[Carotid and aortic lesions: two-stage surgery]. / Lésions carotidiennes et aortiques: chirurgie en deux temps.

The problem of chronology between different surgical acts is at stake when a patient suffering from carotid and aorto-iliac or femoropopliteal diseases requires surgery. The joint operation increases surgical risk and its practice penalizes the surgeon. Sequential surgery is safer. It does not increase the risk of a adverse evolution of the diseases areas which has not been operated on at time of the first operation.

[Sexual complications from superficial venous surgery]. / Les complications sexuelles de la chirurgie veineuse superficielle.

Post-surgical erectile dysfunctions of superficial veins of the lower limbs are seldom reported. It seems to be due to the fact that they are ignored. In most cases, one has to find their origins in an abnormality of arterious distribution towards sexual parts: one or several of these latters come from common femoral veins and their colaterals (the external pudendal arteries) and not from hypogastrics (and internal sexual arteries). Therefore, it is necessary to take care of external sexual arteries during Scarpa's dissections in male patients in order to avoid the possible occurrence of a partial secondary or total impotency.

[Impotence of vascular origin. Techniques of exploration and therapeutic orientations]. / Impuissance d'origine vasculaire. Techniques d'exploration et orientations thérapeutiques.

Vascular problems of arterial and/or venous origin are often found as the cause of erectile dysfunction. Clinical examination alone is insufficient and must followed up by a number of non or minimally invasive tests in order to confirm the etiology. Such testing should include: Doppler measurements or, better, duplex sonography, nocturnal penile plethysmography, psychological status, clinical biochemistry and intracavernous injection of vasoactive drugs. Occasionally, it may be necessary to complete these tests by more invasive examinations: pharmacoarteriography and/or pharmacocavernosography. Several novel therapeutic approaches have been developed in recent years and have given rise to encouraging improvements.

[Panic disorder and microcirculation. Controlled study of capillaries in anxiety disorders]. / Trouble panique et microcirculation. Etude contrôlée des capillaires sanguins dans les troubles anxieux.

However varied the clinical descriptions of anxiety, a sizeable proportion is always allotted to the cardiovascular aspect. One is reminded of Krishaber's cerebral-cardiac neuropathy and Brissaud's conception of anxiety. The implication of the heart in anxiety disorders, especially paroxystic disorder, i.e. panic attacks (PA) is important. Cardiovascular symptoms (tachycardia, increased systolic blood pressure, chest pain) are among the most frequent manifestations of panic; furthermore, recent studies suggest that male panic disorder (PD) patients have an increased mortality risk from cardiovascular diseases. It is with this implication in mind that we undertook this study, the main aim of which was to confirm the existence of an abnormal microcirculation, characteristic of PD, taking the form of an excess number of twisted capillaries. Abnormal capillaries had been described previously in non-controlled studies of patients with psychiatric disorders diagnosed as neurasthenia, neurosis, neurovegetative disorders and more recently as neurocirculatory asthenia, a syndrome similar to PD. This led us to undertake a study of the total number of capillaries observed by photomicrography (capillaroscopy) in the supra-ungueal fold of the fingers of both hands (except thumbs), comparing the number of twisted capillaries of 16 subjects suffering from panic disorder with or without agoraphobia according to the DSM III-R criteria, with those of 16 healthy volunteers matched for age and sex and 14 subjects suffering from other anxiety disorders (10 of them fulfilling criteria for generalized anxiety disorders).(ABSTRACT TRUNCATED AT 250 WORDS)

[Prospective etiologic study of 128 patients with ambulatory dep vein thrombosis]. / Etude étiologique prospective de 128 patients avec une thrombose veineuse profonde survenue en ambulatoire.

