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Biomedical subjects

J M Coget

Publications and source records attributed to J M Coget.

At least 19 recordsLinked to original sources
PubMed1990

Hyperbaric oxygen therapy in chronic vascular wound management.

Many nonhealing tissues are hypoxic, with oxygen tensions frequently ranging from 5 to 15 mmHg. In such an environment, the normal wound healing sequence is disrupted or halted and phagocytic killing activity depressed. So the adjunctive use of hyperbaric oxygen (HBO), based on physiologic data and clinical observations, can provide the substrate necessary to initiate and sustain the healing process. During a twelve-month period, 20 patients with a nonhealing wound were referred to the hyperbaric center: chronic arterial insufficiency ulcers in 9 cases, diabetic wounds (foot lesions) in 11 cases. Adjunctive HBO therapy, initiated twice a day, consisted of pure oxygen, 2.5 ATA, 90 min. The average length of sessions was 46 (15-108). Complete healing was observed in 15 of 20 cases. The wound management can be helped with the transcutaneous oxygen measurements under hyperbaric oxygen. The distal TCPO2 at 2.5 ATA pure oxygen is a reliable test to predict final outcome (healing or no change), when these values were not different in normal air and in normobaric oxygen: (table; see text) In hyperbaric oxygen therapy, when the distal TCPO2 value was inferior to 100 mmHg, all patients showed either no improvement or aggravation, and when the value was higher than 100 mmHg, wound healing was achieved with all patients.

Blood Gas Monitoring, Transcutaneous↗
PubMed1990

[Hyperbaric oxygen therapy in the treatment of wounds, in plastic and reconstructive surgery].

After recalling the mechanism of action of hyperbaric oxygen (HBO) on healing processes, the authors review the principal indications for this technique in plastic and reconstructive surgery, such as crush injuries and acute post-traumatic ischemia of the limbs, skin flaps and skin grafts, when there is a risk of their not taking, and burns. They stress the importance of strict, stratified therapeutic protocols with control of the hyperoxygenation induced by HBO. In the authors' experience, transcutaneous measurements of the partial pressure of oxygen under the hyperbaric atmosphere is a very useful method with a predictive value to determine the indications for treatment with HBO and to monitor its effects.

Blood Gas Monitoring, Transcutaneous↗
PubMed1989

[The value of studying the ocular conjunctiva in case-finding in prediabetic states].

Capillaroscopy, the only method available for the study of the microcirculation, without modifying its hydraulics, often provides a wealth of information in certain systemic diseases in which the microcirculatory involvement precedes clinical manifestations and of course, macrovascular complications. The prospective study of a healthy population is particularly demonstrative and the authors proposed scores on which diabetic microangiopathy could be suspected. The latter was confirmed by detailed laboratory investigations on one hand, and by the course of the disease on the other. For this reason, any subject at risk of diabetes should undergo at least one annual capillaroscopic examination of the ocular conjunctiva or if not, of the peri-ungual region. Furthermore, the study of microvessels in subjects with controlled and treated disease showed a regression of the anomalies which depended on proper control of diabetes, and this particularly nontraumatic test procedure which can be repeated and provides a wealth of information, can give a good reflection of proper therapeutic control, especially if it is performed by a trained and experienced investigator.

Capillaries↗
PubMed1987

[Raynaud's phenomenon and finger necrosis after treatment of ovarian seminoma with bleomycin, vinblastine and 5-fluorouracil].

Bleomycin is sometimes at the origin of a Raynaud's phenomenon (RP). From the literature, there does not seem to exist a dose-dependent relationship. The phenomenon occurs early or late and often is resistant to various medications. The possible physiopathological mechanisms are: direct vascular toxicity, hypersensitivity vascularization, alteration of platelets activity, alteration of Willebrand's factor, and as predisposing factors: association to periwinkle alkaloids or hypomagnesemia.

Adult↗
PubMed1987

[Flushes, blushing or hot flushes].

Apart from physiological flushes represented by emotional or prudish blushing, post-prandial flushes and menopausal hot flushes, various pathologic flushes exist of various etiologies: endocrine, dysmetabolic, histaminic and iatrogenic. Their pathogenicity is based mainly on local metabolites secretion provoking vasodilatation of the intermediary microcirculation rather than of the terminal microcirculation. Treatment is a function of etiology and therefore of the patient's history and results of clinical examination, functional exploration and standard biologic tests.

Blood Vessels↗
PubMedDate not supplied

[Clinical characteristics of pain in chronic venous insufficiency].

Since the report of the 1st International Conference of Phlebology at Chambéry, devoted to venous pain, the subject has scarcely attracted attention apart from the meeting of the Benelux Society of Phlebology devoted to "pain in the legs". Pain due to superficial venous insufficiency has scarcely changed in nature for 30 years and remains one of the major presenting symptoms in phlebology. Acute or chronic, punctate or diffuse, modifications in this functional symptomatology have been accentuated, or have varied in their aspects under the influence of certain fashions or certain habits of modern life, i.e.: sedentary behaviour, underfloor heating, the use of oral contraceptives or of menopausal hormone replacement therapy. However, the distribution of the various aspects of venous pain remains in the same proportions as those described by the authors cited previously. While the etiological diagnosis must essentially eliminate all other causes: arterial, neurological, muscular, articular, it is essential not to neglect deep venous insufficiency of the gemellar veins, often responsible for a wide range of symptomatology and still all too often neglected. The pathogenesis of this pain not only involves the concept of pain receptors but also the appearance of algogenic metabolites at the site of the microcirculatory unit, to which endothelial cells are particularly sensitive during stasis. In fact, pain is the expression of disorders concerning local exchanges, whether thermal, pressure, metabolic or hemorheological. It is the alarm bell of venous insufficiency and merits the attention of the phebologist who must thus undertake active treatment before problems become irreversible.

