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Objectifs Les reunions de concertation pluridisciplinaires (RCP) en pelvi-perineologie sont destinees a la gestion des pathologies complexes impliquant potentiellement des problematiques vesico-sphincteriennes, genito-sexuelles et anorectales chez un(e) meme patient(e). Le but de cette etude etait de presenter l’activite d’une RCP de pelvi-perineologie sur un centre, en etudiant l’influence sur la prise en charge des patients. Methodes Une etude monocentrique a ete realisee sur l’annee 2018 a propos de l’activite d’une RCP de pelvi-perineologie se tenant dans un centre expert, impliquant urologues, gynecologues, chirurgiens digestifs, gastro-enterologues, physiologistes, radiologues specialises et kinesitherapeutes. Tous les patients presentes en RCP ont fait l’objet d’une collection de donnees prospective mentionnant les caracteristiques cliniques, l’historique, la pathologie principale, la proposition de prise en charge initiale par le medecin referent et l’avis collegial (intervention, avis specialise, examen complementaire, chirurgie). Une analyse descriptive a ete menee. Le critere principal etait la modification de la prise en charge proposee par la RCP (avis different de la proposition initiale). Resultats Dix-neuf reunions ont ete conduites sur 12 mois et 154 dossiers ont ete discutes (16 hommes et 138 femmes). Les thematiques abordees par referent et les symptomes touchant les patient(e)s sont presentees dans le Tableau 1 (les symptomes traitees etaient toujours multiples). Il existait un contexte d’endometriose dans 10 cas, un antecedent de chirurgie prothetique du prolapsus ou de l’incontinence dans 33 cas, un contexte neurologique dans 28 cas. Dans 15 cas (10 %), la prise en charge etait directement liee a une complication d’une chirurgie prothetique. La decision de la RCP a ete un traitement chirurgical dans 54 cas (35 %). La decision finale de la RCP etait differente de celle proposee initialement par le medecin referent dans 22 % des cas. Conclusion La tenue d’une RCP en pelvi-perineologie avait, dans notre etude, permis la prise en charge de nombreux dossiers complexes et pluridisciplinaires. La decision de la RCP avait une influence determinante dans plus d’un cas sur 5. Ces donnees legitimaient la prise en compte par la communaute urologique de ces RCP appelees a se structurer et a se generaliser.

Massive haemoptysis are rare in pregnant woman. Besides usual causes of haemoptysis, cases of idiopathic haemoptysis have been described during pregnancy, probably with a hormonal role. A pregnant woman at 22 weeks amenorrhoea was admitted in intensive care unit for massive and recurrent haemoptysis, enhanced by bouts of hypertension in a context of preeclampsia. Arteriography showed bronchial hypervascularisation, with abnormally dilated bronchial arteries, and a lot of collateral arteries. Three sessions of bronchial artery embolization have been performed with success. The management of idiopathic haemoptysis in pregnant woman seems to be based on the usual algorithm of management, emphasizing on the control of blood pressure, and the key role of interventional radiology.

Resume Le diagnostic precoce d’hemorragie meningee permet d’en ameliorer une mortalite et une morbidite importantes. L’objectif de cet article est de determiner les causes des retards diagnostiques. Nous avons repris tous les dossiers des hemorragies meningees hospitalisees dans le service de Neurochirurgie entre 2002 et 2003 en selectionnant les cas de retard diagnostique et nous avons trouve un taux de 16 %, qui est conforme aux donnees de la litterature. Dans tous les cas il s’agissait d’hemorragies meningees pauci-symptomatiques dont diagnostic doit etre systematiquement envisage devant une cephalee brutale ou d’intensite inhabituelle qui est le seul signe constant d’hemorragie meningee. Il faut insister sur l’absence de raideur meningee dans deux tiers des cas car elle est a l’origine de la plupart des erreurs diagnostiques. La cephalee en coup de tonnerre (« thunder clap headhache ») qui peut avoir exactement la meme semiologie est le principal diagnostic differentiel. Mais ce diagnostic ne peut etre retenu qu’apres scanner cerebral en urgence et ponction lombaire normaux.

