Anatomical basis of rat brachial plexus reconstruction.
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Animals↗
Biomedical subjects
A Gilbert
Publications and source records attributed to A Gilbert.
Results of the renewed extravesical reimplant for surgical correction of vesicoureteral reflux.
In 1987 Firlit et al described their results using Hodgson's technique of the modified extravesical Gregoir-Lich procedure. They coined the term detrusorrhaphy or extravesical ureteral advancement to describe this technique. During the last 4 years we performed this reimplantation on 211 ureters in 132 patients. Of the patients 79 had unilateral and 53 had bilateral procedures. Included were 6 megaureters requiring ureteral tailoring and 9 uncomplicated duplications. All but 1 patient were cured of reflux. No postoperative obstruction was encountered. Our results indicate that this is an excellent procedure to repair vesicoureteral reflux with minimal morbidity and short hospital stay.
Child↗
Free bladder mucosal graft biology: unique engraftment characteristics in rabbits.
To study the biology of bladder mucosal grafts we developed an animal model using New Zealand white male rabbits. A 25 x 9 mm. segment of bladder mucosa was harvested and tubularized over an 8F catheter using 7-zero polyglactin sutures. An equivalent portion of rabbit urethra was then excised and the graft was anastomosed to this defect in an end-to-end fashion. A urethral catheter was left in place to provide bladder drainage and to stent the anastomosis. Animals were sacrificed on postoperative days 1 to 90. India ink was injected into the aorta at sacrifice to visualize the microvasculature. All 59 specimens were stained with hematoxylin and eosin, and studied using light microscopy. Our results demonstrated vascular ingrowth at 72 hours. Between postoperative days 8 and 10 healthy viable epithelium first bridged the entire urethral defect. By postoperative day 12 the epithelial lining was complete. A poor outcome was observed in all animals whose stents were removed early. We conclude that the biology of bladder mucosal grafts is unique in that the graft initially undergoes partial degeneration followed by regeneration. Of concern are the results of those animals whose stents were removed early. In all such cases a poor outcome was observed.
Animals↗
A new flap based on the distal branches of the radial artery.
A flap based on the distal branches of the radial artery is raised on the dorso-lateral aspect of the distal third of the forearm. Thirty fresh cadaver dissections have established the anatomical rationale of the flap. The potential territory is supplied by a subaponeurotic plexus of vessels fed by lateral branches of the radial artery in the distal third of the forearm. This new knowledge of the anatomy has been applied to the performance of this flap in seven clinical cases. Various methods of application to hand and wrist reconstruction are described along with a discussion of the various advantages and disadvantages.
Adult↗
The versatile metacarpal and reverse metacarpal artery flaps in hand surgery.
Vascular anatomy of dorsal metacarpal arteries was investigated in fresh cadaver dissections and by injection of methylene blue. Origin and termination of the vessels were studied, as well as their connection to the palmar vasculature. Vascular territories and elevation of flaps based on these vessels are also discussed. The second dorsal metacarpal artery was found to be the most consistent. This vessel has a large distal connection to the palmar vessels which allows both proximal and reverse elevation. Representative cases and surgical technique are described.
Adult↗
Bilateral tibial osteomyelitis in a patient with sickle cell anemia.
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Adult↗
Use of the appendix for urethral reconstruction in children with congenital anomalies of the bladder.
BACKGROUND: The presence of the cecal appendix offers a unique opportunity for the achievement of urinary continence and stable access to the reconstructed urinary bladder. METHODS: We have reviewed the cases of 17 children treated over a 56-month period whose urinary anomalies have required the construction of a neourethra. Fourteen of these patients underwent neourethral reconstruction by use of the appendix. RESULTS: All neourethras are easily catheterized, and all are continent. CONCLUSIONS: The ease of application of this reconstructive modality along with its high success rate makes incidental appendectomy contraindicated in children with congenital anomalies of the bladder.
Adolescent↗
The subtendons of the abductor pollicis longus muscle.
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Humans↗
Obstetrical brachial plexus lesions.
The renewal of interest in brachial plexus surgery has been led by the success of microsurgical techniques in other peripheral nerve repairs. The results in adults remain poor, but in obstetrical palsy the regenerative capacity of babies allows for dramatic recovery after nerve repair or reconstruction. Obstetrical brachial plexus injuries represent a unique group with similar aetiology, age and prognosis.
