Digital pulse volume recording: an essential test for the assessment of arteritis in diabetic patients

The high incidence of medial calcification in the distal arteries of lower extremities in diabetic patients is responsible for most of the errors made in measuring ankle-pressure index. Because digital arteries are rarely calcified, digital pulse volume recording has been proposed as a specific and complementary test. Between march 1993 and march 1996, this test was performed in addition to ankle-pressure index in 66 diabetic patients. The ankle-arm index was overestimated and erroneous in 89.4% of cases. Digital arteries were calcified in 74% of cases and diabetic neuropathy present in 53% of cases. Assessment of the severity of arteritis by digital pulse volume recording [category 1 to 5] has led to better prevention and treatment. It is an essential test for the assessment of arteritis in diabetics, but also for the prediction of success of a surgical procedure: distal amputation, lumbar sympathectomy and arterial reconstruction

goitres plongeants

In a series of 363 patients operated for goiter, 60 were retrosternal [16,5%]. The female incidence although less than in cervical goiters remains predominant [2,5:1]. Most patients are in older age group, 68% being above 40 years. The majority of goiters are multinodular and of long duration. Bilateral [37%] and left sided location [43%] were common. The incidence of cancer was 7%, thyrotoxicosis was noted in 5 patients [8%]. Most patients were symptomatic [97%]. Diagnosis is easily done by physical examination, chest X-Ray and thyroid scintigraphy. Computed tomography might be helpful. Retrosternal goiter is an indication to surgery except in high risk patients. The cervical approach has been used in 98% of cases. There were no postoperative death and no major complications [compressive hematoma, laryngeal nerve paralysis, hypocalcaemia]