Thanks to a magneto-optical method, we have measured the beat length of a photonic crystal fiber (PCF). Our experiments emphasize the singular behavior of the birefringence of a PCF versus the wavelength. We have also studied the birefringence of perfect photonic crystal fibers by means of the finite-element method. We show that detailed attention must be paid to the conditions of simulation for the calculation of the birefringence. Discrepancies between theoretical predictions and experimental results are pointed out and some explanations are proposed.

Three numerical approaches for the analysis of photonic crystal fibres are presented and compared. A full-vector finite element method based on the resolution of the Maxwell equations is found to be a very efficient and reliable tool for accurately modelling these optical guiding structures. The localized function method in the scalar form applies as long as the air-filling fraction is not too large. We present a very simplified novel model based on an equivalent averaged refractive index profile that is in good accordance with the finite element method as long as the optical wavelength is not too enlarged. Finally, comparisons between numerical results and measurements are taken into account in order to discuss the reliability of the three models.

International audience; We report the fabrication of all-dielectric microcavities with a tri(8-hydroxyquinoline) aluminum (Alq3) organic layer as the emitting layer. In a first step, we characterized the materials used in the structures by ellipsometry, and ensured nondegradation of the organic material in the fabrication process. Then, by angular-resolved photoluminescence, we investigated changes in the angular emission pattern caused by the cavities and observed a sharply directed emission. We also investigated the influence of the position of the radiative layer in the cavity on normal spontaneous emission. We observed enhancements in spontaneous emission over 20 times higher than that of a single Alq3 layer. These are the highest reported for organic material based microcavities. They are mainly explained by the very small thickness of the Alq3 layer (20 nm≡0.06λ, λ being the resonant wavelength), by high-quality low-loss dielectric mirrors as well as by the narrow collecting angle of our experiment (±3°). This study corroborates analogous works and demonstrates the possibility of controlling the spontaneous emission of an emitter by a microcavity.

Qualitative and quantitative studies of monolayer properties are important to foster a better understanding of various biological phenomena in which lipid/protein/saccharide interactions are involved. In this framework, the interfacial behavior of monolayers of four synthetic derivatives of N-acetylglucosamine in mixture with dimyristoylphosphatidylcholine (DMPC) has been studied at the air/solution interface. The effect of the hydrophobic chain length and of the presence of a triethylene glycol spacer in neoglycolipid structures on both the miscibility of neoglycolipids with DMPC and on their interaction with a specific lectin has been investigated by surface tension measurements. The results reveal the occurrence of two distinct behaviors depending on the monolayer packing. At low surface coverages, all neoglycolipids appeared to be immiscible with DMPC as demonstrated by an expansion of the monolayers, independently of the molar fraction of a saccharide derivative in a mixture. In a more condensed packing state, the increase in the neoglycolipid/DMPC ratio above 50% led, with the exception of one studied system, to an ideal mixing of monolayer forming components. It has been observed that neoglycolipid and DMPC/neoglycolipid monolayers specifically interacted with wheat germ agglutinin (WGA) only when neoglycolipid saccharide moieties were separated one from the other by phospholipid molecules, and when the presence of a spacer ensured their successful accessibility to the lectin.

Cet article decrit l'etude des proprietes de photoluminescence de films d'oligomeres de phenylene vinylene (OPV) obtenus par evaporation sous vide. La photoluminescence (PL) de ces materiaux depend de la longueur de conjugaison de la chaine. L'emission spontanee est largement modifiee en inserant les films entre deux miroirs et le gain de la microcavite peut etre module en optimisant la position du film a l'interieur de la cavite.