Birth Injuries↗
The superficial anastomosis on the palm of the hand between the ulnar and median nerves.
The communications between the median and ulnar innervated territories on the palm of the hand have been studied anatomically and microscopically. A communicating branch is well appreciated but its description has had little emphasis in anatomical or surgical literature. 50 cadaveric palms were dissected in both sexes and an anastomotic branch was found in 45 hands. In 43 of them it originated proximally from the ulnar nerve and proceeded distally to enter the third common digital nerve; in the other two hands it left the median nerve to reach the fourth common digital nerve. By microscopic dissection we have seen that the ulnar fibres of the anastomotic branch which join the median nerve may contribute to the sensory innervation of the radial half of the ring finger and ulnar side of the middle finger on its palmar surface. We have therefore described a cutaneous area on the palm where care must be taken to avoid surgical damage to this branch.
Aged↗
[Training of microsurgery in the laboratory of the Hôpitaux de Paris].
The Microsurgical Laboratory of Paris Hospitals' Anatomy Amphitheater has been organizing an initiation into microsurgery since 1976 and the University Diploma of Microsurgical Techniques of Paris VI University since 1977. Since this time, 1,426 surgeons have been trained in the laboratory. The geographic origin of the students is worldwide, but predominantly European. The success rate at the final examinations is relatively constant and averages 60%. The results have been compared to the number of sessions in which the candidates had taken part, and a correlation between a number of sessions exceeding 30 and results above 90% at the examinations was established; A minimum number of sessions of vascular microsurgery was therefore laid down in order to ensure the serious training of the students.
General Surgery↗
[Reconstruction of loss of bony substance in limbs by free vascularized fibula transplant].
The authors present their experience of bone-loss reconstruction by a free vasculized fibular transfer. 62 cases were operated, with an average follow-up of 6 years (between 24 to 13 years). Studied were 15 upper limbs (10 humerus, 3 ulna, 2 radius), 28 femurs and 19 tibias. We found a male predominance: 46 cases and the average age was 33 years old. The etiology was often due to trauma: serious road traffic accidents (37 cases). 44 cases were septic and the average bone-loss was of 10 cm (between 4 cm to 30). The most frequent complications were due to fractures of the graft (10 cases) and stiffness (15 cases). Consolidation rate was of 87%: 8 were failures (3 upper limbs: 20% at femur level, 10% at tibia level). The average consolidation rate of the septic cases was of 81%, and the non-septic cases over 97.5%. It seems to be a good technique and in particular for septic cases using a basic orthopedic technique and microsurgical suture.
Bone Transplantation↗
Surgical treatment of brachial plexus birth palsy.
Brachial plexus birth palsy remains a challenging condition. In the 1000 infants followed from 1977 to 1988, functional results were much improved over those obtained by observation only, if surgical exploration and repair were performed when no clinical recuperation of biceps function occurred by three months of age. Recovery is slow, and comprehensive follow-up study of reconstructed and conservatively managed children is required to prevent joint contractures. Children who will benefit from palliative procedures such as tendon transfers must also be identified.
Brachial Plexus↗
Anterior interosseous artery: anatomic bases of pedicled bone-grafts.
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Arteries↗
Reduction of plasma cholesterol levels in normal men on an American Heart Association Step 1 diet or a Step 1 diet with added monounsaturated fat.
The design of diets to achieve optimal changes in plasma lipid levels is controversial. In a randomized, double-blind trial involving 36 healthy young men, we evaluated the effects on plasma lipid levels of both an American Heart Association Step 1 diet (in which 30 percent of the total calories were consumed as fat: 10 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day) and a monounsaturated fat-enriched Step 1 diet (with 38 percent of the calories consumed as fat: 10 percent saturated, 18 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day). The effects of these diets were then compared with those of an average American diet, in which 38 percent of the total calories were consumed as fat: 18 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 500 mg of cholesterol per day. The men consumed the average American diet for 10 weeks before random assignment to one of the two Step 1 diets or to continuation of the average diet for an additional 10 weeks. Caloric intake was adjusted to maintain a constant body weight. As compared with the mean (+/- SD) change in the plasma total cholesterol level in the group that followed the average American diet throughout the study (-0.05 +/- 0.36 mmol per liter), there were statistically significant reductions (P less than 0.025) in the plasma total cholesterol level in the group on the Step 1 diet (-0.37 +/- 0.27 mmol per liter) and in the group on the monounsaturated fat-enriched Step 1 diet (-0.46 +/- 0.36 mmol per liter). There were parallel reductions in the plasma low-density lipoprotein cholesterol levels in these two groups. Neither the plasma triglyceride levels nor the high-density lipoprotein cholesterol concentrations changed significantly with any diet. We conclude that enrichment of the Step 1 diet with monounsaturated fat does not alter the beneficial effects of the Step 1 diet on plasma lipid concentrations.