Chronic Disease↗
PubMedDate not supplied

[Hyperbaric oxygenation therapy and cicatrization].

HOT is a very useful therapeutic addition in chronic wounds presenting a healing problem and for which usual treatment were unsuccessful. In order to be fully effective, HOT must be included in a strategy of care, taking into account, not only the wound itself but the underlying disease. Peripheral delivery of oxygen and induction of tissue hyperoxygenation with HOT may be verified by measurement of the TcPO2 under HOT. The predictive value of these measurements is helpful in the decision for treatment and its management.

Aged↗
PubMedDate not supplied

Microcirculatory unit. Actual news.

The microcirculatory unit is the localization of important exchanges. Any disturbance in the state of equilibrium, though at first functional, quickly becomes organic. This imbalance can appear at the level of the secretion of prostaglandin modification of the capillary permeability, which may be the consequence of Paf Acether secretion. Free Radical release can disrupt the normal functioning of the cell wall. Venotonic drugs act at this level, assisting the return to normal histochemical equilibrium.

Capillaries↗
PubMedDate not supplied

[The compartment syndrome].

The compartment syndrome is in fact secondary to intracompartmental hypertension which creates ischemia of the muscles, nerves, vessels, and anterior tibial and peroneal arteries in the leg. Described in the 19th century, the clinical picture is better known when progressing either in the acute form or in the chronic form. Diagnosis depends basically on the measurement of intramuscular pressure; treatment, at least initially, apart from subcutaneous aponeurotic decompression, also calls for hyperbaric oxygen therapy. The latter is particularly indicated in those cases bordering on surgical and medical treatment, for preventing deterioration and improving muscular possibilities in the post-surgical period. At the present time, the physiopathology of the condition is still poorly understood. The whiplash syndrome was well described by Martorelli and is due to rupture of the muscular veins of the calf. The clinical picture is often ambiguous and can suggest underlying phlebitis. The triad of symptoms --pain, disability and ecchymosis-- generally enables a diagnosis to be made, with treatment consisting primarily of immobilization. As for Bywaters' syndrome (crush syndrome), it is still very topical. The original description of the clinical picture by Bywaters during the bombardment of London in 1942 has been replaced by the picture resulting from large scale accidents that are part of modern society. The picture is still highly dramatic and if untreated progresses to acute renal insufficiency. Treatment has certainly changed and hyperbaric therapy (administered at two or three atmospheres) is a valid adjuvant to basic treatment and modifies the progress of the phenomenon with entirely satisfactory results.

Compartment Syndromes↗
PubMedDate not supplied

[Drug therapy of angiolopathies].

The treatment of angiolopathies is rather difficult, at this time, at least concerning functional angiopathies. It is a fact that protection against cold represents, in all angilopathies, one of the main elements of the treatment besides medications which are essentially vasoactive drugs, myorelaxants or alpha-blockers, and possibly venous tonics. Fluorescein or Sodium fluoresceinate at 5%, administered in slow intra-venous injections, represents one of the best treatment of acrocyanosis, in combination with vitamins A and D, given at the beginning of fall. Other angiolopathies, especially those of organic nature, are represented by allergic vascularitis and will be treated accordingly. In infectious and toxic forms, antibiotics should be prescribed in addition to steroids, preferred in allergic forms, especially granulomatous forms. In conclusion, the treatment of angiolopathies is extremely difficult, and must be particularly adapted to the clinical forms.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

[The role of support in the prevention of venous thromboses of the lower limbs].

Support and exercise has long been accepted as a mechanical method of preventing venous stasis. In recent years the role of the venous endothelium in the pathogenesis of thrombosis has been emphasised. The trouble occurs at the level of the microcirculation. Given the delicate balance at that level, it is easy to appreciate how various antagonistic systems (serotonin, quinine, etc.) can be easily distorted. Elastic support helps prevent these endothelial changes.

Clothing↗
PubMedDate not supplied

[Aging of veins and venules].

There is a distinction between natural ageing and excessive ageing. The problem is not only vascular, it is above all interstitial conjunctival; it is located in the trunk wall and in the initial collector walls; the capillary-venular section is, from this point of view, just a unit of structure and function. The clinical and anatomopathological aspects of venous ageing are known: they are those of phlebosclerosis and deposits of proteoglycanes, the lesions are non-homogenous, dispersed and constantly changing. The elderly patient lives in a state of stasis. Stasis creates exaggerated and uncontrollable histangic neogenesis, it is the backcloth of "micro-angiopathy of senescence", but if the membrane thickens, it is in order to counter the ill effects of stasis; it is a control reaction not one caused by lesion. It is vital to establish an analogy between vascular ageing and "plastic" ageing, the process of polymerization is the same and we shall produce the evidence of this on another occasion.

Aging↗