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

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