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Resume Dans certaines rhizarthroses, la denervation articulaire selective de l’articulation trapezo-metacarpienne (ATM) peut etre proposee. Les resultats observes etant inconstants, le but de notre travail a ete d’etudier l’innervation de l’ATM, afin de determiner la faisabilite technique d’une denervation selective et efficace. Notre etude anatomique a ete realisee par la dissection sous loupes (4,5-x350) de 15 membres superieurs de cadavres frais, sectionnes au niveau du tiers distal de l’avant-bras. Les nerfs disseques etaient le nerf median, avec ses branches thenarienne et cutanee palmaire, ainsi que les rameaux de terminaison de la branche sensitive du nerf radial. Les rameaux articulaires destines a l’ATM ont ete soigneusement identifies, et des prelevements a visee histologique realises afin d’authentifier la nature nerveuse des elements disseques. Toutes les dissections ont retrouve une participation des nerfs radial et median a l’innervation de l’ATM, avec une preponderance pour les rameaux issus du nerf median, de nombre et de calibre relatif plus importants. L’analyse histologique a confirme la nature nerveuse des prelevements. Malgre les constatations de Cozzi en 1960, la branche sensitive dorsale du nerf radial n’a ainsi pas un role exclusif ni preponderant dans l’innervation de l’ATM. La participation du nerf median a l’innervation de l’ATM est plus « importante », notamment par ses branches cutanee palmaire et surtout thenarienne. Realiser une denervation articulaire selective de l’ATM qui soit « totale » semble difficile. En effet, un tel geste comporterait un abord large, et une dissection etendue, source de complications genantes.

A study was made of 100 homogeneous CT scans of the petrous part of the temporal bone to determine whether or not the arcuate eminence (AE) is a good landmark for the superior semicircular canal (SSCC) in the suprapetrous approach to the internal acoustic meatus which is used in the extirpation of acoustic neuromas. Direct measurements were made on consecutive coronal sections, 1 mm thick. The AE was absent from the petrous surface in 15% of cases. It corresponded to the relief of the SSCC in 37% of cases; laterally, however, it was separated from the petrous cortex by bone whose thickness varied from 0.5 to 5 mm. Finally, in 48% of cases, the AE was not a good landmark for the canal although nonetheless it participated in the development of this bulge in 46% of cases, always lying towards the medial border of the pneumatized eminence. In addition, study of the coronal sections with MRI allowed us to confirm that the AE does not routinely correspond to the imprint of a temporal sulcus. The AE, whose presence on the petrous surface is due to the combined effects of the SSCC, the air cells of the petrous part of the temporal bone and the temporal sulci, is only a good guide to the SSCC in 37% of cases and should not be considered as a reliable surgical landmark.

Injury to the mandibular marginal ramus of the facial n. constitutes a risk in cervicofacial surgery. The aims of this study were to define the origin of this nerve branch and its course and relations, especially with the lower border of the mandible and the facial vessels. Our observations revealed differences from the classical description of a single nerve branch traveling on the outer aspect of the body of the mandible above its lower border. We found several marginal branches, which become closely related to the facial pedicle, particularly the intermediate ramus, which can form a neural plexus around the facial a. They may follow a submandibular course, before but also after crossing the facial vessels. They are difficult to classify because of their great variability.

Although rare, ischemic necrosis of the head of the radius after fracture is a theoretic possibility. The epiphyseal vascularisation of the proximal end of the radius was studied by dissection and diaphanisation techniques. The main extra-osseous supply is derived from epiphyseo-metaphyseal arteries given off by the recurrent radial a. and the first collateral of the ulnar a. These, to the number of three or four, anastomose together in a peri-cervical arterial circle continuous with the periosteal vessels of the shaft. From the proximal part of this network there arise three main intra-epiphyseal branches, which traverse the head, but nearly the entire periphery of the osteochondral junction is the site of small periosteal branches penetrating the head, though to no great depth. When the head of the radius is fractured, the commonest displacement is posterolateral, and the main vessel-bearing periosteal layer probably remains intact.

