[Contribution of immunology to the differentiation of arteritis in young persons. Apropos of 2 cases]. / Apport de l'immunologie au démembrement des artérites du sujet jeune. A propos de 2 observations.

The authors report two observations of T.A.O. placed under the heading of "Systems Affections" after the discovery of immunologic abnormalities. Vascular troubles in L.E.A.D. and generalised sclerodermis are, apart from the Raynaud Syndrom, exceptional. They oriente specially towards a T.A.O., and in absence of caracteristic symptoms, they retard the diagnosis of a connective. The reader is reminded of the characteristics of the "Buerger Affection" which must no longer be considered as unique anatomoclinic entity, due to modern immunologic and phlebologic exams.

[Study of the muscular perfusion of the lower limbs using thallium 201 scintigraphy before and after lumbar sympathectomy in 13 patients]. / Etude de la perfusion musculaire des membres inférieurs par scintigraphie au thallium 201 avant et après sympathectomie lombaire chez treize patients.

Scintigraphy with 201-Thallium is a useful method for exploring muscle circulation in lower limbs of patients with arteritis. Comparative values with time can be obtained by studying respective isotopic activity ratios of the thigh, calf and foot. Unilateral isolated lumbar sympathectomy was performed in 13 patients for arteriopathy of the lower limbs (7 claudications, 4 isolated trophic disorders, 1 thrash-foot and 1 juvenile arteriopathy). Investigations included clinical and arteriographic explorations and functional tests (Doppler, distal pressure, digital plethysmography and 201-Thallium muscle scintigraphy) before and after operation. Pathology of the sympathetic chain was determined in each case. Short-term (2 weeks) follow up examinations gave data showing absence of correlation between the operative procedure and scintigraphy results. Muscle perfusion was improved in only 3 cases: one presented paradoxical improvement contralateral to the sympathectomy, while no change from the pre-operative values was recorded in 9 patients. The findings raise questions concerning the reproducibility of the scintigraphic method, and also confirm the pathogenic hypothesis by which lumbar sympathectomy has only a limited effect on muscle circulation.

[In situ venous bypass using the great saphenous vein: analysis of the 5 year outcome of 129 procedures]. / Pontages veineux in situ par veine saphène interne: analyse des résultats a 5 ans a propos de 129 interventions.

One hundred and twenty nine in situ vein bypasses have been reviewed with a five year follow-up. Cumulative patency rates at five year are 71% (+/- 21%) for above-knee femoro-popliteal bypasses, 69% (+/- 11.5%) for below-knee anastomosis and 94% (+/- 35%) when distal anastomosis is performed on tibial or peroneal vessel. Global cumulative graft patency rate is 71% (+/- 9.4%). It is 72% (+/- 11%) in limb salvage.

[Peroperative angiography in reparative surgery of the lower limbs. Apropos of experience with 1099 cases]. / L'angiographie per-opératoire dans la chirurgie de restauration des membres inférieurs. A propos d'une expérience de 1,099 cas.

The authors report their experience of per-operatory angiography in a series of 1,099 cases over 13 consecutive years. The main interest is the limitation in the rate of early reintervention, which frequently causes morbidity and mortality in this type or surgery. The serial nature of the technique is emphasized, and is most comparable to pre-operatory exploration. The various technical details are specified. Some hemodynamic troubles noted during injection (aortography) contraindicate the method in high-risk subjects. The main indications are, above all, control of restorative acts, but also a per-operatory diagnosis of a lesion, and the assessment of blood stream at a lower level. The results are morphological and the various anomalies discovered are reviewed, with iconography, in relation to each type of surgical act (disobliteration, bypass). In situ bypasses are considered separately. The data are also hemodynamic, and justify the six successive X-ray film technique. Deblocking (embolectomy with a balloon catheter) and endarterectomies were found to give more technical imperfections than bypasses. The rate of extemporaneous corrections tripled during the second period (1978 to 1986), and this was no doubt due to an extension in operative indications (19% versus 6% at the beginning). Dacron bypasses (fibrinous debris) and in situ bypasses (detection of anatomical abnormalities, location of shunts) were more often incriminated in immediate reinterventions than Dardik homografts or PTFE.

[Reproducibility of venous occlusion plethysmography. Value of a computerized system of calculation]. / Reproductibilité de la pléthysmographie à occlusion veineuse. Intérêt d'un système de calcul automatisé.