This paper reports on the photoluminescence properties of phenylene vinylene oligomers films (OPV) the emission of which was modified by microcavity effect. Films with 4 and 6 vinyl groups (respectively denoted OPV-4 and OPV-6) were investigated. A strong blue luminescence at 470 nm is observed for OPV-4. OPV-6 shows an emission spectrum quite similar to that of poly phenylene vinylene (PPV). Photoluminescence excitation measurements (PLE) give similar behaviors for the two samples and do not show any change in the shape of the spectra. Ageing under UV irradiation (380 nm) of the unencapsulated OPV-4 layers was evidenced by an exponential decrease of the photoluminescence intensity of about 40% after 3 h a continuous illumination. OPV-6 samples, aged on shelf, for weeks does only show a small decrease (15%) of the PL level over more than 7 h under continuous UV irradiation. Microcavity related effects were observed by inserting the films between two mirrors. These are generally a TiO2/SiO2 distributed Bragg reflectors (DBR) as bottom mirror and a Ag film as top mirror. However best results were obtained with two dielectric DBR. As expected, a strong enhancement of the emission at the cavity resonance and pronounced angular effects (emission peaking in the direction normal to the surface of the device) were observed. The importance of the position of the emitting material within the microcavity is evidenced with a thin tris(8-hydroxy) quinoline aluminum (Alq) embedded in SiO2 with various cavity configurations.

Introduction L’implantation de valve aortique percutanee (TAVI) est devenue une alternative au remplacement valvulaire chirurgical pour les patients consideres a trop haut risque operatoire [1] . Il s’agit pour la plupart de patients âges presentant un etat de fragilite a risque de dependance. L’objectif de notre etude a ete d’evaluer l’influence du type d’anesthesie lors du TAVI par voie retrograde femorale sur l’autonomie du sujet âge. Materiel et methodes Etude prospective observationnelle, comparant l’anesthesie generale (AG) et locoregionale (ALR), chez 40 patients de plus de 65 ans implantes d’une TAVI par voie femorale. Le critere de jugement principal etait l’autonomie des patients, evaluee par les scores activity of daily living (ADL) et instrumental activity of daily living (IADL) a j-1, j30 et j90 [2] , [3] . Ont egalement ete evalues la stabilite hemodynamique peroperatoire, et le vecu de l’anesthesie par le patient. Resultats Notre etude retrouve que la strategie anesthesique ne modifie pas le degre d’autonomie du patient, ni son evolution a j30 et j90. Les deux groupes avaient des scores ADL et IADL comparable en preoperatoire. La variation du score ADL a j30 entre les groupes AG et ALR (–0,2 vs IADL0,4, p = 0.25) etait comparable, de meme qu’a j90 (–0,4 vs –0,4, p = 0,81). Cependant, nous retrouvons une stabilite hemodynamique et un vecu de l’anesthesie significativement superieurs avec l’ALR ( Tableau 1 ). Discussion La strategie anesthesique pour le TAVI femoral ne semble pas influencer l’autonomie des patients a moyen terme. Cependant, l’ALR permet une plus grande stabilite hemodynamique peroperatoire, et un meilleur vecu par le patient.

Massive haemoptysis are rare in pregnant woman. Besides usual causes of haemoptysis, cases of idiopathic haemoptysis have been described during pregnancy, probably with a hormonal role. A pregnant woman at 22 weeks amenorrhoea was admitted in intensive care unit for massive and recurrent haemoptysis, enhanced by bouts of hypertension in a context of preeclampsia. Arteriography showed bronchial hypervascularisation, with abnormally dilated bronchial arteries, and a lot of collateral arteries. Three sessions of bronchial artery embolization have been performed with success. The management of idiopathic haemoptysis in pregnant woman seems to be based on the usual algorithm of management, emphasizing on the control of blood pressure, and the key role of interventional radiology.