Adult↗
The acute phase protein response in mice does not show tolerance to recurrent sterile inflammation.
The response of acute phase proteins to repeated inflammatory stimuli was studied in BALB/c mice and Hylyne Dutch rabbits. Inflammation was produced by subcutaneous injections of turpentine/arachis oil twice weekly for three and a half weeks. Serum amyloid-P component (SAP) levels in the mice showed no significant decrease in the level of response following each injection and the pattern of response was the same in mice previously rendered tolerant to endotoxin. Haptoglobin levels in the rabbits also responded equally to repeated injections in two animals and showed a declining response in a third animal which became unwell during the experiment. The ability of experimental animals to continue to respond fully to repeated inflammatory stimuli supports the suggestion that the subnormal responses seen in certain chronic inflammatory conditions may reflect an underlying defect in the acute phase response rather than an adaptive change following chronic inflammation.
Acute-Phase Proteins↗
Thumb duplication: surgical treatment and analysis of sequels.
Between 1978 and 1988, 50 thumb duplications were operated upon at either the orthopedic department of Hôpital Trousseau (Paris) or at l'Institut Français de la Main (Paris). Following Wassel's classification, we observed a large incidence of types IV, II and VII (in that order). There was a 30% incidence of associated anomalies. The average age at operation was 15 months. We were able to review 30 patients (31 thumbs) with a mean follow-up of 30.9 months. We divided our series into two groups depending on the operative protocol. Group A: 19 patients (20 thumbs), operated on between 1978 and 1982 and reviewed at 33 months on average. Group B: 11 patients (11 hands) operated on between 1983 and 1988 and reviewed with a mean follow-up of 28.5 months. All of the children were evaluated following Wassel's and Tuch's criteria. In groupe A, only five thumbs could be considered normal, or near normal upon this reexamination. All the others were affected by various sequels, which were essentially esthetic. Only two thumbs had a functional deficit, due to instability of the MP joint in one case, and stiffness of the two joints of the thumb in the other. These poor objective results were, however, not shared by the children and their parents, since 16 of them declared themselves satisfied with the appearance and the function of the thumb. 6 patients required further surgery with an average of 2.5 operations per patient. These secondary operations gave imperfect results: out of 6 such patients, we obtained 3 fair results, and three remained poor. This relatively high proportion of sequels in our patients in group A led us to change our treatment protocol in 1983. Our revised attitude was to treat all deformities at once, and especially axial deviation with a corrective osteotomy if soft tissue surgery alone did not afford perfect realignment of the thumb. Thus, among the 11 reviewed patients of group B, 6 results could be considered to be good, 4 suffered from slight sequels, and one patient required a secondary surgery (tenolysis of the extensor apparatus) to correct an inadequate active extension of the IP joint. This result was functionally good on review. The optimal age for operation is between 12 and 18 months. Il seems to us that bad results are apparent early, after 6 to 12 months, because they are mainly due to inadequate treatment. Conversely, good short-term results seem to persist with growth, but there is an overall paucity of studies in this field.
Classification↗
Traumatic brachial plexus palsy in children.
We have reviewed 25 children with traumatic brachial plexus palsy during the last fifteen years. Motor vehicle injury was responsible for 17 of these cases. Associated lesions were noted in 68%. All lesions were supraclavicular, including C5-C6 in 5 cases, C5-C7 in 5 cases and C5-T1 in 13 cases. Precise data was not available for two patients. Root avulsion was noted in 63% of our patients. Neurotization was performed in eight of the sixteen patients who had surgical repair. Tendon transfers were performed in 9 patients, 5 of which have had a previous surgical plexus repair. Elbow flexion was restored in all but one, and protective sensation of the hand in 40% of the patients undergoing plexus surgery. We conclude that surgery should be performed on children who have no evidence of nerve regeneration three months following traumatic brachial plexus palsy.
Adolescent↗