Vasomotor effects of transcutaneous CO2 in stage II peripheral occlusive arterial disease.

Vasomotor effects of skin exposure to carbon dioxide (CO2) have been described in normal subjects. It was of interest, therefore, to determine whether percutaneous CO2 is of therapeutic benefit. In a randomized, double-blind study, 10 patients with lower limb arteriopathy (stage II) were investigated before and after local exposure for twenty minutes to CO2-rich spa gas or to water-vapor-saturated air at the same temperature as that CO2-rich spa gas. Brachial and femoral blood flows, brachial and posterior tibial artery pressures, heart rate, and chest and foot transcutaneous oxygen tensions (tcPO2) were determined. Femoral blood flow, tibial pressure, and foot tcPO2 were significantly increased after exposure of the skin to CO2-rich spa gas. This effect was not accompanied with systemic hemodynamic modifications. Water-vapor-saturated air had no effect. These results suggest that transfer of CO2 across the skin can have beneficial local vasomotor effects in patients with lower limb stage II arteriopathy.

[Muscular fixation of thallium-201 in lower limb arteriopathies before and after injection of Royat thermal gas]. / Etude de la fixation musculaire du thallium-201 dans les artériopathies des membres inférieurs avant et après injection de gaz thermal de Royat.

Thirty patients with peripheral vascular disease (grade II) were studied by way of thallium-201 (Tl-201) muscular scan in order to assess a possible muscular effect of the Royat spa natural gas. Immediately after a 1.1 MBq/kg Tl-201 IV injection, a dynamic scintigraphic study was performed during 15 minutes in order to obtain a time-activity curve (characterized by Tmax) over the thighs, at rest. Then static anterior and posterior views were performed over thighs and calves during 4 minutes each. Perfusion ratios were calculated as thigh/knee and calf/ankle. The GE maxi 400 T gamma-camera was connected to an Informatek treatment system, zones of interest being chosen to obtain anterior and posterior thigh/knee, leg/ankle uptake ratios. Two studies were realized: the first one in basal conditions, the second one 7 days later, immediately after a s/c injection of natural gas. The later study was preceded by a static counting to subtract the residual muscular activity. After gas injection, one observed that Tmax was shorter, on the average, and that the difference between time-activity curves observed during the first study disappeared for patients with unilateral disease. A significant Tl-201 uptake increase was observed for the anterior image of the calf, while no difference was noted on posterior images, natural gas being injected on the front face of legs. This was particularly clear for patients with unilateral disease and receiving only unilateral gas injection.

[Evaluation of the effect of Royat thermal gas in arteriopathy of the legs using thallium-201 muscular scintigraphy]. / Evaluation de l'effet du gaz thermal de Royat dans l'artériopathie des membres inférieurs par la scintigraphie musculaire au thallium 201.

12 patients (group II) suffering from an arteriopathy of the lower limbs, stage II, were examined by thallium 201 muscular scanning. The aim of this study was to look for a possible muscular effect of Royat thermal gas injected subcutaneously. A preliminary study was conducted at rest, and consisted of recording the initial decay curve of thallium in the thighs and the study of the muscular fixation by different segments of the limbs, including the determination of the ratios of amounts fixed by the muscular and non-muscular zones. The results were compared with those obtained in 11 healthy subjects (group I) and no significant difference was noted between the two groups at rest. On the other hand, a considerable improvement of the fixation in the legs was observed after subcutaneous injection of thermal gas. The results are discussed in relation to the clinical and paraclinical data.

[Asymmetrical hypertrophic cardiomyopathy in neonates of diabetic mothers]. / Hypertrophie septale asymétrique du nouveau-né de mère diabétique.

In 11 neonates of diabetic mothers echocardiography was systematically performed and led to the discovery of 6 cases with hypertrophic cardiomyopathy. This abnormality, which may induce cardiorespiratory failure, is usually benign and consists of systolic murmur and transitory cardiomegaly; all these symptoms spontaneously regress within a few weeks. This cardiomyopathy may present with obstructive signs requiring treatment with beta adrenergic blocking agents; however, it is more often pure and needs no treatment. It may be observed after pregnancies that were not well supervised and might be induced by fetal hyperinsulinism.

Red blood cell filterability in non-diabetic patients with chronic occlusive arterial disease.

One-hundred and fifty non-diabetic patients with stage II chronic occlusive arterial disease (COAD), were tested for red blood cell filterability (RBF). At the same time, glycaemia, uricaemia, plasma cholesterol and triglycerides, fibrinogen, haematocrit, and white blood cells (granulocytes and lymphocytes) count, mean corpuscular volume, were measured. Thirty healthy people, tested for the same biological parameters, were used as controls. RBF was performed, using the Reid & Dormandy technique, with the same batch of filters (Nuclepore 5 micrometer, No. 54 A8 A25) for patients and controls. Filtration time was expressed in s.ml-1. Values obtained in patients (41.967 +/- 0.889) were significantly different (P less than 0.005) from controls (32.1 +/- 1.329). RBF alteration was correlated (P less than 0.05) with white blood cells count, haematocrit and plasma fibrinogen values. No correlation was observed with other biological parameters.

[Wolff-Parkinson-White syndrome caused by association of atrio-hisian fibers and Mahaim's fibers. Comparison between the electrophysiology and histology]. / Syndrome de Wolff-Parkinson-White par association de fibres atrio-hissiennes et de fibres de Mahaïm. Confrontation entre l'électrophysiologie et l'histologie

A child of six who had had several losses of consciousness died suddenly during a spell of tachycardia. The EKG showed at times a type B Wolff-Parkinson-White syndrome, at times a Lown-Ganong-Levine syndrome. Intracavitary electrophysiological explorations had been carried out. The interest of this case lies in the comparison between these electrophysiological explorations and the histological examination of the normal and accessory conduction pathways. The short PR interval, which did not lengthen under the effect of premature atrial stimulation, was accounted for by the presence of atrio-His bundle tracts. The intermittent delta wave was due to Hissio-ventricular Mahaim fibres. These two accessory conduction pathways are considered as abnormal.