The aim of this study was to design a three-dimensional model of the human shoulder girdle. Fourteen muscles were modelled geometrically using robotics software (Solid Dynamics System). A static study in reverse dynamics allowed the forces developed in seven muscles to be studied, particularly in the deltoid and supraspinatus during abduction of the arm with the forearm bent at 90 degrees, the scapula being fixed. After optimization by Excel, this model allowed simultaneous curves of forces developed in every modelled muscular bundle to be obtained during various degrees of abduction of the arm from 0 degrees to 100 degrees, in the scapular plane. The analysis of supraspinatus and deltoid curves revealed an interesting chronology of action. The first muscle developed efforts estimated at 140 N, quickly relieved by the deltoid. It is also interesting to note that a constant action of supraspinatus was found throughout abduction of the arm. Clinical applications seem to be in simulation of muscular pathology of the shoulder girdle. This study is continuing by releasing the fixed scapula and by simulating muscle transfers proposed for massive ruptures of the rotator cuff.

Las exigencias actuales con respecto al tratamiento adecuado de las enfermedades del aparato genital femenino, la adaptación de la sensibilidad y de la calidad de las exploraciones clínicas, y la incorporación de nuevas técnicas de diagnóstico por imágenes señalan cuán importante es conocer la anatomía de esa región. Este artículo, dedicado a los órganos genitales pélvicos de la mujer, a su vascularización y a las estructuras circundantes (peritoneo y tejidos de sostén), no sólo tiene por objetivo recordar la descripción modal clásica de las estructuras anatómicas, sino sobre todo, establecer las variaciones anatómicas de Importancia clínica y asociar la dinámica de las visceras pélvicas femeninas a su evolución ontogénica y patológica. El estudio de la mama no se considerará en este capítulo dedicado exclusivamente a los órganos genitales pélvicos.

The aim of this study was to reinforce the importance of the pectineal ligament in laparoscopic surgery for groin hernia and female urinary incontinence, particularly its anatomical importance in the myopectineal region. A morphologic study was conducted on 44 pectineal ligaments from 23 embalmed and one fresh human cadavers, together with a radiological study on four volunteer patients. Anatomical and histological findings confirm the fact that the ligament of Cooper represents a thickening of the pectineal fascia rather than a thickening from the periosteum. The pectineal ligament provides a landmark in each approach, open or laparoscopic, anterior or posterior surgery.

Abstract: Percutaneous puncture of the kidney allows direct access to the pyelocalicial cavities. The posterior approach of this retroperitoneal organ can be complicated of transcolic punctures due to the postrenal position of the colon. A prospective radiological anatomical study of the relationship between the left kidney and the descending colon was undertaken. One hundred computed tomograms of adult subjects were obtained from which the anatomy of the left perirenal area was determined: the descending colon is more frequently behind the kidney in the young females. Two main factors determinants of this situation are: 1) colon ontogenesis in relation to the attachment of the primitive mesocolon, permitting a “fixed” left colon, or “moving” left colon at the end of a long mesocolon, allowing it to pass behind the kidney; 2) a mechanical factor whereby the accumulation of perirenal fat with increasing age may be a limiting factor in lateral displacement of the colon.

We report, in an adult, an asymptomatic association between cystic dilatation of the bile duct (type IV A in Todani's classification) and anomalous pancreatico-biliary ductal union (APBD) with stones in a long common channel. In APBD, the connection between the common bile duct and the main pancreatic duct is located outside the duodenal wall and is therefore not under the influence of the sphincter of Boyden. An abnormally long common channel is in excess of 15 mm. Two types of convergence anomalies are defined according to whether the bile duct opens into the main pancreatic duct (BP) or the main pancreatic duct into the bile duct (PB). In APBD, there is probably a reverse pressure gradient between the bile and pancreatic ducts, with regurgitation of pancreatic juice into the bile duct, repeated attacks of cholangitis, stenosis and cystic dilatation. A long common channel is associated with a higher incidence of carcinoma of the gall bladder or the bile duct.

