[A misunderstood treatment for hyperhidrosis: ionization. Principles, material, methodology, early results]. / Un traitement méconnu de l'hyperhidrose: l'ionisation. Principes, matériel, méthodologie, résultats précoces.

Based on a new and specific apparatus developed by one of the authors, an original method of treatment of palmoplantar hyperhidrosis, either essential or associated with acrocyanosis, is described in detail. The extremities to be treated are placed in tanks containing tap water ensuring conduction fo current between epidermis and electrode. The recommended current of 20 milli-amperes is obtained by adjustment of a potentiometer. Treatment sessions (20 minutes for hands or feet, 40 for all four extremities) take place with a well defined frequency: 3 the first week, 2 the second, I the following two weeks. Maintenance sessions are necessary when sweating recurs. In a longitudinal series of 29 patients, 28 (96.5%) were significantly improved. From the 5th session onwards, the decrease in hyperhidrosis was evaluated by patients as very pronounced in 5 cases (17.2%) and as complete in 21 cases (72.5%). In 5 of the 6 patients with hyperhidrosis associated with acrocyanosis, the patients reported attenuation of cyanotic coloration of skin and relative warming up of extremities treated. Tolerance was excellent in 28 cases, incidents being rare and minor. Patients with pacemakers cannot be treated by this method.

[Value of the velocimetry study of the uterine arteries in retro-placental hematoma. Report of 3 cases]. / Intérêt de l'étude vélocimétrique des artères utérines dans l'hématome rétro-placentaire. A propos de 3 observations.

Retroplacental hematoma is a sudden accident with unfavorable prognosis, especially since predictive signs (clinical, biological or ultrasonographic) are very frequently absent. The purpose of this study was to determine whether velocimetric study of the uterine arteries is of predictive value in this pathology. The equipment used was Doppler ultrasound with spectral analysis (4-MHz probe) without echography. Each examination consisted in systematic study of both uterine arteries and of umbilical flow. The recording technique for the uterine arteries is described, and 3 cases of retroplacental hematoma are reported. In all 3 cases, the resistance index for one of the uterine arteries (right twice, left once) was high, with the presence of a (proto-diastolic notch on the curve, whereas the umbilical index was normal and there were no other signs predictive of the placental accident. The value of Doppler exploration has already been demonstrated for numerous obstetric indications, and it should be possible to include others, particularly if this preliminary study is confirmed on a larger scale.

[Carotid and aortic lesions: two-stage surgery]. / Lésions carotidiennes et aortiques: chirurgie en deux temps.

The problem of chronology between different surgical acts is at stake when a patient suffering from carotid and aorto-iliac or femoropopliteal diseases requires surgery. The joint operation increases surgical risk and its practice penalizes the surgeon. Sequential surgery is safer. It does not increase the risk of a adverse evolution of the diseases areas which has not been operated on at time of the first operation.

[Intermittent claudication of the jaw in temporal arteritis]. / La claudication intermittente de la mâchoire dans l'artérite temporale.

Stiffness of the jaw was noted in the first descriptions of temporal arteritis. It was only in 1944 that Horton used the term intermittent claudication and related this sign to effort ischemia due to thrombosis of facial arteries. The introduction of ultrasound techniques has enabled the permeability of facial arteries to be confirmed in spite of induration and absence of pulsatility clinically. Anatomical studies have defined the preponderant role of the internal maxillary artery in the vascular supply of the masseter muscles and have enabled the localization of an appropriate and reliable site for ultrasound study: the pterygo-maxillary fossa. The velocimetric data thus collected confirm that the internal maxillary artery is affected and define the etiopathogenesis of intermittent jaw claudication during temporal arteritis. This sign is observed on average in one patient in three suffering from temporal arteritis. While several cases of intermittent jaw claudication have been described in severe atheromatous stenosis of the common carotid or external carotid arteries, or in relation to other causes (rheumatological, neoplastic, psychological ...), the observation of this syndrome in a suspicious clinical and paraclinical context constitutes an excellent orientation sign in favor of temporal arteritis.

[A comparative study of pulsed Doppler versus continuous Doppler technic without spectral analysis in obstetrics]. / Etude comparative Doppler pulsé-Doppler continu sans analyse spectrale en obstétrique.

