The aim of this study was to ascertain the impact of injury to the superior mesenteric nerve plexus caused by right colectomy with D3 extended mesenterectomy as performed in the prospective multicenter trial: "Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography" in which all soft tissue surrounding the superior mesenteric vessels from the level of the middle colic artery to that of the ileocolic artery was removed.Bowel function and gastrointestinal quality of life in two consecutive cohorts that underwent right colectomy with and without D3 extended mesenterectomy were compared. Main outcome measures were the Diarrhea Assessment Scale (DAS) and Gastrointestinal Quality of Life Index (GIQLI). The data were collected prospectively through telephone interviews.Forty-nine patients per group, comparable for age, sex, length of bowel resected but with significantly shorter follow-up time in the experimental group, were included. There was no difference in total DAS scores, subscores or additional questions except for higher bowel frequency scores in the D3 group (p = 0.02). Comparison of total GIQLI scores and subscales showed no difference between groups. Regression analysis with correction for confounding factors showed 0.48 lower bowel frequency scores in the D2 group (p = 0.022). Within the D3 group presence of jejunal arteries cranial to the D3 dissection area showed 1.78 lower DAS scores and 0.7 lower bowel frequency scores.Small bowel denervation after right colectomy with D3 extended mesenterectomy leads to increased bowel frequency but does not impact gastrointestinal quality of life. Individual anatomical variants can affect postoperative bowel function differently despite standardized surgery.

Accurate placement of an external ventricular drain (EVD) for the treatment of hydrocephalus is of paramount importance for its functionality and in order to minimize morbidity and complications. The aim of this study was to compare two different drain insertion assistance tools with the traditional free-hand anatomical landmark method, and to measure efficacy, safety and precision.

Image-guided neuronavigation systems provide the ability to accurately visualize surgical targets during operative procedures. Previously, neurosurgeons were limited to viewing intracranial lesions on preoperative radiologic images and using anatomic landmarks to orient themselves during surgery. Neuronavigation systems allow neurosurgeons to directly relate preoperative imaging of local craniospacial anatomy to identified operative anatomy to improve surgical accuracy. In addition, these systems are used in preoperative planning to evaluate surgical risks, select the best interventional method, and decide on the optimal trajectory for a surgical procedure. Recent improvements in medical imaging over the past few decades have led to great advancements in neurosurgery. Surgeons are now able to visualize the location of a brain lesion more accurately, and new imaging modalities allow for the identification of many lesions that had been poorly defined by older imaging methods. The combination of neuronavigation with newer imaging modalities permits surgeons to perform a more complete removal of brain and spinal cord pathologies and helps to avoid damage to important local anatomic structures, resulting in decreased patient morbidity and mortality. This review outlines the history of neuronavigation and discusses new imaging modalities that are being incorporated into current navigation systems used in operating rooms today.Les systèmes de neuronavigation guidée par l'image permettent de visualiser avec précision les cibles chirurgicales durant les interventions opératoires. Auparavant, les neurochirurgiens ne pouvaient voir les lésions intracraniales que sur les images radiologiques préopératoires chirurgicales et ne pouvaient donc utiliser que les repères anatomiques pour s'orienter durant la chirurgie. Les systèmes de neuronavigation permettent aux neurochirurgiens de se référer directement à l'imagerie préopératoire de l'anatomie craniospatiale afin d'identifier l'anatomie opératoire et ainsi améliorer la précision de la chirurgie. De plus, ces systèmes sont utilisés en planification préopératoire afin d’évaluer le risque chirurgical, choisir la meilleure méthode d'intervention et déterminer la trajectoire optimale pour la procédure chirurgicale. Les avancées de l'imagerie médicale au cours des dernières décennies ont conduit à de grands progrès en neurochirurgie. Les chirurgiens sont maintenant en mesure de visualiser l'emplacement d'une lésion cérébrale avec une plus grande précision et les nouvelles modalités d'imagerie permettent l'identification de plusieurs lésions mal définies par les méthodes d'imagerie plus anciennes. La combinaison de la neuronavigation et des nouvelles modalités d'imagerie permet aux chirurgiens d'effectuer une résection plus complète des pathologies du cerveau et de la moelle épinière et aide à éviter des dommages aux structures anatomiques locales importantes, entraînant ainsi une baisse de la morbidité et de la mortalité chez les patients. Cet examen porte sur l'histoire de la neuronavigation et traite des nouvelles modalités d'imagerie qui sont incorporées dans les systèmes de navigation utilisés en salle d'opération aujourd'hui.