OBJECTIVES:Retrospective study of results after intra-uterine artificial insemination performed in the Poitiers University Hospital.MATERIAL:There were 95 infertile couples who benefited from intra-uterine artificial insemination. Indications involved pathology of the cervix in 53% of the cases and male infertility in 30%. Another cause of infertility was found in 5% and no cause could be identified in 12%.METHOD:The technique was as follows. Ovary stimulation using clomifene and hMG, sonographic monitoring with oestradiol assay, hCG for triggering ovulation, 2 inseminations at 24 and 48 h after swim-up sperm preparation and luteal phase supplementation.RESULTS:The overall success rate was 32.6% with a mean success rate per cycle of 11.1%. The best results were obtained in couples with unexplained infertility and cervix-related infertility (42 and 32% respectively). These results are comparable to those in the literature.CONCLUSION:The results of this series and the data reported in the literature demonstrate the interest of intra-uterine artificial insemination in cases of cervical sterility where it is indicated as first intention treatment. In case of impaired ejaculation, unexplained sterility and certain other causes of male infertility, intra-uterine artificial insemination can be useful but requires further study in order to determine the criteria for indications and the techniques to be used. Associating ovary stimulation increases the probability of success, especially in cervical sterility. Finally, more than 4 to 5 attempts do not increased success rate.

In order to assess the tolerance induced by hepatic transplantation in a multivisceral graft, a model of a transplant combining the liver and small intestine was developed in the pig, using animals of Large White Isogroup O, typed in the system of major incompatibility as "Swine lymphocyte antigen" (SLA), whose weight varied from 30 to 40 kg. In order to limit the duration of warm ischemia, dissection of the graft was performed on the donor animal with respect for the following anatomic features: absence of intestinal attachment to the posterior parietal peritoneum, anti-clockwise torsion of 360 degrees of the intestine around the superior mesenteric a. with the small intestine convolutions on the right and the colonic helix on the left. The bifid pancreas follows this rotation and its resection must respect the vascularisation of the proximal small intestine; the hepatic a. arises from a common trunk with a gastrosplenic branch of the aorta between the crura of the diaphragm and travels sagittally from behind forward toward the liver pedicle, which it reaches ar the upper border of the duodenum; the hepatic a. and its branches are dorsal in relation to the portal vein; the hepatic arterial distribution follows a right-left and antero-posterior systematisation for the six hepatic lobes of this quadruped animal.

It is important to recognize exceptional vascular events in celiosurgery because of their gravity. Most occur during pneumoperitoneal manoeuvres using a Palmer needle and rarely at the insertion of the first trocar. We performed a tomodensitometric study in 200 subjects free of abdominal pathology in order to determine the distance from the umbilicus to the aortic bifurcation, their projection over the spine and the superficial relations of the large vessels to the cutaneous umbilical cover. Generally, the projections of the umbilicus, and also the aortic bifurcation, lie over L4. The distance between the skin and the large retroperitoneal vesses is generally equal to one-third of the antero-posterior abdominal diameter. In thin subjects with a flat abdomen however, this distance may be smaller, even less than 3 cm. These findings emphasize the importance of "safety" manoeuvres during celiosurgery, especially during the learning period.

Chez l'homme, les bords inferieurs des muscles oblique interne et transverse se trouvent eloignes de la crete pectineale recouverte du ligament pectine de Cooper. Il existe un orifice denomme trou musculo-pectineal, ferme par le fascia transversalis et ses renforcements. Cette zone de dehiscence est separee classiquement par le ligament inguinal en deux regions femorale et inguinale, mais presente en fait une unite morpho-fonctionnelle. Ce sont les formations anatomiques les plus resistantes de cette region (tendon conjoint, ligament pectine de Cooper, bord posterieur du ligament inguinal et bandelette ilio-pubienne de Thomson), decrites dans cette etude, qui sont utilisees dans les herniorraphies et dans la fixation de materiel prothetique

The technical difficulties in the vaginal hysterectomy (VH) are principally raised by the special conceptualization of the normal anatomy in the craniocaudal direction and the topographical modifications from the surgical manipulations. These modifications have been studied during an operative dissection on a dead body non-formulated, but with the vessels previously injected with coloured latex. Our observation and the numerous works of per-operative radiology are showing that, at every period of the VH there is an ureterical safety margin much more important than in the abdominal hysterectomy. The prime manipulation in its realization is the caudal and continuous traction of the cervix in order to individualize the ligaments and to make easier the dissections. The operation amounts to three primary stages: breaking away the uterus from its visceral connections in order to hold them distant with valves; releasing the uterus from its ligaments with ligatures spaced from the cervix to the fundus; restituating the peritoneal cavity and the vaginal fornix in its topography and statics. The vaginal hysterectomy has notable advantages in swiftness, absence of intestinal manipulations and scarceness of ureterical injuries. The anatomical limits in the low way, depend on the vaginal compliance, the mobility of the pelvic organs and the disproportion between the vagina and the deferent duct.