[Deep vasculitis]. / Les vascularites profondes.

The author gives a definition of the term "vasculitis". Histopathological modifications are the result of a disturbance in the barrier function exerted by the vascular endothelium. The disturbances observed are characterized by piles of endothelial or intimal debris associated with a perivascular inflammatory reaction of the connective tissue and the appearance of a resorption granuloma. Whether superficial or deep, vasculitis can become "nodular" in appearance and is then characterized by "nodules" or "patches". In order to implement aetiological treatment, it is necessary to look for the causative agent: an infectious, drug or bacterial allergen, or hypertension is frequently involved.

[The physiology and physiopathology of the venous system in the obese]. / La physiologie et la physiopathologie du système veineux chez l'homme obèse.

The question of knowing to what extent varices occur more frequently in obese, rather than in non-obese, patients is answered variously in the epidemiological studies carried out. But if pathological venous conditions originate in, or are aggravated by, obesity, the question is raised: to what extent is the venous circulation modified by obesity? The authors discuss the factors at play in venous circulation in the obese patient. The effect of super alimentation on the venous system is demonstrated in the autopsy statistics on the occurrence of fatal pulmonary embolism, compared with the general nutrition index.

[Clinical picture and treatment of the Raynaud syndrome of the upper extremities]. / Clinique et thérapeutique du syndrome de Raynaud des membres supérieurs.

Raynaud's disease occurs in different clinical forms, which are not specific to the vascular spasm which characterizes the disease. This spasm virtually always develops in the same manner. Clinical aspects depend on the underlying pathology, which will define treatment. Therapeutic efficacy in Raynaud's disease is discussed. Current interest focuses on serotonin antagonists.

[Clinical picture of acrosyndromes]. / Tableau clinique des acrosyndromes.

Classification and clinical symptomatology of acrosyndromes. Acrosyndromes are compared to angiolopathies. They have been well studied on the skin, but they also affect other organs. According to our current knowledge, this mostly concerns organic angiolopathies. As long as we do not have a more advanced view of extra-cutaneous localizations, we must keep the classification criteria established after the skin localizations. This classification protocol is presented and justified. The clinical symptomatology of acrosyndromes is presented according to this classification protocol.

[Ulcers in congenital arteriovenous fistula of the lower extremities]. / Ulzera bei kongenitalen arterio-venösen Fisteln der unteren Gliedmassen.

Ulcers of the lower legs caused by arteriovenous fistulae show, on one hand, that diagnoses are often made carelessly and, on the other, that the treatment initiated is often inadequate. In both cases reported, there were several small arteriovenous fistulae in the lower legs, although no symptoms were observed for a long time. The ulcers, which then recurred chronically, resulted from very minor injuries. Their characteristics remained unnoticed for many years. Surgical intervention to remove these fistulae is not always simple because they cannot all be removed at once. Lower leg ulcers caused by arteriovenous shunts are an example of how difficult it can be to prove the cause of such lower leg ulcers.

[The incidence of leg ulcers as a function of age]. / Etude de la fréquence des ulcères de jambe en fonction de l'âge.

In this short paper, the author studies the occurrence of leg ulcers in relation to age and the cause of the ulcer. The data confirm practical ideas which are already well known.

[Does the success of thrombolysis depend on the age of the patient?]. / Le succès d'une thrombolyse dépend-il de l'âge du malade?

This study raises the question whether the age of the patient has any influence on the results of the treatment of the post-phlebitic syndrome of the lower extremities by thrombolysis. Our study demonstrates that elderly patients respond to thrombolysis as well as young patients.

[Effects of horse-chestnut seed extract on transcapillary filtration in chronic venous insufficiency]. / Wirkung von Rosskastaniensamenextrakt auf die transkapilläre Filtration bei chronischer venöser Insuffizienz.

The effect of horse-chestnut seed extract (standardized on aescin; Venostasin retard) was assessed in a randomized placebo-controlled crossover double-blind trial of 22 patients with proven chronic venous insufficiency by measuring the capillary filtration coefficient and the intravascular volume of the lower leg by venous-occlusion plethysmography. Three hours after taking two capsules of Venostasin (600 mg; each capsule containing 50 mg aescin) the capillary filtration coefficient had decreased by 22%, whereas after administration of an identical-looking placebo capsule it rose but slightly over three hours. The difference in the effect of Venostasin and placebo is statistically significant (P = 0.006). The intravascular volume was reduced 5% more after Venostasin than the placebo, but this is not statistically significant. It is concluded that Venostasin has an inhibitory effect on oedema formation via a decrease in transcapillary filtration and thus improves oedema-related symptoms in venous diseases of the legs.

[Pathologic anatomy of white atrophy]. / Anatomie pathologique de l'atrophie blanche.

