[Double-blind randomized comparative study of nicergoline naftidrofuryl on the quality of life in chronic obliterative arteriopathy of lower limbs with intermittent claudication]. / Etude comparative randomisée en double-aveugle de la nicergoline et du naftidrofuryl sur la qualité de vie dans l'artériopathie chronique oblitérante des membres inférieurs au stade de la claudication intermittente.

The functional limitation of patients with obliterative arterial disease, and with intermittent claudication, damages their quality of life. The purpose of this trial was to compare the effects of nicergoline and naftidrofuryl on the quality of life and the functional discomfort of the 131 patients with claudication. It was a multicentre, randomised, double-blind trial with parallel groups. The patients were asked to complete a quality of life questionnaire and a Visual Analogue Scale, and to evaluate the number of steps on flat ground before the pain began. After 6 months of treatment, we observed, for all treatments combined, a significant improvement (p = 0.0001) in the quality of life and in the functional discomfort. Three variables favoured nicergoline: the estimated time before the onset of the pain (p = 0.003), the functional discomfort quantified by the Visual Analogue Scale (p < 0.05), the distance covered on flat ground (p = 0.013). The other variables, and especially the total score on the self-questionnaire, confirmed this impression, without reaching significance (p = 0.136). The data suggest that in terms of quality of life nicergoline is superior. The clinical tolerance is good and comparable between the two treatments.

Beneficial effects of indapamide on lipoproteins and apoproteins in ambulatory hypertensive patients.

Among the numerous risk factors for atherosclerosis, 2 are particularly important: hypertension and primary or secondary abnormalities of plasma lipids and lipoproteins. Antihypertensive treatments significantly decrease the risk of cerebrovascular accidents, renal failure or hypertensive cardiomyopathy, but they have little influence on coronary artery disease. It has been suggested that some antihypertensive agents may have deleterious effects by altering serum lipoproteins and this may override the benefit of blood pressure reduction. Diuretics increase the blood concentration of total cholesterol, low-density lipoproteins and triglycerides. Indapamide, a methylindoline agent with vasodilator activity, has no adverse lipid effects. Twenty-six studies have clearly demonstrated that indapamide appears to be unique among diuretics because of an absence of adverse lipid effects. In some studies indapamide significantly increased high-density lipoprotein cholesterol, apoproteins A1, A2 and apoprotein E. When a thiazide diuretic had been given previously, indapamide treatment normalized the lipid and lipoprotein profiles. The reason for the lack of adverse lipid effects of indapamide is discussed. Thus indapamide, 2.5 mg once daily, is effective and safe for the control of mild to moderate hypertension, both in young and older patients. It may be an optimal diuretic for use in normolipidemic or hyperlipidemic patients, as it increases high-density lipoprotein but not low-density lipoprotein cholesterol.

[Malherbe's calcifying cyst. Apropos of an unusual case in the middle ear. Histopathogenic value]. / Kyste momifié de Malherbe. A propos d'un cas exceptionnel de l'oreille moyenne. Intérêt histopathogénique.

We report the case of a 54 years old man suffering with chronic otorrhea. The surgical procedure let us be surprised at a non specific cyst located in the "additus ad antrum", close to the incus but no damaging it. The result of the histologic examination was: Malherbe's calcifying cyst. After a background study of the publications concerning this type of tumor specially located in the skin, we can affirm this localisation in the middle ear cavity as exceptional. The cutaneous origin of this tumor and its vestigial type let us think about the possible persistence of amniotic fluid cellular content (AFCC) in the middle ear and its tumoral development in adult, explaining maybe partly the chronic otorrhea syndrome of this case.

[Effects of cicletanine on plasma lipid metabolism. Mid-term open trial in hypertensive patients with normal blood lipids and hyperlipidemia]. / Effets du ciclétanine sur le métabolisme des lipides plasmatiques. Essai ouvert à moyen terme chez des hypertendus normo et hyperlipidémiques.

Cicletanine, an antihypertensive drug heralding a new pharmacological family, was tested in a short-term open trial on 39 hypertensive patients with normal or increased lipidemia according to the W.H.O. criteria. This trial confirmed that the drug has excellent antihypertensive activity (normalization of blood pressure in 71.8% of the cases), is very well tolerated and has no unfavourable effect on lipid metabolism.

Changes in lipid and lipoprotein levels and Achilles tendon diameters and indices in familial hypercholesterolaemic patients with tendinous xanthomatosis treated by diet and bezafibrate for 2 years.

Thirteen young adult patients suffering from heterozygotic familial hypercholesterolaemia with tendinous xanthomatosis, previously treated with a suitable special diet, were studied to assess the effect of bezafibrate, given for 2 years at a dose of 800 mg/day, on plasma lipid and lipoprotein levels and on changes in size of the Achilles tendon xanthomas. Measurements were made before and at intervals during treatment, the tendinous xanthomas being measured by an echographic procedure to give data on antero-posterior and lateral diameters, thus enabling an Achilles tendon index to be defined. The results confirm the hypolipidaemic activity of bezafibrate, changes in the levels of total cholesterol, triglycerides, lipids and lipoproteins (LDL, VLDL and HDL) being similar in direction and magnitude to those reported previously. A significant regression in the size of the Achilles tendon xanthomas was observed in 11 of the 13 patients, and the regression in the Achilles tendon index correlated significantly with a favourable change in the ratio HDL/LDL + VLDL. It is suggested that, as a result of this objective observation, a favourable effect of bezafibrate treatment would possibly be seen on the anatomical atheromatous lesions which are usual in this type of hyperlipidaemia.