Among conjoined twins (1 out 50000 births), thoracopagus occurs most frequently and is generally lethal. Our anatomical study of five sets of sternopagus twins (3 female, 2 male) was performed to determine the ability of prenatal sonography to detect these anomalies. Autopsy in four cases revealed identical malformations: common sternum, single malformed heart, joined hepatic parenchyma, and a common small bowel leading to a cystic dilatation situated on the ileal segment at the end of the superior mesenteric artery. The diagnosis of conjoined twins was made in all cases by prenatal sonography at the mean time of 24.6 gestation weeks (range 19-34). The malformations detected by prenatal sonography were a single cardiac mass (all cases), joined hepatic parenchymas (3 cases), and an ileal cystic dilatation (1 case). Pregnancy was terminated in four cases. In one case cesarean delivery was performed, and the infants died 48 hours later. Prenatal sonography currently seems to be the best examination for diagnosis of sternopagus twins and the detection of lethal malformations thus allowing interruption of pregnancy.

1/ To report our experience with multivisceral resections in familial adenomatous polyposis (FAP) for extracolorectal lesions in a cohort of nine patients. 2/ Discuss the long term results of an agressive surgery.Nine patients (7 males and 2 females) were operated at the University Hospital of Nimes (N=4) and Nantes (N=5). The median age at the first operation was 29 years (range 18-43). A genetic study was performed in six patients and confirmed the mutation on APC gene (exon 11, 13 and 15). All the patients were operated through a classic laparotomy.All patients have underwent a mean of three operations (range 2-5). Eight patients have had initially a total colectomy and 4 underwent subsequent proctectomy. Seven patients had pancreaticoduodenectomy for extensive duodenal adenomas and/or carcinoma. Three had one or multiple small bowel resections for development of carcinoma and one had partial gastric resection for large adenovillous tumor. The median follow up was 25 years (range 15-37) since the first operation. Three patients were died: one of gastric cancer with hepatic metastases, one of peritoneal carcinosis after ileal resection and one of astrocytoma.With regard to these nine observations, the authors underline the possibility of multivisceral resection in FAP. Despite a major digestive mutilation, it permits a long survival with acceptable quality of life. The prognosis depends on the aggressiveness of the duodenal or jejunoileal lesions more than of the colorectal tumors if found at the first resection.

When the radiological signs are minimal in patients with a painful carpal syndrome involving the trapeziometacarpal joint (TMCJ), selective articular denervation can be proposed as an alternative after failure of conservative treatment. Results have been variable, sometimes disappointing, suggesting the anatomic basis of denervation should be revisited. The purpose of this work was to study the nerve supply to the TMCJ in order to acquire the indispensable elements necessary for performing effective selective articular denervation.This anatomical study was performed by dissection under magnification (4.5-x350) of 15 upper limb cadaver specimens. The median nerve, its thenar and volar cutaneous branches and the terminal sensorial branches of the radial nerve were dissected. Articular branches to the TMCJ were carefully identified. Histological samples were taken to verify the neurological nature of the elements dissected.All TMCJs dissected exhibited radial and median nerve supply. Branches of the median nerve predominated in number and caliber. The volar cutaneous branch gave rise to articular branches in eleven dissections and the thenar branch gave rise to articular branches via a retrograde arciform trajectory between the short abductor and the opponens digiti pollicis in thirteen. For five dissections, the TMCJ branches arose directly from the median nerve within the carpal tunnel. At histological analysis the dissected elements were identified as nerves.There have been few anatomic studies concerning the nerve supply of the TMCJ. Unlike the findings reported by Cozzi in 1960, we did not find the dorsal sensorial branch of the radial nerve to play an exclusive or preponderant role in the innervation of the TMCJ. The median nerve supply to the TMCJ appeared to be more significant, particularly for the volar cutaneous and especially thenar branches.Total and definitive selective denervation of the TMCJ appears to be a most difficult procedure which would require a very wide access and extensive dissection, including the thenar branch which would raise the risk of significant complications.

Rupture of an intra-abdominal varix in a patient with portal hypertension is a rare but severe cause of massive hemoperitoneum. The authors report the case of a patient with alcoholic cirrhosis that presented to the emergency department with hypovolemic shock. Imaging showed massive hemoperitoneum, severe portal hypertension and suggested the diagnosis of spontaneous rupture of an intra-abdominal varix, confirmed at laparotomy.

