136 results on '"Jean François Uhl"'
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2. Anatomy Studio II A Cross-Reality Application for Teaching Anatomy.
- Author
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Joaquim Jorge 0001, Pedro Belchior, Abel João Padrão Gomes, Maurício Sousa, João Pereira 0001, and Jean-François Uhl
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- 2022
- Full Text
- View/download PDF
3. Adjustable compression wraps: stretch, interface pressures and static stiffness indices
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Jean-Patrick BENIGNI, Jean-François UHL, Pascal FILORI, Florence BALET, and Liliane PENOEL
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Cardiology and Cardiovascular Medicine - Published
- 2023
4. 3D Vector Reconstruction of the Muscles of the Ventral Region of the Neck from Anatomical Sections of Korean Visible Human at the Paris Descartes Anatomy Laboratory
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Abdoulaye Kanté, Jean François Uhl, Mariam Daou, Babou Ba, Tata Touré, Ousmane Touré, Yatera Demba, Moumouna Koné, Drissa Traoré, ouhoum Ongoïba, and Abdel Karim Koumaré
- Published
- 2022
5. Three-dimensional reconstruction of the upper limb from anatomical slices of the Korean visible human: simulation and educational application
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Vincent Delmas, R. Dukan, Maxime Chahim, E. H. Masmejean, and Jean-François Uhl
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medicine.medical_specialty ,Dissection table ,business.industry ,Interface (computing) ,3D reconstruction ,Human body ,Virtual reality ,Pathology and Forensic Medicine ,Dissection ,medicine.anatomical_structure ,medicine ,Upper limb ,Radiology, Nuclear Medicine and imaging ,Surgery ,Medical physics ,Anatomy ,Duration (project management) ,business - Abstract
Digital anatomy is a novel emerging discipline. Use of virtual reality brings a revolution in educational anatomy by improving retention and learning outcomes. Indeed, virtual dissection is a new learning tool for students and surgeons. Three-dimensional vectorial models of the human body can be created from anatomical slices obtained by lengthy series of cryosection from the visible human projects. The aim of this paper is to show how these mesh models could be embedded into an Acrobat® 3dpdf interface, to produce an easy-to-use fully interactive educational tool. The learning of this method and its practical application were evaluated on a multicentric cohort of 86 people divided into 3 groups, according to the duration of their training (1, 2 or 3 days, respectively). Participants learned how to use the Mesh tool and how to model 3D structures from anatomical sections. At the end of the training, they were given a survey form. Participants were also asked to rate the training (Poor; Average; Good; Very Good; Excellent). Ninety four percent of the subjects rated the device as excellent and would continue to use digital anatomy in their practice. This result is the Diva3d® virtual dissection table, a powerful educational tool for anatomists and students. It could also be the basis of future simulation tools for hand surgeons training.
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- 2021
6. Anatomy of Perforating veins of the lower limb
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C. Gillot and Jean-François Uhl
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03 medical and health sciences ,0302 clinical medicine ,media_common.quotation_subject ,Art ,Anatomy ,030204 cardiovascular system & hematology ,030230 surgery ,Perforating veins ,Cardiology and Cardiovascular Medicine ,Lower limb ,media_common - Abstract
ZusammenfassungDie Perforansvenen (PV) der unteren Extremitäten sind nicht nur gerade und direkte Verbindungen zwischen den tiefen und oberflächlichen Venennetzen, sondern bilden gemeinsam ein weit verzweigtes Netz. Trotz ihrer starken anatomischen Variabilität ist ihre Position bemerkenswert konstant und prognostizierbar. Dies ist durch ihre enge Beziehung zu den Muskelvenen bedingt und durch die hämodynamischen Ebenen entlang der Extremität zu erklären. Sie sind bei der Beurteilung durch Ultraschalluntersucher in der täglichen Praxis eine Hilfe.Der anatomische Inhalt dieses Artikels stammt aus folgenden Quellen: Anatomische Präparationen von C. Gillot nach Latex-Injektion und anschließender farblicher Unterteilung von über 400 Extremitäten. Dreidimensionale Rekonstruktionen von CT-Venografien von 1200 Extremitäten und präoperativen Hautvenenvermessungen von 25 000 Extremitäten.Es wird Folgendes beschrieben: Referenzpunkte der Extremität, Perforansvenen des Fußes, Beins und Sprunggelenks, der Wade, Anastomosen zwischen den Perforansvenen, Begleitarterien der Bein-PVs und Oberschenkel-PVs.
- Published
- 2021
7. 3D Vector Reconstruction of the Cerebellum from Anatomical Sections of Korean Visible Human at the Clinical and Digital Anatomy Laboratory of Paris Descartes University
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Mariam Daou, Hassan Brahima Diallo, Youssoufa Maiga, Jean François Uhl, Nouhoum Ongoïba, Abdoulaye Kanté, and Jin Seo Park
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Cerebellum ,medicine.anatomical_structure ,media_common.quotation_subject ,medicine ,Art ,Anatomy ,Euclidean vector ,media_common - Published
- 2021
8. 3D Vector Reconstruction of the Neck Skeleton from the Anatomical Sections of Korean Visible Human at the Anatomical Laboratory of Paris Descartes
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Moumouna Koné, Babou Ba, Vincent Delmas, Nouhoum Ongoïba, Tata Touré, Jean-François Uhl, Ousmane Touré, Mariam Daou, Abdoulaye Kanté, Youssouf Sidibé, Drissa Traoré, Demba Yatera, and Bréhima Coulibaly
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Contouring ,medicine.anatomical_structure ,Sternum ,Computer science ,Hyoid bone ,3D reconstruction ,medicine ,Segmentation ,Anatomy ,Skeleton (computer programming) ,Euclidean vector ,Cervical vertebrae - Abstract
Aim: To perform a vector 3D reconstruction of the neck skeleton from the anatomical sections of the “Korean Visible Human” for educational purposes. Material and Methods: The anatomical subject was a 33-year-old Korean male who died of leukemia. It measured 164 cm and weighed 55 kgs. The anatomical cuts were made in 2010 after an MRI and a CT scan. A special saw (cryomacrotome) made it possible to make cuts on the frozen body of 0.2 mm thick or 5960 slices. Sections numbered 1500 to 2000 (500 neck sections) were used for this study. Manual contouring segmentation of each anatomical element of the anterior neck area was done using Winsurf software version 3.5 on a PC. Results: Our vector 3D neck model includes the following: cervical vertebrae, hyoid bone, sternum manubrium and clavicles. This vector model has been integrated into the virtual dissection table Diva3d, a new educational tool used by universities and medical schools to learn anatomy. This model was also put online on the Sketchfab website and printed in 3D using an ENDER 3 printer. Conclusion: This original work is a remarkable educational tool for the study of the skeleton of the neck and can also serve as a 3D atlas for simulation purposes for training therapeutic gestures.
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- 2021
9. Tridimensional Vectorial Modeling of the Human Body From Anatomical Slices
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Jean François Uhl, Vincent Delmas, Rodolphe Burgade, Guillermo Daniel Prat, Barbara Constanza Lorea, Camillo Ruiz, and Joaquim Armando Jorge
- Abstract
Digital anatomy has emerged as an essential subfield of anatomy that processes the human body with the help of a computer. 3D reconstruction tools have been developed over the years, being always complementary to cadaver dissection. Teachers' main goal is to provide a greater understanding of the spatial structures of the body and its internal organs thanks to 3D reconstruction techniques. Manual segmentation and creation of 3D vectorial models is probably the best anatomy learning tool for beginners and students. The aim of this chapter is to show how to create vectorial models from anatomical slices with Winsurf® software, highlighting their educational value. Resulting 3D models could also be used through the interface of virtual dissection, which has been proven to be immensely valuable for anatomy education, particularly by using immersive reality techniques. It could also be the basis of future simulation tools for surgeon training.
