[Thermal treatment in arterial diseases: an expensive placebo or an effective therapy?]. / Le traitement thermal des maladies artérielles: un placebo coûteux ou une thérapeutique à part entière?

Each year, Royat (Auvergne) receives about 20,000 patients (80 per cent with intermittent claudication), treated by thermal gas (99.5 per cent of CO2). CO2 therapy is dispensed with thermal water or with dry gas (general or local immersion and local subcutaneous injections of gas) during 3 weeks. Local vasodilator effects of CO2 have been demonstrated with several methods in Royat. Physiological and therapeutic effects of thermal CO2 therapy, also used in Germany and Central Europe, were precisely reported during the Consensus Congress of Fribourg in Brisgau (1989); more particularly, this treatment seems provide a reduced ability of haemoglobin to fix oxygen, and therefore a release of oxygen within the cells. Patients with peripheral arterial disease (stage 2) have a walking distance increased and post-exercise ankles' pressures improved after a thermal course of treatment in Royat, while a control group has no significant changes. The discussion will concern also the socio-economic aspects of thermal treatment of arterial diseases.

Laser Doppler flowmetry, transcutaneous oxygen pressure and thermal clearance in patients with vascular intermittent claudication.

In the present study, heat thermal clearance (HTC) was compared to laser Doppler flowmetry (LDF) and transcutaneous oxygen pressure (tcPO2), measured on the forefoot of 17 patients with vascular intermittent claudication and 10 controls in various positions at rest and after a treadmill exercise test. The mean ankle brachial systolic pressure ratio (ABSP) of the patients, measured using ultrasonic Doppler velocimetry, was 0.53 +/- 0.05. Their walking distance was 480 +/- 100 meters, the treadmill exercise being stopped as soon as pain sensation. No statistically significant difference was found between patients and controls for HTC, LDF, tc P02, forefoot and ankle skin temperatures. Statistically significant differences between patients and controls occurred in the sitting position for tcPO2, in standing position for HTC and after treadmill exercise for tcPO2 and LDF. When assuming the sitting position HTC did not vary significantly in patients and decreased in controls, LDF decreased and tcPO2 increased in both groups. After treadmill exercise, HTC in patients did not vary compared to supine values and HTC decreased in controls, tcPO2 remained unchanged in controls and decreased in patients, LDF increased in controls and decreased in patients. No significant correlations were found between the different techniques measured at rest in patients and controls. However in patients, after the treadmill test, LDF correlated with the walking distance (r = 0.667) and with ABSP (r = 0.641), HTC inversely correlated with the walking distance (r = -0.680) and ABSP (r = -0.577). Laser Doppler, tcPO2 and HTC are useful as tools to understand the alterations of cutaneous microcirculation of the lower limbs in patients with V.I.C.. However their results need to be interpreted with caution because these methods do not measure directly blood flow.

[A study of three potential antidepressants (amineptin, mianserin and nomifensin) on the cardiovascular system and isolated intestine (author's transl)]. / Etude des effects cardiaques et sur l'intestin isolé de l'amineptine, la miansérine et la nomifensine.

We studied the effects on the cardiovascular system and isolated intestine of three potential antidepressants : amineptin, nomifensin and mianserin. 1) No animals died in spite of doses well above the therapeutic range, evidencing the good tolerance of the compounds. 2) Effects on heart rate were variable; the only significant effect was cardioacceleration seen with mianserin in doses above 5 mg/kg. 3) The only significant effect on the auriculoventricular refractory period was recorded with mianserin. 4) Amineptin was the only compound that increased blood pressure. 5) Auriculoventricular conduction was slowed with mianserin in doses above 10 mg/kg. 6) On isolated rat duodenum, mianserin was spasmogenic in concentrations above 100 microgram/100 ml. 7) in comparison to tricyclic antidepressants, these three compounds carry only few risks of adverse side-effects.