Peripheral aneurysms.

Between January 1970 and December 1990, 17 cases of peripheral aneurysms were observed in 15 patients. Fourteen patients were male and one patient was female. Age ranged between 4 years and 82 years. From the 17 peripheral aneurysms, 4 were false aneurysms, 9 were true atherosclerotic aneurysms, 2 were mycotic and 2 were true blunt traumatic aneurysms. The false aneurysms were caused by gun shot (one case, common carotid artery); complication of carotid endarterectomy (2 cases); iatrogenic (one case, common femoral artery). The atherosclerotic aneurysms (9 cases) were located in the subclavian artery (one case); superficial femoral artery (2 cases in a single patient); and popliteal artery (5 cases). The mycotic aneurysms (two in one patient) were located in the profunda femoris artery and in the anterior tibial artery. The two traumatic true aneurysms were located in the distal radial artery and in one interdigital artery, respectively. From the 17 peripheral aneurysms, 15 were submitted to surgical treatment, with fairly good results, except for one case of infection and another case of fatal renal insufficiency. Follow-up time ranged from 1 to 18 years.

Axillary-subclavian venous thrombosis.

From 1974 through 1984 six patients with axillary-subclavian venous thrombosis were studied and treated. This disorder represents 1% of the various types of venous thrombosis reported in the literature. Symptoms appeared following effort in four patients, while a cervical rib and a scar bridle after radical mastectomy were identified as the underlying cause in two patients. Ages ranged from 17 to 59 years, with a mean age of 33 and equal sex distribution. None of the six patients had blood clotting defects. The diagnosis was based on clinical evaluation and was confirmed by phlebography. There was edema and functional impairment of the arm in all cases. Pain and venous prominence was found in 83%, rubor of the extremity in 66%, local hyperthermia in 50%, and arterial compression in 33%. Five patients were treated with anticoagulants and bed rest. Surgery was performed in two patients with thoracic outlet syndrome. First rib resection with scalenotomy was performed in one case and cervical rib resection with scalenotomy in the other. After a mean follow-up of 13 months, the results were good in four and average in two patients.

The Doppler flowmeter as an aid in the diagnosis of the hyperstomy syndrome.

A new aid in the diagnosis of the hyperstomy syndrome by non-invasive procedure using the Doppler flowmeter is presented. Several studies prove that there is an increased venous saturation and increased venous pressure in the hyperstomy syndrome, i.e., various degrees of arterialization of the venous system as well as an increase in the venous flow. Based on these studies the authors detected changes of this flow with the Doppler flowmeter interpreted as being the results of the activation of arteriolo-venular communications. In addition, in the first ten cases in which these have been found, serial arteriography confirmed the diagnosis of hyperstomy syndrome.

Hyperstomy Syndrome-a new approach for the treatment of lymphedema of the lower legs.

To improve the results after surgical treatment of the lower legs' lymphedema, a new approach was developed by surgical ligation of the abnormal arteriolovenular shuntings. (Hyperstomy Syndrome). These findings are very common in congenital and postphlebitic lymphedemas. The abnormal branchings are easily localized by serial arteriography. The excision techniques like the Charles' operation, presents after this new method much better esthetic appearance with out formation of hyperkeratosis of verrucous warts commonly found after these operations.

[Acute inflammatory exacerbations in lymphoedema (author's transl)]. / Les poussées inflammatoires des lymphoedèmes.

The author describes changes in the skin, lesions in the lymph vessels and changes seen on lymphography. Amongst cutaneous lesions, necrosing lymphangitis or gangrenous lymphangitis are the most serious. In the calf, they develop after an extensive episode of acute erysipelas. In erysipelas, the most common cutaneous lesion, the course varies according to associated disturbances, lymphatic and lymphnode. Combining of these lesions results in the most severe forms of obliterating thrombolymphangitis, capable of simulating venous thromboses of the lower limbs. In abscesses associated wtih severe erysipelas, massive eosinophilia found. Endoarterial therapy is invariably selected. Lymphographic appearances are dependent upon the stage of progression of inflammation. Disappearance, increase in vascular parietal permeability, varicose and ectasic appearance of the lymphatics may be seen in the superficial and deep collecting vessels. During the chronic phase, lesions are more extensive and more obvious. They are characteristic of severe lymphatic stasis. Histopathological studies show lymphangitis and perilymphangitis characterized by polynuclear neutrophil infiltration during the acute phase. At a more advanced stage, obliterating endolymphangitis and acute thrombolymphangitis are followed at the chronic phase by fibrous lymphangitis.