[Edema of the hand during secondary swelling of the arms: primary etiopathogenic hypotheses]. / Oedème de la main au cours des gros bras secondaires: premières hypothèses étiopathogéniques.

Iatrogenic swollen arms following surgery and radiation therapy after breast cancer, may be -or not- associated with a swollen hand: the percentage is approximately 50%. This study attempts to formulate a few hypotheses regarding the pathogenesis of this distal edema. Clinical examination, lympho-phlebography, isotopic scintigraphy and exploration of the microcirculation (periungual capillaroscopy, distal plethysmography and distal Doppler) were performed in ten patients with hand edema. If the dual nature of the stasis seems to be confirmed the most remarkable result is that in 8 out of 10 patients the anomalies are bilateral. These first hypotheses should be confirmed by a more in-depth quantitative study, and perhaps by more direct paraclinical investigations.

[Lymphopathy in postphlebitic disease]. / La lymphopathie dans la maladie post-phlébitique.

Embryology, anatomy and physiology clearly demonstrate the relationship and interactions between the venous and lymphatic systems. It was therefore logical to expect mutual repercussions of the two systems on the pathological process. In the course of the post-phlebitic disease, structural and functional anomalies of the superficial and deep lymphatic system are demonstrated y microfluoroscintigraphy and isotopic lymphoscintigraphy. The advantage of recognizing this associated lymphatic pathology lies in the resulting therapeutic strategy: combine the usual phlebological treatments with specific treatments of peripheral lymphatic stasis.

[Iatrogenic venous pathology and post-radiosurgery swollen arm. Apropos of 100 cases]. / Pathologie veineuse iatrogène et gros bras post-radiochirurgical. A propos de 100 cas.

Lymphostasis of the upper limb, succeeding the radiosurgical treatment of breast cancer, has been known for some time, along with the clinical entity generally called "swollen arm". Post radiosurgical venous disorders have, however, been much less studied, and so the author's survey is based on a systematic, clinical, and phlebo-lympho-scintigraphical study of 100 case histories. Out of the 100 cases studied, almost 80% presented mixed lympho-venous anomalies, whilst 25% of the cases proved to be "swollen arm" of purely venous origin. Finally the author analyses the different vascular lesions encountered in the follow-up of radio-surgical treatment and the therapeutic conclusions to be drawn from these.

[Comparative study of the clinical examination and the Doppler examination of the external saphenous vein: apropos of 191 cases]. / Etude comparative entre l'examen clinique et l'examen Doppler acoustique de la saphène externe: à propos de 191 cas.

The systematic investigation of the short saphenous vein, from its terminal anastomosis in the popliteal space to the retromalleolar sulcus, using a doppler examination, produces a number of contradictions in comparison with the traditional clinical examination using palpation and succussion sign. In fact, 207 contradictory cases have been detected in which 2/3 of the Doppler examinations were positive without obvious clinical signs, then only 1/3 were positive at clinical examination, and 2/3 negative using the Doppler. These contradictory results ought, in the author's opinion, to mean the systematic use of the Doppler, at least the ultrasound, in standard examinations of the short saphenous areas. Surgical treatment of the short saphena should be envisaged if reflux is found into the retromalleolar sulcus. A simple resection of the saphenofemoral junction will not mean the complete eradication of reflux in this area.

[Lymphatic involvement in postphlebitic disease]. / La participation lymphatique dans la maladie post-phlébitique.

Veins and lymph ducts are closely linked anatomically, embryologically and physiologically. It is therefore not surprising that such a close relationship should reemerge in the pathology of each. Post-phlebitic disorders provide a classic example of this. Microlymphography, using fluorescence, and isotopic phlebolymphography produce positive, unequivocable arguments for the contribution of lymph to the genesis of post-phlebitic disorders; these methods are better than direct lymphology which is technically difficult and not altogether without its dangers. These findings should, of course, have bearing on therapy.

[New local therapy in the treatment of leg ulcers: Biostim cream]. / Une nouvelle thérapeutique locale dans le traitement des ulcères de jambe: le Biostim crème.

The treatment of leg-ulcers involves two sections which are theoretically distinct but in practice closely related: aetiological therapy which aims at correcting the causal factor or factors, and local treatment which is intended to facilitate detersion, granulation, and finally epidermization. Amongst the new local therapies, glycoproteins extracted from Klebsiella pneumoniae (Biostim cream) have immunostimulant properties and have a detersive action, facilitating the granulation, and because of their indirect bactericidal action mean that local antibiotics can be avoided.

[Therapeutic principles of lymphostasis of the extremities]. / Principes thérapeutiques de la lymphostase des membres]

After a short reminder of the posological classification of the lymphoedema of the limbs, the author describes the channels of lymphatic return and their anatomical structure. The medication of lymphostasis aims to increase the lymphatic flow. It is often the association of the various forms of medication (antialdosterone-benzopyrones) that leads to the increased lymphatic evacuation. The so-called conservative methods try to recover a physiological site for the lymphatic reflux. Incision of the fibrous cicatrices, instrumental expulsion of the oedema and, the preferred method, manual lymphatic drainage, associated with a suitable form of compression, are amongst the steps to be taken. Surgery of lymphoedema is today still, as a rule, a mutilating procedure, although often necessary. Excision and drainage are however being replaced by techniques of lymphovenous anastomosis.