Cystic dystrophy of heterotopic pancreas is characterized by the presence of cystic formations in the duodenal wall with or without associated pancreatitis. The mechanism by which the cystic dystrophy develops in heterotopic pancreatic pancreas is poorly understood. These lesions are found in young men (40-50 years old) with abusive alcohol intake. The patients are referred for suspected pancreatic neoplasm or for acute pancreatitis. Endoscopic ultrasonography features allow preoperative diagnosis. First line, treatment is medical with parenteral nutrition and octreotide. Then, if the lesions are complicated, surgery (pancreatoduodenectomy or bypass procedure) is indicated.

4 corpses (1 fresh, 3 formoled) without preliminary injection; age: 84 to 90.a front access enabled us to show the origin of the inferior rectal nerve from the pudendal plexus, its course across the Alcook canal and the ischiorectal fossa. Then a posterior transgluteal access showed the short intragluteal course across the "biligamentary tunnel" (between sacrospinal and sacrotuberal ligaments) of nerves and vessels related to the anus, in particular the inconstant Morestin's nerve.the compression of nerves causing perineal pain can occur at different places. Depending on the localisation of the origin and the course of the inferior rectal nerve (which change) in relation to the place of that compression, and also the existence or not of Morestin's nerve, the changing topography of these pains can be explained.

The aim of this study was to define the anatomic characteristics of the principal arterial source of the atrioventricular node, known as the artery of the atrioventricular node. Forty hearts were studied by various anatomic and radiologic methods: dissection, injection-dissection, injection-corrosion and injection-radiography, but only 23 results were interpretable. The right coronary artery represented the commonest arterial source of the atrioventricular node (21/23 hearts) but numerous variations in the origin and topography of the nodal artery were found.

A comparative study of serial anatomic sections in the transverse, frontal and sagittal planes with corresponding MRI sections of the pelvis allowed the authors to define the most suitable sectional planes and MRI modes for a morphologic study of the levator ani muscle. This study shows the value of MRI examination in the assessment of anorectal malformations.

It is possible to have a good definition of structures with modern neuro-imaging. Ophthalmic artery is a neat vessel with lot of branches and sinous pathway, which are difficult to have in the same frame. A good knowledge of the classical anatomy is necessary to interpret correctly the pictures obtained with neuro-imaging. The aim of this study is to compare classical dissections (dissections after latex injection, corrosion with Altufix P.10, radiography after Minimum injections) with radio-anatomical images (computed scanns, angiographies, MRI). We have also studied origin, pathway, collateral branches of ophthalmic artery.

Thirty-five patients with malignant obstructive jaundice were given palliative treatment by percutaneous self-expandable metallic stents. Cholangiocarcinoma was the most frequent cause of biliary obstruction. The stricture was located in the hilum in more of 50% of cases.Adequate biliary drainage was achieved in 97% of cases. Median survival was 182 days. 11% of patients have died within 30 days. Early complications occurred in 31% of patients. 25% of patients have shown recurrent jaundice after an average of 180 days.Percutaneous self-expandable metallic stents are an efficient means treating malignant biliary strictures, particularly of upper biliary obstructions.

Our anatomic findings have led us to define conflictual relations that may be encountered in their course by the pudendal n. and its branches. Starting from the clinical study of a group of patients suffering from chronic perineal pain in the seated position, we have defined, beginning with the cadaver, three possible conflictual settings: in the constriction between the sacrotuberal and sacrospinal ligaments; in the pudendal canal of Alcock; and during the straddling of the falciform process of the sacro-tuberal ligament by the pudendal n. and its branches. Consequently, considering so-called idiopathic perineal pain as an entrapment syndrome, the clinical and neurophysiologic arguments and infiltration tests have led us to define a surgical strategy which has currently given 70% of good results in 170 operated patients. Earlier diagnosis should improve on this.

