A comparative study of reactive hyperemia in human forearm skin and muscle.

Reactive hyperemia (RH) in forearm muscle or skin microcirculation has been considered as a surrogate endpoint in clinical studies of cardiovascular disease. We evaluated two potential confounders that might limit such use of RH, namely laterality of measurement and intake of non-steroidal anti-inflammatory drugs (NSAIDS). Twenty-three young non-smoking healthy adults were enrolled. In Experiment 1 (n=16), the RH elicited by 3 min of ischemia was recorded in the muscle (strain gauge plethysmography, hand excluded) and skin (laser Doppler imaging) of both forearms. In Experiment 2 (n=7), RH was determined in the dominant forearm only, one hour following oral acetylsalicylic acid (1 g) or placebo. In Experiment 1, peak RH was identical in both forearms, and so were the corresponding durations of responses. RH lasted significantly less in muscle than in skin (p=0.003), a hitherto unrecognized fact. In the skin, acetylsalicylate reduced duration (43 vs. 57.4 s for placebo, p=0.03), without affecting the peak response. In muscle, duration tended to decrease with acetylsalicylate (21.4 vs. 26.0 s with placebo, p=0.06) and the peak increase in blood flow was blunted (27.2 vs. 32.4 ml/min/100 ml tissue with placebo, p=0.003). We conclude that, when using RH as a surrogate endpoint in studies of cardiovascular disease, a confounding by laterality of measurement need not be feared, but NSAIDS may have an influence, although perhaps not on the peak response in the skin.

Foot skin blood flow following infrainguinal revascularization for critical lower limb ischemia.

INTRODUCTION: The aim of this study was to assess the blood flow in the feet before and after lower limb revascularization using laser Doppler imaging (LDI). METHODS: Ten patients with critical lower limb ischemia were prospectively enrolled from June to October 2004. All patients underwent successful unilateral surgical interventions including above-knee bypass, distal bypass and endarterectomy. Skin blood flow (SBF) over the plantar surface of both forefeet and heels was measured by LDI 24h before and 10 days after revascularization, expressed in perfusion units (PU), and reported as mean+/-SD. RESULTS: Measurements in the forefoot and heel were similar. Before revascularization mean SBF was significantly lower in the ischemic foot (130+/-71 PU) compared to the contralateral foot (212+/-68 PU), p<0.05. After revascularization a significant increase of the SBF in the forefoot (from 135+/-67 to 202+/-86 PU, p=0.001) and hindfoot (from 148+/-58 to 203+/-83, p=0.001) was observed on the treatment side. However, a large decrease of the SBF was seen in forefoot and hindfoot on the untreated side (from 250+/-123 PU to 176+/-83 and from 208+/-116 to 133+/-40, p=0.001, respectively). CONCLUSION: This study confirms the benefits of revascularization in patients with nonhealing foot lesions due to critical limb ischemia. A significant increase of the SBF was observed on the treatment side. However, an unexpected decrease was observed on the untreated side.

[Age and toxicopathy--Vaud 1977-1978]. / Age et toxicopathies--Vaud 1977-1978.

Recent work on principles of pleasure and on endogenous opioïd system enlightens some regulations of mental comfort and of homeostasis of the nervous system. From this point of view, the choice of specific drugs, during the first months of their use, would give an indirect picture of the troubles which caused initially the use of these substances. The present study discloses, behind the apparent anarchy of mono- and polytoxicopathies, some constant relations between age and sex of drug-users and specific choice of drugs.

[The nature of drug consumption from 1977-1978 in the canton of Vaud]. / Nature de la consommation de drogues en 1977-1978 dans le canton de Vaud.

In the canton of Vaud, Switzerland, 1589 regular drug consumers used in 1977 and 1978 one or more of the following substances: cannabis, opiates, hallucinogens, amphetamines, cocaine, medicaments (principally usual sleeping pills, analgesic pills, and tranquillizers). Half of the consumers used only cannabis, or opiates, or medicaments. Amphetamines, hallucinogens, cocaine were used very seldom alone. The situation in drug associations is very different. The most popular drug associations are presented. Abuse and abstinence of alcohol and cigarettes could be analyzed among 698 drug consumers.

[Delinquency and drugs in the Juvenile Court of Vaud canton-from 1971 to 1979]. / Délinquance et drogue devant le Tribunal des mineurs du canton de Vaud-de 1971 à 1979.

