[The value of studying the ocular conjunctiva in case-finding in prediabetic states]. / Intérêt de l'étude de la conjonctive oculaire dans le dépistage du prédiabète.

Capillaroscopy, the only method available for the study of the microcirculation, without modifying its hydraulics, often provides a wealth of information in certain systemic diseases in which the microcirculatory involvement precedes clinical manifestations and of course, macrovascular complications. The prospective study of a healthy population is particularly demonstrative and the authors proposed scores on which diabetic microangiopathy could be suspected. The latter was confirmed by detailed laboratory investigations on one hand, and by the course of the disease on the other. For this reason, any subject at risk of diabetes should undergo at least one annual capillaroscopic examination of the ocular conjunctiva or if not, of the peri-ungual region. Furthermore, the study of microvessels in subjects with controlled and treated disease showed a regression of the anomalies which depended on proper control of diabetes, and this particularly nontraumatic test procedure which can be repeated and provides a wealth of information, can give a good reflection of proper therapeutic control, especially if it is performed by a trained and experienced investigator.

[Drug therapy of angiolopathies]. / Thérapeutiques médicamenteuses des angiolopathies.

The treatment of angiolopathies is rather difficult, at this time, at least concerning functional angiopathies. It is a fact that protection against cold represents, in all angilopathies, one of the main elements of the treatment besides medications which are essentially vasoactive drugs, myorelaxants or alpha-blockers, and possibly venous tonics. Fluorescein or Sodium fluoresceinate at 5%, administered in slow intra-venous injections, represents one of the best treatment of acrocyanosis, in combination with vitamins A and D, given at the beginning of fall. Other angiolopathies, especially those of organic nature, are represented by allergic vascularitis and will be treated accordingly. In infectious and toxic forms, antibiotics should be prescribed in addition to steroids, preferred in allergic forms, especially granulomatous forms. In conclusion, the treatment of angiolopathies is extremely difficult, and must be particularly adapted to the clinical forms.

[Ecchymotic patches of the fingers and Gardner-Diamond vascular purpura]. / Orages ecchymotiques des doigts et purpura vasculaire de Gardner-Diamond.

Ecchymotic patches on the fingers and vascular purpura in Gardner-Diamond syndrome are two benign but recurrent clinical disorders occurring chiefly in young women. They involve superficial cutaneous hemorrhagic signs. Both disorders testify to microvascular fragility without perturbation of general hemostasis. Diagnosis is easy for those familiar with the disorders. Ecchymotic episodes accompanied by sharp pain begin at the roots of the fingers. Microtraumatism is soon seen to be involved. Ecchymosis develops at the flexor muscles of the fingers but "capillary" resistance is only reduced in one third of cases. The pathogenic explanation involves rupture of a small post-capillary vein due to disorders in the control system of kinins and local metabolites. The autoerythrocyte sensitization syndrome described in 1955 by Gardner and Diamond is characterized by painful and febrile episodes followed by purpuric and ecchymotic lesions of the skin on various parts of the body, but not necessarily on the legs. Dysneurotonic effects are frequent but diagnosis is based upon promotion of the disorder by intradermal or subcutaneous injection of a minimal quantity of autologous blood. Immunological effects are considered but the ailment involves microvascular control disorders, notably of the capillary-vein segment, in particular at Copley's endo-endothelial fibrin film. Imbalance in fibrin formation and lysis is associated with perturbation of the kinin and serotonin systems. In addition to the use of certain bioflavonoids and calcium inhibitors, prevention and treatment should involve consideration of drugs which affect plasticity in the vascular wall and pericapillary interstitial conjunctiva and the rheological properties of blood flow and interstitial tissue.

[Flushes, blushing or hot flushes]. / Les flushes, bouffées de rougeur ou bouffées de chaleur.

Apart from physiological flushes represented by emotional or prudish blushing, post-prandial flushes and menopausal hot flushes, various pathologic flushes exist of various etiologies: endocrine, dysmetabolic, histaminic and iatrogenic. Their pathogenicity is based mainly on local metabolites secretion provoking vasodilatation of the intermediary microcirculation rather than of the terminal microcirculation. Treatment is a function of etiology and therefore of the patient's history and results of clinical examination, functional exploration and standard biologic tests.

[Aging of veins and venules]. / Vieillissement de la veine et de la veinule.

There is a distinction between natural ageing and excessive ageing. The problem is not only vascular, it is above all interstitial conjunctival; it is located in the trunk wall and in the initial collector walls; the capillary-venular section is, from this point of view, just a unit of structure and function. The clinical and anatomopathological aspects of venous ageing are known: they are those of phlebosclerosis and deposits of proteoglycanes, the lesions are non-homogenous, dispersed and constantly changing. The elderly patient lives in a state of stasis. Stasis creates exaggerated and uncontrollable histangic neogenesis, it is the backcloth of "micro-angiopathy of senescence", but if the membrane thickens, it is in order to counter the ill effects of stasis; it is a control reaction not one caused by lesion. It is vital to establish an analogy between vascular ageing and "plastic" ageing, the process of polymerization is the same and we shall produce the evidence of this on another occasion.