Implantation of an artificial sphincter is an alternative treatment for patients with severe faecal incontinence. This prospective study from one institution has evaluated the results from 13. Preoperative and postoperative incontinence scores, anal manometry, and quality of life were evaluated in 13 patients who had undergone implantation of an artificial sphincter over a 7-year period. Two patients were definitive failures. One developed acute total colitis after 5 years of satisfactory function, and a second had discomfort and demanded removal of an otherwise functioning device. After a median follow-up of 30 (range 5-76) months, 11 patients had an activated and functional device. These included 6 with a urinary AMS 800 and 5 with the newly designed anal ABS. The mean incontinence score decreased from 17 to 4, and quality of life improved markedly. Two of the 11 patients had undergone successful reimplantation, one following rupture of the cuff and the second following ulceration of the control pump through the labia. In no case was infection or erosion of the anal canal a cause of failure. While the cause of incontinence and age did not affect outcome, psychological reaction had a significant impact. The artificial anal sphincter may have a role to play in severe faecal incontinence.

All cancer staging systems seek to identify clinical and pathological features that can predict outcome or guide therapy. In particular, a non-invasive method for the early detection of disseminating disease would be of great interest. We investigated the use of cytokeratin genes expression to detect blood metastases from colorectal tumors. Epithelial tumor cells were isolated from whole blood using the monoclonal antibody (MAb) BerEP4 and magnetic beads, and detected by reverse transcription-polymerase chain reaction using oligonucleotides derived from the cDNA sequences of cytokeratins 8, 19 and 20. The sensitivity of this assay was determined by spiking SW620 colon carcinoma cells in normal blood. Using cytokeratin 19 expression we were able to detect 1 epithelial tumor cell in 1 ml of whole blood. The clinical applicability of this technique was explored by evaluating patients with a colorectal carcinoma. Epithelial cells were detected in the blood of 12 out of 23 patients, 2 (20%) of 10 with Astler-Coller stage A or B, and 10 (77%) of 13 with stage C or D cancer. In conclusion, this test is a non-invasive, sensitive, and specific assay for detecting circulating epithelial cells in blood. It may be useful for the early diagnosis of disseminating disease, to determine whether the presence of micrometastatic cells at the time of surgery is correlated with an early relapse and for monitoring adjuvant therapeutic trials.

Metastasis to muscle is rare in cancer of the pancreas. We observed one case and reviewed the literature. The role of magnetic resonance imaging and the importance of echoguided needle biopsy for diagnosis is emphasized.

Cystic dystrophy in heterotopic pancreas is characterized by the presence in the duodenal thickened muscularis of cysts corresponding to dilated ducts lined with exocrine epithelium. The pancreas proper is normal. Cystic dystrophy in heterotopic pancreas occurs mostly in men, in the periampullary region. Two cases, revealed by duodenal stenosis, are reported here. Symptoms and morphologic investigations favoured a diagnosis of malignancy: in one case, partial portal thrombosis was observed; this complication has not been previously described in association with cystic dystrophy in heterotopic pancreas. Endosonography was non-contributory in these 2 cases because of duodenal stenosis. A pancreaticoduodenectomy was performed associated in one case with portal thrombectomy. Pathologic findings allowed diagnosis of cystic dystrophy in heterotopic pancreas.

The goal of this study was to analyse the management and the long-term evolution of 40 patients surgically treated for acute colitis (AC) during a 10 year period.From June 1985 to June 1995, 40 patients (22 males and 18 females, mean age: 33,5 y.o.) have been consecutively operated on for AC. Assessment of severity was based on clinico-biological, endoscopic and radiological criterias: AC was complicated in 3, failing to respond to medical therapy in 9, resisting to medical therapy in 28. Sub-total colectomy (STC) with ileostomy and sigmoidostomy was the most frequently performed procedure (27 cases-68%).1) The preoperative diagnosis of colitis was modified 6 times (15%) after histological assessment of the specimen: the final diagnosis was ulcerative colitis, indeterminate colitis and Crohn colitis respectively in 36 (90%), 2, and 2 cases. The established diagnosis had to be modified 4 times during follow-up. 2) Postoperative complications occurred in 5 after STC (18%) and in 4 in the other procedures (31%), without mortality. 3) After a mean follow-up of 55 +/- 10 months of the all series, 7 patients (17,5%) had a stoma: 2 had ileo-anal anastomosis taken down and 2 returned to ileostomy for Crohn disease, 1 patient with protected ileo-rectal anastomosis stayed with an ileostomy, 1 patient refused ileo-anal anastomosis, and 1 with imperforate anus had terminal ileostomy. Respectively 25, 6 and 2 patients had a functional ileo-anal, ileo-rectal, and colo-rectal anastomosis and experienced good to excellent digestive comfort in 85% of the cases.