Milian's respectively aetiological and pathogenic hypotheses, based on the infectious origin of this disease, such as tuberculosis or syphilis, have not been confirmed. In almost every case there has proved to be chronic venous deficiency. The histomorphological deterioration shows, as well as the characteristic signs of cutaneous atrophy, the vessel affection developing towards dilation, but also the parietal processes moving towards obliteration. These processes do not correspond to vasculitis, as described by Ruiter. For this reason, we do not go along with those authors associating these histological deteriorations with vasculitis. And we therefore justify our claim that white atrophy cannot be considered as an angiolopathy.

Buflomedil in arterial occlusive disease: results of a controlled multicenter study.

In a double-blind, randomised multicentre study buflomedil, a vasoactive substance, was compared with placebo in the treatment of 93 patients with chronic arterial occlusive disease. After a run-in period of four weeks the patients received either buflomedil (600 mg daily) or placebo over 12 weeks. The pain-free and the total walking distances improved significantly in both groups. However, the differences in the improvement between the two groups were highly significant and in favour of buflomedil: for the pain-free walking distance p less than 0.001 and for the total walking distance p less than 0.01. The results indicate that buflomedil has a beneficial effect on the symptoms and lengthens the walking distance in patients with arterial occlusive disease.

[Determination of venous capacity and flow by plethysmography with occlusion of the veins]. / Détermination de la capacité et de l'écoulement veineux par pléthysmographie avec occlusion des veines.

These examinations are based on the knowledge that mercury-in-rubber strain gauge method for venous occlusion plethysmography is suitable for measuring the venous capacity and venous return. This research reports on the value of this method in diagnostics. The results are as follows: the venous capacity decreases markedly in the group of patients with deep vein occlusions of the legs. However, it is not possible, basing on the measurements, to differentiate between occlusions above and those below the knee. The same applies to multiple occlusions in the same vein meaning that venous occlusions in the deep veins of the lower limb cannot be examined separately. The results of a single patient are mostly but not always similar to those of this corresponding group. Therefore venous occlusion plethysmography does not have the same diagnostic value as phlebography in deep vein occlusions for the individual patient.

[Is the pigmentation a characteristic sign for chronic venous insufficiency?]. / La pigmentation est-elle un signe caractéristique de l'insuffisance veineuse chronique?

In epidemiological studies pigmentations were declared a decisive criterium of stadium II of chronic venous insufficiency. It is discussed in this work if it is possible as the pigmentation is sometimes absent in advanced stages of chronic venous insufficiency. On the other hand it has got to be considered that there are many other possibilities of pigment building on the legs without chronic venous insufficiency. Pigmentation may be of actinic, endocrine, atrophic or especially of inflammatory origin. These pigmentations cannot be differentiated from those caused by chronic venous insufficiency macroscopically, and therefore, in our opinion, the question if pigmentation is a specific sign for chronic venous insufficiency has to be negated. Further, it is examined if the histomorphology of the pigmentation caused by chronic venous insufficiency offers a different aspect from that caused by other diseases. Special attention is given to the pigments containing melanin and iron. Melanin, as an example, is increased in skin inflammation whether there is chronic venous insufficiency or independent of any edematous changes, In subfascial chronic venous insufficiency without any inflammatory component, only the pigment containing iron increased.

[Physico-mechanical treatment of chronic arterial obliterations in the extremities. Attempt to objectify its efficacy]. / Un traitement physico-mécanique des oblitérations artérielles chroniques des extrémités. Essai d'objectivation de son efficacité.

This study shows the objective value of a physico-mechanical high pressure/low pressure therapy using the Vasculator. Until recently, the supposition that such a treatment would improve the blood circulation was based purely on clinical observation. We have been able to define ergometric parameters confirming the improvement of the circulation effected by the Vasculator. This ergometric equipment enables us to measure pace and distance and, at the same time, to check with precision the effort required. Our experiment proves that the Vasculator treatment induces increased muscular effort, approximately 20-25 p. cent, and the quantitative analysis has shown that our results may be considered fully significant. Taking into account the values obtained before and after each treatment, increased parameters lead us to believe that the Vasculator gives not only short-term results, but also effects a long-term improvement of the blood-circulation.

[Possibilities of drug therapy in the fight against deep venous thrombosis]. / Les possibilités thérapeutiques médicamenteuses dans la lutte contre la thrombophlébite profonde.

The aim of treatment of this illness should be recovery of the circulation, i.e. the suppression of thrombi in the deep venous network. This goal may currently be reached, in the same way as embolic lysis, by the early administration of streptokinase and urokinase, whose mechanisms, dosage-problems and chances of success are discussed here. This thrombolytic treatment is charged with major risks. If it is not to be used then anticoagulants are indicated. These have only a prophylactic effect, that is: they prevent the growth of thrombi. Heparin is the most active anticoagulant but it can only be administered parenterally. The author discusses the mechanism and efficiency of heparin and the antagonists of vitamin K1. Anti-aggregates rather show prophylactic action in the formation of arterial thromboses. Their spectacular effect in vitro on coagulation in vivo has not always been clearly proved in the venous system. It can be seen from the varied effects on thrombocytes and the vascular wall why anti-aggregates are not ideal anti-coagulants.