BACKGROUND AND AIMS:The aim of this study was to detect Helicobacter pylori (H. pylori) in colorectal cancer tissue specimens and relate the possible role of this microorganism in the etiology of colorectal cancer.PATIENTS AND METHODS:From February 2002 to April 2003 83 CRC patients (55 male, 28 female) and 40 control patients (19 male, 21 female) entered the prospective study. The biopsy samples of CRC tissue and normal mucosa were obtained during open surgery on CRC patients. In the control patients biopsy samples were taken during colonoscopy. Pathology confirmed adenocarcinoma in all the CRC patients. The existence of genetic material of H. pylori was determined by detection of the ureA gene by nested PCR. K-ras PCR was also performed on all patients.RESULTS:H. pylori PCR was positive in 1 case (1.2%) of CRC in the tumour tissue and in all 5 samples (6.0%) of the normal colonic mucosa in the cancer patients. The control patients were PCR positive to H. pylori in 13 samples (32.5%). According to Chi-square test, there is no statistical correlation between H. pylori infection and CRC (x2 = 2.9395; p > 0.05) but there is a significant prevalence of H. pylori infection in controls compared to CRC (x2 = 15.5625; p < 0.01). The K-ras PCR showed gene mutations in 19 tumour tissues of CRC (31.6%) and in 2 cases (3.4%) of normal colonic mucosa of CRC patients . In controls K-ras PCR showed one gene mutation (3.0%). There is a significant statistical correlation between K-ras mutation and CRC (x2 = 16.0694; p < 0.01).CONCLUSION:Our established PCR for H. pylori is feasible for CRC tissue as well. However, H. pylori is not considered to play an important role in the pathogenesis of CRC. The identification of K-ras mutations in routine PCR analysis correlates with the presence of CRC.

The study aim was to provide data on pattern and length of crossing of the ileocolic artery (ICA) and right colic artery (RCA) with the superior mesenteric vein (SMV).

F.D. Aker F. Anderhuber O. Armstrong C. Avisse P. Baque F. Bargy F.G. Barral F. Bonnel F. Bonnomet P. Bordei E. Brenner P. Breton N. Cheynel Ph. Clavert J.P. Cottier F. Cotton S. Das R. De Caro R. Degeorges B. Delas J.-F. Delattre V. Delmas X. Demondion V. Di Marino R. Douard J.-L. Dumas F. Duparc S. Durand H.M. Duvernoy F. Eckstein J.P. Faure J.M. Faure J.M. Fessy C. Fontaine P. Foulon J.-M. Garcier A. Goncalvez-Ferreira F. Govsa B. Grignon B. Grignon A.M. Guihard-Costa M. Haerle E. Havet A. Herrler H.M. HoVmeister M. Hüdelheimer N. Jakse J.F.K. Jones J. Jupiter J. Kahn J. Kainz J. Koebke T. Koppe L. Kqiku-Biblekaj R. Kuzbari M. Labrousse P. Lasjaunias J.-Y. Lazennec D. Liguoro P. Liverneaux M. Loukas S. Louryan V. Macchi C. Manderim De Lacerda L.L. Maroun P. Mercier P. Mertens D. Midy H. Migaud P.Y. Milliez J. Milon M. Montaudon X. Morandi J. Moscovici H. Muresian S. Natsugol S.A. Papadakis B. Parratte J. Pascal N. Pirro D. Pokorny A. Porzionato J.M. Prades M Pretterklieber F. Proust M. Riquet R. Robert M. Rongières M. Rooze M. Rousseaux J. Sanudo K. Satyapal M. Scepi P. Seguin L. Selvaratnam G. Steinau B. Stimec J. Stingl F. Taser

