[Drug therapy of angiolopathies]. / Thérapeutiques médicamenteuses des angiolopathies.

The treatment of angiolopathies is rather difficult, at this time, at least concerning functional angiopathies. It is a fact that protection against cold represents, in all angilopathies, one of the main elements of the treatment besides medications which are essentially vasoactive drugs, myorelaxants or alpha-blockers, and possibly venous tonics. Fluorescein or Sodium fluoresceinate at 5%, administered in slow intra-venous injections, represents one of the best treatment of acrocyanosis, in combination with vitamins A and D, given at the beginning of fall. Other angiolopathies, especially those of organic nature, are represented by allergic vascularitis and will be treated accordingly. In infectious and toxic forms, antibiotics should be prescribed in addition to steroids, preferred in allergic forms, especially granulomatous forms. In conclusion, the treatment of angiolopathies is extremely difficult, and must be particularly adapted to the clinical forms.

[Microcirculation in white atrophy]. / La microcirculation dans l'atrophie blanche.

There are two clinical phenomena which, owing to the French School, are still subject to violent criticism: the phenomenon described by M. Raynaud (1862) and the white atrophy termed Milian's (1929). Perhaps badly defined by the authors, the facts have been reviewed, but microcirculation - that of gauges less than 30 to 50 m - does not occupy the whole picture. The proof is that in direct capillaroscopy, functional explorations and biopsy are strikingly monotonous and lacking in exactitude. Capillaroscopy provides the usual aspects of cicatrization, "capillary" neogenesis and their histogenic disorders: central avascular zone, corona limited with loops in "club" formation, or in "clusters" owing to their confluence, "key" loops at the periphery near to the normal loops. These "neocapillaries" pose problems of the immaturity of the neovascular elements and of hydraulics in venous stasis. Of course, there are disorders of capillary permeability, and these are linked especially with vascular neogenesis, but it would not be reasonable to speak of "cutaneous infarctus", or "vascularitis", the necessary criteria being absent. On the contrary, we believe that it all comes down to a "histoangiopathy" by deterioration of the pericapillary sheath of proteoglycanes and of the interstitial conjunctiva. The anomalies are of the type of the deteriorations in plastic polymers and the apparatus of the endarterial bloc, which are included. A "trapping" of the leucocytes in the declivitous areas must also play a part.

[Microvascular disorders of adipose tissue]. / Troubles microvasculaires du tissu adipeux.

The microcirculation of adipose tissue is poorly understood either because of the absence of histological documents or because they fail to explain pathological conditions. However, disturbances of blood flow and parietal lesions of the microvessels are the basis for these disorders. Although we speak of disturbances of the vascular control mechanisms, these mechanisms are poorly understood and although we speak of arteriovenous short-circuits, the existence of these lesions has not been proven. In fact, classically, the circulation in the dermis and hypodermis is assured by a meshwork of arterioles, venules and capillaries, but biopsies of lateral and anterior regions of the thigh have demonstrated "block devices" in the walls of small arteries and arterioles which are able to regulate the rate of blood flow towards the capillary bed. Following contraction of these devices, the vascular lumen dilates, ensuring free circulation and when they relax, the lumen closes, resulting in decreased or no blood flow. These smooth muscle devices within the arterial wall resemble small cushions in the small arteries and more or less pedunculated polyps in the arterioles, either simple or fissured in the form of an elephant's trunk with a safety valve effect, arranged either in a single column or in two columns face to face. This provides evidence for the particularly disturbed vasculo-tissue inter-relations observed in venous insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Capillaroscopy at the nail bed in functioning people aged 70 and over.

A long survey in an homogenous population of 150 healthy and functioning male and female subjects 70 years of age and over is reported. In vivo capillaroscopic patterns observed at the nail bed, besides the lips, the gums, the tongue and the bulbar conjunctiva, are described and sometimes compared with fingertip biopsy. Three patterns are distinguished: (1) type I the most frequent similar to the children's one (2) type II less frequent but rather peculiar to senescence (3) type III rather typical but intermediate. Permanent dilatation and congestion of venules and capillaries seem to be related to the permanent opening of pulpar arteriovenous anastomoses and belong to "senile microangiopathy".