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- 2022
10. Anatomy Studio: A tool for virtual dissection through augmented 3D reconstruction
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José João Mendes, Joaquim Jorge, José Mogorron, Daniel Simões Lopes, Ezequiel Roberto Zorzal, Jean-François Uhl, Pedro Silva Rodrigues, Maurício Sousa, Vincent Delmas, Soraia Figueiredo Paulo, Daniel Mendes, Daniel Medeiros, and Rafael Kuffner dos Anjos
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Computer science ,3D reconstruction ,General Engineering ,020207 software engineering ,02 engineering and technology ,Anatomy ,Medical image segmentation ,Tracing ,Collaboration ,Computer Graphics and Computer-Aided Design ,Mixed reality ,Human-Computer Interaction ,Dissection ,Group discussion ,0202 electrical engineering, electronic engineering, information engineering ,020201 artificial intelligence & image processing ,Manual segmentation ,User interface ,Tablet ,Studio - Abstract
"3D reconstruction from anatomical slices allows anatomists to create three dimensional depictions of real structures by tracing organs from sequences of cryosections. However, conventional user interfaces rely on single-user experiences and mouse-based input to create content for education or training purposes. In this work, we present Anatomy Studio, a collaborative Mixed Reality tool for virtual dissection that combines tablets with styli and see-through head-mounted displays to assist anatomists by easing manual tracing and exploring cryosection images. We contribute novel interaction techniques intended to promote spatial understanding and expedite manual segmentation. By using mid-air interactions and interactive surfaces, anatomists can easily access any cryosection and edit contours, while following other user’s contributions. A user study including experienced anatomists and medical professionals, conducted in real working sessions, demonstrates that Anatomy Studio is appropriate and useful for 3D reconstruction. Results indicate that Anatomy Studio encourages closely-coupled collaborations and group discussion, to achieve deeper insights." info:eu-repo/semantics/publishedVersion
- Published
- 2019
11. Vector 3D Reconstruction of the Nerves of the Ventral Region of the Neck from Anatomical Sections of Korean Visible Human at the Laboratory of Digital Anatomy of Paris Descartes
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Mariam Daou, Tata Touré, Bréhima Bengaly, Nouhoum Ongoïba, Abdoulaye Kanté, Yattera Demba, Babou Ba, Jean-François Uhl, Drissa Traoré, Vincent Delmas, and Bréhima Coulibaly
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media_common.quotation_subject ,3D reconstruction ,Nerves of the Ventral Region of the Neck, Korean Visible Human, 3D Vector Reconstruction, Diva3d Virtual Dissection Table, Teaching ,Anatomy ,Art ,media_common - Abstract
Objective: To carry out a 3D vector reconstruction of the nerves of the ventral region of the neck from anatomical sections of the “Korean Visible Human” for educational purposes. Materials and Methods: The anatomical subject was a 33-year-old Korean man who died of leukemia. He was 164cm tall and weighed 55kgs. A cryomacrotome sectioned the frozen body into 5960 sections. Sections numbered 1500 to 2000 were used for this study. A segmentation by manual contouring of each nervous anatomical element of the ventral region of the neck was done using Winsurf version 3.5 software on a laptop PC running Windows 10 equipped with an 8 gigabyte RAM. Results: Our vector 3D model of nerves in the ventral neck region includes the brachial plexuses, vagus nerves, inferior and superior laryngeal nerves, glossopharyngeal nerves, hypoglossal nerves and spinal nerves. This vector model has been integrated into the Diva3d virtual dissection table. It was also uploaded to the Sketchfab website and 3D printed using an ENDER 3 printer. Conclusion: Our 3D reconstruction of the nerves of the ventral region of the neck is an educational tool for learning the nerves of the ventral region of the neck and can also serve as a 3D atlas for simulation purposes for training in therapeutic gestures.
- Published
- 2021
12. Limitations to self-management of adjustable compression wraps in the elderly: results of a prospective cohort study
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Jean-Patrick Benigni, M. Chahim, Florence Balet, Jean-François Uhl, Pascal Filori, CIC Pitié BT, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), and Sorbonne Université (SU)
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medicine.medical_specialty ,Chronic venous insufficiency ,[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,030230 surgery ,03 medical and health sciences ,Nursing care ,0302 clinical medicine ,Compression Bandages ,Humans ,Medicine ,Lymphedema ,Prospective Studies ,Prospective cohort study ,Aged ,Leg ,Self-management ,business.industry ,Self-Management ,Limiting ,Compression (physics) ,medicine.disease ,3. Good health ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Social status - Abstract
Background Adjustable compression wraps are used for treating lymphedema and chronic venous insufficiency. These diseases often affect elderly patients with associated pathologies or other limiting factors. These can prevent the self-application of the device by patients on themselves. A better understanding of these factors or the associated pathology in the elderly is important before prescribing or not prescribing a wrap. Methods The objective of this prospective cohort study was to determine the main factors that prevent the self-application of the device (Circaid Juxtalite, Medi Italia S.r.l., Bologna, Italy) to the lower limb in the elderly. A private nurse selected the first 30 retired subjects over 65 years of age seen at home for routine nursing care. After a demonstration, she asked them to put on the wrap to reach a pressure of 40 mmHg in the calf (point B1). She recorded the pressures as the subjects applied the wrap twice in a row. The next day, the subject repeated the application of the wrap twice. We considered that an average pressure of more than 30 mmHg is recommended to treat venous edema or ulceration. Results Thirty percent of the subjects put on the wrap by themselves with an average pressure of at least 30 mmHg. Age is not a limiting factor. Obesity, gripping difficulties, cognitive impairment and low social status seem to be factors limiting the daily self-management of an adjustable compression wrap in the elderly. Conclusions The self-management of adjustable compression wraps in the elderly person encounters obstacles that need to be known. The investigation has revealed that obesity, gripping difficulties, cognitive impairment and low social status are limiting factors. Age was not shown to be a limiting obstacle.
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- 2021
13. From Anatomical to Digital Dissection: A Historical Perspective Since Antiquity Towards the Twenty-First Century
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Pedro Campos, Daniel Simões Lopes, Jean-François Uhl, Joaquim Jorge, and Vincent Delmas
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Flexibility (engineering) ,Cognitive science ,Engineering ,Dissection ,Interactivity ,business.industry ,Perspective (graphical) ,Twenty-First Century ,Cadaver dissection ,Human body ,business ,Anatomical dissection - Abstract
As the oldest medical craft, anatomy remains the core and foundational field of medicine. That is why anatomy is in perpetual advancement, thanks to the technical progress in exploring the human body through computer science and biomedical research. Knowledge of the human body is the basis of medicine. Classical cadaver dissection, the standard discovery tool for centuries, is both unique and destructive of the surrounding tissues. For many years, anatomists have sought to preserve the shape of dissected organs for reference, teaching, and further inspection through different methods. Wax models make a copy of selected dissections. Vessel or duct injection with resin is another dissection-preserving technique. However, all these anatomical objects are unique in time and frozen in place. In contrast, modern Digital Anatomy aims to preserve structures from dissection in flexible ways. Then deliver the results quickly, flexibly, reproducibly, and interactively via advanced digital tools. Thus, computer-aided anatomical dissection addresses the limitations of classical dissection. Through it, experienced anatomists recognize the structures previously segmented with dedicated software to create accurate 3D models from macro or microscopic slices. Its interactivity, flexibility, and endless reusability make digital dissection a perfect tool for educational anatomy. This chapter explores the history of anatomical studies from their inception to the twenty-first century related to the remainder of the book.
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- 2021
14. 3D Modeling from Anatomical and Histological Slices: Methodology and Results of Computer-Assisted Anatomical Dissection
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Maxime Chahim and Jean-François Uhl
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business.industry ,3D reconstruction ,Anatomical structures ,Medicine ,Manual segmentation ,Hypogastric Plexus ,Anatomy ,business ,3D modeling ,Morphological segmentation ,Anatomical dissection ,Pelvic surgery - Abstract
Computer-Assisted Anatomical Dissection (CAAD) is a new method of 3D reconstruction of anatomical structures from histological or anatomical slices. It uses staining and immunomarking of the tissues for a more precise identification, in particular for the nerves and the vessels, leading to an easy morphological segmentation. Starting from a digitalized series of transverse histological sections, we perform a staining by immune-markers (protein S100, VAChT and D2-40), then alignment of the slices and finally a manual segmentation of the main anatomical structures by using the Winsurf® software version 3.5. This chapter shows the results of CAAD in embryology and for the pelvic nerves in adults. Its main interest is in the field of pelvic surgery for cancer, to improve the knowledge of the pelvic nervous anatomy and preserve the inferior hypogastric plexus. It is also an original method to provide 3D reconstruction of the human embryo, and so bring us an improved understanding of embryogenesis.
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- 2021
15. The Virtual Dissection Table: A 3D Atlas of the Human Body Using Vectorial Modeling from Anatomical Slices
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Jean-François Uhl, Maxime Chahim, and José Mogorron
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Interface (Java) ,Computer science ,business.industry ,Visible human project ,Human body ,Virtual reality ,JavaScript ,projects ,Software ,projects.project ,Human–computer interaction ,Segmentation ,User interface ,business ,computer ,computer.programming_language - Abstract
Teaching morphological sciences’ suffers from the lack of human corpses for dissection due to ethical or religious issues, worsened by increasing students’ demand for educational anatomy. Fortunately, the technological revolution now put at our disposal new virtual reality tools to teach and learn anatomy. These multimedia tools are changing the way students engage and interact with learning material: they can engage in meaningful experiences and gain knowledge. This evolution is particularly true for the virtual dissection table, based on 3D vectorial atlases of the human body. This chapter describes the manual segmentation methodology from the anatomical slices of the Korean visible human project with Winsurf® software. Although using the same slices, our segmentation technique and refinement of the 3D meshes are quite different from the Korean team (Ajou University, Seoul, Korea). The resulting 3D vectorial models of the whole body of men and women include 1300 anatomical objects. After improvement with a modeler (Blender® version 4.79), we export 3D atlas into a “.u3d” format to take advantage of the powerful interface of the 3Dpdf Acrobat® file working in four different languages. The user interface is simplified by a touch screen to manipulate and dissect the virtual body with three fingers easily. Anatomical regions, systems, and structures are selected and controlled by javascript buttons. We developed this educational project under the Auspices of the Unesco chair of digital anatomy (www.anatomieunesco.org).
