[Evaluation of intermittent claudication using a treadmill with measurement of systolic pressure at the ankle following exercise]. / Evaluation de la claudication intermittente sur tapis roulant avec mesure de la pression systolique à la cheville après effort.

Intermittent claudication (IC) and maximum walking distance (MWD) were studied in 173 patients and compared to post-stress Doppler claudicant ankle pressure (PSCAP) and to ankle index (PSCAI) recorded 2 minutes after exercise. Self-evaluation of MWD by the patient was inaccurate in 60% of cases. The treadmill testing (at 12% of rate and 2 miles/hour) exhibited a clinically overt IC in 93 cases with MWD of 166 m +/- 76, a PSCAP of 24 mm Hg +/- 24 and a PSCAI of 0.17 +/- 0.17. A clinically questionable IC occurred in 50 cases with significantly higher values (p less than 0.001) for MWD (278 m +/- 75) PSCAP (52 mm Hg +/- 24) and PSCAI (0.34 +/- 0.16). In 30 cases without IC after 400 m on treadmill, the PSCAP (81 mm HG +/- 26) and the PSCAI (0.57 +/- 0.18) were significantly (p less than 0.001) higher than in IC groups and related to milder iliofemoral stenosis. Overall reproducibility of MWD (mean = 190 m +/- 90) with 2 or 3 repeated measures in 75 cases, was 10.8% +/- 8.6 with large individual variations. Overall reproducibility of PSCAP after standardized treadmill testing in 42 cases was 6.5 +/- 5.3 (range of CV = 0 to 16%). A variation of PSCAP of more than 15 mm Hg is considered significant at level 0.01. It is concluded that overt IC with foot pallor and PSACP at 40 mm Hg or less reflects actual and reproducible MWD (especially below 300 m).(ABSTRACT TRUNCATED AT 250 WORDS)

[Discrete distal gangrene]. / Gangrènes parcellaires distales.

The authors present their statistical findings from 114 cases of discrete distal gangrene. They stress the importance of a rigorous methodology to detect mechanical causes from the thoracic outlet syndrome and immunological causes, predominantly scleroderma, especially in women. It is important not to overlook blood diseases nor those cases which are a presentation of underlying cancer. Finally, the iatrogenic cause is now well known. Treatment depends on the causes of this distal lesion. However, in cases of severe connective tissue disease, the use of plasmapheresis is beginning to give interesting results.

[Radiation-induced coronary artery disease. One observation (author's transl)]. / Etude des coronaropathies post-radiques. Une observation.

Twenty-seven reports (26 from the literature) of radiation ischemic heart diseases are studied in order to specify their clinical and pathological findings and their natural history. This complications appear after treatment of radiation-curable diseases with a mean delay of 4 years in young patients (mean age of 31). Several coronary arteries are often injured with fibrous and or atherosclerotic anatomical lesions. The frequency of this coronary artery diseases is certainly more important than reported since they are often latent but probably progressive. However, atherogenic factors increase the risk and must be lowered in a preventive aim; as a rule, the radiotherapeutic technique must also be as perfect as possible. The prognosis of this radiation induced coronary artery diseases is poor: 19 myocardial infarctions and 12 deaths are observed but no cardiac death occurred in patients who received a by-pass graft. So, radiation ischemic heart disease needs active investigation and therapy.

[Alpha blockers and microcirculation (author's transl)]. / Alpha bloqueurs et microcirculation.

The new compounds such as Prazosin are antihypertensive agents. Their action on blood pressure are a consequence of a direct action on vascular smooth muscle with little or no effect on cardiac output. This action is very important to reduce total peripheral resistance. In our Vascular Laboratory, we study 14 patients treated by Prazosin. They were all studied by capillaroscopy, ultrasonic investigations and plethysmography. Since Prazosin is primarily an alpha receptor blocker, it might be expected to have an action in microcirculation and in vasospastic diseases. We don't find modifications of microcirculation in seven people treated for hypertensive disease. Among seven patients with Raynaud phenomenon, we have only a good result in one case (Buerger disease) and two cases with a little increase of the fingertips blood flow.

[Cross-over study of benfluorex and a hypolipemic agent in diet-resistant types IV and II b hyperlipemia (author's transl)]. / Etude de l'efficacité du benfluorex et d'un hypolipidémiant de référence en traitement croisé dans les hyperlipidémies de types IV et II b non corrigées par le régime seul.

The effects of benfluorex and a hypolipemic agent were compared in 24 patients with types IV or II b hyperlipoproteinemia unimproved after 4 months diet, by means of a cross-over study with two periods of two months treatment separated by two months without treatment. Results showed similar efficacy for each treatment against lipid parameters; statistically significant variations in body weight (-0,8%; p < 0,0001), fasting blood sugar (-11,7%; p < 0.001), and of uric acid (-8,3%; P greater than or equal to 0,001) with benfluorex VS., respectively (-0,1%; P: NS), (+ 3,4%; P < 0.05), and (+ 1,3% PP: NS) with the hypolipemic agent; statistically significant reductions in VLDL electrophoretic levels; (29,7%: P < 0,001) with benfluorex VS., (17,3%; P < 0.001) with the hypolipemic agent; and an increase in HDL electrophoretic levels; benfluorex (10,7%; P < 0,001) VS., (0,9%; P: NS) with the hypolipemic agent.