This work reports on color controlled light converters fabricated from organic dyes (coumarin, DCM) and luminescent organic (Alq 3 ) and inorganic (SrGa 2 S 4 :Eu ++ ) molecules dispersed in a transparent polymer host matrix. These blends were pumped with a commercial GaN blue LED having a peak emission at 430nm. First are reported the photoluminescence spectra of Alq 3 -DCM and coumarin-SrGa 2 S 4 :Eu ++ -DCM blends. By photoexcitaton of these blends with GaN blue LEDs (which is partially absorbed by the dispersed dyes), it has been observed that the color can be tuned from blue to red depending on the composition. In particular, very pure white emitting hybridLEDs could have been obtained with organic-inorganic blends. Observed luminescence is due to cascade light absorption and emission from the various dyes in the blend. The influence of the polymer host matrix on the emitted color was also evidenced. Our results show how multicolor and white emitters could be fabricated with commercially available organic materials and rare earth doped inorganic dyes.

In this paper we report on Organic Light Emitting Diodes (OLEDs) based on heterojunctions between a polymer, Poly(N-vinylcarbazole) (PVK) as hole transport layer (HTL) and an evaporated layer ofTris (8-Hydroxy) quinoline) Aluminum(Alq3) as electron transport layer (ETL) and emissive layer (EM). The electrical properties of ITOIPVK/A1q3/Mg-Ag werethoroughly investigated and Trapped Charges Limited (TCL) currents were shown to be the main transport process in thesedevices. In order to assess the pertinence of PVK as HTL, a comparison with other HTL deposited by vacuum evaporationwas carried out. The color of the emitted light then could have been tuned by adding DCM in PVK. Light emitted by A1q3was partly absorbed by DCM thus exciting the photolummescence of DCM. Exiting light was thus a combination of green-yellow characteristic of Alq3 and of red-orange due to DCM. Wavelengths spanning the range 530-620 nm were obtainedfor DCM concentrations in PVK up to 20% wt. without significant degradation ofthe external quantum yield.Key words: organic LEDs, electrical transport, color tuning, A1q3, PVK, DCM

Brain abscesses and empyemas are severe infections with lethal outcomes in the case of inappropriate treatment. The files of 34 patients with brain abscesses, and nine with intracranial empyemas treated over eight years (1990-1997) were analyzed retrospectively. Cases were evaluated for treatment and compared with data from the literature. Patients with brain abscess underwent either aspiration of the lesion through a burr hole (79.5% of the cases), or craniotomy and excision (8.8% of the cases); 11.7% were treated only with antibiotics. The operative mortality was 2.9% and the outcome was satisfactory in 85% of patients. These results are in agreement with data from the literature. Prognosis is strongly related to the initial clinical status. Current methods of treatment include surgical aspiration of large abscesses with a mass effect, and are usually associated with a poor clinical status. Excision is suggested whenever aspiration procedures have failed, or in the presence of foreign material or fungal abscess. Medical treatment is indicated for small and deeply located abscesses in patients with satisfactory clinical states. Empyemas in our series were treated with burr hole and pus aspiration. The mortality rate was 11%, and 62.5% of the patients made a good recovery. In agreement with other reported studies, the method of treating subdural empyema is much less significant than an aggressive early drainage of the infection. Although brain abscesses and empyema remain a significant neurosurgical concern, aggressive treatment can result in an excellent outcome in the majority of patients.

This paper reports on the fabrication and on the characterization of LEDs consisting of two layers: a spinned-on hole transport layer, PVK layer and an evaporated tris(8-hydroxy) quinoline aluminum (Alq) emitter and an electron injection layer. Dye-doping of PVK with DCM induced a red shift of the spectrum due to concomitant emission from Alq and DCM. Some devices were passivated with Si3N4 deposited by RF sputtering. In that latter case, the threshold voltage of the LED slightly increased, but the emitted power was kept constant. The LED surface was imaged with a lateral resolution as low as 30 μm using Scanning ElectroLuminescence Imaging Microscopy (SELIM), a technique derived from the well-known Scanning Photo-Luminescence (SPL) widely used for III–V and II–VI semiconductors. This technique was successfully used to assess the lateral homogeneity of the emitting surface, and the aging of the diodes. At increasing working time, the devices did not show dark spots formation but a uniform decrease of the luminescence.