The anatomical features of splenic segmental vessels in 102 human spleen autopsy specimens were analyzed. Methods applied were corrosion casting and post-mortem arteriography. The superior terminal splenic branch divided extracapsularly into 2.8+/-0.9 (range 2-5) and the inferior terminal splenic branch into 2.3+/-0.75 (range 2-5) branches per sample. The extracapsular lengths of the segmental branches ranged from 4.0 to 16.7 mm and the calibers from 0.4 to 2.2 mm. Superior polar arteries occurred in 31.3% and inferior polar arteries in 20.6% of cases. Their average extracapsular lengths were 39 mm and 31 mm, respectively. In conclusion, segmental splenic arteries have an extrasplenic origin and course, with an average length and caliber that allow surgical access and ligation, in order to achieve segmental dearterialization for hemostasis purposes and splenic preservation.

Immature teratomas of the ovary represent less than 1% of all ovarian teratomas. They contain several tissues that derive from the three embryologic layers: ectoderm, mesoderm, and endoderm. We report the case of a 17-year-old girl who presented with an immature teratoma of the left ovary that recurred 3 months later as an inoperable malignant neuroepithelial peritoneal tumor resembling a glioblastoma. She died 3 weeks after the second explorative operation. The very aggressive course and fast lethal outcome could be explained by the patient's refusal to receive chemotherapy after the initial operation.

A study of structure and function of the minor duodenal papilla was carried out on 36 autopsy specimens of the human duodenopancreas. An original perfusion method with manometric control was developed for testing the minor papilla patency, i.e. resistency to intraductal pressure. According to this test, all the specimens were classified as: Type I: non-patent (45%); Type II: patent under normal, physiological pressure (36%); and Type III: patent under increased pressure (19%). After that, the whole minor papilla specimens underwent longitudinal sectioning with HE staining. Light microscopy showed various degrees of fibrosis (mild—45%, moderate—29%, and severe—26%). The correlation between the fibrosis and the patency was significant: papillae with lower degrees of fibrosis were more patent and vice versa. Further, the pancreatic tissue in the Santorini segment of the pancreatic head followed the same manner. No apparent sphincter of the minor papilla was found in any of the specimens analyzed.

The gastrocolic trunk of Henle has not been described indetail in context with right hemicolectomy. The aim of thisstudy was to define the caliber, length and three-dimensionalposition of the gastrocolic trunk of Henle (GTH).

BACKGROUND. The etiology of tumors arising in the biliary tract remains unclear. Several previous studies have detected Helicobacter pylori organisms in bile from patients with gallstones or cholecystitis. The objective of this study was to determine whether there is an association between H. pylori in bile and biliary tract carcinoma.METHODS. The authors used polymerase chain reaction (PCR) assays to detect the presence of H. pylori in the stomach and bile from 89 patients: Sixty-three disease free patients had biliary calculi, 15 patients had carcinoma of the biliary tract, and 11 patients had neither gallstones nor carcinoma. Bile was considered to contain H. pylori only if the results of PCR determinations were positive in two or more samples assayed independently in two separate laboratories.RESULTS. There was a strong association between the presence of H. pylori in the stomach and in the bile (P less than or equal to 0.01). Biliary H. pylori was associated with age but not with gender, and it was associated strongly with the clinical diagnosis. Patients with gallstones were 3.5 times as likely to have H. pylori in the bile compared with patients in a control group (95% confidence interval [95%CI], 0.8-15.8; P = 0.100), and H. pylori was 9.9 times more frequent in patients with biliary tract carcinoma compared with patients in the control group (95%CI, 1.4-70.5; P = 0.022).CONCLUSIONS. There is a strong association between biliary tract carcinoma and H. pylori in bile. If these results are confirmed by prospective studies, H. pylori may be responsible for a significant proportion of malignant biliary tract disease. (C) 2002 American Cancer Society.