Angiomyolipoma is a benign mixed mesenchymal tumor. It is a well known entity in the kidney, but very rare in the liver. A case of renal and hepatic angiomyolipoma without no evidence of tuberous sclerosis is presented. This association has been previously described only once before. Radiologic and ultrasonographic findings may be suggestive of the lesion, showing both fatty and hypervascular components. The definitive diagnosis requires histologic and immunohistochemical confirmation by fine needle aspiration biopsy. Surgical excision is unnecessary unless abdominal discomfort is present or malignant tumor is not completely ruled out.

In 1989, we reported our thoughts on the neurophysiological and anatomic aspects of pudendal nerve involvement in certain types of perinal pain. Since that time, the surgical approach has been modified. Here we report our follow-up of 40 patients with 48 operated nerves. Follow-up ranged from 6 months to 7 years and outcome revealed improvement in 67% and no change in 33%. Thus surgery had been useful in two-thirds of the cases; in 44% of the patients, there was either a frank improvement or no change. Early diagnosis appears to be the determining factor in improving results. Operating for the canal syndrome must be performed before lesions to the nervous trunk become too important.

The authors report the case of a 12-year-old girl presenting with a diffuse sclerosing papillary carcinoma of the thyroid. The diagnosis was made on a total thyroidectomy specimen three months after thyroid enlargement was detected. This child had previously been treated medically for thyroiditis because of an enlarged thyroid gland with serum antithyroid autoantibodies. A few cases have been described in the literature. Six morphologic findings define this variant of papillary carcinoma: a diffuse growth pattern involving one or both lobes of the thyroid, prominent fibrosis, heavy lymphocytic infiltration with germinal centers, large numbers of psammoma bodies, squamous metaplasia and papillae within cleft-like tissue spaces. Some authors stated that this variant has a poorer prognosis than the usual papillary carcinoma of the thyroid. However, in some series a few patients survive without local recurrence or distant metastasis at a mean follow-up period of more than 10 years. Immunohistochemical studies have shown high accumulation of S-100 protein positive dendritic cells. Such an infiltration has been correlated with a better prognosis.

The problems arising from the discovery of a colorectal tumor during an infectious endocarditis caused by Streptococci D have rarely been mentioned in the surgical literature. The frequency of association of an asymptomatic colorectal tumor and of a Streptococcus bovi endocarditis is now undisputed. This notion implies the systematic search for an intestinal lesion (adenoma or carcinoma) in case of endocarditis or septicemia without involvement of the valves, caused by a streptococcus of group D. The authors report about 3 cases of enterococcal (1 case) and S. bovis (2 cases) infectious endocarditis revealing a colic adenocarcinoma (2 cases) and a villous adenoma (1 case), all being perfectly latent. The specific therapeutic problems arising from this association are outlined, including the antibiotic therapy, the role of the anticoagulant treatment and the priority given to valve surgery in case of hemodynamic instability.

Technical alternatives in conservative proctocolectomy are presently investigated to improve the safety and the functional results of the operation. Abdominal transection of the rectum is not always satisfactory in this procedure. A new technique of stapled anastomosis is described: after full mobilization and eversion of the rectum, this latter is closed using a linear stapler and cut immediately above the anal canal via a perineal access; a 18 cm long J pouch is constructed and the anastomosis is stapled using the new premier EEA instrument through the staple line of the previously transected anorectal junction. This technique has been evaluated in dogs (N = 10): colo-anal anastomosis was easy, quick, and safe to perform. Clinical, radiological and gross results have confirmed the quality of these circular stapled anastomoses through an inverting linear suture of the anorectal junction. Clinical experience is actually based on 7 patients operated since January 1989 (proctocolitis: 3, polyposis: 4). The value of the technique was confirmed with ileostomy closure at 3 months for the 7 patients and good functional results. This method has several advantages: 1) to retain all of the anal canal, 2) to avoid prolonged anal dilatation, 3) to perform a rapid and safe stapled anastomosis.