We investigate the experimental time delay over the bandwidth of apodised fiber Bragg gratings, as a function of the grating apodisation profile. We present evidence of the necessary tradeoff between sidelobes suppression and low chromatic dispersion suitable for 50 GHz-DWDM transmissions.

Infarction in the territory of the posterior spinal arteries is uncommon, giving rise to a softening of variable extend in the peripheral arterial system. In the reported case, the lesion was restricted to a posterior column and produced a syndrome of crural ataxic hemiparesis.

Cervical spondylotic myelopathy is usually a chronic and progressive disease. In a few cases, however, dramatic tetraplegia sometimes occurs after even minor injury.We report seven patients (6 males, 1 female, aged from 41 to 63), who suffered from acute myelopathy after an injury.In 5 cases, the injury revealed the cervical spondylotic myelopathy. A hyperextension of the cervical spine was found in 5 cases. The injury was severe in only one case, but there was no bony abnormalities, except arthrosis. The most common cause was a fall. In contrast, severe tetraplegia was found in 4 cases. Spontaneous, but incomplete, recuperation occurred in 4 patients. In all 7 cases, CT scan and MRI showed congenital cervical stenosis associated with cervical spondylosis. The level of disco-osteophytic changes was mainly in C4, C5, C6. On T2-weighted spin-echo image, an increased signal intensity was present in the cord of 3 patients, but was not correlated with the severity of the symptoms, nor with improvement. Surgical treatment was performed in 6 cases: 3 laminectomies, 3 anterior or antero-lateral approaches. Improvement after operative decompression was observed in all but one case, even when the motor or sensory deficit persists for more than one year. Motricity of the inferior limbs improved better than the other deficits, perhaps because of the location of non-reversible lesions in the spinal gray matter.The acute medullary syndrome of cervical spondylotic myelopathy is serious and can cause major handicaps. This complication justifies a preventive surgical attitude when medullar signs are moderate, and cervical imagery shows a spondylotic compression of the cord with congenital stenosis.

Six patients with neurological complications in Rendu-Osler-Weber disease were reviewed. There were 4 patients (3 int the same family) with a brain abscess, one patient with a brain abscess and a spinal cord subarachnoid hemorrhage, one patient with a recurrent intracerebral hemorrhage due to a vascular malformation. The infectious complications are related to the presence of pulmonary arterio-venous fistula, which should be treated, whenever diagnosed. Because of the potentially severe outcome of these neurological complications of the Rendu-Osler-Weber disease, screening of the patient's relatives is highly recommended.

Pituitary apoplexy results from necrosis or haemorrhage of a pituitary adenoma. This rare complication occurs in 2 to 10% of operated adenomas. The acute form results from massive intrapituitary bleeding leading to violent headache, meningeal signs, impaired conscience and ophthalmology signs, basically bilateral blindness. Associated signs are frequent including paralysis of the oculomotor nerves, epilepsy seizure, hemiplegia. Diabetes insipidis is exceptional. In less acute forms, the sudden nature of the headache and ophthalmology signs can suggest diagnosis. Standard X-ray reveals destruction of the sella turcica. Computed tomography shows either a haematoma or a cystic cavity in the pituitary gland which must be perfectly described together with the integrity of the bone structures due to the risk of lysis. Magnetic resonance imaging is an essential technique which can be used to describe the volume and suprasellar extension of the tumour, its texture, possible compression of adjacent structures and determine the age of the haemorrhage. This imaging technique can also isolate rare optochiasmatic apoplexia requiring intracranial evacuation. Emergency surgery is mandatory for most all authors. Rhinal-septal decompression is usually used, but the intracranial route may be preferred for very large suprasellar tumours. Medical treatment alone may be successful for small prolactin adenomas. Outcome depends on the time lapse to decompression. Optic nerve recovery is usually possible if the delay is less than 7 days. Cranial nerve recovery is less dependent on the time interval. In all cases hormone substitution is required.

