Magaye Gaye

Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery

ObjectivesTo specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC).Materials and methodWe injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects.ResultsAt the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes.ConclusionThe variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

Variations in lung lymphatic drainage into the inferior tracheobronchial lymph nodes junction: Applications in lung cancer.

The group of inferior tracheobronchial lymph nodes (ITB) is a lymphatic junction through which the lymph from both lungs is carried. Lymphatic activity in this area can be used to assess the lymphatic spreading of lung cancers. Our aim was to quantify lymph drainage from the lung segments towards the ITB group and to determine the direction of the lymph flow into other mediastinal and abdominal lymph nodes. We injected dye directly into the subpleural lymphatic vessels in 100 lung segments of 25 fresh cadaver subjects; the cadavers were then dissected. Thirty‐eight segments (38%) drained into the ITB group in 18 subjects. The drainage into the ITB group involved 15.6% of the upper lobe segments, 87.5% of the middle lobe segments, and 70.6% of the lower lobe segments in the right lung. On the left, 6.9% of the upper lobe segments and 83.3% of the lower lobe segments were drained into the ITB group. For three subjects, the dye did not pass beyond the ITB group. The efferent vessels of the ITB group drained towards the right paratracheal and tracheoesophageal chains in 12 subjects and through the left ascending recurrent chain in five subjects. For six subjects, the efferent channels reached the abdominal lymph nodes. A contralateral drainage involved 14 segments (36%). The size and variety of the segments that drain into the ITB group, coupled with the efferent contralateral mediastinal and abdominal pathways, account for the severity of metastasis to this area. Clin. Anat. 29:955–962, 2016.

Arteriovenous Malformations: Clinical Aspects and Surgical Results

Arteriovenous malformations (AVM) are vascular malformations, broadband, formed of arterial and venous dysmorphic vessels interconnected directly without transition in a capillary bed. Arteriovenous malformation surgery is particularly demanding owing to the need to control bleeding. This is probably one of the most critical moments of arteriovenous malformation surgery. The purpose of this study is to analyzed the clinical aspects and evaluate the results of surgery in the treatment of these AVMs. This is a retrospective and descriptive study that took place in Dakar over a period from January 2004 to December 2017 on patients operated for arteriovenous malformations. The total number of our series was 11 cases. These AVMs represented 32.35% of all tumors and vascular malformations operated during this period. The mean age at surgery was 25 years old [1 year-56 years old]. A male predominance was noted with 7 male to 4 female (sex ratio 1.75). The average time of consultation was 8.3 years [1 months-30 months]. The main reason for consultation was the appearance of a mass in 11 cas. We noted a notion of traumatism or recent surgery were done in 4/11 before the onset of symptoms. The location of the lesions was at the head or the face (5 cases), neck (1 case), the upper member (2 cases), the lower member (3 cases). No multiple location were noted. After physical examination, two patients were classified Schobinger stage 1, stage 2 in 7 cases, 2 cases in stage 3. No patient was classified stage 4. The vascular Doppler ultrasound was performed in 10 cases (91%) and allowed to confirm the diagnosis in 10 cases. The CT angiography was performed in 8 cases (73%). It elicited the feeding artery and draining veins, the number of nidus and topography. We found 6 truncal AVM and 5 extratruncal including 4 limited. A first embolization was performed in 2 cases (18.2%). A one-stage surgery was performed in 7 cases and two times in 4 cases. The average hospital stay was 15 days [3 days-60 days]. The average healing time was 18 days [15 days-30 days]. Operative mortality as early mortality was zero. Late mortality was zero. The average follow-up time was 50.3 months [2 months-96 months]. In recent years, the multidisciplinary approach of tumors and vascular malformations has made important advances in the delineation of nosological frameworks and in the understanding of the natural history and structure of these complex lesions. This is why the treatment of these AVMs requires a multidisciplinary consultation exchange between vascular surgeons, plastic surgeons, interventional radiologists and anesthetists.

