[Popliteal artery thrombosis from an osteochondroma of the upper end of the tibia. Apropos of a case]

A rare case of thrombosis of the popliteal artery due to an exostosis of upper end of tibia is reported. It is rare for exostoses to develop at the upper metaphysial region of the tibia, rare fore vascular complications to develop and particularly rare for these to consist of thromboses. This lesion is a differential diagnosis in young adults with lower limb ischemia. Follow up of these exostoses should be by Doppler, after dynamic arteriography to serve as a reference. Surgical treatment should be adapted to the degree of functional disability and the course of the exostosis or the complications it provokes.

[Crossed iliofemoral bypass]

Crossed shunts between the two femoral axes constitute a useful safeguard in unilateral iliac occlusions when the abdominal approach is contraindicated. Hemodynamic considerations suggest the need for iliac implantation from the donor side. This simple technique does not complicate the operation and provides a more satisfactory result than the interfemoral shunt.

[Extra-anatomical femoropopliteal shunt]

The construction of an extra-anatomical femoropopliteal shunt resulted in the saving of a lower limb following a gunshot wound to the upper third of the thigh involving vascular lesions and extensive tissue loss. By applying this technique it was possible to obtain revascularization of the limb without the septic risks of reconstruction in situ, with the attendant difficulty of initial skin coverage of the wound.

[Functional anatomy of humero-radial articulation]

From a theoretical study combined with dissection of twelve joints and the building of a mechanical model, the authors describe the contact zones between capitulum and conoìdal zone of the humerus on one hand, and cupule and radial bevel-edge on the other, and this, during the various phases of pro-supination. In supination, the contact is essentially forward. In pronation, it is mostly backward. In each position, it is approximately the same area of the cupule which is in contact with the capitulum. The best fit is in the functional position. Major displacement occurs with almost flat cupules, displacement is minimal with hollow cupules which correspond to rounder heads.

[Topographic study of parasternal lymph nodes. Finding a window for radiotherapy]

A series of arteriographies of the internal thoracic arteries was performed by the authors. By superimposing the tracing of 55 thoracic walls thus obtained, the authors were able to observe a preferential pathway. This pathway is located at a rather precise distance of the manubrio-corporeal angle and of the median axis. 22 parasternal chains were dissected. The lymphatic chains appeared closely linked with the arteries. An irradiation field covering all the parasternal nodes was thus precisely defined.

[Bypass on a single major artery of the leg. Theoretical modalities and results apropos of 100 cases]

Sub-crural bypass operations on a single leg artery were analysed retrospectively with a follow-up period ranging from six months to eight years. The vitality of the limb was threatened in the majority of cases (91/96). Whenever possible (79/96) the internal saphenous vein was used as a graft, preferably by the in situ technique. Mortality was 6%. Morbidity with the exception of thromboses was 14.5%. Patency by actuarial analysis was 71.6% at 5 years and 65.8% beyond. The majority of thromboses occurred during the first few months and led, in the majority of cases, to amputation. Secondary thromboses were better tolerated. The influence of various parameters was studied: clinical stage, peroperative flowmeter results, material used, technique, associated procedure (sympathectomy), implantation site and permeable vessel.

[Reconstruction of the lumbosacral plexus of an embryo at stage 23 (25mm) and an embryo at stage 16 (7,5mm)]

Two embryos, one at stage 23 and another at stage 16, are reconstructed in view of studying the evolution of the lumbosacral plexus. At stage 16, the sacral plexus begins its development with anastomosis of L5, S1 and S2 roots, while the pelvic member is scarcely sketched. At stage 23, the evolution is complete, the pelvis is entirely constitued and the femoral, sciatic and obturator nerves of adult type. The coccygian plexus is in process of construction.

[Isotopic phlebography for control of venous surgery of the lower limb]

Isotopic phlebography with microspheres containing 99 mTc aggregated human albumin is a simple and easily reproducible means of controlling the results of venous surgery of the lower limb and ilio-caval confluent. A comparison in 34 cases with the results obtained by conventional contrast phlebography showed close correlation between the two methods. However, since the images are not as sharp as with contrast phlebography, isotopic phlebography cannot be used for planning procedures prior to reconstructive venous surgery and should be reserved to post-operative control.

[Anatomical problems in prevention of pulmonary embolism (author's transl)]

The prevention of recurrent pulmonary embolism by caval clip or intracaval filter may be difficult when the infrarenal segment of the inferior vena cava is double or left sided. Two such cases of anatomical variations are reported.

[Contribution of computed tomography to the exploration of aortic aneurysms (author's transl)]

A technique for exploring aortic aneurysms is described, and the results analysed in 50 cases (11 thoracic, 32 abdominal, 3 multiple, and 4 with both thoracic and abdominal aneurysms). The diagnostic value of this method appears evident for aneurysms in the thorax, and it can reduce the need for conventional radiological examinations. Results of examination of abdominal aneurysms were compared with those of ultrasonography and angiography. Angiography was more effective for studying collateral lesions, while ultrasonography is still a reliable, non-aggressive, low cost investigational procedure. Computed tomography, however, represents the most polyvalent, non-aggressive technique for evaluating the size of the aneurysm, its thrombotic components, and its extension to neighbouring organs.