Seventeen patients with subdural empyema were treated from 1985 to 1993. These included 13 males and 4 females with 11 patients aged between 12 and 30 years old. Sinusitis was found to be the primary source of infection in 16 cases. The clinical presentation was classic and the preoperative diagnosis was established on the first CT in 12 cases. In the remaining cases a second or third CT was necessary to demonstrate the empyema, 24 to 48 hours later. Surgical management was first made by burr holes with a small craniectomy in 15 cases. A large craniotomy was performed in 2 patients. Soft catheter drainage was carried out in 6 cases, 9 patients received surgical treatment once (3) or twice (6). Two patients, operated on while in a coma (stage IV of Bannister scale) died and one patient survived with severe disability (operated at stage III). The others (14) made a good recovery (6 in grade A and 8 in grade B of Mauser). These results were compared with those in the literature and we concluded that the mean factor of prognosis is the level of consciousness at the time of initial treatment. In most of the cases, burr holes or a small craniotomy, carried out on the basis of CT or MRI data, are the easiest and most effective method of surgical treatment.

We describe the case of a woman, who presents a spontaneous rhinorrhea. The metrizamid computerized tomographic cisternography proves the precise anatomic location of the dural osseous defect, in the left sphenoidal sinus. Transsphenoidal approach terminated the leakage in a single procedure, without shunt.

Using latex injections we have studied the anastomoses between the ophthalmic artery (a. ophthalmica) and the branches of the external carotid (a. carotis exerna) in the orbital region (regio orbitalis). We have limited this report to the macroscopic anastomoses which have a functional supply and which are accessible to examination by the Doppler technique. After examination of 60 specimen pairs it is clear that most anastomoses were inconstant. We have thus recorded their frequency: for the facial artery (a. facialis) the frequency of anastomoses was 60%, for the superficial temporal artery (a. temporalis superficialis) it was 33%, for the infraorbital artery (a. infraorbitalis) anastomoses were present in 37%. We have furthermore studied the association between the different anastomoses to establish whether their relationship to one another was organized or simply random. We found that the anastomoses between the branches of the opthalmic artery and those of the external carotid artery were much more frequent on the right side. Finally, we have compared our anatomical results with those of a series of Doppler examinations designed to detect reversal of the circulation at the level of different anastomoses of the ophthalmic artery in subjects who presented with unilateral thrombosis of the internal carotid artery (a. carotis interna). This study revealed a good correlation between the anatomical findings and those observed on Doppler examination. There are however differences which can be explained by the small number of subjects examined, by the calibre of the vessels and also by the fact that in certain subjects, the circle of Willis (circulus arteriosus cerebri) was particularly well-developed. In such circumstances the anastomoses were not clinically functional and there was no reversal of blood flow within them.

Rupture of the dura mater during lumbar laminectomy may result in destruction of the herniated sacral and lumbar nerve roots. This can be avoided by a simple but immediate surgical procedure, details of which are presented here.

We have performed micro-anastomoses by continuous suture technic: --circular suture of an aorta with 9/0 and with 10/0 Vicryl three (90% permeability); --next we performed an aortic-iliac bypass thanks to a carotid graft (70% permeability). The verification was carried out by injection of the complete arterial system with solidifying agent, and we obtained an arterial fitting after corrosion by the mean of hydrochloric acid.

Pharmacokinetics and biodistribution of 99m Technetium (99mTc) labelled heparin were studies to assess its value as a tracer of heparin kinetics in comparison with unlabelled heparin. In vitro, the stability and labelling efficiency (98%) of the labelled drug were excellent and elution was minimal. In vivo, after I.V. infusion of the drug, there was no difference in the same animal between anticoagulant activity measurements and radioactive countings, both displaying a plasmatic biexponential pattern (T1 = 2.9 minutes, T2 = 76 minutes). Biodistribution studies showed primarily liver, spleen and kidney accumulation, with no thyroid uptake. The advantages of this technetium labelling may therefore be used for the heparin drug in various experimental and pathological situations even in humans.

