[Effect of adrenaline on muscle blood flow in chronic arterial diseases of the lower limbs].
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Arm↗
Biomedical subjects
H Boccalon
Publications and source records attributed to H Boccalon.
[Cost effectiveness of Doppler-echocardiography in the diagnosis of deep venous thrombosis of the lower limbs. Theoretical calculation from a prospective series of 511 patients].
The management of deep venous thrombosis has non-negligible financial implications due not only to the high frequency of clinical suspicion--and therefore to the methods used a positive diagnosis--but also to the overall cost of management. To evaluate the expenditure incurred for the diagnostic tests, 511 patients suspected of deep venous lower limb thrombosis were examined clinically, then by Duplex ultrasonography combined with plethysmography. Whenever a suspected phlebitis was detected by this method, or at random if it was not, phlebography was performed. The 185 phlebography/ultrasonography comparisons enabled us to extrapolate the results obtained to all 511 patients and thus to compare the theoretical cost of 4 decisional algorithms according to the diagnostic criteria utilized. Our conclusions were as follows: the clinical diagnosis alone is not cost-effective, whereas Duplex ultrasonography is reliable and, compared with phlebography, saves more than 1,500,000 francs per year, including 1,000,000 francs saved on the global hospital budget in France. Phlebography used in each proximal venous thrombosis for accurate localization of the upper end of the clot does not significantly increase the cost: the annual savings on systematic phlebography are still above 1,200,000 francs, including 800,000 francs to the benefit of public hospitals.
Algorithms↗
[Surface electromagnetic rheography. Index of peripheral arterial flow in man].
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Animals↗
Bone mineral decrease in the leg with unilateral chronic occlusive arterial disease.
OBJECTIVE: The links between osteoporosis and arteriosclerosis have been established by numerous epidemiological studies. Could arteriosclerosis induce bone mineral loss via ischemia or other pathological process? We carried out a comparative study of bone mineral density in both legs of patients with unilateral arterial disease of the lower limbs. METHODS: We studied 25 patients, 22 men and 3 women, whose mean age was 62.3 years (range 35-88 years). These patients had unilateral lower limb arterial disease of at least 3 months duration with a systolic index at least 50% lower on the affected than on the healthy side. Bone mineral content (BMC) and bone mineral densities (BMD) of the femoral neck, femur, tibia, foot and ankle of the affected and the unaffected legs were measured by dual x-ray absorptiometry (Lunar DPXL) and the results compared. RESULTS: Bone mineral density was significantly lower in the femur (-3.7%, p = 0.04), the foot and the ankle (-3%, p = 0.05) of the affected leg. There was a non-significant decrease in BMD of the whole femoral neck (-1.2%) and the trochanter (-4.4%, p = 0.08) on the affected side. Tibial bone mineral density was identical in both legs. Bone mineral content was lower on the affected side (-5.3%, p = 0.05) whereas fat mass and muscle mass were the same in both legs. CONCLUSION: The ischemia resulting from arterial disease of the lower limbs appears to have a direct deleterious effect on bone mineralization.
Absorptiometry, Photon↗
Plethysmographic findings in normal subjects using a capacitance mode.
A new strain-gauge plethysmographic system, Phlebotest, was evaluated in 19 normal subjects, yielding 38 lower limbs for study. A capacitance mode was used which allowed both the left and right calves to reach their maximal volume expansion before releasing the cuff pressure (60 mmHg in this study). Parameters such as the maximum volume change (V sec), the outflow rate during the first second after deflation (F 1.0), the expelled volume in four seconds (EV 4.0) and the surface area over the curve during the first four seconds after deflation (IND) were automatically calculated and their side differences between the left and right legs were determined respectively. There was a good linear correlation between EV 4.0 and V sec (r = 0.9274, p less than 0.0005) and the EV 4.0/V sec ratio was calculated. In contrast to the previous reports, between three consecutive determinations there were no significant differences in the measurements of these parameters, and V sec consistently kept an identical mean value. These results suggest that using this new system only one determination of calf expansion is required. The reason might be that, in addition to some technical improvements, the computer-controlled capacitance function can secure the optimal venous filling in every determination.
Adult↗
Detection of deep vein thrombosis with a computerized strain gauge plethysmograph.