The etiological diagnosis of obstruction is difficult during pregnancy. The authors report 3 cases of this rare association: obstruction due to adhesions [1], volvulus of the transverse colon on a common mesentery [1] and obstruction due to an appendix abscess [1]. Complementary investigations, obviously limited under these circumstances, were based on plain abdominal X-rays, repeated if necessary. The diagnosis must be made early and appropriate treatment given in order to ensure a good materno-fetal prognosis as was obtained in these 3 cases.

Fifteen patients with biliopancreatic carcinoma were treated by monoclonal antibodies (12 pancreatic adenocarcinomas, 3 bile duct carcinomas). In 7 cases, a tumor resection was associated with immunotherapy: 5 partial pancreatic resections for stage III and IV disease, according to Hermreck's classification, and 2 biliary resections (Whipple resection for distal duct tumor, biliary and liver resection for proximal bile duct tumor). We use the 17-1.A antibody, an IgG-2a murine monoclonal antibody, either isolated (6 cases) or in association with other monoclonal antibodies (4 cases) or gamma IFN (5 cases). All of these patients underwent leukapheresis. Response to 17-1.A therapy was evaluated by laboratory tests (CA 19-9) and by morphological investigations (US, CT, radioimmunolocalization scanning). The median survival of patients with unresectable pancreatic carcinoma (7 cases), was 7.4 months. For pancreatic adenocarcinoma, treated by resection associated with immunotherapy (5 cases), the median survival was 21 months. Monoclonal antibody therapy was effective in a third of evaluated pancreatic adenocarcinomas (4 clear objective responses) but only transiently except in one patient still alive after 57 months. The low rate of therapeutic responses may been attributed to inadequate doses and the development of human anti-murine antibodies.

Eleven cases of rupture of bladder were observed within 7 years. Four of them were due to a direct trauma on a full bladder (group I), the other seven occurred during a complex trauma, constantly with a fracture of the pelvis (group II). In group I, the rupture was situated on the apex of the bladder. The symptoms were a suprapubic pain in four patients, a hematuria in two, and an anuria in one. In the four patients, intraperitoneal fluid was clinically evident, and confirmed ultrasonographically. An urography was performed in two patients and showed an intraperitoneal leak in our patient, and intravesical clots in the other one. The four patients were operated on within 48 hours, and were successfully treated by suture and vesical catheter. In group II, the vesical injury was revealed by hematuria (2 patients) hemorragic shock (2 patients) or both (2 patients). In the last patient, an abdominal pain after 10 days was the only symptom. Clinical signs of hemoperitoneum were present in only four patients and were confirmed ultrasonographically in two out of five patients. The urogram was normal in two of four patients. In one patient it showed a small bladder, and in another one a vesical leak. Five patients were operated on among where three in emergency and two after 9 and 10 days. Four patients with intraperitoneal rupture were successfully tread by suture of the bladder. Among three patients with extraperitoneal rupture, one had an additional tear of the mesentery and died from intravascular coagulation, the second was successfully treated by a suture, and the last one by a vesical catheter only.(ABSTRACT TRUNCATED AT 250 WORDS)

Bowel preparation is frequently impossible in various acute colonic diseases, such as left-sided colonic obstruction. The goal of intraoperative colonic irrigation is to obtain, during surgery, a bowel preparation offering the possibility of primary resection with immediate anastomosis, when pre-operative bowel preparation has not been feasible. Technical aspects of intra-operative colonic irrigation are described. Indications for this method are presented: left-sided obstructing carcinomas, diverticulitis, more rarely inflammatory stenosis or functional obstruction.

We report three cases of young female patients (26, 30, 36 years) with intraperitoneal hemorrhage associated with a rupture of a liver cell adenoma. Their topography was central or with central extension. Three patients had taken oral contraceptives, for a period of 10 years, before diagnosis in two cases and for only three weeks in the remaining patient. The diagnosis of hemoperitoneum from a liver tumor was established on initial symptoms and ultra sonographic examination. Angiography and CT were the most valuable investigations. The control of hemorrhage was obtained by hepatic artery ligation (2 cases) and angiographic embolization (1 case). We observed one patient with liver adenomatosis, uncommon lesion consisting of numerous adenomas in an otherwise normal hepatic parenchyma. In emergency major hepatic resection for an adenoma, in central localization, is too a high risk procedure for a benign tumor. Control of hemorrhage should be the aim of treatment, best achieved by alternative treatment, such as hepatic artery ligation of angiographic embolization, highly effective in our experience. Resection may be delayed for a residual tumor.

