[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).

[Plasma, red cell, and cerebrospinal fluid folate in Alzheimer's disease]. / Variations des folates plasmatiques, intraérythrocytaires et intrarachidiens, dans la démence sénile de type Alzheimer.

This study compares plasma, red cell, and cerebrospinal fluid (CSF) folate levels in subjects with mild or moderate Alzheimer's disease (AD) of senile onset and in non-demented control subjects. Twelve subjects with mild or moderate (Folstein's Mini-Mental-State-MMS--between 10 and 23) AD (DSM3 R criteria) and 12 control subjects without dementia and with MMS above 23 were included. To avoid any change in plasma folate levels due to dehydration, all dehydrated subjects were excluded. Were also excluded all subjects obviously suffering from malnutrition or alcoholism, or taking drugs likely to interfere with folate metabolism. Changes in folate levels due to posture or prolonged venous occlusion were carefully avoided. Patients with AD were 5 males and 7 females aged (Mean +/- SD) 80.2 +/- 5.7 years, MMS 14.8 +/- 2.6; controls were 7 males and 5 females aged 78.9 +/- 7.2 y, MMS 28.3 +/- 1.5. The two groups were not statistically different for these variables, except for the MMS. Plasma folate levels were lower (p < 0.006) in patients with AD (4.5 +/- 1.5 micrograms/l) compared with controls (7 +/- 2.2 micrograms/l). Red cell folate levels were lower (p < 0.007) in patients with AD (183.7 +/- 91.1 micrograms/l) compared with controls (300.4 +/- 96.1 micrograms/l). CSF folate levels were lower in AD (18.9 +/- 9.7 micrograms/l) than in controls (21.9 +/- 8.2 micrograms/l) but the difference was not statistically significant (p > 0.05). Our results indicate poorer nutrition in patients with AD.

[Use of homologous erythrocyte concentrates. Analysis of economical factors]. / Consommation de concentrés érythrocytaires homologues--Analyse des facteurs d'économie.

The factors involved in reducing consumption of bank packed red cells (PRC) were studied over three one year periods (1983, 1987 and 1989) in a Department of Vascular and General Surgery. The effects of autologous blood salvage (started in 1987), associated with the management of homologous blood by a branch of the blood bank inside the operating theater suite were assessed. In 1989, intentional normovolaemic haemodilution became virtually systematic, on top of the intraoperative blood salvage, for all patients due to undergo surgery with a risk of severe blood loss. The number of surgical procedures carried out during those three years did not vary. However, in the same time, the annual consumption of homologous PRC decreased by an overall 56% (36.7% between 1983 and 1987, and 29.8% between 1987 and 1989). This decrease was mostly due to a fall in prescription in the operating theaters, and not in the wards. In the same time, albumin consumption increased sixfold. Such transfusional policies can only be carried out if there is good cooperation between the blood bank and the prescribers of blood products.

[Peroperative autotransfusion]. / La transfusion autologue peropératoire.

Between April 1976 and December 1984, 297 patients underwent major elective and emergency surgery using intraoperative autotransfusion (Bentley ATS unit). An amount of 732 l of blood was reinfused, representing 61% of the total intraoperative blood transfusion. Thanks to this method, an average 2.46 l of blood per patient was spared, with a range of 0.9 to 6 l according to the type of surgery (elective or emergency). Twelve accidents are reported, including four bradycardias (less than 45 b X min-1), two air emboli and six haemorrhages due to an excess of anticoagulation. These complications were related either to poor technique (too great a transfusion output) or insufficient blood anticoagulation control. Simplicity of use and high transfusion output of the device adapted to the blood loss are the advantages of intraoperative autotransfusion.

[Hemodynamic changes caused by laparotomy during aorto-iliac surgery]. / Variations hémodynamiques induites par la laparotomie en chirurgie aorto-iliaque.

A haemodynamic study was carried out on 53 patients undergoing elective surgery of the abdominal aorta in order to assess the haemodynamic changes consequent to abdominal manipulations prior to aortic clamping. Surgery was carried out under general anaesthesia and ventilation was controlled. The following parameters were monitored: mean arterial pressure (Pa), cardiac index (CI), systolic index (SI), systemic vascular resistances (Rsa), pulmonary vascular resistances (Rpa), heart rate (fC). Cutaneous circulation was monitored using a photoplethysmographic transducer. The following haemodynamic pattern was seen as the peritoneal cavity was opened and traction on the mesentery was applied: CI +40.7%; fC +28.61%; SI +9.85%; Rsa -39.16%; Rpa -28.43%; Pa -15.7%. The recording of the facial cutaneous photoplethysmographic wave showed an increase of 50%. In some extreme cases, a state of cardiovascular collapse with marked cutaneous erythema strongly resembling anaphylactic shock ensued. The physiopathology of these cardiovascular reactions is unclear, but the haemodynamic pattern as well as the cutaneous vasodilation suggest a stimulation of both vagal and sympathetic nervous systems and the release of vasoactive substances into the general circulation.