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- 2021
16. Les veines perforantes trans-osseuses du genou
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Jean François Uhl
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Cardiology and Cardiovascular Medicine - Published
- 2022
17. Where should stiffness be measured in vivo?
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Jean-François Uhl, Jean-Patrick Benigni, and André Cornu-Thenard
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compression, stiffness index. ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Three points in the medial aspect of the leg are routinely used to measure the interface pressure of a compression: the C point, at the largest circumference of the calf; the B point, at the smallest circumference of the leg; the anatomical B1 point, at the apex of the gastrocnemius muscle and the manufacturer’s B1 point, computed in the midline of the line joining the B point to the C point). The anatomical B1 point is the most reliable point from a practical point of view, and is easier to use. The underlying anatomy is the Soleus muscle. Stiffness at the anatomical B1 point seems adequate sufficient to assess stiffness of a medical device in vivo.
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- 2013
- Full Text
- View/download PDF
18. Feasibility of a fetal anatomy 3D atlas by computer-assisted anatomic dissection
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Vincent Balaya, Alexis Guédon, Salma El Batti, Jean-François Uhl, Fabien Guimiot, Richard Douard, Matthieu Bruzzi, Martin Lhuaire, Jean-Marc Chevallier, and University of Lausanne (UNIL)
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[SDV]Life Sciences [q-bio] ,Sural nerve ,Gestational Age ,Pelvis ,Masson's trichrome stain ,03 medical and health sciences ,User-Computer Interface ,0302 clinical medicine ,Atlases as Topic ,Fetus ,Imaging, Three-Dimensional ,Morphogenesis ,Medicine ,Humans ,030219 obstetrics & reproductive medicine ,Paraffin Embedding ,business.industry ,Dissection ,Obstetrics and Gynecology ,Brain ,Anatomy ,Microtomy ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Reproductive Medicine ,Lower Extremity ,Ventricle ,In utero ,030220 oncology & carcinogenesis ,Embryology ,Feasibility Studies ,Sciatic nerve ,Autopsy ,business - Abstract
Objective To assess the feasibility of 3D modelisation of fetal anatomy by using the Computer-assisted anatomic dissection (CAAD) based on immunolabeled histologic slices and MRI slices with a specific 3D software. Study design For pelvis and lower limbs, subjects came from legal abortion, medical pregnancy termination, or late miscarriage. Specimens were fixed in 10 % formalin, then embedded in paraffin wax and serially sectioned. The histological slices were stained using HES and Masson Trichrome. Protein S-100 and D2−40 markers were used for immuno-labelling. Serial transverse sections were digitalized and manually aligned. Fetal brain slices were obtained from in utero or post-mortem MRI. Results CAAD was performed on 10 fetuses: pelvis was modelised with 3 fetuses of 13, 15 and 24 W G, lower limbs with 2 fetuses of 14 and 15 W G and brain with 5 fetuses aged between 19 and 37 W G. Fetal pelvis innervation was analysed after immunolabelling and nerves appeared proportionally bigger than in adults with the same topography. Lower limbs analysis revealed that nerve development was guided by vascular development: the sciatic nerve along the big axial vein, the saphen nerve along the big saphen vein and the sural nerve along the small saphen vein. Fetal brain study allowed to describe the gyration process and the lateral ventricle development. Conclusion CAAD technique provides an accurate 3D reconstruction of fetal anatomy for lower limbs and pelvis but has to be improved for brain model since midline structures were not amendable for analysis. These results need to be confirmed with larger series of specimens at different stages of development.
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- 2020
19. Digital Anatomy : Applications of Virtual, Mixed and Augmented Reality
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Jean-François Uhl, Joaquim Jorge, Daniel Simões Lopes, Pedro F. Campos, Jean-François Uhl, Joaquim Jorge, Daniel Simões Lopes, and Pedro F. Campos
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- Virtual reality in medicine, Human anatomy--Data processing, Virtual reality in education
- Abstract
This book offers readers fresh insights on applying Extended Reality to Digital Anatomy, a novel emerging discipline. Indeed, the way professors teach anatomy in classrooms is changing rapidly as novel technology-based approaches become ever more accessible. Recent studies show that Virtual (VR), Augmented (AR), and Mixed-Reality (MR) can improve both retention and learning outcomes. Readers will find relevant tutorials about three-dimensional reconstruction techniques to perform virtual dissections. Several chapters serve as practical manuals for students and trainers in anatomy to refresh or develop their Digital Anatomy skills. We developed this book as a support tool for collaborative efforts around Digital Anatomy, especially in distance learning, international and interdisciplinary contexts. We aim to leverage source material in this book to support new Digital Anatomy courses and syllabi in interdepartmental, interdisciplinary collaborations. Digital Anatomy – Applications of Virtual, Mixed and Augmented Reality provides a valuable tool to foster cross-disciplinary dialogues between anatomists, surgeons, radiologists, clinicians, computer scientists, course designers, and industry practitioners. It is the result of a multidisciplinary exercise and will undoubtedly catalyze new specialties and collaborative Master and Doctoral level courses world-wide. In this perspective, the UNESCO Chair in digital anatomy was created at the Paris Descartes University in 2015 (www.anatomieunesco.org). It aims to federate the education of anatomy around university partners from all over the world, wishing to use these new 3D modeling techniques of the human body.
- Published
- 2021
20. The 2020 update of the CEAP classification system and reporting standards
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Fedor Lurie, Michael C. Dalsing, Tomasz Urbanek, Elna Masuda, Patrick Carpentier, Nicos Labropoulos, William A. Marston, Bo Eklof, Gregory L. Moneta, Peter Gloviczki, Mark Meisner, Anthony Gasparis, Marianne De Maeseneer, Andre M. van Rij, Jean-François Uhl, Robert L. Kistner, Marc A. Passman, Ruth L. Bush, Thomas W. Wakefield, Michel Perrin, Joseph Rafetto, Fabricio Santiago, Peter F. Lawrence, Cynthia K. Shortell, John Blebea, Harold J. Welch, Frank T. Padberg, and Dermatology
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medicine.medical_specialty ,Consensus ,Delphi Technique ,Delphi method ,030204 cardiovascular system & hematology ,Corona phlebectatica ,Severity of Illness Index ,Postthrombotic Syndrome ,Veins ,Varicose Veins ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Terminology as Topic ,Varicose veins ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Ceap classification ,Evidence-Based Medicine ,Task force ,business.industry ,Prognosis ,Venous Insufficiency ,Chronic Disease ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions. In May of 2017, the American Venous Forum created a CEAP Task Force and charged it to critically analyze the current classification system and recommend revisions, where needed. Guided by four basic principles (preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical for clinical use), the Task Force has adopted the revised Delphi process and made several changes. These changes include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier "r" for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. This report describes all these revisions and the rationale for making these changes.
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- 2019
21. Effects of compression stockings and leg positions on the caliber of the reticular veins
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Jean-François Uhl, Jean-Patrick Benigni, and Maxime Chahim
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Male ,Leg ,business.industry ,medicine.medical_treatment ,Posture ,Compression stockings ,Compression (physics) ,Healthy Volunteers ,Veins ,Caliber ,Calibration ,Healthy volunteers ,Reticular connective tissue ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Stockings, Compression ,Biomedical engineering - Published
- 2019
22. Sizing of medical below-knee compression stockings in an Indian population: A major risk factor for non-compliance
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Jean-Patrick Benigni, Ravul Jindal, and Jean-François Uhl
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,India ,Compression stockings ,030204 cardiovascular system & hematology ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Non compliance ,medicine ,Humans ,Risk factor ,Aged ,Leg ,business.industry ,Indian population ,General Medicine ,Middle Aged ,Sizing ,Compliance (physiology) ,Physical therapy ,Patient Compliance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Stockings, Compression - Abstract
Background The compliance to compression stockings in India is poor. One of the reasons is related to the inadequacy of sizing tables of compression stockings sold in India by western companies. Methods In 922 Indian patients, three circumference measurements of leg were taken in a standing position at different levels: Instep (level Y), Ankle (level B) and largest part of the calf (level C). We compared these measurements with the standard sizing tables according to the recommendations of the manufacturers’ sizing tables. The statistical analysis method: mean comparison of the circumferences was tested with the Wilcoxon test. Result The measurements found do not allow a satisfactory adaptation of compression stockings marketed in India by Medi®, Sigvaris® and Jobst®. The risk of threading difficulties is 15% with Medi® and Sigvaris® compression stockings. The risk of slippage is 61% for Sigvaris® and 48% for Medi®. With the Jobst® sizing table, no knitting makes it possible to reach a pressure at point C equal to at least 50% of the pressure of point B. Conclusion These data underline the need to adapt the measurements of compression stockings to the morphologies of patients' lower limbs in India, to improve compliance.