[Microcirculation in white atrophy]. / La microcirculation dans l'atrophie blanche.

There are two clinical phenomena which, owing to the French School, are still subject to violent criticism: the phenomenon described by M. Raynaud (1862) and the white atrophy termed Milian's (1929). Perhaps badly defined by the authors, the facts have been reviewed, but microcirculation - that of gauges less than 30 to 50 m - does not occupy the whole picture. The proof is that in direct capillaroscopy, functional explorations and biopsy are strikingly monotonous and lacking in exactitude. Capillaroscopy provides the usual aspects of cicatrization, "capillary" neogenesis and their histogenic disorders: central avascular zone, corona limited with loops in "club" formation, or in "clusters" owing to their confluence, "key" loops at the periphery near to the normal loops. These "neocapillaries" pose problems of the immaturity of the neovascular elements and of hydraulics in venous stasis. Of course, there are disorders of capillary permeability, and these are linked especially with vascular neogenesis, but it would not be reasonable to speak of "cutaneous infarctus", or "vascularitis", the necessary criteria being absent. On the contrary, we believe that it all comes down to a "histoangiopathy" by deterioration of the pericapillary sheath of proteoglycanes and of the interstitial conjunctiva. The anomalies are of the type of the deteriorations in plastic polymers and the apparatus of the endarterial bloc, which are included. A "trapping" of the leucocytes in the declivitous areas must also play a part.

[Chilblains]. / Les engelures.

Chilblain is a frostbite, it belongs to the vascular acrosyndromes by the mere fact of symmetrical lesions and to the dystrophic group by its organic obstructive and thrombotic microangiopathy, especially of venules. Chilblain is conditional on a dysesthesia for cold, diagnosis is easy if in the know, prognosis as usual good and treatment must be more preventive than curative.

[Microvascular disorders of adipose tissue]. / Troubles microvasculaires du tissu adipeux.

The microcirculation of adipose tissue is poorly understood either because of the absence of histological documents or because they fail to explain pathological conditions. However, disturbances of blood flow and parietal lesions of the microvessels are the basis for these disorders. Although we speak of disturbances of the vascular control mechanisms, these mechanisms are poorly understood and although we speak of arteriovenous short-circuits, the existence of these lesions has not been proven. In fact, classically, the circulation in the dermis and hypodermis is assured by a meshwork of arterioles, venules and capillaries, but biopsies of lateral and anterior regions of the thigh have demonstrated "block devices" in the walls of small arteries and arterioles which are able to regulate the rate of blood flow towards the capillary bed. Following contraction of these devices, the vascular lumen dilates, ensuring free circulation and when they relax, the lumen closes, resulting in decreased or no blood flow. These smooth muscle devices within the arterial wall resemble small cushions in the small arteries and more or less pedunculated polyps in the arterioles, either simple or fissured in the form of an elephant's trunk with a safety valve effect, arranged either in a single column or in two columns face to face. This provides evidence for the particularly disturbed vasculo-tissue inter-relations observed in venous insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Capillaroscopy at the nail bed in functioning people aged 70 and over.

A long survey in an homogenous population of 150 healthy and functioning male and female subjects 70 years of age and over is reported. In vivo capillaroscopic patterns observed at the nail bed, besides the lips, the gums, the tongue and the bulbar conjunctiva, are described and sometimes compared with fingertip biopsy. Three patterns are distinguished: (1) type I the most frequent similar to the children's one (2) type II less frequent but rather peculiar to senescence (3) type III rather typical but intermediate. Permanent dilatation and congestion of venules and capillaries seem to be related to the permanent opening of pulpar arteriovenous anastomoses and belong to "senile microangiopathy".

[Incidents and accidents due to sclerotherapy. Prevention of pigmentation]. / Incidents et accidents dus à la sclérothérapie. Prévention de la pigmentation.

Even though sclerotherapy is a method which, in careful and experienced hands, is entirely harmless, the assault on the venous endothelium can, nevertheless, precipitate incidents and accidents, which the authors enumerate briefly in order to pinpoint that of pigmentation. The authors consider that, although this is not certain, venous stasis is responsible for this, venous stasis causing erythrodiapedesis followed by the formation of haemosiderin and the increased activity of the dermic melanocytes, a process which is exacerbated by subjacent inflammation. An axon reflex releasing P substance (Van Euler and Gaddum) modulating the chemical influx on the endothelial receptors in the microcirculation. Prevention will be achieved by combatting the venous hypertension and stasis, and the formation of heamosiderin, melanoids, and the inflammatory process.

[The connective tissue component and its connections with the terminal circulatory unit in macrophlebopathies]. / La composante conjonctive et ses connexions avec l'unité circulatoire terminale dans les macrophlébopathies.