[Effect on lipids, lipoproteins and apoproteins of labetalol prescribed in doses of 400 mg/day in hypertensive patients. Double-blind versus placebo study]. / Effet sur les lipides, lipoprotéines et apoprotéines du labétalol prescrit à la dose de 400 mg/j chez des patients hypertendus. Etude en double aveugle contre placebo.

The effects of labetalol on plasma lipoprotein metabolism were evaluated in a 3-month double-blind drug versus placebo study conducted on 30 consenting hypertensive patients, 15 of whom had normal plasma lipid levels and 15, minor type II hyperlipoproteinaemia; 20 patients received labetalol 400 mg/day and 10 the placebo. All patients remained in stable nutritional status throughout the study. Full clinical examination and blood sampling were carried out 30 days before, and on days 0, 30 and 90 of treatment. Whole blood was collected after 12 hours' fasting and immediately centrifuged prior to determination of plasma lipids (total cholesterol and triglycerides, by enzymatic assay), lipoprotein lipids (HDL, HDL2, HDL3, LDL, VLDL separated by ultracentrifugation in density gradient), apoproteins A1 and B (by laser immunonephelometry) and post-heparin lipoprotein lipase activity (PHLA). Significant changes in heart rate and systolic and diastolic blood pressures were noted in patients under labetalol but not in patients under placebo. Lipid and apolipoprotein levels were similar in both groups on day 0, and no significant variation in lipids, lipoprotein lipids and apolipoproteins were observed after 30 and 90 days of treatment with either labetalol or the placebo. At the end of treatment PHLA was unmodified in the group under placebo and raised in the group under labetalol (p = 0.05). The absence of changes in blood lipid values was found both in patients with normal lipidemia and in those with hyperlipidaemia. This study confirms that labetalol in doses of 400 mg/day has notable anti-hypertensive activity and, as previously reported and in contrast with other beta-blocking agents, is devoid of any adverse effect on lipid metabolism.

[Pseudophlebitis of the lower limbs. A critical study from 102 suspected cases of deep venous thrombosis]. / Les pseudo-phlébites des membres inférieurs. Etude critique à partir de 102 suspicions de thrombose veineuse profonde.

Clinical diagnosis of deep venous thrombosis appears as uneasy, because of inconstant and non-specific symptoms. When studying a phlebitis, the risk to diagnose venous thrombosis is over 50 p. 100. This review of 102 patients, supposed to present with phlebitis, confirms such data. The diagnosis reliability depends mainly on the physician's experience. Examination and clinical research, combined with Doppler data make possible to perform a good diagnosis in 4 cases out of 5. However, in 20 p. 100, phlebography is strongly required, appearing as an essential examination. Analysis of epidemiologic and clinical data demonstrates the importance of certain data as for the diagnosis: female sex, age superior to 60 years, existence of two antecedents and/or a cardiopathy, a complex clinical picture might demonstrate a diagnosis of deep venous thrombosis. Post-phlebitic syndrome and skin infectious pathologies are the main pseudophlebitis etiologies. Popliteal cyst (often mentioned in English literature as a pseudophlebitis factor) is diagnosed in 11 p. 100 of cases.

Comparative evaluation of the effects of ciprofibrate and fenofibrate on lipids, lipoproteins and apoproteins A and B.

In a double-blind study over a 3-month period, a daily dose of 100 mg ciprofibrate, prescribed in a single administration and a daily dose of 300 mg fenofibrate, prescribed in 3 administrations, significantly reduced the mean values of total cholesterol, LDL cholesterol and VLDL cholesterol, apoprotein B (P less than 0.001) and increased the mean values of HDL cholesterol (P less than 0.01) and total apoprotein A (P less than 0.05). The study, followed-up as an open trial using higher doses (100 or 200 mg/day ciprofibrate, 400 mg/day fenofibrate) tried to demonstrate clearly the benefit of therapy after 9 months with the 2 drugs and to establish the dose-response effects. Comparison of the 2 drugs at the optimal dosages, after 9 months of treatment, showed ciprofibrate to be more effective in increasing HDL cholesterol (P less than 0.05) and apo A (P less than 0.001). No other significant differences in terms of either therapeutic efficacy or biological tolerance became apparent between the 2 drugs. The results obtained in this comparative study were in accordance to those observed in separate trials for ciprofibrate or fenofibrate. Ciprofibrate has the benefit of a long half-life and may also be administered in the form of a single daily dose to patients suffering from major type II hyperlipoproteinaemia.

[A new case of basal cell naevomatosis (author's transl)]. / Un nouveau cas de naevomatose baso-cellulaire. (Syndrome de Gorlin-Goltz).

The authors, in the light of a new case of naevomatosis, review the description of the disease, emphasising its symptoms and signs, and inheritance, drawing attention to the need for surveillance of such patients in view of the risk of malignant change in the naevi. The other signs of the disease must be sought following the discovery of multiple epidermal cysts of the maxilla and mandible.