[Beta blockers and disturbances of the microcirculation (author's transl)]. / Béta bloqueurs et troubles de la microcirculation.

Study of 192 cases of hypertensive patients, 89 of whom were treated by diet, general advice and correction of risk factors for an average period of 8 months. The group of patients treated beta blockers consisted of 103 subjects, 28 of whom received Propranolol, 29 Oxyprenolol, 20 Atenolol and 26 Practolol. The prevalence of Raynaud's phenomenon was markedly greater in the patients treated with beta blockers, in comparison with the group not receiving any drugs. The highest incidence of vasomotor problems was seen in the group of subjects treated with Propranolol, with 57% of patients having a Raynaud-type paroxysmal acrosyndrome. In more than half of the cases attributed to Propranolol, the clinical picture of Raynaud's syndrome was severe. Discussion of the mode of action of beta blockers on the microcirculation.

[Raynaud's syndrome: study of fingertip blood flow by plethysmography with venous occlusion (author's transl)]. / Syndrome de Raynaud: étude du débit pulpaire digital par pléthysmographie avec occlusion veineuse.

The fingertip blood flow was measured by venous occlusion plethysmography in a room at 22 degrees C, in 52 patients with Raynaud's syndrome and 24 healthy controls. In severe Raynaud's syndroms (24 cases incuding: scleroderma: 7 cases, thromboangitis: 5 cases, disabling syndrom without known etiology: 12 cases), the flow was significantly lower than in moderate Raynaud's syndroms (19 cases including 10 primary and 9 secondary syndroms) i.d. 7.5 +/- 7.3 ml versus 25 +/- 15 ml (p < 0.001). Controls had significantly higher flow (35 +/- 12.3 ml) than moderate Raynaud's syndroms (p < 0.05). Raynaud's syndroms with permanent acrocyanosis had a low flow (8.7 +/- 5.3 ml) not different from severe syndroms.

[Merits of the assay of plasma catecholamines in a glucagon test to diagnosis of pheochromocytoma (author's transl)]. / Diagnostic d'un phéochromocytome par dosage des catécholamines plasmatiques au cours du test au glucagon.

In one female patient suffering from an extra-adrenal pheochromocytoma, a stimulation test with glucagon was performed. In spite of the absence of an increase in heart rate and blood pressure, a pronounced increase in plasma catecholamines showed this test to be positive. The authors discuss the reliability criteria of this test, and confirm its good tolerance.

[Platelets fatty acid variation in patients with atherosclerosis (author's transl)]. / Variation des acides gras plaquettaires chez des malades atherosclereux.

Plasma linoleic acid levels were found to be low in the atherosclerosis patients investigated. In contrast, platelet arachidonic acid levels were decreased only when atherosclerosis was combined with diabetes or mixed hyperlipidemia. In acute vascular thrombosis, a marked decrease in platelet arachidonic levels occurrrd, irrespective of whether the patient had atherosclerosis or not.

[Epileptic seizure revealing a cerebral arterial accident during administration of oral contraceptives with platelet function disorders]. / Crise comitiale révélatrice d'un accident artériel cérébral sous oestroprogestatifs avec troubles des fonctions plaquettaires

The authors observed the onset of an epileptic fit in a 27 year-old woman, ten months after starting treatment with the contraceptive pill. Carotid arteriography revealed the existence of non-obstructive lesions in the area supplied by the left anterior cerebral artery. Disorders of platelet aggregation and disaggregation were demonstrated 15 days after stopping the contraceptive treatment. The significance of these abnormalities is discussed in the light of data in the literature.

[Circulatory disorders induced by amantidine]. / Les troubles circulatoires provoqués par l'amantadine

Amantadine has been used since 1969 in the treatment of Parkinson's disease. In 1970, were described the special symptoms noted in the lower limbs due to this drug. The authors, after a review of the various disturbances, have studied 10 cases by Capillaroscopy. They emphasize the interest of the study of this abnormality of the micro-circulation, producing vaso-constriction of the arterioles and venules.

[Mixed hyperlipoproteinemias. Importance of diet]. / Les hyperlipoprotéinémies mixtes. Importance de la diététique

The interest of diet is particularly clear in mixed hyperlipemia. In fact, the authors were only able to define the type of lipid abnormality after a test diet and prolonged supervision. One should never treat mixed hyperlipemia straightaway with hypocholesterolemic agents. The authors studied 22 patients with a form only demonstrable in the laboratory. There were no clinical signs of arteriosclerosis. In the group of dyslipemic subjects with minor hyperlipemia, they obtained normal figures for serum cholesterol and triglyceride. The results remained stable after 4 months supervision.