[Destruction of the valve of the great saphenous vein in the technique of femoro-popliteal bypass in situ (author's transl)]

Destruction of the valves of the great saphenous vein is one of the essential steps in femoro-popliteal bypass in situ. The authors suggest the use of bougies with a tip in the form a shell, the base of which is adorned with 4 rounded and smoothed teeth. After destruction of the great saphenous and ligation of the collaterals, arterial filling of the vein after superior anastomosis and the retrograde insertion of strippers may be used the collapse the valves opened by the blood flow. Amongst 40 bypasses performed using this technique, 38 were without problem.

[Intra-aortic obstruction with a balloon catheter. Means of control of massive retroperitoneal hemorrhage of aortic origin (author's transl)]

Temporary hemostasis with an inflatable intra-arterial balloon is useful in injuries of the great vessels. It permitted repair under satisfactory conditions of a perforating wound of the abdominal aorta.

[Serological analysis of coagulase-negative staphylococci: study of characteristic agglutinogens in type strains of the nine species individualized by Schleifer and Kloos (author's transl)]

The occurrence of characteristic agglutinogens has been searched for in the type strains of the following species: Staphylococcus xylosus, S. cohnii, S. epidermidis, S. capitis, S. saprophyticus, S. warneri, S. haemolyticus, S. hominis and S. simulans. Serotyping of these nine strains and study of their antisera have been carried out with formalin-treated and autoclaved bacteria. It has been shown that the characteristic agglutinogens of S. epidermidis and S. haemolyticus were respectively identical to the agglutinogens previously described in the coagulase-negative type strain 52.186 and in the S. aureus type strain 18. Characteristic agglutinogens have been found in each of the other seven type strains. Agglutinogens found in S. xylosus and S. saprophyticus are thermolabile, the corresponding absorbed sera reacting only with the formalin-treated homologous strain. Concerning S. cohnii, S. capitis, S. hominis and S. simulans, their absorbed sera reacting both with formalin-treated and autoclaved homologous strains, the observed reactions can be accounted either by one thermostable agglutinogen or by two characteristic agglutinogens, one thermostable, the other thermolabile. In S. warneri, only one thermostable agglutinogen has been characterized, the specificity of the reaction observed between the absorbed S. warneri antiserum and the homologous formalin-treated strain having to be confirmed. The use for serotyping of absorbed sera prepared against the type strains of the species S. xylosus, S. cohnii, S. capitis, S. saprophyticus, S. warneri, S. hominis and S. simulans should permit to improve the individualization of coagulase-negative staphylococci.

[Extrinsic compression of the celiac trunk by the arcuate ligament of the diaphragm. Apropos of 5 cases]

The authors report 5 cases (3 women and 2 men) of extrinsic stenosis of the coeliac axis by the arcuate ligament of the diaphragm. In one of the latter, the stenosis of the coeliac axis was associated with chronic calcific pancreatitis. These 5 patients were operated on. Division of the arcuate ligament gave on the whole very favourable results. (3 excellent results, one good and one average result). The authors then recall the clinical, angiographic and pathogenic data in this disease which remains exceptional. The diagnosis should be made and operation decided only after a fairly long period of observation during which one has elimiatned the diagnoses of gastro-intestinal, gall bladder, pancreatic and above all psychiatric disease by endoscopy, radiography and symptomatic medical treatment.

Progressive muscular dystrophy. Functional improvement after a renal allograft

From his first years a child showed signs of a primary and rapidly developing muscular dystrophy. The diagnosis was established by an increased serum CK level and by electromyography and muscle biopsies. Afterwards this child developed a severe renal deficiency which needed binephrectomy and the graft of a normal kidney. During the few months just after the graft, the disability increased and the patient could not stand upright by himself. Later on, he gradually became able to walk on his own and without bracing. He could climb stairs and stand up from the floor. The CK activity returned to normal. At present, 4 years after the graft (the patient is 16 years), the improvement of his functional abilities is constant, although the CK activity has increased again. In this article we give evidence that this patient suffers from a primary muscular dystrophy. We discuss the type of dystrophy concerned. We believe that it is the graft of a normal kidney which was responsible for the improvement observed, and not the physiotherapy or the drugs administered after the graft.

Ungual prostheses

Adhesives and surgical techniques are of limited value in the fixation of ungual prostheses. A finger-cover prosthesis that allows excellent fixation and good cosmetic result is described.

[Upper implantation of an axillo-femoral bypass. Technical point]

Very medial implantation of an axillo-femoral by-pass at the level of the external thoracic artery, permits one to avoid mobilisation of the anastomosis during movements of the arm and thus avoid breakdown of the sutures.

[Radio-anatomical study of the arteries of the foot]

30 Cadaveric feet were injected with minium by 3 catheters, one in each foot artery. The A. tibialis posterior is the most voluminous. It branches off in A. plantaris lateralis, main artery of the sole of the foot and A. plantaris medialis, small artery terminating on the medial edge of the big toe (in fact, in most cases (60%), it divides into 3 branches). The third branch has a double destiny, it vascularizes the shell of the calcaneus and it anastomoses with the posterior fibular artery. The A. dorsalis pedis, in 80% of the cases rejoins the lateral plantar artery in the first space. Among the 5 classical branches, the lateral tarsal artery and the dorsal metatarsal artery are constant. The other branches are more uncommun. But some anastomoses are frequent: - with the posterior fibular artery, (20%); - with the anterior fibular artery (10%). The A. fibularis is divided over the talo-tibial joint. Only the posterior branch is always injected. It gives three anastomoses: - The supra-malleolar artery with the posterior tibial artery, of great value because it is able to inject all the foot arteries. - The two others are narrower, the supracalcanean artery with the posterior tibial artery, and the medial supratarsal artery with the lateral tarsal artery. It ends in the sole of the foot after having given the vascularisation of the external face of the calcaneus. It is possible to oppose: The parts with a good vascularisation: - sole of the foot, - internal face of the calcaneus, - external face of the big toe, - internal face of the last 4 toes; The parts with a poor vascularisation: - dorsal face of the foot, - external face of the calcaneus, - internal face of the big toe, - external face of the last 4 toes.

[Atheromatous thromboses of the superficial femoral artery. (Apropos of 400 surgically treated cases)]

The authors report a consecutive series of 400 cases of atheromatous thrombosis of the femoral artery operated on between 1962 and 1972, which gave them an overall idea of the results of surgical treatment with a certain follow-up. This study confirms the importance of the state of the vascular bed beyond the obstruction in the maintenance of permeability after the operation. There are 50 p. 100 long-term failures when the thrombosis extends into the popliteal artery. On the other hand, lesions above the thrombosis, in the aortic or iliac arteries, have little influence on the final result, provided they are treated during the same operation. Lumbar sympathectomy alone gave very poor results but one should note that, in this series, it was reserved for the cases with the poorest prognosis, when any other operation was impossible or contra-indicated. In extreme cases, revascularisation alone of the profunda femoris permitted us in almost all cases to save the limb, leaving intact the symptoms of obstruction of the superficial femoral artery, in particular, intermittent claudication.