Treatment of stage II chronic arterial disease of the lower limbs with the serotonergic antagonist naftidrofuryl: results after 6 months of a controlled, multicenter study.

A study was carried out in patients with intermittent claudication (Fontaine's stage II). The atheromatous origin of the disease was confirmed and localized by angiography or Doppler. One hundred eight-three patients were selected initially (day -30) with a pain-free walking distance on a treadmill (at a speed of 3 km/h and a slope of 10%) ranging from 150 to 300 m. During the first month (washout period) all patients received two placebo tablets daily. At the end of this run-in period (day -30; day 0) and after checking walking distance stability (allowed variation: 20% between the two measurements), patients were included in the study. According to this criterion, 112 patients were selected and 94 remained during the whole study. The study was designed in double-blind, using two parallel, randomly selected groups. Fifty-two patients received naftidrofuryl (2 x 316.5 mg tablets daily with meals) for 6 months; 42 patients received placebo under the same conditions. During this period, clinical and paraclinical examinations were carried out every quarter (day 90 and day 180). After checking the initial homogeneity of the naftidrofuryl and placebo groups, the comparison between the two groups indicates a significant improvement in the naftidrofuryl group after 3 months and 6 months of treatment, for the pain-free walking distance. For the maximal walking distance, a significant improvement was found at day 180. Nonparametric analysis (chi 2 test) also indicated a significant improvement for the naftidrofuryl group. These results confirm that naftidrofuryl is beneficial in the treatment of patients with chronic arterial disease.

[Aneurysm of the pancreaticoduodenal arteries and stenosis of the celiac trunk. Apropos of a case]. / Anévrisme de l'arcade pancréatico-duodénale et sténose du tronc coelique. A propos d'une observation.

The authors describe the different imaging techniques and their interest. They discuss their etiology. The association with stenosis of the coeliac axis incites to think at a hemodynamic theory.

[Digestive hemorrhage caused by seromuscular erosion of the wall of a section of the small intestine at the level of an aortic prosthesis implanted 5 years earlier]. / Hémorragie digestive par érosion séro-musculeuse de la paroi d'une anse grêle au niveau d'une prothèse aortique mise en place cinq ans auparavant.

A new paraprosthetic enteric fistula case between the small bowel and the body of a Dacron aortobifemoral prosthesis is presented. That complication happened five years after the initial reconstruction and the fistula does not interest an anastomotic site. A process is rare (22 published cases); if symptomatology is often less important than complete fistulas, surgical therapy must be aggressive to be effective.

[Post-partum development of a mesenteric venous infarct and portal thrombosis in a young woman taking an oral contraceptive (author's transl)]. / Infarctus mésentérique veineux avec thrombose portale chez une jeune fille en post-partum et sous contraceptifs oraux.

A 19-year-old girl developed a total venous infarct of the small intestine secondary to extensive portal thrombosis, on the 21st post-partum day. She had started to take an oral contraceptive on the 9th post-partum day, and the association of these two factors appears to have played a major role in the physiopathology of this accident. Diagnosis is difficult and often delayed in this affection, which can only be suspected as a function of the previous medical history. Prognosis is usually very poor in cases of massive mesenteric vein infarcts, and can only be improved by early removal of the venous obstruction, with or without intestinal resection.

PIP: The article presents the case of a 19-year-old woman who developed a massive venous enteromesenteric infarct secondary to extensive portal thrombosis on the 21st day postpartum. The patient, who died notwithstanding tentative surgery to bypass the mesenteric obstruction, had started taking oral contraceptive (OC) pills on the 9th day postpartum, rather than wait until the return of menstruation. According to recent statistics thromboembolic risk is 9/100,000; the risk is multiplied by 6 in the postpartum, and by 3 under OC treatment. The diagnosis of venous mesenteric infarct is very difficult, and must take into consideration all possible antecedents. The treatment can sometimes be clinical; only surgery, however, can cure the problem, and bring the chances of survival to about 50%.

Experimental study of sensitization to catecholamines after lumbar sympathectomy.

In a first time, the authors have shown a real supersensitivity to the action of catecholamines after lumbar sympathectomy in dog. Then, they have established a protocol which can be applied to the exploration of those phenomena in arteritic patients. Same doses of epinephrine and norepinephrine (which correspond to a slight hypercatecholamine blood level under stress) are injected intravenously, comparatively before and after lumbar sympathectomy. The modifications of E.C.G., arterial blood pressure and rheographic record, caused by those injections seem to prove the existence of a sensitization which is still lasting 4 months after the operation, but which does not seem to be noxious. Therefore, this sensitization generates compensating reflex reactions to arterial hypertension, leading to a favorable increase of the blood flow in the denervated territories.

[Electron microscopic studies of lumbar sympathetic chains resected for arteritis of the lower limbs (author's transl)]. / Etude en microscopie électronique des sympathiques lombaires réséqués pour artérite des membres inférieurs

Eighteen lumbar sympathetic chains resected for lower limb arteritis are examined on electron microscopy. A comparative study of the nature of lesions is done for diabetics and non-diabetics. Development of vascular lesions, clearly accelerated in the diabetic does not coincide with neurological lesions. These are much more frequent in diabetics, which explains the increased failure rate of lumbar sympathectomy in this disease as the result of lumbar sympathectomy depends on the state of nervous tissue. Examination of the state of nervous tissue. Examination of this tissue could therefore help establish a surgical prognosis.

[Experimental study of the sensitivity to catecholamines after lumbar sympathectomy (author's transl)]. / Etude expérimentale de la sensibilisation aux catécholamines après sympathectomie lombaire

To determine sensitivity to catecholamines after lumbar sympathectomy the authors first tested it in dogs : there was an increase in reactions to catecholamine beyond doubt after bilateral lumbar sympathectomy. In patients with arteritis they recorded, on a segment of the lower limb, a rheographic tracing with simultaneous modifications of the arterial blood pressure and electrocardiogram. These were studied after injection of adrenalin or noradrenalin in a dose of 5 to 7.5 mug (physiologic or stress level). Each of these tests were performed before and after lumbar sympathectomy.

[Isotopic criteria for the assessment of the effects of lumbar sympathectomy (author's transl)]. / Critères isotopiques pour évaluer les effets de la sympathectomie lombaire

The authors present a work intended to assess the effects of lumbar sympathectomy using radioactive microspheres. These contain 99mTe and are injected into the femoral artery. The distribution of radioactivity is then measured at the lower limb with a gamma camera linked to a computer. Seventeen patients were tested before and after lumbar sympathectomy. It appears from this short series that lumbar sympathectomy causes a redistribution of the radioactive material directed towards the extremities, mainly the feet.