Forty patients suspected clinically the first episode of deep vein thrombosis (DVT) were studied using a new computerized strain gauge plethysmographic (SGP) system, the Phlebotest. A capacitance mode was used to secure the obtaining of maximum venous filling before deflation in every determination. Following parameters were calculated automatically and instantly: the maximum volume change (V sec), the outflow rate during the first second after deflation (F 1.0), the expelled volume in four seconds (EV 4.0) and the surface area over the curve during the first four seconds after deflation (IND). The eighty lower limbs of the patients were divided into three groups according to the Duplex scanning results: proximal (n = 19), distal (n = 13) and no DVT (n = 48) groups. The diagnostic accuracy of the Phlebotest parameters was determined and compared with that of another widely used SGP system, the Perivein. In this case the maximum volume change and the maximum venous outflow (MVO) were calculated manually. The results of the two systems were compatible. For the detection of proximal DVT, the parameters of venous outflow were better than maximum volume change and the best single parameter was maximum venous outflow: F 1.0 for Phlebotest and MVO for Perivein. The two parameters had a similar sensitivity of 79% when 50 and 27 ml/100 ml/min were used as the lower limits of normal respectively. The best criterion for the diagnosis of proximal DVT was F 1.0 < 50 ml/100 ml/min plus the EV 4.0/V sec ratio < 60%, which had a sensitivity of 90%, specificity of 96% and overall accuracy of 94%.(ABSTRACT TRUNCATED AT 250 WORDS)
Female↗
Graduate and postgraduate teaching program on angiology in France.
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Cardiology↗
[Round table on the methodology of clinical evaluation of prostaglandins in the treatment of arteriopathies].
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Clinical Trials as Topic↗
[Photoplethysmography (PPG) or photoreflexometry (PRM): principle and reproducibility (study of the validity of the method in healthy subjects)].
Photoplethysmography, a non-invasive vascular exploratory test, has recently made great in the evaluation of venous haemodynamics. The principle of Photoplethysmography uses the cutaneous reflection of infrared light in the intradermal venous plexi. Then methods are presented for a reliable implementation of the tests. Validity of the method is verified by applying statistical tests to measurements carried out in two healthy subjects. In conclusion, Photoplethysmography may be produced, providing that the method used is strict, that three successive measurements are carried out, so that only the mean value is considered; because of the low value of the variability index of the total filling time, this parameter is used in the interpretation of the method.
Female↗
[Diagnostic value and significance of photoplethysmography in venous insufficiency].
In this study, including 62 patients, or 104 lower extremities, the author demonstrates first, with the chi-2 test, that the method based on Photoplethysmography has a good diagnostic value (sensitivity: 92%, specificity: 88%). Then, with the Student t-test, he demonstrates that the advantage of Photoplethysmography in venous insufficiency is to differentiate easily normal subjects from subjects affected with valve insufficiency, and to establish the differential diagnosis between superficial valvular insufficiency and deep valvular insufficiency. On the contrary, in analyzing the discrepancies between clinical examination and the results of Photoplethysmography, he demonstrates that the diagnosis obtained with Photoplethysmography is limited in the presence of edema, isolated varicose veins, Phlebitis and arterial disease, or during an ineffective compression of the reflux of the superficial venous system. Finally, the author suggests an approach in patients with chronic venous insufficiency, based on clinical examination, Doppler examination and Photoplethysmography.
Aged↗
Cardiovascular surgery and heparin induced thrombocytopenia.
The Authors report a series of 21 cases of heparin induced thrombocytopenia (HIT) observed in a Department of Cardiovascular Surgery. The indication for heparin treatment was a cardiac procedure in 12 cases, peripheral arterial reconstructive surgery in 3 cases and in 6 cases a prevention of embolism. Two routes were used for heparin administration: subcutaneous and intravenous injections. The diagnosis was biological on low platelet counts (p.c.) in 4 cases, in 7 cases a deep venous thrombophlebitis and in 9 cases an acute arterial ischemia complicated the heparin treatment. From the 7th to 15th day after heparin treatment the p.c. had risen to the average value of 46,857/mm3. The diagnosis was clinical in 3 cases, biological with a positive aggregation test in the presence of heparin in 11 cases out of 14 biological tests performed and pathological with observation of white clots in 11 cases. The related mortality rate to HIT was 28.5% of the cases (6 cases). HIT is a rare but severe complication often associated with thrombo-embolic complications. The routine check of p.c. before and after the first week of heparin treatment is reasonable. The negative aggregation test in the presence of heparin does not permit to confirm this diagnosis. The drop in the p.c. between the 6th to 10th day after heparin treatment required an immediate arrest of this type of anticoagulation and replacement with Coumadin. The low molecular weight Heparin may induce cross matching reactions with heparin and therefore is not used as treatment for HIT. In emergency, cardiac surgery with the use of the extra-corporeal circulation device can be performed with success with heparin (2 cases).
Adult↗
[Difficulties of functional exploration of the veins in the obese. Problems that may be posed in its interpretation].
Obesity modifies the tissular anatomy and the mechanical characteristics of the limb. Because of this, there are difficulties in the interpretation of results produced by techniques designed to explore the venous functioning of the limbs. Our work has two main objectives. First of all a retrospective study shows that venous plethysmography is comparably sensitive in the obese patient with regard to the diagnosis of phlebitis (90% in the obese patient; 95% in the non-obese). As regards specific detail, however, it is not as good in the case of the obese patient (88.7% against 97.5%). Another, prospective, study on the normal, that is non-varicose, subject (obese and non-obese), enables us to analyse parameters modified by obesity, certain false positives in venous distensibility.
Adult↗
[The immediate arterial and microcirculatory hemodynamic effects of elastic support in arteritic varices].