We conducted a study in 48 parturients in order to: --assess the possibilities of continuous Doppler examination without preliminary ultrasonographic localization and without spectral analysis, to measure the traditional hemodynamic parameters of fetal development (in particular on the umbilical cord). --to compare these results with those obtained using pulsed Doppler-scan as reference. The protocol was very strict and neither of the two practitioners was aware of the other practitioner's results. With the continuous Doppler examination, the uterine arteries were systematically localized and recorded. The technique is simple in trained hands. The material included an ultrasonograph fitted with two probes (3.5 and 5 MHz, equipped with a pulsed Doppler) and a continuous Doppler (only the 4 MHz probe was used). Because the tests were sometimes repeated, 63 measurements were obtained in 48 parturients, mean age was 29.3 years and mean gestational age was 32.9 weeks. The reason for the examination varied: intrauterine growth retardation and/or maternal hypertension, diabetes, etc. The results obtained from the cord proved to be very encouraging: 42 of the 54 measurements were comparable (77.7%) showed an index difference less than or equal to 0.05. Only 4 (7.4% of the measurements) maximum deviations were observed (exceeding 0.10). The mean Pourcelot index on the Doppler scan was 0.677. With the continuous Doppler, it was 0.676. The 13 abnormal measurements with the pulsed Doppler were also abnormal with the continuous Doppler. The uterine arteries were recorded and measured with the continuous Doppler 42 times on the right (68.8% of the cases) and 34 times on the left (55.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous transluminal angioplasty in atheromatous stenosis of the proximal supra-aortic trunks: the brachiocephalic trunk and the subclavian artery]. / L'angioplastie endoluminale percutanée des sténoses athéromateuses des troncs supra-aortiques proximaux. Tronc artériel brachio-céphalique, artères sous-clavières.

The authors are reporting their experience about percutaneous transluminal angioplasty (PTA) in atheromatous stenosis of proximal supra-aortic arteries. In this series of 17 patients, with a 6-month follow-up, vertigos were the main clinical symptoms (8 cases), and it must be pointed out that 5 of these 8 patients also underwent a proximal angioplasty of one or the two of their vertebral arteries at the same time. Three subclavian steal-syndromes, one arterial insufficiency of an upper limb, one transient cerebral ischaemia, and four asymptomatic cases were also treated by the same procedure. For diagnosis as well as for follow-up, the authors are emphasizing the value of hemodynamic results of Doppler recording. As for the technics itself, it mainly derives from the PTA of the lower limbs arteries. The results in this series appear to be good from an hemodynamic point of view, with neither morbidity nor mortality.

[Prospective etiologic study of 128 patients with ambulatory dep vein thrombosis]. / Etude étiologique prospective de 128 patients avec une thrombose veineuse profonde survenue en ambulatoire.

Etiology of deep vein thrombosis in ambulant patients (DVTA = TVPA in text) varies: cancer, blood disease, infectious focus, dysimmunity syndrome, dysglobulinemia, extrinsic compression, metabolic disorder, anomaly of hemostasis. A prospective study was carried out between June 1988 and September 1989 by angiologists in 5 regions of France to evaluate the diagnostic rentability of an epidemiologic survey and to determine possible distinctive characters of DVTA. The survey was comprised of a questionnaire, a full clinical examination and screening tests: chest x-ray, abdominopelvic ultrasound imaging, a-uro/gynecologic examination, full blood count, serum iron, ferritin, uric acid, triglycerides, cholesterol, protein electrophoresis, antinuclear antibodies, circulating anticoagulant, hemostasis factors and liver function tests. The study included 128 patients, mean age 60 +/- 16 years with a DVTA developing without a previous immobilization. The usual predominance in the left leg was not observed. The etiology was identified in 33 cases, including 20 (15.6%) as a result of the screening tests: anomalies of hemostasis (8), blood diseases (3), dysimmunity syndromes (4), extrinsic compression (3), cancer metastasis (1) and hypertriglyceridemia in a diabetic (1). The screening procedure was of no greater value in the absence of a triggering or predisposing factor, on the contrary. An anomaly of hemostasis was detected more frequently in the presence of local or regional triggering factors in the men (4 out of 4) and in the women on the pill (4 out of 4). The number of cancers discovered following screening (2%) was smaller than that expected according to the literature (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

[The history of Horton's disease or ... 10 centuries of a fascinating adventure]. / Historique de la maladie de Horton ou ... dix siècles d'une fascinante aventure.

