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Biomedical subjects

H Boccalon

Publications and source records attributed to H Boccalon.

At least 109 records · Page 6Linked to original sources
PubMed1986

[Computerized records in vascular pathology. I. Basic elements].

Computerized processing of medical case-report data in angiologic practice should be conceived in two parts: the basic elements which define patients during their identification, and the specific disease-related elements. The basic file raises the problem of coding of data and of who does what. The choice of objectives and of coding is the responsibility of the doctor in charge of the project. Data processed should not be in his language only and cannot substitute for him when a decision has to be made. Collection and storage of data also fall within the medical field, apart from certain sections: identification of patients, intensive care, vascular explorations, the person directly concerned being either the secretary, the nurse or the doctor.

Computers↗
PubMed1985

[Raynaud's phenomenon, laser Doppler, isothermal chamber. Exploration of normal and pathologic subjects].

The investigation of Raynaud's phenomenon in angiological practice has not yet been standardized. Two points need to be resolved. The cold test is either too empirical and inaccurate or non-uniform. None of the tests of functional vascular exploration have been proven to be reliable, except, perhaps, for capillaroscopy. Laser Doppler studies the cutaneous microcirculatory velocity and its response to thermal stimulation. An isothermic chamber can be used to chill the skin and reheat the skin according to a simple and standardized technique. This protocol was performed in 14 normal subjects, 28 patients with Raynaud's disease and 19 patients with Raynaud's phenomenon, which is clearly individualized. In Raynaud's disease, there appears to be an exageration of cutaneous sympathetic tone compared to normal subjects. This methodology is simple to perform and it provides rapid diagnostic results in the consulting rooms.

Blood Flow Velocity↗
PubMed1985

[Critical study of the measurement of pulsatile flow in arteritis patients. Value of non-invasive electromagnetic flowmetry].

Hemodynamics of an arteriopathy of lower limbs can be assessed by determination of arterial pressure and flow, the two variables being both useful and complementary. Arterial flow can be measured in two ways: mean arterial flow (plethysmographic or isotopic methods) cannot differentiate the different stages of arteriopathy sufficiently; a more specific method is by determination of pulsatile arterial flow. A non-invasive electromagnetic flowmeter method was developed for measuring pulsatile arterial flow in the upper third of the leg. Specificity in normal subjects was 100% in males and 98% in females, and selectivity 100% in stages II and III and 95% at stage I. The method is therefore specific, sensitive and very reproducible. Whereas pulsatile flow alters in a linear manner with distal arterial pressure when the latter is less than 100 mm Hg, this is no longer the case above this threshold. Calf flow, and particularly its relation to pulsatility measured at rest, is correlated with results of Strandness's test; it is not essential therefore to conduct an exercise tolerance test. Finally, the non-invasive electromagnetic flowmeter investigation is an excellent means of monitoring effects of certain drugs with vascular (vaso-active) or cardiac (nitroglycerin) activity, and of tobacco.

Arteritis↗
PubMed1985

[Flowmeter monitoring following lumbar sympathectomy].

Lumbar sympathectomy is still a subject for debate with respect to its results and mechanism of action. Effects were assessed objectively by measuring hemodynamic parameters of blood flow. The study protocols are discussed. Muscle nutritional capillary flow was determined by clearance of radioactive Xenon. Within a period varying from 8 to 24 months. 31 to 51% of patients with arteritis show increased muscle flow after sympathectomy. Effects are analyzed as a function of site of lesion, duration of claudication and uni- or bilateral operation performed. The non-invasive electromagnetic flowmeter measures global pulsatile arterial blood flow in the upper third of the leg: improvement in pulsatile flow was noted in 86% of cases six months after sympathectomy. Finally, skin microcirculation velocity was measured by Doppler using a laser beam: improvement occurred immediately after sympathectomy for well defined clinical indications, whereas no effect was noted in arteriopathy of diabetic origin. This method can therefore clarify mechanisms of action of sympathectomy and justify its indications.

Arterial Occlusive Diseases↗
PubMed1985

[Exploration of the cervical arteries within the framework of an angiology service. Our experience using Doppler spectral analysis].

Diagnosis and quantification of severity of carotid lesions were assessed by different procedures. Oculoplethysmography was of value only in cases of significant occlusive lesions. Ultrasound methods possessed enhanced sensitivity: Doppler velocimetry, ultrasound imaging and particularly spectral analysis of the Doppler signal. Efficacy of this exploratory method was assessed in a department of angiology, spectral analysis being rated as 5 different grades as a function of degree of arterial stenosis (fig. 1). It was routinely combined with Doppler velocimetry and ultrasound imaging in 35 patients, a total of 64 carotid bifurcations being analyzed. Digital subtraction venous angiography was performed in 28 of these cases. Study of the reading effect on interpretation of the spectral analysis showed 37 agreements and 27 divergences; among the latter the definition of normality in relation to grades I or II appears to be responsible. Greater significance was noted for the reading effect in cases explored by Doppler velocimetry and ultrasonography. Positive findings were obtained with spectral analysis in 41 of 64 patients, either by detection of non-significant lesions or by precise quantification of stenotic lesions. Results of digital subtraction angiography were debatable in 8 of 28 patients and were unconfirmed on ultrasound imaging. Spectral analysis of the Doppler signal has therefore an advantage over Doppler velocimetry and ultrasonography in that more precise data is obtained on stenotic lesions and that those of little significance are detected. It supplies an effective means of diagnosis and surveillance and it establishes the need for angiography. Lack of sensitivity and reproducibility of ultrasound and digital subtraction venous angiography raises the problem of an effective reference test.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Diseases↗
PubMed1985