- Published
- 2019
23. Functional anatomy of the semi-membranosus muscle: main thigh pump and derivative route of the Hunter’s canal
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Jean-François Uhl, C. Gillot, Vincent Delmas, and Maxime Chahim
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medicine.anatomical_structure ,business.industry ,Medicine/Pathology ,Functional anatomy ,Hunter's canal ,Medicine ,General Medicine ,Anatomy ,Thigh ,business ,Venous return curve - Abstract
Introduction: Our objective is to highlight the role of the semi-membranosus muscle, which is surprisingly not described in the major books of anatomy, as main thigh pump in the venous return [1]. Material and methods: Latex injection of fresh cadavers followed by anatomical dissection and colored segmentation of the whole venous network of 300 lower limbs, 3D reconstructions by CT venography of 1000 CVD patients are at the basis of this study. Results: The venous arcades of the semi-membranosus muscle constitute a main deep collateral route by-passing the narrowed area of the Hunter’s canal. This anatomical study clearly shows that these venous arcades are regularly connected:(Figure 1) • By their 2 lower branches to the popliteal vein • By their 2 higher branches to the deep femoral vein. Consequently, they constitute a derivative route of the femoral axis, explaining their dilatation in case of stenosis of the Hunter’s canal outlet. Similarly, in a physiological situation, the whole amount of blood ejected by the powerful calf pump through the popliteal vein cannot always reach the femoral vein through the Hunter’s canal: the arcades then play the role of a safety valve. Moreover, the veins of the semi-membranosus muscle constitute a main thigh pump: they push up the blood towards the femoral crossroad at the root of the limb. Discussion and conclusion: The veins of the semi-membranosus should be systematically investigated by USD : their dilatation is the witness of venous outlet syndrome of the Hunter’s canal which is a major cause of femoral vein thrombosis. USD investigation should be systematically carried out at that levels to prevent future deep vein obstruction.
- Published
- 2019
24. Tridimensional vectorial modeling of the upper limb from anatomical slices of the Korean visible human: Presented at the 3rd World Congress of the UNESCO Chair for Teaching and Research in Digital Anatomy Paris Descartes at Egas Moniz University Institute - Almada, Portugal
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Jean-François Uhl, Vincent Delmas, Jose Ramon Mogorron, and Maxime Chahim
- Subjects
media_common.quotation_subject ,Medicine/Pathology ,3D reconstruction ,General Medicine ,Art ,Anatomy ,030204 cardiovascular system & hematology ,Surgical training ,03 medical and health sciences ,Dissection ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Three dimensional anatomy ,Upper limb ,030212 general & internal medicine ,Surgical simulation ,media_common - Abstract
Introduction: The virtual dissection is a new and remarkable learning tool in anatomy. The authors present here a 3D reconstruction of the upper limb from the Visible Korean human slices. [1–4] Materials and methods: The manual segmentation of 1640 anatomical slices was achieved with the SURFdriver® software producing an interactive 3D vectorial model of the left upper limb. Eighty seven anatomical structures were reconstructed as separate 3D objects i.e skin, 31 bones, 29 muscles, 7 tendons, 6 nerves, 5 arteries and 9 veins (ligaments and lymphatics were not reconstructed). Results: They were gathered into a 3D vectorial model of the whole limb and exported in Acrobat(®) 3Dpdf format, producing a true virtual dissection tool: 87 anatomical structures can be individually and interactively manipulated with a touch screen: you can swipe, scroll, zoom, rotate and navigate inside the model as well as remove layers of skin and muscle and take measurements. In addition, 3D labels with the name of each anatomical element are available. Discussion and conclusions: This new computerized virtual dissection table is a simple and powerful learning tool for students. It is also the basis of future simulation tools for surgeon’s training.
- Published
- 2019
25. 3D venous anatomy of the venous network of the lower limb: Presented at the 3rd World Congress of the UNESCO Chair for Teaching and Research in Digital Anatomy Paris Descartes at Egas Moniz University Institute - Almada, Portugal
- Author
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Maxime Chahim, Jean-François Uhl, Jose Ramon Mogorron, and Vincent Delmas
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Computer science ,Medicine/Pathology ,Interactive 3d ,Venography ,3d model ,General Medicine ,030204 cardiovascular system & hematology ,Venous network ,Lower limb ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Multislice ,Medical physics ,030212 general & internal medicine ,Spiral ct ,Venous anatomy - Abstract
Introduction: The aim of this work is to build a new educational tool to better understand venous anatomy of the lower limbs by the help of embryology, Duplex color assessment and 3d modeling by CT venography (CTV) Materials and methods: Pictures of anatomical drawings from the Atlas book of Gillot [1] are illustrated and enhanced by the new imaging techniques of the venous system: 3D venography [2–5] and Color Duplex [6]. A multislice with 64 detectors spiral CT acquisition of the lower limb with contrast injection of the foot produces about 800 slices of the whole limb in 40 seconds. Image processing is done by VRT technique with 2 free softwares running on Macs: Osirix® [www.osirix.com] and Horos® [www.oros.com] Results: Interactive 3d modes are built in real time and movie files of a 360 degres rotation of this 3D model are easily exported to quicktime format. • Easy learning of the superficial venous network, perforators and their connection to the deep system, with the help of embryology • Explanation of the 3 venous compartments of the sural nerve pedicle and hemodynamics of the GSV and SSV termination • Pre-operative surgical assessment of complex /redo varices and congenital vascular malformations in addition to US Duplex and MRI. Discussion and conclusions: The VCT is a powerful tool to investigate the venous system of our patients with chronic venous disease, but it is providing no hemodynamical data, so an additional DUS (color duplex) is mandatory. It makes possible a virtual dissection of the limb, which gives an accurate and interactive 3d map of the whole limb in addition to the landmarks provided by the DUS skin marking before treatment. A lesson of anatomy is proposed, illustrated by a full Interactive use of 3D models. and illustrated by case reports with « virtual dissection » of the patients.
- Published
- 2019
26. Anatomy of the bony perforators veins of the knee
- Author
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J. Merino, Jean-François Uhl, J. Ovelar, and C. Gillot
- Subjects
musculoskeletal diseases ,biology ,business.industry ,Medicine/Pathology ,Witch ,General Medicine ,Anatomy ,030204 cardiovascular system & hematology ,biology.organism_classification ,musculoskeletal system ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular system ,Medicine ,030212 general & internal medicine ,business - Abstract
Introduction: The aim of this study is to make an anatomical description of the bony venous perforators (PVs) at the knee level witch are frequently missed during investigation of patients with chronic venous disease. Material and methods: Multiple series of anatomical slices of fresh cadavers injected with green latex and series of CT venographies as well as Duplex color investigations were used to study their precise location and the connections with the venous network of the knee. Results: Anatomically, these PVs are commonly located anteriorly around the patella, and posteriorly in the inter-condylar grove, medially and laterally. Their connections with the popliteal vein are multiple. During Duplex ultrasound assessment, as well as CT venography, they are often ignored due to their small caliber. Discussion and conclusions: Physiological hypothesis: At the knee level, The spongy bone of both tibia and femur epiphysis is an important place of production of red blood cells. They connect the venous system in the popliteal vein by several tiny perforators. In practice, these tiny perforators are not investigated and ignored by the sonographers. They should be distinguished from the big PVs of the tibial diaphysis responsible for varicose veins of the leg [1]. These PVs could also be linked to the so-called “phleboarthrosis” described recently [2]. The bony perforator veins of the knee are commonly responsible for reticular veins or telangiectases around the knee, but they are underdiagnosed by the sonographers. This explains why the injection of these cosmetic lesions around the knee frequently leads to recurrence.