Etiology of deep vein thrombosis in ambulant patients (DVTA = TVPA in text) varies: cancer, blood disease, infectious focus, dysimmunity syndrome, dysglobulinemia, extrinsic compression, metabolic disorder, anomaly of hemostasis. A prospective study was carried out between June 1988 and September 1989 by angiologists in 5 regions of France to evaluate the diagnostic rentability of an epidemiologic survey and to determine possible distinctive characters of DVTA. The survey was comprised of a questionnaire, a full clinical examination and screening tests: chest x-ray, abdominopelvic ultrasound imaging, a-uro/gynecologic examination, full blood count, serum iron, ferritin, uric acid, triglycerides, cholesterol, protein electrophoresis, antinuclear antibodies, circulating anticoagulant, hemostasis factors and liver function tests. The study included 128 patients, mean age 60 +/- 16 years with a DVTA developing without a previous immobilization. The usual predominance in the left leg was not observed. The etiology was identified in 33 cases, including 20 (15.6%) as a result of the screening tests: anomalies of hemostasis (8), blood diseases (3), dysimmunity syndromes (4), extrinsic compression (3), cancer metastasis (1) and hypertriglyceridemia in a diabetic (1). The screening procedure was of no greater value in the absence of a triggering or predisposing factor, on the contrary. An anomaly of hemostasis was detected more frequently in the presence of local or regional triggering factors in the men (4 out of 4) and in the women on the pill (4 out of 4). The number of cancers discovered following screening (2%) was smaller than that expected according to the literature (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pain in venous thrombosis of the leg]. / La douleur dans les thromboses veineuses des membres inferieurs.

According to D. Reinharez, pain and edema are the commonest presenting symptoms in phlebology. Pain is one of the most classical symptoms of an ordinary deep venous thrombosis, a valuable feature when present, in the form of deep tension, heaviness, swelling and a feeling of dead weight. It is often absent or slight. It may consist merely of a dull cramp, or of an "undefinable" (C. Bourde) odd, heavy leg. It generally affects the calf but may involve the sole of the foot, the heel, the thigh, the groin or even the true pelvis. This feeling, although "imprecise and variable" (P. Wallois, P. Griton) is highly suggestive. It increases on standing and walking in the form of unilateral uncomfortable tension, heaviness or painful swelling, which maybe a source of worry or even anxiety to the patient. Tenderness on palpation of venous tracts and their stretching is more suggestive. In the opinion of M. Duruble, Neuhof's sign (feeling of tender fullness of the calf) is more reliable than Homans' sign (pain in the calf caused by passive dorsiflexion of the foot, with the lower limb in extension) which essentially stretches only the posterior tibial venous system. The value of Sigg's sign (pain in the popliteal fossa on passive extension of the knee) is controversial. Far more rare is phlegmasia coerulea dolens or Grégoire's blue leg, complicating phlegmasia alba dolens or of sudden onset, with initial very severe or even "intolerable" pain (J.J. Pinot) in Scarpa's triangle, rapidly spreading to the limb. In varicose phlebitis (M. Perrin) or superficial thrombophlebitis or varico-phlebitis (A.A. Ramelet) or superficial venitis (J.P. Henriet), pain most often consists of moderate burning tension overlying the thrombosed vein(s), increased by palpation and mobilisation. Sometimes severe initially, it is exacerbated by the slightest touch. In total, pain, regardless of its characteristics, its site and/or its severity, is one of the most constant clinical features of venous thrombosis. It is a warning sign for the clinician and should lead to emergency request for non-invasive investigations (Doppler-Echo) which will enable confirmation or elimination of the diagnosis.

[Value of the velocimetry study of the uterine arteries in retro-placental hematoma. Report of 3 cases]. / Intérêt de l'étude vélocimétrique des artères utérines dans l'hématome rétro-placentaire. A propos de 3 observations.