[Juvenile distal cerebral ischemia: value of pulp biopsy]. / Ischémie cérébrale distale juvénile: intérêt de la biopsie pulpaire.

Juvenile distal cerebral ischemia has been attributed to small artery atherosclerosis (Arnold, Benoit, Merlen, Dobbelaere, Delandsheer, 1979), based on clinicopathologic findings in one male patient and results of big toe pulp biopsy in three other cases. Pathological findings were obstruction of small artery lumens by hypertrophic endothelium and loose fibrocellular bands, their origin being the result possibly of partial intimalization of media by elastic neogenesis. Appearances were similar to those described by Dahl in human cerebral atherosclerosis in 1976, and approached those of the initial stages of experimental atheroma (Ross, Glomset, 1976). Arterial exiguity was also present in the 4 cases. Results of biologic, metabolic, inflammatory and immunologic examinations were negative. The present study concerns 4 additional cases of juvenile distal encephalic ischemia. One case in a female patient not on oral contraceptives confirmed the hypothesis of intimalization of media of arterioles of big toe pulp. Elastic neogenesis was present in the tunica media in areas where there was a change of direction of myocytes, and was apparent at a distance from the internal elastic layer. The latter was fragmented, sometimes doubles and of variable color. In another case, a woman taking oral contraceptives, there was almost total obstruction of the pulp arteriolar lumens with a very thin tunica media. Elastic neogenesis encircled two very narrow lumens in the center of the vessel and there were also elastic changes common to both.(ABSTRACT TRUNCATED AT 250 WORDS)

[Klippel-Trenaunay syndrome of the upper extremity. Apropos of 2 cases]. / Le syndrome de Klippel-Trenaunay du membre supérieur. A propos de 2 cas.

The authors report a case of Klippel-Trenaunay syndrome in the upper limb of a 27 years old migrant manual worker. This very typical case due to agenesis of the humeral vein is used as a basis for a discussion of the theories of Servelle on the pathogenesis of this syndrome.

[Full popliteal fossa]. / Creux poplité comblé.

Many reasons of clinical discussions about a filling of the popliteal fossa arise from this special anatomical area which is encumbered, so often requested by the activity of joints and muscles and so, since the embryological development. Although rare, perhaps because unrecognised, ischemic disorders, venous signs, swollen legs, permanent or intermittent full fossa . . . are the more frequent clinical aspects. The main patterns are arterial, rarely venous and more rarely arteriovenous aneurysms, adventitial cystic disease, lipoma, synovial or sebaceous cyst . . . malignant tumours, exostosis . . . Serious examination, functional techniques of which Doppler, angiographies . . . So, quite a lot of diagnostic discussions, even during surgical interventions.

[Acrorhigosis]. / Les acrorhigoses.

Acroasphyxia is not acrocyanosis and acrocyanosis is not acrorhigosis; this classification was drawn up in 1932 by Comel and his school. It involves persistent sensations of cold in the extremities, often with hypothermia but without cyanosis and without wetness. Young women often suffer from this complaint, classified clinically as sine materia but in fact accompanied if not caused by a slight decrease of the distal flow, by dystonia reactive to the exterior cold, and by acrothermic, poikilothermic behaviour. Digital pulp biopsy shows an abnormally high number of glomic anastomoses. Acrorhigosis may be explained by an atonic, hypertonic syndrome, by hyperactive block dispositives and by excessive anastomosisation. Treatment of acrorhigosis is possible.

[Capillaroscopy in rheumatoid arthritis]. / La capillaroscopie dans l'arthrite rhumatoide.

Three capillaroscopic features to be found at the base of nails are recognizable in rheumatoid arthritis. This is in conjunction with the clinical picture, the biological data, and the course of development. In the first, the tissue is transparent, there are many small comma-shaped capillary loops; the second feature is characterized by extreme transparency, pale base and long "hair-pin" loops spread in treillis form over the venular plexus in slow, granular circulation. A third feature recalls from the start a state of collagenosis, because of the inhomogenous opacity of the tissue, the presence of capillary hemorrhage and the irregular appearance of the loops, often of the "megacapillary" variety (I.E. congenital capillary dilatation). This division into three categories determines the character prognosis and treatment. It corresponds histologically to "pulp" biopsy and to the region of glomie arterio-venous anastomosis. There is therefore a real rheumatoid histoangiopathy.

