Since 1945, we have operated on 786 patients with Klippel and Trénaunay's syndrome. Elongation of the impaired limb was invariably found while edema was present in 84%, varicose veins in 36%, and flat angiomata in 32%. Venography and surgical exploration have demonstrated malformation of the deep veins involving the popliteal vein in 51%; superficial femoral vein, 16%; both popliteal and superficial femoral veins; 29%; iliac veins, three per cent; and lower vena cava, one per cent. Good clinical results have been achieved following the surgical release of these deep veins in the lower limb. During childhood, when the difference in limb length is noteworthy, ligature of the popliteal vein of the shorter limb induces a compensating elongation. Klippel and Trénaunay's syndrome may be associated with lymphatic malformations, including lymphedema and malformation of the lymph vessels. Knowledge of the pathophysiology of these malformations of the deep veins enables a better understanding of the clinical manifestations of the condition, as well as the improved treatment of the serious vesical or rectal hemorrhage which occurs in one per cent of these patients.
We have operated upon 588 patients with Klippel and Trenaunay syndrome. The underlying factor is a congenital malformation of the deep veins: agenesis, atresia or compression by fibrovascular bands of the popliteal, femoral or iliac veins. Of these 588 patients, 6 children between 15 months and 4 years of age had severe rectal bleeding and hematuria. One of these children died from massive bleeding of the rectum with septicemia. Another boy was saved by rectal resection and the last one by subtotal cystectomy. The important venogram shows an absence of the anterior venous pathway (superficial femoral vein) compensated by the abnormal development of 2 venous groups, the vein of the sciatic nerve and large veins along the external aspect of the inferior limb. These 2 venous groups penetrate into the pelvis by the sciatic and gluteal notches and terminate in the internal iliac vein which becomes enormous and has a very high flow. This overflow hinders drainage of the venous collateral from the rectum, the bladder and the vagina. The retro adductor vein, prolongated by the deep femoral vein, represents an anastomosis between the sciatic nerve vein and the common femoral vein. The surgeon must try to widen this pathway.
Stase veineuse et croissance osseuse par M. SERVELLE, H. Sr. woNNET et H. LEBARs L'histophysiologie du tissu osseux est bien connue depuis long temps, de même que les facteurs infl" uenç. ant la croissance osseuse. Les actions hormonales ont été bien étudiées du point de vue physiologique. La glande thyroïde joue une action certaine sur la croissance des os. Les éthyroïdés sont des nains, les insuffi sances de croissance dans le myxoedème en sont une preuve. L'action de ]'hypophyse est indéniable. Les diverses glandes endocrines génitales sont en rapport surtout avec l'arrêt de la; croissance. Il semble bien que les actions vasculo-nerveuses influençant la croissance osseuse soient moins connues. LERICHE et PoLI CARD, dans un traité récent, écrivent : ((Mais, le sens exact de cette action vasculo-nerveuse, son mécanisme intime reste encore
RÉSUMÉNous avons étudié l'absorption intestinale par le cathétérisme non seule ment de la veine mésentérique supérieure mais aussi celui du tronc lympha tique intestinal. Le cathéter introduit dans le . tronc lymphatique inte s tinal nous a permis d'étudier la pression dans Jes chylifères pendant la· digestion et après injection de prostigmine. Pour l'absorption de l'eau, .Je . tronc lympha tique intestinal absorbe 2,5 fois plus que la veine mésentérique supérieure. Les glucides sont absorbés plus par fos chylifères que par la veine mésen térique supérieure. Les lipides et les triglycérides sont absorbés uniquement par les chylifères. L'absorption des protides · a été . réalisée après injection de viande hachée dans l'intestin grêle. Nous allons Ja · refaire en injectant des protides de soja.
SUMMARY
IMPORTANCE OF THE CHYLIFEROUS VESSELS IN THE PHYSIOLOGY OF INTESTINAL ABSORPTIONFor the study of intestinal absorption we put a catheter in the superior mesenteric vein and one another in the intestinal lymphatic trunk. We studied the pressure in the chyliferous vessels during the digestion and af ter an intravenous injection of prostigmine. Most of the water injected in the small bowel is i absorbed by the chyliferous vesse! an Jess by the superior mesenteric vein. The glucose is absorbed mostly by the chyliferous vessels and Jess by the mesenteric vein. The absorption of lipids and ·triglycerids are realized only by the chyliferous vessels. For the protids we used fine choped meat but we will use protein of soja beans.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.