising from the aortic arch in 2 specimens and the inferior thyroid artery in 1 specimen. For both the VN and RLN the veins were located under the pleura and directed towards the internal thoracic vein anteriorly and the thoracic intercostal veins posteriorly. In conclusion, the inferior thyroid artery at the thoracic inlet for the RLN and the anterior bronchoesophageal artery are the more consistent vessels supplying the VN and RLN. Vascular damage occurring during mediastinal lymph node excision to the VN and RLN, especially in the subaortic region, may explain postoperative vocal fold paralysis.

Une prise de Gadolinium permettait de prevoir constament un effet favorable des anti-inflammatories.

Dynamic MRI of the pelvis was performed in 16 young nulliparous, normally continent women. The examinations were performed in the dorsal decubitus position. Using Turbo-Flash scans (acquisition time: 2.1 sec), sagittal images were obtained at rest and with maximal pelvic straining. The sacral promontory-subpubic (PSP) and the subpubic-subsacral axes (SPSS) measured respectively 80.5 degrees and 30 degrees in relation to the horizontal plane, without a statistically significant difference between rest and straining. A marked deformation of the posterior wall of the bladder was observed in 13 cases and the bladder neck was frontally deformed in 10 cases. With straining, the base of the bladder did not descend beyond 15 mm below the SPSS, and the cervix stayed at least 14 mm above the SPSS. These were established as the normal criteria for pelvic assessment. 20 multiparous patients (mean age 65 years), referred for urinary stress incontinence and/or prolapse, were investigated using the criteria previously established. The PSP, SPSS, and vaginal angle measured 80.95 degrees, 30.57 degrees, and 69.69 degrees respectively in relation to the horizontal. No statistically significant difference was detected between straining and rest conditions. The angle of the uterus in relation to the horizontal was 57.36 degrees at rest and 65.90 degrees in straining with a difference that was statistically significant. In six patients, the base of the bladder descended more than 1.5 cm while straining and in seven patients the cervix descended at least 1.4 cm below the SPSS while straining, both statistically significant differences. Overall, between our control and study populations, there were no significant differences between PSP and SPSS measured on straining and at rest. However, differences were detected in the vaginal angle, bladder-base position, and cervical position. These results suggest the potential substitution of MRI for colpocystography.

L'architecture, les mecanismes de la statique et de la dynamique du pelvis rendent difficiles les indications therapeutiques en cas d'incontinence urinaire et/ou de prolapsus, soulignant l'interet de bilans precis statiques et dynamiques, en particulier chez les patientes multi-operees ou les modifications anatomiques sont nombreuses. A cote de ses performances purement morphologiques, l'IRM, en utilisant des sequences rapides, est surement un examen d'avenir dans l'expertise des desequilibres de la statique pelvienne. Si la realisation de l'exploration en decubitus dorsal est un inconvenient de depart a ce jour incontournable, l'absence d'opacification pelvienne instrumentale rend l'IRM beaucoup plus physiologique que le colpocystogramme. Apres avoir etabli des criteres de normalite, nous avons tente chez des patientes affectees d'une incontinence et/ou d'un prolapsus de mettre en evidence des criteres predictifs pour une decision therapeutique. Les limites que nous avons rencontrees sont peut etre a rapporter a la population (heterogeneite et importance des antecedents). L'impossibilite de visualiser avec precision le col vesical et la filiere ano-rectale, contrairement a l'avis d'auteurs anterieurs, [6] constitute egalement un handicap. La substitution de l'IRM au colpocystogramme nous apparait donc aujourd'hui prematuree. Mais la technique, tres evolutive, est susceptible d'amendements rapides, notamment par la majoration de la resolution spatiale. Sa place dans les bilans de routine devra surement etre rediscutee bientot.

Finite element modelling of the human lumbar vertebral column employs data-processing procedures for study of the linear and nonlinear elasticity of materials such as are currently used in mechanics or in civil engineering. Thanks to developments in computer science, requiring a close collaboration between doctors and engineers, we put forward in this preliminary study a linear computerised model of the lumbar column comprising 4824 meshes and 6813 nodes. By reducing the simplificatory hypotheses and integrating new parameters, this model as developed is capable of important clinical applications in surgery and ergonomics.