Following demonstration of a method of assay of circulation heparin by measurement of radioactivity after labelling with 99 m technetium, the technique was used to study effects of arterial microsuture on metabolism of heparin injected postoperatively. Results of a study involving rat aorta showed that local binding was maximum during the first half-hour and that abnormal consumption of heparin continued during the 6 hours following operation. These finding suggest that a risk of thrombosis probably persists throughout this postoperative period.

The introduction of vascular micro-surgical techniques has allowed to treat cerebral ischemia, through extra-intra-cranial anastomosis, when the causative arterial lesions have a surgically unfavorable location. Thirty patients underwent brain revascularization through extra-intra-cranial micro-anastomosis between the superficial temporal artery (branch of the external carotid artery) and a cortical branch of the middle cerebral artery. Twenty five patients had definite sensitive and motor deficits. Five patients, on the other hand, underwent preventive surgery because of transient cerebral ischemia. In our series, the global rate of the microanastomosis patency is 78%. When the anastomosis is patent, 85% of the cases with motor deficits are cured or improved. The results are even more favorable in case of transient cerebral ischemia, for the anastomosis in such cases was always patent. None of these later patients had ischemia attacks with a one-year follow-up.

In 21 autopsy specimens, we performed latex injection, and studied the rate and the diameter of the anastomosis between the ophthalmic artery and the facial artery: we find 26 cases in 42 face-sides, 60 %; which can supply rapidly a circulatory insufficiency. The anastomosis which go to the ophthalmic artery from the others branches of the external carotid are less frequent.

The use of a floating graft is proposed in order to attempt resolution of surgical problems raised by distal internal carotid artery lesions located high in the neck. Surgical treatment is essential, but vascular suture is impossible below the petrosa and ligature of internal carotid artery is often the only solution. The floating graft, which is fixed proximally only and is allowed to float in the circulation, allows exclusion of the lesion and maintenance of the carotid vascular axis. Preliminary experimental studies in the rat have provided satisfactory results and research should be continued in larger animals prior to possible clinical use.

Following an anatomical study of the lateral suboccipital region, the authors have devised an approach to the third segment of the vertebral artery, from C2 to the foramen magnum, which enabled them to treat an arteriovenous fistula in C1 while preserving the vertebral artery. The different operative stages and anatomical features are described. The simplicity and safety of this approach should encourage surgeons to use it.

40 temporo-sylvian anastomoses were controlled using Doppler ultrasonic examination. The results are compared to post-operative arteriograms. The Doppler examination has proved to be highly accurate when compared to contrast arteriography in the survey of extra-intracranial anastomosis. This non invasive procedure can easily be repeated. However the size of the revascularized area cannot be estimated. The simultaneous isotopic studies of regional cerebral blood flow could provide a means of quantifying the results of the anastomoses.

Pharmacokinetics of technetium 99m (99mTc) labelled heparin was studied after I.V. infusion (70 IU/kg) in normal rats and in a group of animals just after aortic longitudinal incision and suture. Anticoagulant activity measurements and radioactivity were compared on the same plasma samples. The pharmacokinetic decay of 99mTc-heparin followed a bi-exponential pattern. Half-lives (T1, T2) were significantly shortened after surgery using both techniques. Liver accumulation of labelled heparin was decreased in "sutured" rats and a high uptake of 99mTc-heparin was found on the operated area of the aorta.

Description of an arterio-venous fistula of the suboccipital V3 portion of the vertebral artery in a male of 48. The first clinical manifestation of the fistula was a bruit following an injury, which had produced i.a. a mandibular fracture. For various reasons, the authors are of opinion that the fistula was rather congenital than traumatic. The technique of a paramedian surgical approach of the lesion is described. The authors think that this is a valuable procedure in the treatment of vertebral arterio-venous fistulas in the region between C2 and the foramen magnum.