Retroplacental hematoma is a sudden accident with unfavorable prognosis, especially since predictive signs (clinical, biological or ultrasonographic) are very frequently absent. The purpose of this study was to determine whether velocimetric study of the uterine arteries is of predictive value in this pathology. The equipment used was Doppler ultrasound with spectral analysis (4-MHz probe) without echography. Each examination consisted in systematic study of both uterine arteries and of umbilical flow. The recording technique for the uterine arteries is described, and 3 cases of retroplacental hematoma are reported. In all 3 cases, the resistance index for one of the uterine arteries (right twice, left once) was high, with the presence of a (proto-diastolic notch on the curve, whereas the umbilical index was normal and there were no other signs predictive of the placental accident. The value of Doppler exploration has already been demonstrated for numerous obstetric indications, and it should be possible to include others, particularly if this preliminary study is confirmed on a larger scale.

[The treatment of prolonged erection after intracavernous injection of a vasoactive drug]. / Traitement des érections prolongées après injection intracaverneuse de drogue vaso-active.

The intracavernous injection of a vaso-active drug may induce an erection lasting for over 3 hours. The physician must carry out a simple procedure: an evacuatory puncture, which results in immediate detumescence of the penis and spares the patient any complications.

[The role and practical application of a diagnostic test using papaverine in erection dysfunction]. / Place et réalisation pratique d'un test diagnostique à la papavérine dans les dysfonctions érectiles.

The intracavernous injection of papaverine for diagnostic purposes in the impotent subject can facilitate the velocimetric exploration of the penile arteries and may induce a rigid erection which may have a therapeutic application. This simple procedure does however necessitate prudence and experience. In particular, the dose injected and the site of injection are subject to precise criteria.

[The value of velocimetric investigation of the uterine arteries in retro-placental hematoma. 3 cases]. / Intérêt de l'étude vélocimétrique des artères utérines dans l'hématome rétro-placentaire. A propos de 3 observations.

Retro-placental hematoma is a sudden event with a serious prognosis which is aggravated by the very frequent absence of premonitory clinical, biological or ultrasonic signs. Does a velocimetric investigation of the uterine arteries have any predictive value in this disorder? The apparatus used was a continuous Doppler with spectral analysis and a 4 MHz probe no ultrasonic location. Each examination involved the exploration of 2 uterine arteries and of the umbilical flow. The method of recording the uterine arteries is described. Three cases of retro-placental hematoma are reported. In these three cases, an increase in the resistance index of one of the uterine arteries (the right artery in 2 cases and the left in 1 case) was detected with the presence of a protodiastolic notch on the trace, whereas the umbilical index itself was normal and no other sign was present which could predict the placental event. The value of the Doppler recording is already established in many obstetric indications, and these should be extended yet further, particularly if this preliminary study is confirmed on a larger scale.

[The history of Horton's disease or ... 10 centuries of a fascinating adventure]. / Historique de la maladie de Horton ou ... dix siècles d'une fascinante aventure.

In 1932, Horton, Magath and Brown reported two cases of a "new form of arteritis affecting the temporal vessels ... which probably represents a new clinical syndrome". In reality, several publications, devoted to the same pathology already preceded this article. The most ancient is that of an ophthalmologist from Baghdad, Ali Ibn Isa (940 to 1010). In his memories, translated and published in english in 1936, the author states that "he undertook excision and cauterisation of arteries to treat patients who were suffering from heat and inflammation of their temporal muscles and which sometimes ended in loss of vision ...". In 1890, J. Hutchinson, an English surgeon, reported a case "... of inflammed and swollen temporal arteries ...". This article was only brought to light in 1946. In 1930, M. Schmidt, published a probable case of temporal arteritis, subsequently reported in 1947. In 1934 and 1936, Horton published new cases of temporal arteritis and defined the clinical characteristics of the disease and its histology. In 1938, Jennings made a particular contribution in reporting the first case of blindness. From this time on, cases of temporal arteritis became increasingly common in the literature. The first French case was described by J. Paviot et al. in 1934, but remained largely unrecognized until 1942. In 1936, J. Chavany was the first to describe the pillow sign, but more particularly in 1948, he prescribed the first treatment with steroids, with spectacular results. It was only in 1950 that R.M. Shick et al. published the effects of steroid therapy in temporal arteritis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intermittent claudication of the jaw in temporal arteritis]. / La claudication intermittente de la mâchoire dans l'artérite temporale.