The aesthetic hand prosthesis

The high-quality aesthetic prosthesis can be equally helpful to those with acquired amputation and to those whose loss is due to agenesis. Restoring near-normal appearance improves patients' function in a global sense, enabling them to better utilize what they have in the complex socioeconomic environment of today's mobile society. The aesthetic prosthesis often also gives some prehensile assistance, providing an opposition part for remaining digits or thumb. The needs of each patient must be carefully considered, and the prosthesis must conform to the high standards of quality outlined. Its use is primarily for the unilateral amputee who is making a good adjustment to the loss with realistic expectations.

Plasmid DNA content of multiresistant Staphylococcus aureus strains

Multiresistant S. aureus strains (also called methicillin-resistant in clinical laboratories) share many common properties. In addition to the commonly used epidemiological markers (pattern of resistance to antibiotics and metal ions, serotype and lysotype), we considered using the molecular and genetical properties of the plasmid DNA harboured by these strains. In this paper we report an epidemiological study of two groups of S. aureus strains sampled since 1975 and carrying new resistance characters which appeared with increasing frequency in France. The Tm-SgR strains (5 strains) carry, in addition to 13 resistance characters commonly observed, two new characters: the resistance to gramin components A and B (Sg). The two new characters were shown to be encoded by a single plasmid. Amongst the 5 strains studied, two harbour a similar plasmid DNA content while the three others were clearly distinct. Because of the variability of the plasmid DNA content observed in these strains, the similarity of this content observed between two of them suggest a close phylogenic relationship. These two strains are probably derivatives from a single clone. The spread of the two new characters amongst the distinct strains might be related to the spread of ancestrally related Tm-Sg plasmids. The Tob-GenR strains (16 strains) carry, in addition to 12 wide-spread resistance markers, the newly observed resistance to many aminoglycosides, mainly the resistance to tobramycin (Tob) and gentamicin (Gen). They all harbour a 22-kb plasmid DNA generating similar restriction cleavage patterns and conferring the resistance to penicillin G, arsenate, arsenite and cadmium. Some of them harbour one or two extra small plasmids (3.4 and 2.3 kb); the presence of these two plasmids was not associated with a modification of the resistance pattern of the strains. Most of the resistance characters--including the new ones--are probably encoded by chromosomal genes. In this epidemiological situation, the spread of the new aminoglycoside resistance characters carried by the 16 strains having the same phenotype and harbouring the same 22-kb plasmid is attributed to the spread of derivatives from a single clone.

[By-pass from sub-clavian to carotid artery. A rescue procedure in the treatment of common carotid artery hemorrhage (author's transl)]

Rupture of a carotid artery in an infected or irradiated environment is a tragic event that frequently causes immediate death. Plain ligature, when possible, for these patients in a state of shock, leads to cerebral ischemia in 65% of cases. This can be prevented, if one operates soon enough by an extra-anatomic by-pass, avoiding the infected or irradiated area, between the subclavian artery and the homolateral carotid artery. (Study of 2 cases). Such a procedure could be used preventively when the risk for the carotid is highest (particularly septic surgery followed by irradiation).

[Radio-anatomy of anastomoses between the deep femoral artery and the femoro-popliteal axis]

The anastomoses between the deep femoral artery and the femoro-popliteal arterial axes are clearly visible in angiographic studies when there is an obstruction of the main arterial axis. These anastomoses which allow blood to flow into the distal arteries occur especially in the femoral perforating arteries (ramus perforans arteriae femoralis) in the lateral circumflex femoral artery (arteria circumflexa femoris lateralis) and in the medial circumflex femoral arteries (arteriae circumflexae femoris medialis).

[A case of arteriovenous fistula of the anterior tibial vessels following fracture of the tibia (author's transl)]

A case is reported of arteriovenous fistula of the anterior tibial vessels following a spiral fracture of the tibia treated conservatively. The fistula was operated on at the seventh month, after bony union had occurred and the artery was repaired by a venous graft.

[Ischio-popliteal artery trunk, persistence of the axial artery]

The authors studied two cases of persistent axial artery of the lower limb, a classic but exceptional variation (42 cases in the literature). It is well explained by embryology and is a recapitulation of anatomy in the animal series. By the systematic study of the literature, we can isolate four distinct types: Type I: Complete axial artery, normal femoral artery. Type II: Id., but incomplete femoral artery, with two subdivisions: II a: Femoral artery is present but incomplete. II b: Femoral artery is absent. Type III: Axial artery only in the proximal zone. Type IV: Axial artery only in the distal zone. In these two last types, the femoral artery is complete. The I, III and IV types correspond to organogenetic perturbation at the stage 21 of Streeter. The type II implies a more early disturbance, prior to stage 18.