The authors have analyzed several aspects of the surgical anatomy of spleen, commencing with historical data, topography, peritoneal ligaments, variations in shape, embryology and accessory spleens and venous system of the spleen. The mode of splenic artery branching, variations of polar arteries, and intra- and extraparenchymatous arterial anastomoses were thoroughly analyzed. It was shown that the spleen in most cases consists of five vascular territories (segments) clearly demarcated from each other, stressing the practical significance of splenic anatomy in segmental dearterialization of the spleen.

The diagnosis of ovarian pregnancy is based on the improper rise of serum beta-hCG levels, sonographic findings of an empty uterus, highly characteristic ovarian formation with double hyperechogenic ring surrounding small hypoechogenic field, and the laparoscopic verification of Spiegelberg's criteria. We present a case of ovarian pregnancy in spontaneous cycle in 34-year-old woman following two unsuccessful IVF/ET procedures and ovarian pregnancy on contralateral side laparoscopically treated seven months ago, also achieved in non-stimulated, spontaneous cycle. On admission she had a serum hCG level of 596 mIU/mL on cycle day 46 and an empty uterus. Transvaginal sonography showed a 20 mm ring-like thick-walled hyperechogenic structure within the left ovary. The echogenic ring was surrounded by irregular, hypoechogenic structures suggestive of an ovarian pregnancy with periluteal hemorrhage and blood clots. The ruptured cystic ovarian pregnancy and the corpus luteum were removed by laparoscopy. During the procedure we have seen two clips on the right ovary placed laparoscopically to achieve hemostasis after rupture of the ovarian pregnancy seven months ago. Histopathology showed isolated chorionic villi within hemorrhagic areas in the vicinity of the corpus luteum.

The surgical anatomy of the left pancreatic portion includes topography of this entity in relation to the peritoneum and the adjacent organs, variations of the arterial vascularization and venous drainage, and of the ductal system. A particular emphasis was on the practical significance of the variations of the pancreatic tail, the arterial anastomoses of the corporocaudeal region, and the position and morphology of the pancreatic veins. Ending remarks include a small review on distal pancreatectomy.

The study of minor duodenal papilla topography and structure was carried out on 36 fresh autopsy specimens of human duodenopancreas. We performed precise measurements of its distance to the major duodenal papilla and to the superior duodenal flexure. There was no correlation between the position of the minor papilla and the incidence of duodenal ulcer disease. Microdissection and histological staining of the minor papilla did not reveal an anatomically defined sphincter around the terminal portion of the accessory pancreatic duct. All the specimens of the minor papilla contained within acini of pancreatic tissue. A terminal dilation of the accessory pancreatic duct was found in 22% of the cases.

The authors analyzed the frequency of anastomotic bridges between the terminal branches of the splenic artery, their location related to the splenic surface, length and caliber on a total of 102 autopsy specimens of human spleen and pancreatic tail. The methods applied were corrosion casting and postmortem arteriography. The incidence of cases with the splenic artery anastomotic bridges was 33.3%. They were located as follows: intrasplenic 25.5%, extrasplenic 4.9%, both intra- and extrasplenic 2.9%. The remaining two-thirds of spleens were free of anastomoses and thus hypothetically acceptable for partial and segmental splenectomy, as arterial bridges can jeopardize such surgical procedures. Intrasplenic arterial anastomotic bridges were of small caliber and ruled negligible, while the extrasplenic arterial anastomoses are of large caliber being of surgical importance.