- Published
- 2019
27. 3D Anatomy and dissection of the Hunter’s canal: its role in the outlet compression syndrome of the femoral vein: Presented at the 3rd World Congress of the UNESCO Chair for Teaching and Research in Digital Anatomy Paris Descartes at Egas Moniz University Institute - Almada, Portugal
- Author
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C. Gillot, Jean-François Uhl, Jose Ramon Mogorron Huerta, and Vincent Delmas
- Subjects
Adductor canal syndrome ,business.industry ,Medicine/Pathology ,digestive, oral, and skin physiology ,Hunter's canal ,Acute arterial occlusion ,Femoral vein ,General Medicine ,Anatomy ,musculoskeletal system ,3d anatomy ,Dissection ,stomatognathic system ,Medicine ,business - Abstract
Introduction: “Adductor canal syndrome”, or “Jogger’s syndrome” has been described as an unusual cause of acute arterial occlusion in younger men. It is also been identified as a cause of compressive neuropathy of the saphenous nerve. Nevertheless, femoral vein compression in the canal has never been described. Our aim is to describe the anatomy and physiology of Hunter’s canal, and to show that the femoral vein is much more exposed than the artery to compression inside the adductor hiatus, particularly at the outlet [1]. Material and methods: Fifty fresh cadavers were used to surgically expose the adductor hiatus for anatomical study. A series of 200 phlebographies and 100 CT venographies were also used to study the 3D morphology of the adductor hiatus. Results: Anatomically, in all cases we found that an abnormal musculotendinous band arose from the adductor magnus muscle, and joined the adductor tendon to the vastus medialis. The femoral vein is located more posteriorly and is frequently narrowed at this level : the edge of the vasto-adductor membrane. This was particularly true when the artery was calcified. Different types of anatomical compression of the femoral vein could by described, but the main is in the Hunter’s outlet: the edge of the vasto-adductor membrane. The resultant anatomical structure creates a notch with venous stenosis frequently occurring at the lower part of the hiatus, well seen in the cast of a femoral vein injected with latex and on the phlebographies In a majority of cases where such a stenosis was found, it was at the lower part of the canal, 13 to 15 cm above the femoral condyle. Compression by the artery or higher inside the canal could also be identified, but they are often ignored. Discussion and conclusion: Physiological hypothesis: The cadaveric simulations showed that contraction of the adductor longus closes the hiatus, and the adductor magnus opens it. Our hypothesis is that Hunter’s canal prevents femoro-popliteal axis reflux by synchronizing with calf pump ejection during ambulation. So in clinical practice, USD investigation should be a routine, seeking for a dilatation of the derivative routes, particularly the arcades of the semi-membranosus muscle: Compression of the femoral vein in the adductor canal is an underestimated cause of venous obstruction and deep vein thrombosis. Ultrasound investigation of both limbs should systematically be carried out at this precise level to prevent future venous obstruction from occurring here.
- Published
- 2019
28. The value of segmentation with 2D and 3D reconstruction before vascular surgery (about a case of aortic aneurysm): Presented at the 3rd World Congress of the UNESCO Chair for Teaching and Research in Digital Anatomy Paris Descartes at Egas Moniz University Institute - Almada, Portugal
- Author
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Maxime Chahim, Mohammed Saidi, and Jean-François Uhl
- Subjects
medicine.medical_specialty ,History ,Medicine/Pathology ,General Medicine ,Anatomy ,030204 cardiovascular system & hematology ,Vascular surgery ,medicine.disease ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,medicine ,cardiovascular system ,Segmentation ,030212 general & internal medicine ,cardiovascular diseases - Abstract
Introduction: The development of digital research at the level of the anatomy laboratory with the vascular surgery unit by anatomo-radiological interpretation based on 2D segmentation and 3D reconstruction [1] using serial sections of medical imaging (angiogram) for the aortic aneurysms, realizes a fundamental element in the diagnosis approach and offers a panel of tools adapted to the constraints of the clinical practice to optimize the decision of the surgical act and the restoration of the function. The objective of this study is to highlight the anatomical reports of aneurysm to improve the management of a 68-year-old patient. Materials and methods: The 256 sections of a CT angiogram of a 68-year-old patient with aortic aneurysm for exploration of chest pain. The morpho-anatomical study of the thoraco-abdominal visceral structures, as well as the posterior mediastinal region and the aneurysmal dilatations at the level of the aortic vascular axis is performed by the 3D volume rendering technique using OSIRIX® software [2]. Results: Interactive 3d modeling of the aorta was achieved with volume quantification of the aneurysm. Discussion and conclusion: The three-dimensional volumetric modeling of an aneurysm in a 68-year-old patient visualizes the thoraco-abdominal aortic dilatation and the importance of the aneurysm in the mediastinum on 3D reconstruction images, hence the surgical or endovascular indication and the technical management [3].
- Published
- 2019
29. Stasis edema in poorly mobile nursing home patients: A treatment protocol
- Author
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Florence Balet, Jean Patrick Benigni, Jean-François Uhl, and Maxime Chahim
- Subjects
medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Treatment protocol ,business.industry ,lcsh:RC666-701 ,medicine ,Stasis edema ,Intensive care medicine ,Nursing homes ,business - Abstract
Not available
- Published
- 2019
30. 3D modeling of the vascular system
- Author
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Maxime Chahim, Francois Cros, Jean-François Uhl, and Amina Ouchene
- Subjects
Engineering ,business.industry ,Angio ct ,Computer graphics (images) ,3D reconstruction ,Augmented reality ,Computer vision ,Multislice ct ,Artificial intelligence ,Virtual reality ,business ,3D modeling ,Surgical training - Abstract
The 3D modeling of the vascular system could be achieved in different ways: In the venous location, the morphological modeling by MSCT venography is used to image the venous system: this morphological modeling tool accurately investigates the 3D morphology of the venous network of our patients with chronic venous disease. It is also a fine educational tool for students who learn venous anatomy, the most complex of the human body. Another kind of modeling (mathematical modeling) is used to simulate the venous functions, and virtually tests the efficacy of any proposed treatments. To image the arterial system, the aim of 3D modeling is to precisely assess and quantify the arterial morphology. The use of augmented reality before an endovascular procedure allows pre-treatment simulation, assisting in pre-operative planning as well as surgical training. In the special field of liver surgery, several 3D modeling software products are available for computer simulations and training purposes and augmented reality.
- Published
- 2016
31. Treatment protocol on stasis edema in poorly mobile nursing home patients
- Author
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M. Chahim, Florence Balet, Jean-Patrick Benigni, and Jean-François Uhl
- Subjects
Male ,Paris ,Time Factors ,Compression Bandage ,Treatment protocol ,medicine.medical_treatment ,Pilot Projects ,Compression stockings ,030204 cardiovascular system & hematology ,Sitting ,Veins ,Venous stasis ,03 medical and health sciences ,0302 clinical medicine ,Compression Bandages ,medicine ,Edema ,Humans ,Prospective Studies ,Mobility Limitation ,Prospective cohort study ,Aged, 80 and over ,Sitting Position ,business.industry ,Equipment Design ,medicine.disease ,Nursing Homes ,Treatment Outcome ,Lower Extremity ,Venous Insufficiency ,Regional Blood Flow ,Anesthesia ,Stasis edema ,Female ,Sedentary Behavior ,Cardiology and Cardiovascular Medicine ,business ,Stockings, Compression ,030217 neurology & neurosurgery ,Volume (compression) - Abstract
Background Prolonged immobility in the sitting position in the elderly is known to produce venous stasis with leg edema and possible skin changes. Methods The authors have tested a treatment protocol in 30 patients to quantify the reduction of volume caused by an adjustable compression Velcro® wrap (Circaid Juxtalite®, medi GmbH, Bayreuth, Germany) after 15 days and to compare its effect on the leg volume for the next 15 days with 15- to 20-mmHg compression stockings (CS). Results The authors noted a volume decrease between T0 and T15 by 10.8% (52 legs) under Circaid Juxtalite®. At T30, they observed a non-significant difference between Circaid Juxtalite® (-1%) and the CS (1.3%). Conclusions A Velcro® adjustable compression wrap (Circaid Juxtalite®) is efficient in reducing stasis edema in the elderly. Stabilization of the leg volume with the use of 15-20 mmHg CS suggests that a high pressure to maintain results is not required to maintain results.
- Published
- 2018
32. Three-Dimensional Modelization of the Female Human Inferior Hypogastric Plexus: Implications for Nerve-Sparing Radical Hysterectomy
- Author
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Fabien Guimiot, H Bonsang-Kitzis, Fabrice Lecuru, Marie Gosset, Anne-Sophie Bats, Richard Douard, Vincent Balaya, M Deloménie, Myriam Mimouni, Vincent Delmas, Charlotte Ngo, and Jean-François Uhl
- Subjects
Models, Anatomic ,Uterosacral ligament ,Urinary Bladder ,Dissection (medical) ,Hysterectomy ,Pelvis ,medicine.nerve ,Ureter ,medicine.artery ,medicine ,Superior hypogastric plexus ,Humans ,Radical Hysterectomy ,Uterine artery ,Hypogastric Plexus ,business.industry ,Uterus ,Obstetrics and Gynecology ,Anatomy ,medicine.disease ,medicine.anatomical_structure ,Reproductive Medicine ,Ligament ,Lymph Node Excision ,Female ,business - Abstract
Background/Aims: This study aims to describe the autonomic nervous network of the female pelvis with a 3D model and to provide a safe plane of dissection during radical hysterectomy for cervical cancer. Methods: Pelvises of 3 human female fetuses were studied by using the computer-assisted anatomic dissection. Results: The superior hypogastric plexus (SHP) was located at the level of the aortic bifurcation in front of the sacral promontory and divided inferiorly and laterally into 2 hypogastric nerves (HN). HN ran postero-medially to the ureter and in the lateral part of the uterosacral ligament until the superior angle of the inferior hypogastric plexus (IHP). IHP extended from the anterolateral face of the rectum, laterally to the cervix and attempted to the base of the bladder. Vesical efferences merged from the crossing point of the ureter and the uterine artery and ran through the posterior layer of the vesico-uterine ligament. Conclusions: The SHP could be injured during paraaortic lymphadenectomy. Following the ureter and resecting the medial fibrous part of the uterosacral ligament may spare the HN. No dissection should be performed under the crossing point of the ureter and the uterine artery.
