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From 1989 to 1993, 11,535 extracorporeal shock wave lithotripsy (ESWL) sessions were performed in 6,066 patients in our centre. In contrast, simple or extended pyelolithotomy was the treatment of choice in a small group of patients. The object of this paper is to review the results and complications of this type of operation. A total of 57 pyelolithotomies was performed, including 33 extended pyelolithotomies, in 55 patients (26 men and 29 women). The mean age of the series was 50 years (range: 5-77). The operated kidney was the left kidney in 34 cases and the right kidney in 23 cases. The mean interval between the diagnosis and the operation was 31 months. 64% of the patients had history of stone disease (33 ipsilateral and 2 bilateral). Thirteen patients had already been treated by ESWL (10 patients), percutaneous nephrolithotomy (PNL) (2 cases) and one case had previously undergone pyelolithotomy. A urinary tract infection was observed in 26 patients (47%). The incision consisted of lumbotomy in 40 patients (71%), or a subcostal incision in 12 cases. The mean operating time was 161 minutes (range: 90-245) and the mean intraoperative bleeding was 500 ml. Thirteen patients were transfused (23%). The renal artery had to be clamped in 9 cases (for an average of 19 minutes). After a mean follow-up of 20 month, 50.8% of patients were stone-free. 49% of patients presented residual caliceal fragments on the immediate postoperative X-ray. One patient had to be treated by percutaneous nephrolithotomy and ESWL. 12 cases (41% of patients with residual fragments) required subsequent treatment by ESWL and the remaining patients with residual fragments were asymptomatic and did not receive any further treatment. The immediate postoperative complication rate was 17% and 10% of patients developed late postoperative complications. Simple or extended pyelolithotomy remains an effective treatment for stones of the renal pelvis, either on its own or associated with ESWL. However, the possibility of serious complications demands meticulous patient selection.

Intra-carpal ligament tears lead to radiocarpal arthritis early diagnosis allows early treatment. Standard and dynamic X rays are not always able to make the diagnosis. In these cases, arthrography of the wrist may give the diagnosis. To establish the specificity of this examination we tried to correlate surgical findings with arthrographic suspicions. Exact diagnosis was established in 12 out of 13 cases of suspected scapholunate ligament tears in 5 out of 6 cases of suspected luno-triquetral ligament tear suspicion and none of the 3 cases of suspected T.F.C.C. rupture suspicion. Wrist arthrography appears to have a good specificity for first row intra-carpal ligament tears. The indication arthrography must be discussed with wrist arthroscopy for the diagnosis of long term wrist pain after clinical examination and standard and dynamic X rays.

Hemoptysis is not considered as an hemorrhagic complication of portal hypertension. We report a patient with liver cirrhosis and portal hypertension who developed a hitherto unreported porto-pulmonary transdiaphragmatic collaterality many years after splenectomy. Life threatening hemoptysis complicated this unusual shunt after banal bronchitis. A proximal splenorenal shunt was performed and was completely effective at 26 months.

The authors have studied anatomically and angiographically 50 cadaveric foot specimens, emphasizing; the vascular flow predominance between dorsalis pedis and plantar arteries; the anastomosis between the three arterial supplies in the foot; the dividing pattern and the distribution of each artery; the blood flow distribution pattern at the level of the first and second toes and especially the anastomosis between the dorsal and plantar vessels and the branches for the metatarsic-phalangeal joint. The study presents new data about the indications of preoperative angiography of the forefoot, about the surgical technique of toe transfer, articular transposition and multiple transposition (2 toes, skin and bone...).

Two cases of mandibular angiodysplasia associated with hemorrhagic phenomena were treated surgically, by conservation resection in one patient and conservative surgery following embolization in the other. External carotid artery ligature is a useless and even risky procedure, whereas surgery should be preceded by tumoral embolization whenever possible. Prognosis, according to the classification proposed by Merland, depends upon whether active vascular malformations, mainly represented by arteriovenous fistulae, are present, or whether the lesions are inactive vascular malformations or with slowed circulation.

A case of pseudocyst of adrenal gland is reported. The first findings have been acute pain and falling hematocrit. Then hepatomegaly is present. All the investigations--ultrasonography, radionuclidescan, arteriography--failed to demonstrate the origin and saided liver cyst. The diagnosis is operative. The pseudocyst hemorrhagic are 32% of adrenal cysts. We think the computer tomography will be an important contribution for the diagnosis of false hepatomegaly.

About an experience of 7,757 investigations and after study of the published series in the literature, it appears the frequency of the accidents following vascular roentgenology has not really changed since ten years. -- 0,5% complications; 0,07% death in aortographies; -- 0,4% complications; 0,09% death in femoral artery catheterization; -- 3% complications; no death in axillary artery catheterization. The authors use the term "complications" when a surgical operation is necessary or after effects are present in the evolution. The study of the recent literature proves no significant amelioration in comparison with the last ten years. The accidents are analysed in aortography, in arterial catheterization using femoral or axillary arteries: the latter is the most dangerous. The considerable increment of the number of investigations suppressed the progresses provided by the material improvements. An explanation: in hospitals, it is necessary to train the students for roentgenology.