We forget too often that the primitive mesenchyme cells are at the origin of healthy microvessels, lymphatic canaliculi and the conjunctival interstitium. In our different disciplines we tend to study in isolation the terminal circulatory unit, the lymphatic system, and the conjunctival tissues. Why not refer from the outset to histangiopathy in clinical situations as common as varicose illness, certain post-thrombotic syndromes and, in its classic form, to histangiopathy of stasis? In varicose illness, the conjunctival component of the vein wall is quantitatively differentiated from the normal wall; it is responsible for histochemical anomalies, and the inhomogeneities encountered are determined by the variable conditions of mechanomorphosis. There are also those very specific immunological reactions which some people have made so bold as to deny and changes in the ultrastructure, especially lysosomal changes which are not necessarily irreversible. Since 1965, amongst the post-thrombotic syndromes, Mario Degni has, with the aid of anatomopathological sections, isolated a very specific situation following parietal inflammatory lesions not the affection of the wall and valvules; the treatment of this is especially singular because the conjunctiva play a major part here and "parietal lymphostasis" is absent. There are many microvasculoconjunctival connections in the histo-angiopathy of stasis which are to be met in macrophlebopathies; they are responsible for the various clinical, capillaroscopic and histological pictures. The part played by the derivative channels, the tissular canals and the lymphatic canaliculi is important. The part played by the conjunctiva is even more important because of its retroactive information regulation. In pathological cases it is a degradation of plastic polymers.

[Microvascular consequences of low distal blood perfusion rates]. / Conséquences microvasculaires des bas débits de perfusion sanguine distale.

It is classical, in obstructive arterial disease, to be most concerned with the truncal arteries, although nutrition and exchanges occur at the level of the terminal vessels. The most important events occur in the muscles and in the skin, at the extremity of the limb and one wonders whether "ischaemic disease" could perhaps be summarized as the result of low perfusion rates. The laws of hydraulics are unusual in this situation, the microcirculation is autonomous and autoregulated. The architectonics are also unusual: the distribution into asymmetrical parallel networks explains the heterogeneity of the distribution in which stasis, conglutination and red cell rigidity, interstitial flooding and the rheological consequences play a major though unequal role in the skin and the muscle. The problems of the haematocrit, viscosity, surface tension or interface and the electrostatic potentials are more important at this level and they determine the therapeutic decisions.

[The nail in vascular pathology]. / L'ongle en pathologie vasculaire.

The nail is part of the ungual unit; it is affected indirectly and late in vascular disease. The authors recall the anatomy and the blood supply of the ungual unit and describe the alterations in terms of the level of the lesion. They describe the changes seen in systemic diseases such as the collagen disease, in vascular disease, venous, arterial and lymphatic disease and in vascular acrosyndromes. These alterations are often a result of several diseases, but may, nevertheless, help orient the diagnosis.

[Evolution of vasomotor tone in chronic obstructive arteriopathy of the lower limbs]. / Evolution du tonus vasomoteur dans l'artériopathie oblitérante chronique des membres inférieurs.

Progressive degradation in the appearance of digital plethysmogram tracings occurs during acute episodes of occlusive arteriopathies, and is of importance for establishing the diagnosis and the choice of therapy. The distal microvasculotissular score is of major interest during the stages defined by R. Fontaine in 1966. Changes are in fact those of rheologic factors in the terminal network. It is logical to incriminate variations in "tone" and of vasomotor response, the final relay being at the site distal to the circulatory units and their endothelial receptors. The problem should be envisaged at each stage in the course of the disease. Vasoplasticity is a function of the severity of the arteriopathy.

[Juvenile distal cerebral ischemia: value of pulp biopsy]. / Ischémie cérébrale distale juvénile: intérêt de la biopsie pulpaire.

Juvenile distal cerebral ischemia has been attributed to small artery atherosclerosis (Arnold, Benoit, Merlen, Dobbelaere, Delandsheer, 1979), based on clinicopathologic findings in one male patient and results of big toe pulp biopsy in three other cases. Pathological findings were obstruction of small artery lumens by hypertrophic endothelium and loose fibrocellular bands, their origin being the result possibly of partial intimalization of media by elastic neogenesis. Appearances were similar to those described by Dahl in human cerebral atherosclerosis in 1976, and approached those of the initial stages of experimental atheroma (Ross, Glomset, 1976). Arterial exiguity was also present in the 4 cases. Results of biologic, metabolic, inflammatory and immunologic examinations were negative. The present study concerns 4 additional cases of juvenile distal encephalic ischemia. One case in a female patient not on oral contraceptives confirmed the hypothesis of intimalization of media of arterioles of big toe pulp. Elastic neogenesis was present in the tunica media in areas where there was a change of direction of myocytes, and was apparent at a distance from the internal elastic layer. The latter was fragmented, sometimes doubles and of variable color. In another case, a woman taking oral contraceptives, there was almost total obstruction of the pulp arteriolar lumens with a very thin tunica media. Elastic neogenesis encircled two very narrow lumens in the center of the vessel and there were also elastic changes common to both.(ABSTRACT TRUNCATED AT 250 WORDS)