The evolution of illicit drug consumption by adolescents in the canton of Vaud, 1971 to 1979, was assessed from data available by the Juvenile Court. Some results of this study are presented. The quantitative changes are then discussed in relation with changes in the social framework, such as the evolution of the ideology of delinquent adolescents, the altered concepts of repression by the police and jurisdiction, and the evolution of facilities for the care of drug users.

[The importance of social factors in the treatment of aged persons]. / L'impact des facteurs sociaux sur la thérapeutique des personnes gées.

At the end of life, human abilities decline and diseases become more and more resistant to therapy. But it remains possible to adapt the physical and social environment to the patient's residual capacities. Biological and social medicines are tightly linked. The former is predominant as long as the old patient is self-sufficient; as soon as he becomes dependent, diseases concern more and more the social environment and the social services. During the last decade of human life, medical therapeutics give way to social therapeutics, which are the treatment of the physical and social environment for the patient's comfort.

[Legal termination of pregnancy. Economic and social aspects]. / L'interruption légale de la grossesse. Aspects économiques et sociaux.

PIP: The article analyzes the socioeconomic aspects, but especially the economic ones, of induced abortion, whether it is legal or illegal, and of an unwanted pregnancy. Costs are based on 1979 prices in the Vaud canton, Switzerland. Obviously, the pure economic cost of induced abortion is much lower than that of regular or even complicated delivery, much lower than the cost of treating complications from illegally induced abortion, and enormously lower than the cost involved in raising a child, whether the expenses are paid for by the mother, or by the community, as it very often happens with teenage mothers. In a world where money is getting an ever increasing importance, psychological side effects of abortion are almost completely discarded. To encourage young couples to have children, or to keep a baby, governments should consider financial benefits and/or social advantages, such as free lodgings for the family.^ieng

[Insurance and preventive medicine]. / Assurances et médecine préventive.

Not only do insurance companies have to pay in case of death, injuries or disease, they are also concerned with their prevention. This is particularly true for the "Swiss National Accident Insurance Fund" (Caisse nationale suisse d'assurance en cas d'accidents--(CNA): for them the prevention of work related accidents and occupational diseases is required by law. Preventive activities in this area are very promising. The progress in the sickness insurance programmes for preventive medicine in the general population has, however, not been as successful. To date, the legislation denies payment for preventive medical care. Why is there this difference? In the case of accidents and occupational diseases, the cause of the pathologies are for the most part exogenous and develop in well known and controlled environments. In the case of disease or invalidity in the general population, the factors are in a large part endogenous and therefore very difficult to supervise, as they develop in much more complex and uncontrolled environments. Nevertheless progress has been done in this field as well. At present, some selected scientifically proven preventive examinations could be included in insurance programmes as part of a general plan and with strict quality control of laboratory findings.

[Preventive medicine in private medical practice]. / La médecine préventive au cabinet de consultation.

The basis of preventive medicine for the individual is composed of health education, certain examinations and preventive treatments. A coherent approach is essential for efficiency of a program and avoidance of costly and nonessential expenditures. In the Swiss health system, the doctor's office could become more and more the center of preventive medicine for the individual. It would concern a large part of the population (in the United States, 80% of the men and 90% of the women consult a doctor at least once a year); offering a direct contact with the doctor of choice, advice specific for each case and the possibility of regular examinations by the same doctors. In many situations both public and private sources are involved in preventive medicine (public health services, doctors involved in the educational system, doctors involved in controll of security of working conditions, out-patient clinics, various health organizations). A collaboration among these sources should be organized and a reasonable division of the work established. A list of examinations and preventive treatments is presented.

Congenital 'frozen eyes', with other mesodermal abnormalities: report of a case.

A case is reported of a 41/2-year-old girl with generalized fibrosis, no active or passive eye movements, anisohyperopia, craniofacial asymmetry and hypoplasia of a toe. There was no ptosis, nor backward head tilt and only a moderate exotropia. Study of the fixation and of the binocular relationship met with unusual difficulties owing to the absence of eye movements. Mesodermal abnormalities were noted in the anterior chamber. A normal female karyotype was reported and family history was noncontributory.

[Current developments in violent crime]. / Evolution actuelle de la délinquance violente

In the years 1960-1973 we see a great stability of all crimes of violence in Switzerland, while in the USA in the same years their increase was constant; in England and France, robberies with violence increased in the years 1960-1970.