In 1932, Horton, Magath and Brown reported two cases of a "new form of arteritis affecting the temporal vessels ... which probably represents a new clinical syndrome". In reality, several publications, devoted to the same pathology already preceded this article. The most ancient is that of an ophthalmologist from Baghdad, Ali Ibn Isa (940 to 1010). In his memories, translated and published in english in 1936, the author states that "he undertook excision and cauterisation of arteries to treat patients who were suffering from heat and inflammation of their temporal muscles and which sometimes ended in loss of vision ...". In 1890, J. Hutchinson, an English surgeon, reported a case "... of inflammed and swollen temporal arteries ...". This article was only brought to light in 1946. In 1930, M. Schmidt, published a probable case of temporal arteritis, subsequently reported in 1947. In 1934 and 1936, Horton published new cases of temporal arteritis and defined the clinical characteristics of the disease and its histology. In 1938, Jennings made a particular contribution in reporting the first case of blindness. From this time on, cases of temporal arteritis became increasingly common in the literature. The first French case was described by J. Paviot et al. in 1934, but remained largely unrecognized until 1942. In 1936, J. Chavany was the first to describe the pillow sign, but more particularly in 1948, he prescribed the first treatment with steroids, with spectacular results. It was only in 1950 that R.M. Shick et al. published the effects of steroid therapy in temporal arteritis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Panic disorder and microcirculation. Controlled study of capillaries in anxiety disorders]. / Trouble panique et microcirculation. Etude contrôlée des capillaires sanguins dans les troubles anxieux.

However varied the clinical descriptions of anxiety, a sizeable proportion is always allotted to the cardiovascular aspect. One is reminded of Krishaber's cerebral-cardiac neuropathy and Brissaud's conception of anxiety. The implication of the heart in anxiety disorders, especially paroxystic disorder, i.e. panic attacks (PA) is important. Cardiovascular symptoms (tachycardia, increased systolic blood pressure, chest pain) are among the most frequent manifestations of panic; furthermore, recent studies suggest that male panic disorder (PD) patients have an increased mortality risk from cardiovascular diseases. It is with this implication in mind that we undertook this study, the main aim of which was to confirm the existence of an abnormal microcirculation, characteristic of PD, taking the form of an excess number of twisted capillaries. Abnormal capillaries had been described previously in non-controlled studies of patients with psychiatric disorders diagnosed as neurasthenia, neurosis, neurovegetative disorders and more recently as neurocirculatory asthenia, a syndrome similar to PD. This led us to undertake a study of the total number of capillaries observed by photomicrography (capillaroscopy) in the supra-ungueal fold of the fingers of both hands (except thumbs), comparing the number of twisted capillaries of 16 subjects suffering from panic disorder with or without agoraphobia according to the DSM III-R criteria, with those of 16 healthy volunteers matched for age and sex and 14 subjects suffering from other anxiety disorders (10 of them fulfilling criteria for generalized anxiety disorders).(ABSTRACT TRUNCATED AT 250 WORDS)

[Correction of erectile impotence of venous origin using detachable balloons and coils]. / Correction des insuffisances érectiles d'origine veineuse par ballonnets largables et coils.

The authors review a radiological classification of venous impotence and report their therapeutic approach. 13 patients with a venous insufficiency of Santorini's plexus were treated by detachable balloons and coils. This technic was convenient in 11 of the 13 cases. 5 patients with a superficial venous insufficiency were treated by embolization by coils. The results in this group appear to be good in 4 cases.

[Endoluminal angioplasty for atheromatous stenoses of supra-aortic trunks. The brachiocephalic arterial trunk, subclavian arteries]. / L'angioplastie endoluminale des sténoses athéromateuses des troncs supra-aortiques. Tronc artériel brachio-céphalique, artères sous-clavières.

The authors are reporting their experience about percutaneous transluminal angioplasty in atheromatous stenosis of proximal supra-aortic arteries. In this series of 12 patients, with an 6 months follow-up, vertigo was the main clinical symptom (6 cases), and it must be pointed out that 5 of these 6 patients also underwent a proximal angioplasty of one or the two of their vertebral arteries at the same time. Two subclavian steal syndromes, one arterial insufficiency of an upper limb, one transient cerebral ischaemia, and two asymptomatic cases were also treated by the same procedure. For diagnosis as well as for follow-up, the authors are emphasizing the value of hemodynamic results of Doppler recording. As for the technics itself, it mainly derives from the PTA of the lower limbs arteries. The results in this series appear to be good from an hemodynamic point of view, with neither morbidity, nor mortality.

[Impotence of vascular origin. Techniques of exploration and therapeutic orientations]. / Impuissance d'origine vasculaire. Techniques d'exploration et orientations thérapeutiques.

Vascular problems of arterial and/or venous origin are often found as the cause of erectile dysfunction. Clinical examination alone is insufficient and must followed up by a number of non or minimally invasive tests in order to confirm the etiology. Such testing should include: Doppler measurements or, better, duplex sonography, nocturnal penile plethysmography, psychological status, clinical biochemistry and intracavernous injection of vasoactive drugs. Occasionally, it may be necessary to complete these tests by more invasive examinations: pharmacoarteriography and/or pharmacocavernosography. Several novel therapeutic approaches have been developed in recent years and have given rise to encouraging improvements.