- Published
- 2018
33. Evaluation of three different devices to reduce stasis edema in poorly mobile nursing home patients
- Author
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Maxime Chahim, Pascal Filori, Florence Balet, Jean-François Uhl, and Jean-Patrick Benigni
- Subjects
Male ,medicine.medical_specialty ,Compression Bandage ,medicine.medical_treatment ,Pilot Projects ,Compression stockings ,030204 cardiovascular system & hematology ,030230 surgery ,Sitting ,Venous stasis ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Compression Bandages ,Edema ,Pressure ,Humans ,Medicine ,Prospective Studies ,Mobility Limitation ,Aged, 80 and over ,Leg ,business.industry ,Equipment Design ,medicine.disease ,Compression (physics) ,Nursing Homes ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Stockings, Compression ,Bandage ,Volume (compression) - Abstract
Background Prolonged immobility in the sitting position in the elderly is known to produce venous stasis with leg edema and possible skin changes. Compression stockings are often applied for this clinical problem. There is few experienced nursing staff available to supervise the difficult task of stocking application. Methods The authors have researched other effective and simple devices that may be suitable alternatives. This article reports the results of three different devices to reduce leg edema, as measured by reduction in leg volume: an electro-stimulation device, an adjustable compression Velcro® wrap and a short stretch bandage, each tested over a two-hour period. Results In this randomized pilot study including 38 patients, the authors observed no difference in leg volume following electro-stimulation (Veinoplus®). They noted a significant reduction in leg volume following use of the other two devices, more with the adjustable Velcro® wrap compression (Circaid Juxtafit®) than with the short stretch bandage (Rosidal K®). Measurement of the interface pressures created by these two devices and also assessing the stiffness created by applying each device for two hours confirm that pressure is more important than stiffness in the reduction of edema in these particular patients. Conclusions This pilot study is to be added to the results of previous published studies showing the efficacy in reducing leg edema of Velcro® adjustable compression wrap and its ease of use.
- Published
- 2018
34. Anatomy of the Venous System of the Lower Limbs
- Author
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C. Gillot and Jean-François Uhl
- Subjects
business.industry ,Medicine ,Anatomy ,Perforating veins ,Venous disease ,business ,Venous network - Abstract
The embryogenesis of the venous network of the lower limbs explains the main variations of the venous network superficial veins, perforating veins, and deep venous system. It is likely that the number of the so-called primitive chronic venous disease could be explained by unknown underlying anatomical abnormalities [1].
- Published
- 2018
35. DICOM format: definition and practical use in vascular medicine
- Author
-
Jean-François Uhl
- Subjects
medicine.medical_specialty ,DICOM ,Computer science ,health services administration ,medicine ,Medical physics ,Vascular Medicine - Abstract
The imaging is essential in vascular medicine for diagnosis and treatment. New imaging techniques since the advent of the spiral CT scan, invented by Hounsfield and Mac Cormack in 1972, brought us a revolution in whole medicine. This has been possible thanks to the development of new standards for imaging, particularly DICOM format. The aim of this paper is to explain what is DICOM and how we use it in vascular medicine. DICOM (Digital Imaging and Communications in Medicine standards) is an universal worldwide format used for medical imaging for all vascular investigation techniques: sonography, CT (computed tomography) and MRI (magnetic resonance imaging). This format allows 3D reconstruction of the patient's anatomy and gives access to quantification of all anatomical structures of the body, in particular of the vessels. It is achieved with dedicated software called DICOM browsers. These new tools of tridimensional (3D) modeling of the vessels bring us more accurate data of vascular anatomy. They make us enter in an era of new endoscopic and surgical techniques fully based on the image data, and so open the way for simulation, training and augmented reality.
- Published
- 2018
36. In memory of Prof. Claude Gillot
- Author
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Jean François Uhl
- Published
- 2018
37. MASTERCLASS OF MULTIMODALITY VENOUS IMAGING Paris Descartes University 15-16th JUNE 2019
- Author
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Jean-François Uhl and Vuolo, Miguel Lo
- Published
- 2018
- Full Text
- View/download PDF
38. The technological and educational revolution of digital anatomy: building a 3D vectorial atlas from a set of anatomical slices
- Author
-
Jose Ramon Mogorron Huerta, Jean-François Uhl, and Vincent Delmas
- Subjects
Engineering ,business.industry ,Medicine/Pathology ,education ,Library science ,General Medicine ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Atlas (anatomy) ,medicine ,030212 general & internal medicine ,business - Abstract
Introduction: Teaching of the morphological sciences suffers today from the lack of human corpses for dissection (due to ethic or religious issues), worsened by an increasing demand for educational anatomy. Fortunately, the technological revolution now put at our disposal educational tools to teach and learn anatomy: virtual dissection table, virtual reality techniques, and 3D printing. The network of partners of the Unesco Chair of Digital anatomy [1] in Paris Descartes University collaborates to setup educational models of the human body in order to build 3D databases for virtual dissection. This can be done by 2 different techniques producing 3d vectorial models: • Manual segmentation of the anatomical slices of “visible human” projects: US VHP [2] Korean visible human [3] and Chinese projects [4,5] as well as modeling of the uro-genital system [6] • Modeling of angio-CT by semi-automatic segmentation. Can be achieved on patients exams by the use of Horos software. [7] Material and methods: 250 students preparing the master of anatomy of Descartes University (DUACN) have worked since 2015 on this project. They used the winsurf software version 3.5 [8,9] to make the segmentation of the main anatomical structures on the 5650 slices of the Korean visible woman (thickness 0.2 mm) Then, the whole 3d vectorial model has been exported into Blender software version 4.79 [10] to improve the meshes and correct mistakes. Finally the model was converted into .u3d format, in order to take advantage of the powerful interface of 3dpdf Acrobat file [11] The main steps are shown on Figure 1. Results: The display device is a 65 inches touch screen: all the 3d functions could be easily controlled with only 3 fingers. The final 3D model includes 1200 anatomical structures. The 3dpdf Acrobat interface makes possible to move, zoom, rotate each of them. Their transparency could be modified. The selection is possible by system (bones, ligaments, muscles, vessels, nerves, organs) or by region. The original slices can be displayed within the 3d model. The name of a selected structure is displayed in 4 languages. A window on the left is available to drop and display anatomical drawings pictures and texts, so that anyone could easily build a course or a lesson of anatomy. Discussion and conclusion: The Korean team has already provided 3d vectorial models of the man and woman [12]. The Unesco Chair of Digital Anatomy aims to develop and share these new tools in the laboratories of anatomy around the world.
- Published
- 2019
39. Relationship between medical compression and intramuscular pressure as an explanation of a compression paradox
- Author
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Jean-Patrick Benigni, E. Blin, Fournier J, André Cornu-Thenard, and Jean-François Uhl
- Subjects
Male ,medicine.medical_specialty ,Blood Pressure ,law.invention ,Varicose Veins ,law ,Interface pressure ,Humans ,Medicine ,Intermittent Pneumatic Compression Devices ,Intramuscular pressure ,Aged ,Leg ,medicine.diagnostic_test ,business.industry ,Healthy subjects ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Compression (physics) ,Surgery ,Radiography ,Prone position ,Pressure measurement ,Cuff ,Female ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography ,Biomedical engineering - Abstract
Background Using standing magnetic resonance imaging (MRI), we recently showed that medical compression, providing an interface pressure (IP) of 22 mmHg, significantly compressed the deep veins of the leg but not, paradoxically, superficial varicose veins. Objective To provide an explanation for this compression paradox by studying the correlation between the IP exerted by medical compression and intramuscular pressure (IMP). Material and methods In 10 legs of five healthy subjects, we studied the effects of different IPs on the IMP of the medial gastrocnemius muscle. The IP produced by a cuff manometer was verified by a Picopress® device. The IMP was measured with a 21G needle connected to a manometer. Pressure data were recorded in the prone and standing positions with cuff manometer pressures from 0 to 50 mmHg. Results In the prone position, an IP of less than 20 did not significantly change the IMP. On the contrary, a perfect linear correlation with the IMP ( r = 0.99) was observed with an IP from 20 to 50 mmHg. We found the same correlation in the standing position. Conclusion We found that an IP of 22 mmHg produced a significant IMP increase from 32 to 54 mmHg, in the standing position. At the same time, the subcutaneous pressure is only provided by the compression device, on healthy subjects. In other words, the subcutaneous pressure plus the IP is only a little higher than 22 mmHg—a pressure which is too low to reduce the caliber of the superficial veins. This is in accordance with our standing MRI 3D anatomical study which showed that, paradoxically, when applying low pressures (IP), the deep veins are compressed while the superficial veins are not.