La frequente lesion du RMM lors de la chirurgie cervico-faciale est a l'origine de nombreuses tentatives de systematisation de ce rameau. Toutes concluent a son extreme variabilite qui explique sa vulnerabilite.

The authors describe the anatomical basis of splenorenal anastomosis via the retroperitoneal approach. This technique can be used in cases where the transperitoneal approach is contraindicated.

The action of the omohyoid muscle on the hemodynamics of the internal jugular vein is controversial. For some authors, contraction of this muscle, by tightening the cervical fascia, promotes jugular venous return. For others, contraction of this muscle compresses the jugular vein in its cervical path. With this latter point in mind, the hemodynamics of the internal jugular vein have been studied in its cervical path by echography in 10 healthy volunteers. One hundred twenty measurements of the venous surface were made at rest, with the mouth open and during deep inspiration. In the last 2 situations, evidence of a significant increase in the venous surface was found above the omohyoid muscle. These data confirm the role of compression of the vein by the omohyoid muscle, leading to modifications in intracerebral venous hemodynamics, which can be affected in yawning.

L'Altufix P 10 est une nouvelle masse d'injection des cavites ou des vaisseaux. Le moulage de structures est obtenu sans retraction de volume, lors de la dessiccation. Des structures tres fines peuvent etre injectees. La technique est simple, mais longue (2 mois). Le moulage est fragile et doit etre manipule avec precaution. Cette technique donne d'excellents moulages des cavites du coeur et des arteres coronaires.

Les veines sus-hepatiques, longtemps considerees comme un element secondaire de l'architecture vasculaire du foie, prennent actuellement un grand interet avec le developpement de la chirurgie hepatique.

Ce travail montre l'originalite du lobe caude due a son origine embryologique particuliere. Morphologiquement, les PC et PP sont constants et separent 2 territoires independants. Cette separation retrouvee en anatomie comparee est importante puisqu'elle autorise l'exerese isolee d'une partie de ce lobe caude.

L'identification et l'abord des nerfs erecteurs (nervi erigentes) en vue d'une resection nerveuse peut s'averer delicate. Leur dissection vient rappeler la complexite de leur anatomie macroscopique. Elle conduit a considerer leur segment initial tendu entre les racines nerveuses sacrees d'origine et le plexus hypogastrique comme le seul segment chirurgical.

The contents of the infratemporal fossa have been studied using CT scans, anatomical dissections and radiography of the anatomical specimens. On the strength of this, 3 distinct regions are discernable: the anterior part of the fossa contains the fat pad of the cheek and this area corresponds to the retromaxillo-zygomatic region; the region of the pterygoid m. contains vascular structures and lies behind the preceding region; the pterygopalatine fossa, formerly considered the deepest part, extends the infratemporal fossa superiorly and medially. These anatomical and radiographic findings could serve as a guide to maxillo-facial surgeons dealing with expanding lesions within the infratemporal fossa, or invading it from adjacent regions.

Les resultats de notre etude echographique de la veine jugulaire interne confirmeraient la compression de la veine lors de la contraction du m. omo-hyoidien. Les donnees fragmentaires de la litterature concernant, par exemple, les relations entre l'ouverture de la bouche et les modifications de pression du LCR, suggerent que l'action du m. omo-hyoidien peut etre liee au reflexe du bâillement, lui-meme tres mal connu. Une etude synthetique de l'ensemble des phenomenes que nous avons evoques sera necessaire.

The great variety of anatomical dispositions of the azygos system explains its facility of adaptation. The second lumbar vein is able to play a buffer role between the caval systems or, conversely, is able to direct venous flow to a preferential system. In case of portal hypertension, an inferior omphalo-azygos flow by the right ascending lumbar vein was noticed. Finally, the left venous system may either be the major element of the azygos system (mainly by a big ascending lumbar vein) or be divided in 2 distinct streams to the azygos venous trunc. The final disposition of the azygos system seems to correlate well with a progressive evolution towards an unique trunc, linking directly the two caval systems (this being confirmed by foetal data). Practically, the study of the arterial and venous relations of the azygos crossing have interesting applications in surgery.