Intra-medullary pressure and intra-osseous phlebography in paraplegia.

Intra-medullary pressure and intra-osseous phlebography have been studied in the femurs of ten paraplegics. These methods are reliable for studying bone circulation. Results show that there exists an increase of intra-medullary pressure of more than twice the normal value and signs of delayed blood flow as well as a diaphyseal reflux in the bone. The blood gases are also modified (O2 saturation; pO2 and pCO2). These signs indicate that there is a venous stasis. These circulatory disturbances are due to an autonomic nervous system lesion. Furthermore it seems that these vascular modifications below the neurological lesion have an influence on the osteoporosis in paraplegia.

[Heparin treatment. Comparison between intravenous and subcutaneous administration]. / Traitement héparinique. comparaison entre les voies d'administration intraveineuse et sous-cutanée.

48 patients with acute deep venous thrombosis of the lower limbs were treated with sodium heparin. In 23 patients heparin was injected subcutaneously (s.c.) twice a day and in 25 patients heparin was given by continuous intravenous perfusion (i.v.). Pain and edema disappeared after 8.7 days (s.c.) and 11.7 days (i.v.) respectively. One non fatal pulmonary embolism occurred in each group. A second venography was performed in 24 patients after 7 days of treatment and revealed no difference between the two groups. As judged by repeated thrombin time determination, anticoagulation was ineffective on at least one day in 39% of patients treated subcutaneously and in 60% of patients treated intravenously. The two pulmonary embolisms occurred in patients with ineffective anticoagulation. It is concluded that heparin may be used either intravenously or subcutaneously in the treatment of acute deep venous thrombosis. Thromboembolic complications occurred with both methods of treatment when anticoagulation was ineffective.

[Arteriovenous fistulae following liver puncture biopsy]. / Les fistules artério-veineuses après ponction-biopsie du foie.

5 cases of arterio-venous fistula secondary to needle biopsy of the liver are reported. In 4 cases the lesion was a chance radiologic finding during arteriography and did not require a surgical procedure. In two cases spontaneous closure of the fistula was demonstrated by a second arteriography. Only in the fifth case did development of portal hypertension require a surgical procedure, ligature of the right hepatic artery being performed.

Dysplasia of the lymphatic system.

A case of diffuse lymphangiectasis without lymphedema of the limbs is reported in a woman. Translucent vulvar vegetations with edema were noted. Lymphatic vessels enveloping the iliac veins were resected over a length of 10 cm above the termination of the inferior vena cava, followed by complete remission. Abundant leucorrhea was probably due to chylous discharge by reflux at the ectatic vessels of the vulvar region.