Biomedical subjects
Publications and source records attributed to B Planchon.
We report the case of a 62-year-old man with Behçet's disease revealed by double aneurysmal involvement of the posterior tibial and popliteal arteries. The diagnosis was suggested because of repeated phlebitis, buccal aphthous ulcerations, and results of human leukocyte antigen gene typing. The different arguments leading to the diagnosis of Behçet's disease and appropriate treatment are presented.
The coexistence of giant cell arteritis (GCA) and autoimmune thyroid diseases has been suggested. In our prospective study of 39 patients with GCA, we measured autoantibodies and thyroid function and compared the results to those of a control group. No statistical difference was found. Our conclusions differ from those of other authors.
Endocrine function was prospectively evaluated in 98 patients (73 men and 25 women) infected by HIV in various stages of illness: Centers for Disease Control groups II (19), III (20), IVA and IVC2 (27), IVC1 and IVD (32). Testing included baseline and post-stimulation evaluation of gonadal, thyroidal, and adrenal axes. Although adrenal function was within normal values in most cases, with no differences between patient groups, nine out of 98 patients had either a low baseline or post-stimulation serum cortisol, cytomegalovirus adrenalitis being suspected in two cases. Mineralocorticoid response was normal in all individuals. The main abnormalities were sick euthyroid syndrome with low tri-idothyronine and/or thyroxine in 16% of patients and hypotestosteronemia in 29% of men with AIDS. These abnormalities, related to a functional deficiency of the hypothalamic-pituitary axis, were highly correlated with the degree of illness, i.e. weight loss and low CD4+ cell count. It was concluded that endocrine dysfunction in HIV-infected patients is rarely of clinical significance, that it is related more to cachexia and advanced disease than to HIV or opportunistic infections, and that it could serve as a prognostic marker.
On the basis of a prospective study of 104 patients, the authors discuss the diagnostic value of the clinical symptoms revealing the thoracic outlet syndrome (TOS), as well as the specificity of the vascular functional exploration carried out to establish the diagnosis. Non-systematized pain and dysesthesia in the upper limb, with a postural or nocturnal onset, and Raynaud's sign are the most frequently observed signs. The "candlestick" maneuver still is the most reliable clinical triggering maneuver. The clinical features and the vascular functional explorations (capillaroscopy and digital plethysmography) allow demonstrating the existence of a true Raynaud's syndrome secondary to the TOS. The results of the arterial Doppler study distinguish the symptomatic and asymptomatic sides in the same patient, though without any correlation with the symptoms observed. The Doppler examination therefore seems to be reliable to demonstrate an anatomical duct, but remains insufficient to establish a causal relationship with the signal symptoms in most cases.
Three cases of hypothenar hammer syndrome are reported in manual workers who experienced repeated traumatism of the palm of the hand either because of personal habit or the use of professional tools. Hemodynamic examination of the upper limb was performed by plethysmography (Perivein Etna) and Doppler ultrasound (8 MHz) complemented by angiography by direct puncture of the humeral artery. Ultrasonography was performed using a 7.5 MHz probe (Sononranger) for exploration of the ulnar artery at the wrist and in its course through the palm. The 3 patients presented aneurysmal dilatation of the ulnar artery in the palm, complicated by postembolic thrombosis of the collateral arteries of the fingers. The ulnar artery lesion was permeable 1 time, already thrombosed 1 time and thrombosed secondarily 1 time. Ultrasonography of the palm showed suspected aneurysm of the ulnar artery in 2 patients: one case was confirmed by angiography, whereas the other remained only suspect since the thrombosed ulnar artery was not opacified. The third patient presented an ulnar artery thrombosis without true aneurysmal dilatation. It may be concluded that ultrasonography can show suspected aneurysmal dilatation of the ulnar artery and be complementary to arteriography when the ulnar artery is thrombosed.
The potential advantage of using 111In-antifibrin (111In-AF) monoclonal antibody for the diagnosis of deep venous thrombosis (DVT) was studied in 44 patients with suspected DVT (27 underwent heparin therapy before 111In-AF injection). All patients had contrast venography (considered as the gold standard) and 111In-AF scintigraphy within 24 hr. Two to 3 mCi of 111In-AF were injected intravenously, and planar scintigraphy of the limbs was recorded within 10 min (17 times), 3 hr (44 times), and 18 hr (39 times). Indium-111-AF images were then interpreted without knowledge of the results of the other examinations. The DVT diagnostic accuracy of 111In-AF was greater when interpretation was based on images recorded at different time periods after injection. Indium-111-AF sensitivity for diagnosis of DVT was 85% (29/34) and was not apparently decreased by heparin therapy. None of the 10 patients with negative contrast venography had a positive 111In-AF scan. The results demonstrate the importance of recording serial images and the excellent accuracy of 111In-AF for diagnosing DVT.
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Raynaud's phenomenon is usually a benign acrosyndrome which few of the currently available therapies improve significantly. This makes the evaluation of the efficacy of vasodilators very difficult, especially as there are no standardised complementary investigations to quantify their effects. Assessment is based essentially on careful interrogation and the use of an analogical scale remains the method of reference. The multiplicity of factors inducing the acrosyndrome necessitates cross-over trials versus placebo over sufficiently long periods of observation (if possible, one month). As regards follow-up and objective evaluation, reactivity to cold is a promising method providing the tests can be standardised with respect to methodology and expression of results.
