Comparative analgesic efficacy and tolerability of ketorolac tromethamine and glafenine in patients with post-operative pain.

In a randomized, single-dose, double-blind, parallel comparative trial of analgesic efficacy, 96 adult patients received either 10 mg ketorolac tromethamine or 400 mg glafenine orally the morning after surgery if they requested pain relief medication. Each patient provided a baseline pain assessment and then received the assigned medication. Patients assessed pain intensity and pain relief and reported any adverse events in interviews held 30 minutes after drug administration and then hourly for 6 hours. The demographic characteristics, baseline pain intensity, and surgical categories of the 47 patients who received ketorolac tromethamine and the 49 who received glafenine were similar. Both drugs provided prompt, sustained pain relief throughout the 6-hour observation period, and there were no statistically significant differences between the two groups in any of the efficacy measures analyzed. The global assessment recorded by patients suggested a slight clinical advantage for ketorolac tromethamine (32.6% of 'excellent' responses) as compared to glafenine (12.5% 'excellent'). The differences in overall response were statistically significant (p = 0.017). Fourteen (30%) patients who received ketorolac tromethamine and 17 (35%) who received glafenine reported adverse experiences that began or seemed to worsen after administration of the study drugs. The most prominent were drowsiness and sleeping, both of which are common in post-surgical patients.

Obstruction of the iliac vein by mucoid cyst: successful result of surgical excision.

The third case, if the literature's survey has been exhaustive, of mucoid cyst of the venous wall is reported. Venous obstruction with palpable tumour in the iliac fossa is not always of poor prognosis.

Clinical evaluation of a venotropic drug in man. Example of Daflon 500 mg.

Chronic venous insufficiency (CVI) of the lower limbs is a complex and fluctuating disease by its pathogenic mechanisms and its clinical symptoms. Although symptoms are subjective, they affect the quality of life and socio-professional activity of many patients. This is why convincing demonstration of therapeutic activity of a venotropic drug should be carried out according to strict methodology. Only randomized double-blind controlled trials versus placebo (no reference drugs being available) could demonstrate the activity on condition that they are set up in a protocol, the statistical design of which, is adapted and defined "a priori". Inclusion, non inclusion and judgement criteria must be rigorous, taking into account many exogenous and endogenous factors which could have influence on the severity or the change in CVI and on the comparability of groups at the beginning and at the end of the study. Thus, the main risk factors of CVI (heredity, obesity, obstetrical and gynecological history, estroprogestogen treatment, profession, environment, etc.) and the season when the patient is recruited should be taken into account. With respect to all these restraints on methodology, the venotrotopic activity of a flavonoid Daflon 500 mg (2 tablets daily) was demonstrated in 200 patients (174 women, 26 men) with organic CVI (n = 83) or functional CVI (n = 117) treated for two months in two double-blind randomized trials versus placebo. The venotropic activity of Daflon 500 mg, was shown by a significant reduction of CVI signs and symptoms, whether organic or functional, and a significant improvement in venous hemodynamics according to plethysmographic parameters. Good acceptability was observed after medium and long term trials.

[Peroperative sclerosis]. / La sclérose per-opératoire.

Complete, rapid destruction of the insufficient surface network as a one-stage procedure constitutes the best method for prevention of trophic disorders and especially pigmentation. Marked, rapid regression is obtained when these have unfortunately become installed. Combined surgery and multiple peroperative injections of a sclerosant allows the exclusive use of a gently acting sclerosant, 66% glucose solution, which is particularly well tolerated.

[66% glucose, a safe sclerosant. Experimental study]. / Le glucose à 66%, sclérosant de sécurité. Etude expérimentale.

Although accidents due to the intra-arterial injection of detergent sclerosant are very rarely observed, they are dramatic in their effects and often result in amputations, a risk accepted with difficulty for a treatment with a functional aim. To avoid these incidents, which may occur even when treatment is applied by the most experienced surgeons, the authors have used 66% glucose solution without accident since 1948. To confirm efficacy of the method, an experimental study compared 66% glucose (66 G) with a very commonly used product, 1% sodium tetradecyl sulfate (STD), in the rabbit. Except when enormous doses of 66 G are employed, the only effect noted was eosinophilic necrosis of the vessel wall without clinical symptoms, whereas doses eight times lower of STD produced an irreversible ischemia from obliterating endarteritis of the branches of the vascular tree injected. The 66% glucose solution appears to be a very safe, gently acting sclerosant, and the product of choice for peri- and post-operative sclerosis, particularly in regions where accidental arterial puncture is anatomically possible.

[Revascularization of the 2 lower limbs from the descending thoracic aorta without laparotomy]. / Revascularisation des deux membres inférieurs à partir de l'aorte thoracique descendante sans laparotomie.

Arterial bypass of the lower limbs from the thoracic aorta approached through a thoracic or abdominal route has already been described. The technique reported here is original in that the descending thoracic aorta is exposed through thoracotomy, and the prosthesis is passed behind the left kidney, then, for the right leg bifurcation, through Retzius' space without laparotomy. Two patients were operated upon with this technique which is described in detail, together with its potential indications, advantages and disadvantages.

[Venous bypass on the opposite side (Palma's operation). Preoperative evaluation. Technical variants. Indications and results]. / Dérivation veineuse contro-latérale. (Opération de Palma.) Bilan pré-opératoire. Variantes techniques. Indications et résultats

Permanent obstruction of an iliac vein may produce serious consequences. Palma's operation of inter-femoral transposition of the internal saphenous vein on the opposite side, has permitted numerous improvements, but may lead to 30 p. 100 failures. Temporary arterial blood supply to the area increases the operative risk and requires a second stage operation for suppression of the fistula, but it maintains permeability of the by-pass, if correctly performed. The indications should thus be drawn up with circumspection and one may regret that such extensive venous lesions had not been prevented or treated actively as soon as they started to develop.

[Ischemia or acute vascular stasis of a limb related to psychopathological behavior. Pathominia]. / Ischémie ou stase vasculaire aiguë d'un membre liées a un comportement psycho-pathologique. Pathomimie

Disorders due to voluntary use of a tourniquet may produce numerous therapeutic errors with serious consequences. The difficult diagnosis of this hysterical behavior is recalled here and the authors report two cases.

[Direct approach for bypass of the distal deep femoral artery. The supra mediocrural route]. / Abord direct pour pontage de l'artère fémorale profonde distale. La voie sus-médiocrurale

The medio-femoral route permits a simple, direct approach to the distal part of the profunda femoris artery outside Scarpas triangle, i.e. below the first perforating artery. The quadriceps femoris and sartorius muscles are separated. This segment may reach the lower part of the popliteal artery through various collaterals supplying the muscle and nerve arteries and, hence, the leg. In selected cases with severe ischemia and absent femoral pulse, a by-pass operation carried out at this level permitted one to obtain a satisfactory arterial blood supply to the leg and foot. Used in only three patients, with a follow-up of several months, we cannot yet draw final conclusions, but the quality of the early results is evidence for the interest of the method.