- Published
- 2014
40. Anatomy of the veno-muscular pumps of the lower limb
- Author
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C. Gillot and Jean-François Uhl
- Subjects
Male ,medicine.medical_specialty ,business.industry ,General Medicine ,Anatomy ,Lower limb ,Veins ,Surgery ,Lower Extremity ,Humans ,Medicine ,Female ,Muscle, Skeletal ,Cardiology and Cardiovascular Medicine ,Venous anatomy ,business ,Lower limbs venous ultrasonography - Abstract
Objective To study the anatomy of the veno-muscular pumps of the lower limb, particularly the calf pump, the most powerful of the lower limb, and to confirm its crucial importance in venous return. Methods In all, 400 cadaveric limbs were injected with green Neoprene latex followed by an anatomical dissection. Results The foot pump is the starter of the venous return. The calf pump can be divided into two anatomical parts: the leg pump located in the veins of the soleus muscle and the popliteal pump ending in the popliteal vein with the unique above-knee collector of the medial gastrocnemial veins. At the leg level, the lateral veins of the soleus are the bigger ones. They drain vertically into the fibular veins. The medial veins of the soleus, smaller, join the posterior tibial veins horizontally. At the popliteal level, medial gastrocnemial veins are the largest veins, which end uniquely as a large collector into the popliteal vein above the knee joint. This explains the power of the gastrocnemial pump: during walking, the high speed of the blood ejection during each muscular systole acts like a nozzle creating a powerful jet into the popliteal vein. This also explains the aspiration (Venturi) effect on the deep veins below. Finally, the thigh pump of the semimembranosus muscles pushes the blood of the deep femoral vein together with the quadriceps veins into the common femoral vein. Conclusion The veno-muscular pumps of the lower limb create a chain of events by their successive activation during walking. They play the role of a peripheral heart, which combined with venous valves serve to avoid gravitational reflux during muscular diastole. A stiffness of the ankle or/and the dispersion of the collectors inside the gastrocnemius could impair this powerful pump and so worsen venous return, causing development of severe chronic venous insufficiency.
- Published
- 2014
41. Prospective randomized controlled study of patient compliance in using a compression stocking: Importance of recommendations of the practitioner as a factor for better compliance
- Author
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Jean-Patrick Benigni, Delinotte Fréderic, Jean-François Uhl, and Maxime Chahim
- Subjects
Adult ,medicine.medical_specialty ,Paris ,Time Factors ,Thermometers ,medicine.medical_treatment ,Reminder Systems ,Compression stockings ,Thermometry ,030204 cardiovascular system & hematology ,law.invention ,Veins ,03 medical and health sciences ,0302 clinical medicine ,Stocking ,Randomized controlled trial ,law ,Medicine ,Humans ,Single-Blind Method ,030212 general & internal medicine ,Prospective Studies ,Vascular Diseases ,Patient compliance ,Ceap classification ,Aged ,Physician-Patient Relations ,Text Messaging ,business.industry ,Communication ,Skin temperature ,General Medicine ,Middle Aged ,Compression (physics) ,Compliance (physiology) ,Treatment Outcome ,Chronic Disease ,Physical therapy ,Quality of Life ,Patient Compliance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Skin Temperature ,Stockings, Compression - Abstract
BackgroundPatient compliance is the cornerstone of compression therapy success. However, there has been up to now no tool to assess it other than self-reporting by the patient, which is not reliable.Material and methodsForty active females classified C2S were enrolled to wear compression stockings (CS) providing a pressure of 15–20 mmHg at the ankle. A thermal probe was inserted in the stocking (Thermotrack®), recording the skin temperature every 20 min for four weeks. The patients were randomized in two groups of 20: – Group 1: Receiving minimal recommendations by their physician at the office. – Group 2: Receiving in-depth recommendations by the physician reinforced with SMS message which were repeated once a week for four weeks. The basic CEAP classification and the quality of life (QoL) were recorded before and after four weeks.ResultsThe two groups are similar for age, symptoms and type of CS. The analysis of the thermal curves showed a significant increase (+33%) in the average wearing time daily in the group 2: 8 h vs. 5.6 h (group1) p ConclusionThis is the first study assessing the real compliance in CVD patients of using compression. It shows that better and repeated recommendations by the practitioner result in an increase in time the compression is used by 33%. The study also suggests that the number of days the compression stocking is worn is a good criterion of patient compliance.
- Published
- 2016
42. Localisation anatomique des nodules dans l’endométriose profonde : revue de la littérature
- Author
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Richard Douard, Jean-François Uhl, Vincent Balaya, Jean-Marc Chevallier, Vincent Delmas, and Jennifer Bell
- Subjects
Anatomy - Abstract
Introduction/Objectifs Le but de cette etude etait de decrire la topographie et la frequence des differentes lesions d’endometriose pelvienne profonde. Materiels et methodes Revue de litterature de 2003 a 2017 en utilisant les mots cles suivants : « anatomical distribution », « deeply infiltrating endometriosis », « deep endometriosis », « surgery », sur PubMed via Medline. Resultats Quinze articles sur 45 correspondant a l’objectif de l’etude ont ete analyses. Mille trois cent soixante-dix-neuf patientes presentaient 2265 lesions histologiquement prouvees. Les lesions d’endometriose etaient localisees aux ligaments utero-sacres (41 % ; 925), au septum recto-vaginal (13,6 % ; 309), au niveau de la jonction rectosigmoidienne (13,2 % ; 298), au vagin (9 % ; 212), au cul-de-sac de douglas (5,6 % ; 128), a la vessie (3,1 % ; 72) et a l’uretere (2,5 % ; 57). Cent cinquante-six patientes (11,3 %) presentaient au moins 2 lesions avec notamment une atteinte simultanee des ligaments utero-sacres et du rectum (62 patientes) et une atteinte simultanee des ligaments utero-sacres et du cul de sac de Douglas (31 patientes). Conclusions L’endometriose pelvienne profonde interesse principalement les ligaments utero-sacres et le septum recto-vaginal. Les atteintes multifocales doivent etre recherchees lors du bilan pre operatoire afin de garantir l’exhaustivite de l’exerese chirurgicale qui conditionne le succes.
- Published
- 2018
43. 3D modeling of leg veins from MRI slices: interest of volume quantification to assess the effects of compression therapy
- Author
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Vincent Delmas, Maxime Chahim, Jose Ramon Mogorron Huerta, and Jean-François Uhl
- Subjects
Engineering ,medicine.medical_specialty ,business.industry ,Medicine/Pathology ,General Medicine ,030204 cardiovascular system & hematology ,Compression therapy ,3D modeling ,03 medical and health sciences ,0302 clinical medicine ,Mechanical compression ,medicine ,Medical physics ,030212 general & internal medicine ,business ,Volume (compression) - Abstract
Introduction: Direct mechanical compression of the veins seems to be the main mechanism of action of compression therapy in venous disease. New imaging techniques allow a quantitative evaluation of the biophysical impact of compression on the 3D anatomy of the leg, particularly on the venous system The aim is to use 3D modeling and volume quantification in order to better understand the anatomical effects of compression therapy on the venous system [1,2]. Material and methods: A total of 13 individuals were studied by T2 weighted MRI of the calf or thigh in different body position: supine, prone, upright (6 cases) before and after application of different stockings and bandages. In every case the interface pressure was measured by the use of Picopress® pressure transducer. Compression devices producing different pressures and stifness were assessed. 3D vectorial models were built with Winsurf® software from cross sectional pictures by manual segmentation of all important anatomical structures (bone, muscles, skin, superficial and deep veins). A realistic interactive 3D vectorial model of the extremity was obtained for each leg showing the influence of compression on the leg’s anatomy not only in a single cross-sectional slice but for the whole calf. Results: Surprisingly, even low external pressure (22 mm Hg) is able to induce changes of venous caliber in the deep veins, while there is no compression of the superficial veins. The quantification of each vein volume was done If we increase the external pressure, a compression could be obtained with a pressure of 80 mm Hg Similar results could be obtained in supine position at rest and during contraction of the calf muscles with a compression stocking. The reduction in the venous volume is more important in the deep system, and this effect is enhanced by the compression of the calf with a stocking. And finally, without any compression stocking, the superficial system is dilated in standing position, and the deep system reduced by the muscular contraction of the Soleus. Discussion and conclusion: Limitations of this MRI technique: A long acquisition time is necessary (2-3 minutes) making it difficult to remain in standing position or muscular contraction with no move. For the same reason, the number of slices/thickness are limited. As a result, the acquisition is limited to a segment of the calf 12-25 cm). The 3D modeling technique has also limits and pitfalls: It is mandatory to take landmarks on the skin before acquisition to scan exactly the same zone. Manual drawed boundaries of the anatomical structures are tedious and the interval between slices is large causing partial volume effect (hazy limits). Nevertheless, acurate 3D models can be obtained making possible a quantification of the venous volume. 3D modeling and volume quantification renders clear images of the anatomical structures of the leg demonstrating the effect of different kinds of venous compression.