Associated ultrasonic Doppler study (D) and plethysmography (P) were evaluated as compared to phlebography in diagnosis of venous thrombosis of the lower limbs (TVP). Probes (5 and 7.5 MHz respectively) were used in D for examination of proximal and calf veins. Plethysmography using a mercury ring gauge (Perivein, ETNA) was considered pathologic if filling volume was less than 1.5 vol% and/or emptying volume less than 40 ml/min/100 ml. One hundred and four patients hospitalized in an internal medicine department for suspected deep venous thrombosis were studied, including 97 for whom phlebography interpretation was unmistakable: 11 calf vein, 28 collector trunk and 42 total limb involvement TVP. In these localizations, D sensitivity was respectively 55, 72 and 100% (mean 85.5%) and that of P 63.5, 68 and 88% (mean 77.7%); association of D or P improved sensitivity: 82, 82 and 100% (mean 91.5%). Specificity was 86.6% for D, a poor 62.5% for P and 93.5% for associated D and P. The results are comparable to those in the literature but disappointing for diagnosis of isolated calf vein TVP. False-negatives in both D and P were due to strong collateral circulation or limited thrombus extension.
The hemorrheologic impact of an inflammatory syndrome was investigated in a prospective biological study of 65 patients by using an erythrocyte filtration test on total blood. Impact was assessed by a statistical study of correlations between relative filtration time (RFT), inflammation-reactive proteins (IRP) and the different parameters of the hemogram. A stepwise multiple regression test (SMRT) indicated the dominant role of fibrinogen in determining acceleration of the sedimentation rate (p less than 10(-3) and lengthening of RFT (p less than 10(-3). Moreover, RFT appeared to be very significantly correlated with polymorphonuclears (R = 0.55; p less than 10(-3] hematocrit as measured by the centrifugation technique (R = 0.34; p = 0.005) and corpuscular concentration in hemoglobin (CCHM) (R = 0.30; p = 0.01). A chart predictive of microcirculatory risk was deduced from the study based on fibrinogen values and hematocrit. However, the relatively low rate of reduction in the total variance observed during SMRT suggests the quite relative role of the studied parameters in erythrocyte filtration disturbances during an inflammatory syndrome.
99Tcm-labelled aerosol ventilation and 99Tcm-macroaggregate albumin (99Tcm-MAA) perfusion can be performed in the diagnosis of pulmonary embolism (PE). If both examinations are performed on the same day, the superposition of activity from the first scintigraphic examination might mask defects in the second. In this study, 106 examinations were carried out for suspected PE. Aerosol ventilation was performed first with 20 to 30 mCi 99Tcm-labelled rhenium sulphur (four views, 200,000 counts). Immediately afterwards, with the patient remaining in the same position, 5 to 7 mCi of 99Tcm-MAA were injected (four views, 400,000 counts). After normalization, aerosol activity was subtracted from perfusion images and unprocessed perfusion (UP) and ventilation subtraction perfusion (SP) images were compared. Interobserver diagnostic reproducibility between three readers was calculated both for UP and SP images. Intraobserver reproducibility between UP and SP images was calculated for each reader. Interobserver reproducibility was comparable for SP and UP images. Intraobserver reproducibility was good. Thus, whether ventilation was subtracted or not from perfusion images, there was no appreciable effect on perfusion defect detection. However, some perfusion abnormalities showed up more clearly on SP images. Perfusion can be performed immediately after aerosol ventilation; the images thus obtained are reliable for interpretation, and subtraction of ventilation is not necessary.
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Maximal digital pulse (M.D.P.) is measured by digital plethysmographic technic with strain gauge. Our normal values are: 0.19 +/- 0.06% delta V. Diagnostic and prognostic significance of this parameter were studied on ten patients with digital necrosis. An arteriography of the hand was performed in each case. We have demonstrated that any value of P.D.M. below 0.10% delta V was always correlated with digital arteriopathy and with high risk of trophic complications. A normal value didn't exclude an arteriopathy. However, in these cases, the risk of trophic complications was get off.
A 40 year old man presented fibromuscular hyperplasia of posterior tibial artery media, a rare lesion, and only exceptionally reported in the calves since a total of 3 cases were found in the literature.
The authors have developed a vascular reactivity test to cold using the digital plethysmograph technique with a mercury strain gauge. Three types of arterial reactivity were determined: local reactivity after immersion of the hand in 11 degrees C water, general reactivity after thorax ventilation, and cumulative reactivity associating both of these cooling modes. The method is based on measurement of the digital plethysmographic signal expressed as a ratio of a reference warm amplitude obtained after immersion of the hand in 45 degrees C water for 3 min. The method was tested and perfected in 66 control subjects before being applied to 65 patients with Raynaud's disease. Significant differences were noted between these 2 groups, especially in cumulative reactivity (p less than 10(-9)), which led to numerical expression of results in 5 types of increasingly important reactivity. It would appear that the test has diagnostic and prognostic value in the exploration of vascular acrosyndromes and their therapeutic follow-up.
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Digital plethysmography allows investigation of maximum digital pulse (M.D.P.) after immersion of hands at 45 degrees C over three minutes. It is correlated with digital arterial blood flow. Reactivity to cold is determined from the ratio M.D.P./digital pulse after local and body cooling over 3 minutes. Tests were performed on 65 controls, 69 patients with idiopathic Raynaud's syndrome, 12 with scleroderma, 10 with digital arteritis and 15 with Raynaud's phenomenon secondary to hemorheologic affections. Maximum digital pulse was significantly decreased in patients with digital arteritis and scleroderma. The M.D.P. was normal in controls and patients with idiopathic Raynaud's syndrome, and was significantly increased in patients with a rheologic Raynaud's phenomenon. Digital artery reactivity differentiates the populations studied: it was maximum in patients with scleroderma, moderate in controls and patients with isolated digital arteritis and marked in patients with idiopathic Raynaud's disease and those with rheologic Raynaud's phenomena.