Diagnosis and indications for revascularization in Takayasu’s Arteritis: Report of two cases and literature review

Takayasu’s arteritis (TA) is an infl ammatory disease of large vessels that predominantly affects the aorta and its main branches such as supra-aortic trunks, renal and digestive arteries. The diagnosis is based on criteria proposed by the American College of Rheumatology and modifi ed by Sharma. These vascular lesions present a problem of surgical indications because of their pathogenic particularity. In this work, we report our experience on the diagnosis and management of two cases of TA.

Thoracoplasty in the Management of Chronic Empyema: Experience of a Sub Saharan African Country

Introduction: The current main indication of thoracoplasty is empyema following or not lung resection, when the other surgical methods such as thoracic drainage, pleurostomy and/or pulmonary decortication have failed or are not useful. The authors report the role of thoracoplasty in the management of chronic empyema. Method: Between 2004 and 2015, eight male patients underwent thoracoplasty, in the Department of Thoracic Surgery at the University Hospital of Fann, Dakar, Senegal. The mean age was 40 years old. In all cases, the first step of the treatment was thoracic drainage with Heimlich valve in an ambulatory patient, associated with antibiotic according to the result of bacterial culture. In three patients, thoracostomy was indicated to control local infection before thoracoplasty. Results: Indications for thoracoplasty were refractory post resectionnal lung empyema in 6 cases and chronic primary apical empyema in 2 cases. Bronchopleural fistula was found in 5 patients. We performed three superior partial thoracoplasty, and five enlarged thoracoplasty. A myoplasty, using latissimus dorsi to fill the empyema space, was associated with thoracoplasty in five cases. Bronchopleural fistula cure consisted of a direct X form suture in two cases and of intercostal muscle apposition on the fistula in others ones. Partial scapulectomy, by resection of the inferior third part of the scapula was done in three patients. After a mean follow up of one year, no patient presented with persistence or recurrence of empyema. Then we concluded that they were healed. Conclusion: Thoracoplasty is an efficient procedure for the management of chronic empyema. So it is necessary for each team to established define criteria that will allow a patient to undergo thoracoplasty in order to do not use it for any desperate case of refractory chronic empyema.

Penetrating chest injuries caused by swordfish sword used as a weapon

We report 5 cases of penetrating chest wounds caused by weapons made from swordfish swords, involving breakage of the sword that later appeared as a thoracic foreign body. The patients had been assaulted 2 days to 17 years earlier. Three of them had a chronic infected wound, one had a penetrating thoracic wound with hemopneumothorax, and one had a foreign body. Computed tomography showed a foreign body in the lung in 4 cases, with aortic penetration in one. The foreign body was removed via thoracotomy in all 4 patients, with aorta repair in one who presented later with a pseudoaneurysm.

Bases anatomiques des lésions de l’artère pudendale externe lors de la chirurgie des varices du membre pelvien

Introduction L’artère pudendale externe est une branche collatérale de l’artère fémorale commune qui est destinée à la vascularisation du pénis ou du clitoris. Ses rapports avec la crosse de la grande veine saphène et de ses afférences, dans le trigone fémoral, sont très étroits. Cette situation fait qu’elle est souvent lésée lors de la crossectomie et de l’éveinage de la grande veine saphène. Ces lésions peuvent être à l’origine d’une dysfonction sexuelle. Méthodes Il s’agit d’une dissection de 22 régions inguinales chez 13 hommes et 9 femmes qui ont bénéficié d’un abord chirurgical du trigone fémoral. La distribution et les rapports de l’artère pudendale externe par rapport à la crosse de la grande veine saphène sont étudiés. Résultats L’artère pudendale externe unique est la plus fréquente. Toutes les artères pudendales externes ont pour origine l’artère fémorale commune. Le rapport le plus fréquent est le sous croisement de la crosse de la grande veine saphène par une artère pudendale externe unique. Par ailleurs, on a un précroisement, un croisement alterné et des rapports avec la veine fémorale commune et des afférences de la crosse de la grande veine saphène. Certaines techniques chirurgicales exposent plus ou moins à une lésion de l’artère pudendale externe. Conclusion Ce travail confirme les données antérieures mais montre encore quelques particularités sur les rapports entre la crosse de la grande veine saphène et l’artère pudendale externe.