[Ease of use, feasibility and performance of ankle arm index measurement in patients with chronic leg ulcers. Study of 100 consecutive patients]. / Mesure de l'index de pression artérielle systolique à la cheville chez un patient porteur d'un ulcère de jambe. Faisabilité et performance chez 100 patients consécutifs hospitalisés dans un service spécialisé

International guidelines on leg ulcers recommend measuring the ankle arm index (AAI) to diagnose and assess peripheral arterial occlusive disease (PAOD) of the lower limbs. These guidelines do not, however, describe the method which should be used to make the measurement: which artery should be measured -in the event of an open leg ulcer, what are the practical difficulties for positioning the cuff- how well do patients tolerate the procedure? We conducted a prospective study focusing on ease of use, tolerance and performance of AAI measurements in patients with leg ulcers. In compliance with recent French guidelines, we measured the AAI for both distal leg arteries and retained the lowest value for analysis. Within a six-month study period, 100 consecutive inpatients with leg ulcers of various etiologies were studied. Mean age was 75, female predominance 60%, body mass index 27. Etiologies of leg ulcers were pure venous (29%), mixed venous predominant (17%), pure arterial (9%), mixed arterial predominant (8%), mixed (6%), hypertensive ulcers (11%), rare cause (8%), multifactorial (12%). Pain was present in 92%, with a VAS above 3 for 73%. Measurement of AAI was possible in 98% of patients. It was too painful and thus considered unethical for two patients with hypertensive ulcers. For the 98 patients measured, the ulcer had to be protected during the measurement in 76%. The measurement procedure only took five minutes for one leg, and was judged easy to perform by 93% of the operators. For the majority (76%) of patients, the measurement was not painful. We determined the diagnostic performance of AAI by comparing the results with those of arterial ultrasound in 90 patients who had a complete arterial ultrasound exploration of the legs. Compared with arterial ultrasound, the sensitivity of AAI<0.9 for detecting the presence of PAOD was 84.7%, with 97% specificity. PAOD was not diagnosed in any patient who had two palpable distal pulses and a normal AAI. Measurement of AAI in patients with leg ulcers is an easy to use, well-tolerated, high-performance tool for the assessment of PAOD.

[Role of growth hormone in proliferative diabetic retinopathy. Clinical and immunohistochemical aspects]. / Rôle de l'hormone de croissance dans les rétinopathies diabétiques prolifératives. Aspects cliniques et immunohistochimiques.

The first part of this work deals with the various therapeutics with pituitary aims on ten patients with proliferative retinopathy. In the second part, the Growth Hormone involvement is considered, by the mean of IGF-I dosages in the serum and the vitreous of diabetic and non-diabetic patients. IGF-I is also sought in neovascular membranes by immunohistological methods. If radioimmunological dosages are negative, IGF-I deposits are found into new vessels wall. The significance of these immunohistological findings remains to be determined.

[Eales' disease: therapeutic considerations]. / La maladie de Eales: considérations thérapeutiques.

Five cases of Eales syndrome are analysed in this report. The tuberculous etiology of this disease oblige, during the treatment, a medical survey. After photocoagulations, a medical treatment with acetylsalicylic acid seem to be useful to decrease evolution of this thrombosant vasculopathy. A precocious vitrectomy gives good results.

[Meningeal hemorrhage and Hermansky-Pudlak syndrome]. / Hémorragie méningée et syndrome d'Hermansky-Pudlak.

We studied the case of a young patient affected by a Hermansky-Pudlak syndrome: oculocutaneous albinism of variable intensity with essentially an haemorrhagic diathesis due to a "pool vide" thrombopathy. In beginning the only obvious symptom was a nystagmus and an ocular albinism. Cerebrospinal hemorrhage has up to now never been reported to our knowledge. Healthy carriers can be detected by ophthalmological examination and hematological coagulation tests. Albinos must benefit of systematical coagulation tests in order to prevent drug induced haemorrhagic accident.