[Atypical compression of the humeral axial artery treated by surgical arteriolysis].

A 28-year-old man with atypical humeral artery compression presented clinical signs and results of Doppler tests suggestive of a cervicothoracic outlet syndrome: dysesthesie disorders and pain in left upper limb on active abduction. Murmurs over the vascular pathways were not elicited on clinical examination. Pulses were palpable in the upper limbs at rest but were abolished during abduction and external rotation. Data were confirmed by velocimetric studies, and dynamic arteriography showed absence of compression at the cervicothoracic outlet but its presence at the humeral head level. Axillohumeral surgical exploration provided evidence of compression of the nerve-vessel bundle, which was stretched within its sheath over the head of humerus. Incision of the fibrous sheath and freeing of the artery restored distal vascular pulsatility during abduction movements. This clinical pseudosyndrome of the cervicothoracic outlet appears to result from a rare cause of compression situated distal to this anatomic zone, and to respond to simple treatment.

Adult↗
PubMed1985

[Thromboembolic disease in pneumology. Value of mercury-gauge plethysmography with venous occlusion].

Mercury gauge plethysmography with venous occlusion (PJC) is an atraumatic procedure for the diagnosis of deep venous thrombosis (TVP) of the lower limbs: 103 patients were studied both by plethysmography and phlebography (the reference examination). 54 were hospitalised for a suspicion of pulmonary emboli (EP), 21 for clinical phlebitis and finally 28 subjects had the studies as part of a systematic work-up. 60 cases of TVP of the lower limbs were discovered: 47 were recent, 34 were proximal and 13 sural. The clinical examination failed to reveal these in 36% of cases; the phlebographic and PJC results were concordant for 75% of cases: PJC seemed particularly to be the technique of high sensibility for the early diagnosis of proximal TVP but of a lesser interest for the early diagnosis of peripheral TVP (sensibility 69%). This examination makes an important contribution: for the early diagnosis of hidden proximal TVP; for the diagnosis of EP in its deceptive forms where the presence of a peripheral embolic focus constitutes one weighing factor towards the diagnosis of peripheral thrombo-embolic disease (MIE); for the control of anti-coagulant therapy in the clinic where the local inflammatory process and the biology controlling the consumption of heparin are jointly observed and the study of venous drainage allows an appropriate decision to be made as to the cessation of anticoagulant therapy and minimises the risk of recurrence or avoiding postphlebitis disease by a prolonged treatment.

Anticoagulants↗
PubMed1984

[Introduction to Doppler laser flow measurement. Study of cutaneous vascularization].

The microcirculatory unit, which links arterioles with venules, is responsible for metabolic exchanges with the interstitial tissues and for the regulation of skin temperature. The sympathetic system controls cutaneous vascularization. A satisfactory method for dynamic clinical investigation of skin vascularization, previously not available, is now possible with the Doppler laser flowmeter which provides relative measurement of blood flow in the microcirculation. Three studies were conducted using this simple technique. Changes in skin blood flow were recorded in healthy volunteers during physiological stress: reactive hyperemia, hot and cold reaction test, respiratory changes, postural modifications. In patients with arteritis, the immediate effects of lumbar sympathectomy on skin blood flow were measured. During exploration of patients with vasomotor disorders, the cold test was performed by exposing the extremities in a thermal chamber: laser flowmeter recordings provided data on specific alterations occurring during a disease or Raynaud's syndrome. These findings will assist quantification of, and the application of predictive tests to the most useful measures to adopt for vasomotor disorders.

Doppler Effect↗
PubMed1984

[A thermal chamber for the cold test in vasomotor disorders].

The cold test represents an essential part of the functional exploration of the vascular system performed in Raynaud's disease, but its physiological nature depends upon the use of a sufficiently large area of skin. Several measurements must be conducted simultaneously and various temperature ranges used to allow for the variable threshold of vascular reactivity to cold of different individuals. A thermal chamber is presented which enables the simultaneous performance of plethysmography, digital pressure recordings and capillaroscopy at different temperature ranges. A novel use of a laser flowmeter is also described. Peri-ungual capillaroscopy enables determination of the temperature, when capillary spasm appears and then is relieved during progressive cooling followed by reheating. This apparatus can be adapted for use of all techniques for exploration of vascular function.