Stiffness of the jaw was noted in the first descriptions of temporal arteritis. It was only in 1944 that Horton used the term intermittent claudication and related this sign to effort ischemia due to thrombosis of facial arteries. The introduction of ultrasound techniques has enabled the permeability of facial arteries to be confirmed in spite of induration and absence of pulsatility clinically. Anatomical studies have defined the preponderant role of the internal maxillary artery in the vascular supply of the masseter muscles and have enabled the localization of an appropriate and reliable site for ultrasound study: the pterygo-maxillary fossa. The velocimetric data thus collected confirm that the internal maxillary artery is affected and define the etiopathogenesis of intermittent jaw claudication during temporal arteritis. This sign is observed on average in one patient in three suffering from temporal arteritis. While several cases of intermittent jaw claudication have been described in severe atheromatous stenosis of the common carotid or external carotid arteries, or in relation to other causes (rheumatological, neoplastic, psychological ...), the observation of this syndrome in a suspicious clinical and paraclinical context constitutes an excellent orientation sign in favor of temporal arteritis.

[A comparative study of pulsed Doppler versus continuous Doppler technic without spectral analysis in obstetrics]. / Etude comparative Doppler pulsé-Doppler continu sans analyse spectrale en obstétrique.

We conducted a study in 48 parturients in order to: --assess the possibilities of continuous Doppler examination without preliminary ultrasonographic localization and without spectral analysis, to measure the traditional hemodynamic parameters of fetal development (in particular on the umbilical cord). --to compare these results with those obtained using pulsed Doppler-scan as reference. The protocol was very strict and neither of the two practitioners was aware of the other practitioner's results. With the continuous Doppler examination, the uterine arteries were systematically localized and recorded. The technique is simple in trained hands. The material included an ultrasonograph fitted with two probes (3.5 and 5 MHz, equipped with a pulsed Doppler) and a continuous Doppler (only the 4 MHz probe was used). Because the tests were sometimes repeated, 63 measurements were obtained in 48 parturients, mean age was 29.3 years and mean gestational age was 32.9 weeks. The reason for the examination varied: intrauterine growth retardation and/or maternal hypertension, diabetes, etc. The results obtained from the cord proved to be very encouraging: 42 of the 54 measurements were comparable (77.7%) showed an index difference less than or equal to 0.05. Only 4 (7.4% of the measurements) maximum deviations were observed (exceeding 0.10). The mean Pourcelot index on the Doppler scan was 0.677. With the continuous Doppler, it was 0.676. The 13 abnormal measurements with the pulsed Doppler were also abnormal with the continuous Doppler. The uterine arteries were recorded and measured with the continuous Doppler 42 times on the right (68.8% of the cases) and 34 times on the left (55.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

[A misunderstood treatment for hyperhidrosis: ionization. Principles, material, methodology, early results]. / Un traitement méconnu de l'hyperhidrose: l'ionisation. Principes, matériel, méthodologie, résultats précoces.

Based on a new and specific apparatus developed by one of the authors, an original method of treatment of palmoplantar hyperhidrosis, either essential or associated with acrocyanosis, is described in detail. The extremities to be treated are placed in tanks containing tap water ensuring conduction fo current between epidermis and electrode. The recommended current of 20 milli-amperes is obtained by adjustment of a potentiometer. Treatment sessions (20 minutes for hands or feet, 40 for all four extremities) take place with a well defined frequency: 3 the first week, 2 the second, I the following two weeks. Maintenance sessions are necessary when sweating recurs. In a longitudinal series of 29 patients, 28 (96.5%) were significantly improved. From the 5th session onwards, the decrease in hyperhidrosis was evaluated by patients as very pronounced in 5 cases (17.2%) and as complete in 21 cases (72.5%). In 5 of the 6 patients with hyperhidrosis associated with acrocyanosis, the patients reported attenuation of cyanotic coloration of skin and relative warming up of extremities treated. Tolerance was excellent in 28 cases, incidents being rare and minor. Patients with pacemakers cannot be treated by this method.