[Hemodynamic and gasometric modifications during the anesthesia recovery period in patients undergoing ventilation after surgery of the abdominal aorta]. / Modifications hémodynamiques et gazométriques á la phase de réveil chez le sujet ventilé après chirurgie de l'aorte abdominale.

This study was carried out on 12 patients (mean age 61) in order to assess the oxygen consumption (VO2) in the post-operative stage of an elective surgical procedure (replacement of the abdominal aorta). Anesthesia was a combination of thiopentone, pancuronium bromide and high doses of droperidol and fentanyl. Patients were kept intubated and ventilated in the post-operative period. VO2 and other related metabolic parameters as well as hemodynamic parameters were measured every 45 minutes over a period of 5 hours. A VO2 increase (127%) related to the increase in body temperature was noted. Mean VO2 for all patients during the whole period was 170 +/- 13 ml.min-1.m-2 (range: 51-411 ml.min-1.m-2). Mean value of maximal VO2 was 240 +/- 21 ml.min-1.m-2 (range: 1471-411 ml.min-1.m-2). Large dose of droperidol are shown to limit VO2 increase. In patients with shivering, the maximal value of VO2 was found during shivering. The amount of droperidol administered during anesthesia was greater in patients without shivering. VO2 increase was due to a rise in tissular O2 extraction. Cardiac index was insufficiently increased (+ 9.4%) and a certain extent of myocardial inadaptability was suspected in relation with: high blood pressure, hypovolaemia and/or myocardial effect of anesthesia agents.

[Purulent pleurisy caused by anaerobic bacteria. Apropos of 2 observations]. / Les pleurésies purulentes à germes anaérobies. A propos de deux observations.

Purulent pleural effusions due to anaerobic organisms secondary to infections of the pulmonary parenchyma are complications which often occur following the inhalation of organisms from the buccal cavity. The most commonly found organisms belong to the endogenous anaerobic flora of Veillon. Rapid encystment of the pleural collection is suggestive of this diagnosis. Treatment consists of drainage of the cavity associated with specific antibiotics.

An open trial of enoxaparin in the treatment of deep vein thrombosis of the leg.

An open and prospective phase II trial assessing the action of a fixed dose of a low molecular weight heparin (enoxaparin), determined by the patient's weight, in the treatment of established deep vein thrombosis of the leg is hereby described. A series of 51 patients received a regimen of 1 mg.kg-1 or 105 anti-Xa IU.kg-1 s.c. every 12 h for a period of 12 days. Thromboses were categorized as postsurgical (28 cases) or medical (23 cases). There was a significant improvement in clinical signs (pain and edema) and phlebographic indices (Marder and Arnesen scores). The extent of vascular clearing was a 30% reduction in phlebographic scores between day 0 and day 12. Only 5 patients had an absence of improvement. Two of the 51 patients stopped the drug in the first week of treatment because of bleeding. There were no occurrences of thrombocytopenia, and the agent was well tolerated.

Treatment of established venous thromboembolism with enoxaparin: preliminary report.

Unfractionated heparin is effective in the treatment of deep venous thrombosis and pulmonary embolism but may lead to significant side-effects (bleeding complications and thrombocytopenia). Low molecular weight heparin fragments have been shown to be as effective as unfractionated heparins during prophylaxis with a once-daily injection regimen. The aim of this open study was to assess the tolerance and the efficacy of enoxaparin in established venous thromboembolism. The study included 36 consecutive patients (mean age 60 years) (range 13-87) with recent deep vein thrombosis (less than 5 days) documented by venography. All patients received enoxaparin twice daily at a fixed dosage of 2 mg/kg/day. The efficacy was assessed by the evolution of Arnesen venographic score. Seventeen patients showed a moderate improvement (less than 35%) and 17 patients had a marked improvement (over 35%). Two patients were not evaluated for efficacy because they displayed bleeding complications. No relationship was found between anti-Factor Xa level and regression of venographic score. In conclusion, subcutaneous administration of enoxaparin proved to be an effective antithrombotic therapy. A fixed dosage of 2 mg/kg/24 h should be the basis of the randomized controlled study ongoing at the present time.

Treatment of deep venous thrombosis with a very low molecular weight heparin fragment (CY 222).

Thirty patients presenting with phlebographically confirmed deep venous thrombosis were treated with a very low molecular weight heparin fragment (CY 222) in an open and prospective phase-2 trial. A uniform dosage of 750 IC anti-factor Xa units/kg/day was administered subcutaneously for 10 days or more to patients whose thromboses were categorized as postsurgical (17 cases) or medical (13 cases). The clinical symptoms of venous thrombosis diminished in 93% of the patients overall. The extent of vascular clearing was assessed by an original scoring system which compared the pre- and posttreatment phlebographies. The effect of treatment was globally rated 'very good' (more than 75% lysis) in 37% of the patients, 'good' (about 50% lysis) in 40% and 'poor' (0-25% lysis) in 17%; the phlebographic thrombosis worsened in 6.6%. Little change occurred in laboratory tests exploring thrombolysis, but a strong anti-factor Xa activity was detected.