Primary phlebitis or sprain phlebitis in the upper member are caused by a compressive mechanism in the thoraco-brachial passage. Thrombosis most often originates in the area of the cost-clavicular hinge, and spreads towards the extremity of the member. In this series, 19 cases were treated: 8 recent cases of phlebitis, in which results were all too often imperfect (5 failures), 11 post-phlebitic syndromes, in which there were 9 good results. The surgical procedure which we therefore recommend aims at the decompression of the collateral circulation flowing around the thrombosed area: this should be enough to improve results in a large proportion of cases.

The segmental anatomy of the liver in situ in the abdominal cavity has been studied in five corpses after portal opacification. The location of the segments of the liver in situ is different from that described in the classical anatomy handbooks, and the nomenclature used in France proves to be ambiguous. The international nomenclature seems to be better adapted to the radioanatomical reality.

Fifty-five pyelovesical endoprostheses were inserted percutaneously in 56 patients. The indication for this procedure was a benign disease in 22 cases and a malignant disease in 34 cases. Early complications were haemorrhagic (3 haematomas) and infectious (septicaemic syndrome: 2 cases). 80.6% of the stents remained patent and most of the obstructions occurred before the second month in the benign indications (mean: 4.1 weeks) and later (mean: 13 weeks) in the malignant indications. Two-stage insertion (nephrostomy then insertion of the endoprosthesis under conditions of sterile and non-haemorrhagic urine) decreased the risk of early occlusion of the stent by urinary debris and clots. Abundant diuresis and control of urinary tract infection by prophylactic antiseptic treatment contribute to the maintenance of the patency of the prosthesis.

Idiopathic left varicocele is not always due to renospermatic reflux, as is shown by left renal phlebography. Furthermore, radiological exploration of the left iliac venous axis has shown the frequency of main iliac obstruction, compressed by the right iliac artery. The lumen of the iliac vein frequently bears traces of this compression (May and Thurner). The multiplicity of the colateral pathways draining the iliac vein in stasis, is evidence of the reigning increase in pressure. The authors propose the hypothesis that the varicocoele may be due to iliospermatic reflux. This occurs through anastomoses which are well known to anastomists and found on 2 occasions in the series presented. If this hypothesis were verified, it would incite an approach to the cord via the inguinal canal in order to ligature the spermatic veins above their anastomoses with the epigastric.

The aim of this study was to determine whether the prior injection of betamethasone was capable of preventing blood pressure changes and the fall in arterial pO2 when following the fixation of total hip protheses with methyl metacrylate. It involved 54 patients in whom systolic, diastolic and mean blood pressure (BP), arterial pO2, pCO2 and heart rate were noted at different times: T1, 15 minutes after the beginning of the operation; T2 and T3, one minute and five minutes after application of the cement; T4, at the end of the operation. There was no significant difference between the various measurements at times T1, T2, and T3 as far as blood pressure and heart rate were concerned. By contrast, there was a fall in pO2 at times T2 and T2 in relation to times T1 and T4. This fall was significant (p is less than 0.01) but never theless remained moderate. The possible influence of betamethasone is discussed.

Over a period of ten years, 88 cases of diphtheria were diagnosed in the North of France especially in the area of Lille, Roubaix and Tourcoing. 25 p. cent of the patients had been correctly vaccinated within less than five years, and among the latter 25 p. cent died from their diphtheria. The clinical presentation was typical but delay in diagnosis is frequent.

A North African brother and his sister, whose parents were first cousins, presented with the same disorder. It consisted of congenital dwarfism, facial dysmorphy and several skeletal anomalies including bilateral agenesis of the ala of scapula and hypoplasia of the ala of ilium and acetabulum, responsible for hip dislocation. No similar case was found in the literature. A recessive autosomal transmission of the disease is suggested.

Fine needle aspiration of iliac lymph nodes after lymphography was performed in nineteen patients with prostatic carcinoma, ranging from stage A to C. In four patients (21%), fine needle aspiration showed lymph node dissemination. 3 patients were classified as stage B, and 1 as stage C before aspiration. In this study, fine needle aspiration biopsy proved to be useful in the staging of prostatic carcinoma.

The well known effects of the lowering of the intraerythrocyte 2, 3, diphosphoglycerate (2, 3, DPG) level and hypothermia, on the affinity of oxygen for hemoglobin, lead the authors to study the influence of these parameters on this affinity during general anesthesia. The following observations were made in 15 adult subjects, undergoing prolonged general anaesthesia (average time: 3 hrs. 10 minutes): the dissociation curve of oxyhemoglobin (DCO) by the method of mixing, the intraerythrocyte 2,3, DPG level, the hemoglobin concentration and arterial blood parameters (PO2, PCO2, pH). These measurements were recorded before and after the general anaesthesia. The results were the following: a significant reduction of P50, measured under standard conditions (from 27.64 +/- 1.74 torr to 25.57 +/- 2.28, p less than or equal to 0.01) associated with a decrease in 2,3, DPG (from 0.94 +/- 0.31 mol/mol Hb at 0.64 +/- 0.24 p less than 0.01). Among the factors responsible for this variation in the affinity, it was proved that the volume of blood transfused was of importance as well as a decrease in body temperature during the operation. When the temperature is made to vary from 37 degrees C to 35 degrees C. the P50 ranges from 25.57 +/- 2.28 to 22.86 +/- 0.97 (p less than 0.01). To conclude the authors underline the importance of hypothermia and the volume of blood transfused (average time of preservation = 15 days) on the effects of the affinity of oxygen for hemoglobin.