The manual interpretation of identical occlusive venous plethysmography curves by different technicians is subject to a wide variation. The object of this study is to verify this state of affairs and to propose an automatic calculation of the different parameters usually used: the percentage volume increase (delta V), the time taken to half empty (t V/2) and the maximal venous outflow (MVO). We compared the variations, due to the operators, in the measurement of the parameters characterising identical curves obtained by occlusive venous plethysmography. Sixty curves from 30 patients, were photocopied and each was measured independently by four different operators. The results were compared with the measurements obtained automatically from a micro-computer connected to the plethysmograph. The measurements of the percentage volume increase and the time taken to half empty differed among the operators and the computer by less than 2%. However, the maximal venous outflow was subject to very large variations amongst the operators (up to 60%). This uncertainty is due to the operators choice of the point on the curve where the tangent is measured. The micro-computer, by fixing this point at 0.3 second after releasing the cuff allows a standardisation of this parameter.

[Peroperative measurement of peripheral vascular resistance. Significance for the indications, technic and prognosis of distal bypasses. Apropos of 35 cases]. / La mesure per-opératoire des résistances vasculaires périphériques. Intérêt pour les indications, la technique et le pronostic des pontages distaux. A propos de 35 cas.

The authors report their experience of the per-operative measurement of the "absorption capacity" of a distal vascular network. This constitutes an absolute measurement and provides a reliable per-operative indication of a bypass, and eventually that of surgical reintervention in early thrombosis. The techniques are described with a brief overview of the major physical laws in this field. As a predictive test, the measurement is highly reliable, and a threshold value of 3 PRU was found in the series; beyond this value, all bypasses were thrombotic. A brief survey of the literature considers the theme of peripheric resistances. A table of clinical indications is situated at the end of the study, and is related to values of residual pressure and peripheric resistance. Glossary: R: peripheral resistance PAF: Pressure in femoral artery P: Pressure (mmHg) Pr: residual pressure Rp: Physiological resistance RS: stenotic resistance RC: Resistance due to collateral flow D: Femoral flow d and d': successive variations of flow.

[Value and limitations of venous blocks using reserpine in acrosyndromes of the upper extremities]. / Intérêt et limites du bloc veineux à la réserpine dans les acrosyndromes du membre supérieur.

A block Bier technique using a one milligram Reserpine injection has been applied to ten patients with severe Raynaud's phenomenon (six of them had digital gangrene). Six patients have been improved and three have completely healed. This method must only be applied to severe cases and may be used as a pretherapeutic test in upper sympathectomy.

[CY 222, a very low molecular weight heparin, in the curative treatment of deep venous thrombosis. Apropos of 95 cases. Clinical and phlebographic results]. / Le CY 222, Héparine de trés bas poids moléculaire dans le traitement curatif des thromboses veineuses profondes. A propos de 95 observations. Résultats cliniques et phlébographiques.

Efficacy of a very low molecular weight heparin, CY 222, in the treatment of deep venous thrombosis of lower limbs was evaluated in a prospective clinical trial instituted in November 1984. CY 222 was administered as subcutaneous injections of 0.03 ml.kg-1 daily (750 anti-Xa U.kg-1.d-1) as 3 divided doses over a minimum of 10 days. Efficacy was rated as a function of clinical and phlebographic criteria. The group of 95 patients treated was a heterogenious one: 38% medical, 62% surgical, and 48% of the total group had partial interruption of vena cava previous to study. The period between first clinical manifestations of the deep thrombosis and therapy varied between one day and 3 months (mean: 1 1/2 days). Clinical symptomatology significantly and globally regressed in 88% of the patients. Comparisons between phlebographic findings at start and end of treatment are expressed using Arnesen's score (cf. table).

[Paradoxical systemic emboli. 5 case reports]. / Embolies paradoxales systémiques. 5 observations.

Paradoxical systemic embolism by venous emboli in the arterial circulation can be explained by a right-left shunt. In 5 patients, the diagnosis of paradoxical emboli was definite in three cases, and suspected in two others. Venous, arterial and cardiac angiography define the anatomical criteria which alone can confirm the diagnosis. The introduction of a caval filter can prevent recurrent emboli which has a serious prognosis.

[Familial malignant carotid body chemodectoma with lymph node metastases. Light and electron microscopy study (author's transl)]. / Chemodectome carotidien malin avec incidence familiale et métastases ganglionnaires. Etude optique et ultrastructurale d'un cas et revue de le littérature.

A case of malignant carotid body chemodectoma with neighbouring lymph nodes metastases is reported. The case is noteworthy as it was accompanied by another jugulotympanic chemodectoma. There was also hereditary component as four of the patients forebears had been operated for cervical chemodectomas. An ultrastructural study showed the characteristic secretory granules. 32 other cases of tumors of carotid body and jugular glomus with metastases are reviewed.