Cold Temperature↗
PubMed1984

[A comparative study of percutaneous transluminal angioplasty of the iliac and femoropopliteal arteries in arterial disease of the lower extremities].

The authors compared the anatomo-radiologic data from a series of 100 consecutive percutaneous transluminal angioplasties (PTA), as well as the immediate and long-term results as a function of the level of the lesion--iliac or femoropopliteal. Proximal to the thigh, there were 57 PTAs, 36 of the common iliac and 21 of the external iliac. In the lower thigh, there were 43 PTAs, 9 of the upper part of the popliteal artery and 34 of the external femoral artery. Percutaneous transluminal angioplasty of the common iliac lesion was dominant in patients under 60 years of age (p less than 0.05). At the iliac level, 89% of the patients had severe claudication; at the femoropopliteal level, 39% had trophic problems. The "dominant" or "accessory" character of the lesion did not modify the indication for the procedure, regardless of the level. Segmental thrombosis accounted for 44.2% of the femoropopliteal PTA indications, compared with 7% at the iliac level (p less than 0.04). The failure rate was less at the iliac than at the femoropopliteal level. Follow-up was available for 86.6% of the patients for an average of 22 months. The systolic indices at the thigh after iliac PTA and at the ankle after femoropopliteal PTA were significantly increased (p less than 0.01). At the femoropopliteal level, 74% of the patients were totally asymptomatic. There was one failure (3.8%); amputation at thigh level was carried out 12 months after the PTA. At the iliac level, improvement was observed in 91% of the patients and 70% became asymptomatic. The overall success rate (clinical patency and improvement) was 92% +/- 0.09%, based on the life-table method.

Aged↗
PubMed1984

[Percutaneous transluminal angioplasty in chronic arteriopathies of the lower limbs. Immediate anatomo-radiological results and functional outcome].

The immediate anatomo-radiological results and functional outcome of a continuous series of 100 percutaneous transluminal angioplasties (PTA) in patients with chronic obliterative arterial disease of the lower limbs are reported. In 8 out of 10 cases, the patients had no previous surgical history. The iliac axis was more commonly affected than the infracrural arteries (57% compared to 43%). The indication of choice was the Leriche stage II (73%). The arterial lesion was responsible for the ischaemic pathology in 2 out of 3 cases. There was a higher incidence of preocclusive lesions (46%) than thromboses to be recanalised (23%) or significant stenoses (23%). The anatomo-radiological results were satisfactory in 80% of cases: a normal calibre was restored in 31% and stenosis was reduced to non-significant levels in 49% of cases. The morbidity associated with this technique was 7%: inability to dilate or thrombosis of the vessel. In 7 cases, failure was due to inability to pass the catheter across the stenotic lesion. Complementary surgical treatment was carried out on "accessory" arterial lesions in 33 cases; 32 sympathectomies for distal lower limb lesions and I femoro-popliteal bypass after iliac PTA. A total of 86.6% of PTA were followed up for an average of 22 months; 72% were totally asymptomatic; 21 were classified as stage II with improvement of their walking limits. The 3 year success rate was 0.92 +/- 0.1. Arterial surgery was necessary in 5.6% of cases for persistent severe intermittent claudication.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

[Experimental model for hemodynamic and metabolic studies of extracorporeal circulation. Apropos of 14 cases].

The authors present an homogeneous and stable experimental model, the basic characteristics of which are: 14 extracorporeal bypass with: total bypass; normothermia; total haemodilution; beating heart; continuous flow in dogs anesthetised with chloralose. Three methods were employed: continuous recording of the venous lactate concentration; invasive electromagnetic measurement of the arterial blood flow; measurement of the tissular capillary blood flow with radioactive labelled microspheres. The statistic treatment of the informations gathered confirms that those experimentations took place in normothermia and constant: pH, venous and arterial pressure, cardiac pacing and arterial carotid blood flow. We noticed no modification of the body electrolytic repartition; blood gas variations do not modify haemodynamic conditions. Increase of the lactate concentration, as noticed in the literature, is in relation with a catecholamine hypersecretion and not with an anaerobic tissular function. Tissular capillary blood flow is constant if reported to cardiac index. This model will allow us to compare those results with new series where only one of the basic elements will be modified.

Animals↗
PubMed1982

[The place of intraluminal angioplasty in a vascular surgery department].

The advent and rapid strides made in the use of percutaneous intraluminal angioplasty (P.I.A.) in the treatment of chronic obliterating arteriopathies of the lower limbs have provoked a great deal of discussion. The exact place of this technique among the various therapies available is assessed in a different manner by radiologists, angiologists, and vascular surgeons. This report attempts to supply answers to two questions posed by certain authors in a more or less implicit manner: what is the importance of P.I.A. in relation to other therapeutic methods, and does P.I.A. have a marked diminishing effect on the need for surgery?

Angioplasty, Balloon↗