- Published
- 2019
44. Anatomie des perforantes osseuses du genou
- Author
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Jean-François Uhl, Maxime Chahim, and C. Gillot
- Subjects
03 medical and health sciences ,0302 clinical medicine ,030204 cardiovascular system & hematology ,030230 surgery ,Cardiology and Cardiovascular Medicine - Abstract
Objectif Decrire la disposition anatomique des veines perforantes (VPs) du genou qui sont le plus souvent negligees ou ignorees lors des explorations des patients atteints de maladie veineuse chronique (MVC). Materiel et methodes De nombreuses series de coupes anatomiques realisees apres injection de latex sur des cadavres frais, des explorations par phlebo-scanner et duplex couleur ont ete utilisees pour etudier leur repartition et leur connexion avec le reseau veineux du genou. Resultats Anatomiquement, ces VPs sont principalement situees en avant, autour de la patella, et en arriere dans l’echancrure inter condylienne de part et d’autre de la veine poplitee avec laquelle elles ont des connexions multiples. Leur petit calibre explique qu’elles soient souvent meconnues lors de l’exploration par Duplex couleur ou par phlebo-scanner. Discussion Explication physiologique au niveau du genou, l’os spongieux situe dans les 2 epiphyses du tibia et du femur est un important lieu de production des globules rouges (plus important que le rachis). Ces globules doivent donc regagner le systeme veineux vers la veine poplitee par des communication trans-osseuses. Ceci explique la presence de ces multiples petites perforantes gonales. En pratique, leur petit calibre et leur situation expliquent qu’elles passent souvent inapercues lors d’une exploration sonographique du reseau veineux. Diagnostic differentiel: il faut bien les distinguer des grosses perforantes osseuses de la diaphyse tibiale, assez rares et responsables de varices anterieures de jambe rapportees par A.A Ramelet [1] . Enfin, ces VPs jouent probablement un role dans la “phlebarthrose” decrite recemment dans les insuffisances veineuses d’origine variqueuse par plusieurs auteurs [2] . Conclusion Les perforantes osseuses du genou sont tres souvent impliquees dans les recidives apres traitement des veines reticulaires ou des telangiectasies du genou. Leur connexion etroite avec le reseau genicule en est une explication plausible.
- Published
- 2019
45. Focus on corona phlebectatica: Diagnostic, significance and predictive value in chronic venous disorders
- Author
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Pier Luigi Antignani, André Cornu-Thenard, Jean-François Uhl, and Patrick H. Carpentier
- Subjects
endocrine system ,medicine.medical_specialty ,business.industry ,Telangiectases ,Disease ,Predictive value ,Corona phlebectatica ,Surgery ,Corona (optical phenomenon) ,Venous ulceration ,medicine ,Decompensation ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Ceap classification - Abstract
Background Corona phlebectatica (corona) is a clinical sign associated with chronic venous disorders (CVD). It is a good predictor for skin changes indicating a decompensation of the disease. However, it is not yet included in the clinical part of the CEAP classification, mainly due to the lack of operational criteria for its positive diagnosis. Aim To focus on the diagnostic and predictive values of corona, and to answer some relevant questions: How to define relevant operational criteria for a simple and reliable diagnosis in daily practice? Is the diagnosis reproducible? What is the value of this sign for the prognosis of CVD and their treatment? Results In order to clinically define corona, the association of blue telangiectases and stasis spots has the best specificity, and the blue telangiectases is the most sensible item. Their associated presence can be considered as a good operational criterion for the positive diagnosis of corona. Corona has also shown to be significantly correlated with the presence of incompetent leg perforator veins. The presence of corona also has a high value to predict the occurrence of skin changes and venous ulceration in the next few years of evolution of the disease. Conclusion Corona should no longer be considered as simple telangiectases of the foot (C1). It is a simple and reliable clinical entity, extremely relevant for the severity of the disease. This is the reason why a careful examination of the ankle should be done in any patient with CVD.
- Published
- 2013
46. Reconstruction tridimensionnelle informatisée du segment rétrohépatique de la veine cave inférieure d’un embryon humain de 20mm
- Author
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Jean-Marc Chevallier, N. Hentati, Richard Douard, B. Abid, A. Ghorbel, Vincent Delmas, and Jean-François Uhl
- Subjects
Dissection ,medicine.vein ,Common cardinal veins ,business.industry ,cardiovascular system ,medicine ,Venous drainage ,Anatomy ,Anastomosis ,business ,Inferior vena cava ,Subcardinal Vein - Abstract
The subdiaphragmatic venous drainage of the embryo is provided by the two caudal cardinal veins to which is added the subcardinal vein system, draining the mesonephros, the perispinal supracardinal veins and the umbilical and vitelline venous system. The anastomosis of certain segments of the embryonic venous structures and the disappearance of others are at the origin of the inferior vena cava. Since the 19th century, three-dimensional reconstruction of solid models from histological sections were developed. At present, the development of computerized three-dimensional reconstruction techniques allowed to operate a multitude of techniques of image processing and modeling in space. Three-dimensional reconstruction is a tool for teaching and research very useful in embryological studies because of the obvious difficulty of dissection and the necessity of introducing time as the fourth dimension in the study of organogenesis. This method represents a promising alternative compared to previous three-dimensional reconstruction techniques including Born technique. The aim of our work was to create a three-dimensional computer reconstruction of the retrohepatic segment of the inferior vena cava of a 20mm embryo from the embryo collection of Saints-Peres institute of anatomy (Paris Descartes university, Paris, France) to specify the path relative to the liver and initiate a series of computerized three-dimensional reconstruction that will follow the evolution of this segment of the inferior vena cava and this in a pedagogical and morphological research introducing the time as the fourth dimension.
- Published
- 2013
47. Anatomy and embryology of the small saphenous vein: nerve relationships and implications for treatment
- Author
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Jean-François Uhl and C. Gillot
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,Popliteal fossa ,Small saphenous vein ,Predictive Value of Tests ,Sclerotherapy ,Varicose veins ,Humans ,Medicine ,Saphenous Vein ,Aponeurosis ,Vascular Diseases ,Vein ,Ultrasonography, Doppler, Duplex ,business.industry ,Phlebography ,General Medicine ,Anatomy ,Fascia ,Trunk ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Anatomic Landmarks ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Lower limbs venous ultrasonography - Abstract
The aim of this paper is to describe the anatomical relations of the small saphenous vein (SSV) in order to define the high-risk zones for the treatment of chronic venous disease. The SSV runs in the saphenous compartment demarcated by two fascia layers: a muscular fascia and a membranous layer of subcutaneous tissue. The clinician should be keenly aware of the anatomical pitfalls related to the close proximity of nerves to the SSV in order to avoid their injury: At the ankle, the origin of the SSV is often plexiform, located deep below the fascia, and the nerve is really stuck to the vein. The apex of the calf is an area of high risk due to the confluence of nerves which perforate the aponeurosis. Moreover, the possible existence of a ‘short saphenous artery’ which poses a high risk for injection of a sclerosing agent due to a highly variable disposition of this artery surrounding the SSV trunk. For this reason, procedures under echo guidance in this area are mandatory. The popliteal fossa is probably a higher risk zone due to the vicinity of the nerves: the small saphenous arch is close to the tibial nerve, or sometimes the nerve of the medial head of the gastrocnemius muscle. In conclusion, before foam injection or surgery, a triple mapping of the small saphenous territory is mandatory: venous haemodynamical mapping verifying the anatomy that is highly variable, nerve mapping to avoid trauma of the nerves and arterial mapping. This anatomical study will help to define the main high-risk zones.
- Published
- 2013
48. A New Tool to Study the 3D Venous Anatomy of the Human Embryo: The Computer-Assisted Anatomical Dissection
- Author
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C. Gillot and Jean-François Uhl
- Subjects
Text mining ,business.industry ,Medicine ,Gross anatomy ,Surgery ,Anatomy ,Cardiology and Cardiovascular Medicine ,business ,Venous anatomy ,Bioinformatics ,Anatomical dissection - Published
- 2016
49. Anatomie veineuse du pied
- Author
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Jean-François Uhl and Marc Lefebvre-Vilardebo
- Subjects
Podiatry - Published
- 2012
50. La pompe veineuse du pied
- Author
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Marc Lefebvre-Vilardebo and Jean-François Uhl
- Subjects
business.industry ,Medicine ,Podiatry ,business - Published
- 2012
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