[Angiodysplasias]. / Les angiodysplasies.

The angiodysplasias represent a "disease of the vasculo-connective tissue system", the cells of the primitive area vasculosa being simultaneously histoblastic and haemoblastic. This accounts for the many facets of the clinical picture and the nosology. The slightest deviation in ontogenetic organization involves one or more malformations which embryology unfolds in the course of the various stages of development, provided that the importance of vasculo-connective tissue correlations and hydraulic factors is never forgotten. The problem of nosological classification is very difficult ; many have attempted it, including the School of Nancy with Kissel and André, that of Milan with Puglionisi, that of Schobinger and Leu, that of J. Natali... it remains to classify the clinical picture presented in one or another list.

[Klippel-Trenaunay, syndrome or disease]. / Klippel-Trenaunay, syndrome ou maladie.

Two cases which were clinically typical of the Klippel Trenaunay syndrome and in which the integrity of the deep venous system demonstrated by phlebography form the basis for the author's discussion of the various theories and classifications which have been put forward up to now. The authors favour Schobinger's opinion, according to which three varieties of the Klippel Trenaunay syndrome are recognised. Malan's anatomoclinical classification has been adopted : this permits the grouping together of the numerous variations possible in this type of dysplasia.

[Successive encephalic ischemic accidents in a young patient: Buerger's disease, buergerian syndrome, or juvenile atheroma? A report in clinical, angiographic, and anatomical findings in one case, compared to three other ones, in which a biopsy of the pulp of the toes was also performed (author's transl)]. / Accidents ischémiques encéphaliques successifs chez un sujet jeune: maladie de Buerger, syndrome buergerien ou athérome juvénile? A propos d'une observation clinique, angiographique et anatomique, comparée à trois autres avec étude de biopsie de pulpe d'orteil.

A man of 19 years of age was found to have a diffuse livedo, a quadruple asphyxic acrosyndrome, and dementia. Angiography confirmed the presence of distal ischemia with multiple circulatory blocks and a reduced distal network. The patient died at the age of 25 years and histopathological examinations of the vessels demonstrated obstructive atheromatous lesions in the medium sized and small arteries of the brain and viscera. By comparing these findings with those observed in three other cases, in which biopsy of the pulp of the toe was also performed, the hypothesis can be advanced that these juvenile encephalic ischemic accidents are caused by atheroma, which can be detected, at an early stage, by studying the distal arteries in the finger or toe pulp.

[Thrombophlebitis migrans]. / Les thrombophlébites migratrices.

Semantically, the term is correct, because inflammatory involvement of the vein wall predominates over thrombosis, and the indication for anti-inflammatory drugs is absolute while that for anticoagulants is secondary. The nosological characteristics are its relapsing, migratory and primary nature. But, in fact, this is a "signal-symptom", whether involving normal or varicose veins, with nodular or stranded appearance, with patches of hypodermal inflammation or erysipeloid. The major problem is that of aetiology: infections, systemic disease, blood diseases, deep-seated neoplasia... not to mention the gouty diathesis, hiatus hernia, polycythaemia, Buerger's disease and Behçet's syndrome... The author emphasizes the value of capillaroscopy, biopsy of vein and digital pulp and the search for antivein antibodies. Therapy is discussed.

[Calcinoses of the leg]. / Les calcinoses des membres inférierus

Calcinosis, wherever it appears, is no more than overloading of the conjunctive tissue with calcium. Arterial calcinoses are perhaps the type most frequently recognized : obliterating arteriopathy of middle aged and elderly subjects, arteritis in diabetics, Mönkeberg's arteriosclerosis. Venous calcinoses are either phleboliths, more rarely subcutaneous deposits, or atherocalcinosis of the inferior vena cava, or Cramer and Schilling's lesion. Subcutaneous calcinoses that appear to be nonvascular may give rise to some diagnostic problems. These concern the pathogenesis : calcium transfer by LERICHE and POLICARD, metaplasia of the conjunctive tissues and the elastic fibres, transformation of lipoproteins, hydraulic disturbances, Selye's calciphylaxia.