Opto-electronic systems utilising measurement of displacement of skin markers allows study of movement in the living subject. The authors have used this method in a kinematic study of the thoracic and lumbar spine measuring the displacement of skin markers placed over the spinous processes. It was possible to approach the physiological state of these complex movements once the apparatus had been calibrated to the correct level, and the error margins minimised. Repeated measurements confirmed the reliability of this method even if movement of the skin with respect to the bony reference points introduced some margin of error. Three dimensional displacement of the vertebrae were measured during voluntary movements of the spine demonstrating the complex geometry. Since opto-electronics are non-invasive they constitute an important advance in the study of the kinematics of the spine.

The infratemporal fossa and its contents (particularly the pterygoid muscles) is a region difficult to explore, in spite of its importance in odontostomatological pathology. In order to reduce the indications that justify examination by computed tomography and magnetic resonance imaging, for reasons of economy of health, the authors describe by application of orientated anatomical slices the way in which ultrasonography can be performed. Only the posterior approach between the mandible laterally and the mastoid process medially provided consistently adequate exploration of the infratemporal fossa and the pterygoid muscles.

According to the ultrasound and MRI findings, supported by planned dissections, the female perineum is organised around the musculofascial system converging towards the fibrous structure of the central perineal tendon (CPT). Behind the CPT the fascial layers form part of a fibrous assembly extending from the ventral surface of the sacrum to the anal complex, prolonging the direction of the sacral concavity downwards and forwards. On the other hand, in front of the CPT the fasciae fuse to form two aponeurotic bands circumscribing the urogenital fossa. The fascial system is reinforced cranially by the structures of the hypogastric sheath and the uterosacral ligaments. The weak point of the urogenital fossa is partly filled by the urethral-clitoridal-vulvar complex. The perineum so formed plays a cardinal role in stabilising the pelvic viscera. Stress is placed on the firmness of the posterior perineum, a key element in pelvic stability. The posterior perineum is often involved in pathological conditions and a good acquaintance with these structures is essential in defining therapeutic indications.

The authors have studied the relationship between anatomic and CT sections of the lateral pterygoid muscle in 39 anatomic specimens. Good superimposition of the images was found, which seems important in neoplastic invasion of the infratemporal fossa and which may lead to a pathogenic interpretation of the algo-dysfunctional syndrome of the masticatory apparatus.

The utility of the inferior oblique m. radioanatomical study by a FLASH 3D sequence in magnetic resonance imaging (MRI). Twenty eyes (ten healthy volunteers aged 21-32 years, without any history of significant ocular pathology) were explored by MRI (1 Tesla; cranial coil) and comparisons were made between spin echo (SE) T1 sequence (through the neuro-ocular and coronal planes; thickness of slices = 3 mm) and a gradient echo FLASH 3D sequence (thickness of slices = 1 mm). This enabled a mm by mm reformation of the inferior oblique m through the frontal-oblique plane, made possible by new SE T1 sequences through the same plane. Position, height, and signal of the m. were estimated. The mean frontal angle formed by the muscle and the sagittal axis measured 29 degrees for the right eye and 27 degrees for the left eye. The muscle was always identifiable in the reformation despite its thin dimensions: 1.9 mm (1.5 - 2.8) on the right and 2 mm (1.7 - 2.5) on the left, in low signal silhouetted by the high signal of orbital fat. Thus, thanks to mm by mm reconstructions using FLASH 3D sequence, a good radioanatomic study of the inferior oblique m. by MRI is possible. This could be useful particularly for the strabismus of children.

Ce travail global a permis d'observer des elements qui doivent etre analyses plus precisement par des investigations complementaires : - influence d'autres positions des art. coxo-femorales (adduction, rotations mediale ou laterale, flexion), ou des genoux (flexion), sur la cinematique de la colonne lombaire et thoracique ; - analyse opto-electronique des variations angulaires des capteurs au cours de la realisation d'un mouvement du tronc dans un plan anatomique ; - determination des mecanismes precis et des structures musculo-ligamentaires concernees par les techniques anatomiques, de comportement des materiaux et de robotique.