[Ionophoresis: effective and misunderstood treatment in hyperhidrosis. Principles, material, methodology and results]. / L'ionophorèse: traitement efficace et méconnu de l'hyperhidrose. Principe, matériel, méthodologie, résultats.

The development of a modern and specific device, using the principle of ionophoresis, enables now to treat a symptom, sometimes severely disabling, before which physicians felt helpless until now: hyperhidrosis. The methodology is simple, and the treatment well tolerated. The efficacy, demonstrated by our study, is particularly impressive, if a strict protocol is followed.

[Value of sclerotherapy in the treatment of certain types of impotence caused by venous leakage]. / Intérêt de la sclérothérapie dans le traitement de certains types d'impuissance par fuite veineuse.

Certain types of impotence, primary or secondary, are due to an "escape" through the superficial venous network of the penis, connecting distally with the femoral veins. Until now, the treatment was surgical and marred with recurrences. The use of sclerotherapy on these superficial veins enables their "closure" which is elegant, fast, almost painless, effective and inexpensive, leading to the cure of the disorder and a normal erection.

[Sapheno-femoral venous confluence and the external pudendal network: anatomical data and new statistics]. / Le confluent veineux saphèno-fémoral et le réseau artériel honteux externe: données anatomiques et statistiques nouvelles.

In 1983, we had the opportunity to encounter a case of impotence following eveinage in a man aged 58. The complete aetiological investigation of the disorder proved to favour the ligation of an external pudendal artery during the operation, a cause already anticipated by Dr D. Reinharez in 1980, in an article published in Phlebologie, where he described 5 similar cases. In 1984, we demonstrated, thanks to the Doppler velocimeter and also common selective femoral angiography that, contrary to the classic descriptions, approximately 7% of men have a particular anatomical distribution; the external pudendal arteries play a not insignificant haemodynamic role in the vascularization of the erectile organs. Since then, we have encountered further cases of impotence following eveinage. This being so, we wanted to know more about the anatomical relationship between the saphenofemoral venous confluent and the external pudendal arteries such as number, calibre, and variations according to age and sex... In order to achieve this, we requested the collaboration of five surgeons known for their thoroughness, their experience and their competence in venous surgery. They were asked to complete a pre-drawn diagram after each eveinage carried out, and to draw onto it the different arterial and venous branches observed, their calibres, and the relation between them. 140 subjects were included in this study (79 women, 70 men) with longitudinal selection; 256 eveinages were carried out and indexed. The average age of patients was 42.9 years: 40.5 for women, 45.5 for men. The analysis of the results enables us to improve our knowledge of this "strategic" region for the surgeon and the phlebologist, by contributing new anatomical and statistical elements, in particular: the very large number of times that an external pudendal artery is at least encountered during dissection of the saphenofemoral venous confluent: round about 97%; the number of external pudendal arteries, classified usually as 2, proves in fact to be more often one: in about 75-80% of women and 65% of men. Triple pudendals are exceptional; the average calibre of the pudendal artery is 1/3 greater in the male sample than in the female: 0.8 mm v 0.6 mm.(ABSTRACT TRUNCATED AT 400 WORDS)

[Value of velocimetric studies in acrosyndromes of the upper extremities]. / Intérêt de l'examen vélocimétrique dans les acrosyndromes des membres supérieurs.

The velocimetric examination by Doppler effect of arteries and veins of the arm, forearm and hands, performed in an indifferent position, then during dynamic exercises, provides sometimes determining factors in the etiology of some vascular disorders of the upper extremities. Requiring learning, experience, time and patience, this examination is debatable, but, in our experience, absolutely necessary to the work-up of these disorders.