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Arteritis↗
[Measurement of capillary permeability in chronic venous insufficiency using sodium fluorescein video-densitometry].
The measurement of capillary permeability in chronic venous insufficiency (CVI) requires techniques able to modify local microcirculatory hemodynamics and therefore the results. As for instance, venous occlusion in the Landis test or occlusive plethysmography. We are presenting a selective method which visualizes and quantifies capillary permeability without modifying the hemodynamics. A skin area on the lower extremity is observed on a microscope with blue filters. This optical device is linked with a camera transmitting information to a TV monitor and a video cassette recording system. When focusing is done, the patient's brachial vein is injected with an IV bolus of 1 ml if sodium fluorescein (Na flu). This dye diffuses rapidly from the intra toward the extra-capillary compartment. A densitometer connected to a graph measures the capillary permeability selected dynamics. The capillary permeability to Na flu is evaluated qualitatively on the TV screen (pericapillary halo), and quantitatively by the densitometric curve. In practice, this technique is advocated in the physiopathological study of any edema, especially in early CVI.
Capillary Permeability↗
[The value of postural plethysmography in the study of venous physiology and in the evaluation of vasotonic agents].
Venous physiology is generally neglected and badly studied. Knowledge of it is nevertheless essential in pathological cases such as venous incompetence and its treatment. It is this which is principally responsible for cardio-vascular adaptation after positional changes. Mercury gauge venous occlusion plethysmography has contributed certain progress. Postural mercury gauge plethysmography without venous occlusion answers the chief physiological preoccupations. No artefact impedes the physiology. The positional adaptation is tested. A DV/DP diagram is established and compared in normal subjects and patients with venous incompetence. A complementary procedure for a microcirculatory study is proposed: the measurement of cutaneous flux using laser Doppler or photoplethysmography and a study of the permeability of the capillary walls using fluorescein videodensitometry. This veritable testing stand of the venous system can serve as reference for procedures of therapeutic tests for all medication for venous tropism (vasotonics, vasodilators of venous location) or in studies on spatial medicine.
Humans↗
[Effects of intravenous electrodes of cardiac pacemakers. Clinical and plethysmographic approach].
The authors study the haemodynamics of the endovenous electrodes of cardiac stimulators (EE) in the light of clinical and plethysmographic investigations. Seven venous thromboses were observed out of 2,000 implantations of stimulators (0.35%). The risk increases with age 7th decade) and the presence of multiple EEs. The comparative plethysmography of a series of 22 normal young subjects and 28 old patients equipped with EEs demonstrates that the deep venous return in the upper limbs of a normal subject is better in a young person and in a dominant limb. In the subject equipped with an EE, distensibility is reduced. Temporary coagulation has its place in the treatment of these phlebites (heparin, followed by calciparin). Surgery to disobstruct or excise EE or fibrinolytics are only required exceptionally.
Adult↗
[Non-invasive hemodynamic evaluation of male impotence (author's transl)].
Since male impotence may be caused by a variety or non vascular factors, more precise techniques for identifying potential operative candidates must be developed. Our protocol includes nocturnal penile plethysmography, Döppler velocity at 8 levels, penile systolic pressure, electromagnetic blood flow measurement, penile reactive hyperemia. This non-invasive protocol applied on 21 patients aims to select those who would benefit from direct penile revascularization procedures. We are studying the venous emptying rate for more complete physiologic approach.
Angiography↗
[Peripheral vasodilators: from the hemodynamic effect to clinical benefit].
Patients with chronic occlusive arterial disease of lower limbs have an excess mortality due to associated cardiovascular diseases or cancer. They also have an important morbidity with a high prevalence of coronary artery diseases and strokes. In this context, the only benefit of peripheral vasodilators devoid of any effect on morbidity and mortality, could be only on quality of life. Haemodynamic effects of these drugs have been evaluated by several reproducible techniques in order to measure the peripheral blood flow (plethysmography, 133Xe clearance, transcutaneous oxygen-pressure, electromagnetic debimetry). An increase in blood flow has been demonstrated in patients receiving pentoxifylline, naftidrofuryl, or blufomedil in phase II clinical trials using these different methods. No general haemodynamic effect has been observed with these drugs which were better denominated vaso-active drugs. However the most relevant criteria remained to confirm a clinical benefit, particularly on intermittent claudication. Number of positive clinical trials in patients with intermittent claudication have been published, but from a methodological point of view few of them were suitable and demonstrated a statistically significant benefit. Criticisms were mainly related to the type of trial (cross-over is not recommended because of the drug-period effect), the lack of 'intention to treat' analysis, the inhomogeneity of the compared groups (for example different percentages of diabetics and excess of drop-outs). In spite of an established haemodynamic effect and of a demonstrated benefit in claudicants, peripheral vasodilators appear to have a slight interest in the global care of patients with occlusive arterial disease of lower limbs mainly on functional symptoms.
Clinical Trials as Topic↗