[Hypolipidemia in myeloma].
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Albuminuria↗
Biomedical subjects
J N Fiessinger
Publications and source records attributed to J N Fiessinger.
Infrarenal aortic stents: initial clinical experience and angiographic follow-up.
From March 1990 to May 1991, arterial stents were placed in seven patients because of a tight stenosis (five patients) or a total chronic occlusion (two patients) located in the infrarenal aorta. In one case, the aortic occlusion extended to both common iliac arteries. After balloon dilatation, aortic stents were successfully positioned in all cases. Bilateral common iliac recanalization and stent placement were performed in one case. No complications occurred in any of the patients. No complications occurred in any of the patients. Follow-up data were derived from clinical assessments and angiographic results. After a 15.1-month mean follow-up period (range 12-24 months), the seven aortic stents remained patent. Three iliac artery procedures were performed in two of the patients as well. Claudication recurred in three of the seven patients which was related to a common iliac occlusion (one case) or distal progression of atherosclerosis (two cases). Aortic stents seem to be suitable for treating failed angioplasty of aortic lesions but the procedure remains technically difficult when there is associated severe atherosclerosis of the proximal common iliac arteries. Nevertheless, considering the morbidity rate (0%) and the patency rate in this series, this technique could become an alternative to surgical treatment for infrarenal aortic occlusive lesions.
Angioplasty, Balloon↗
[Identification of persons with high risk of venous thrombosis].
The aim of identification of patients with high risk of deep venous thrombosis is a selective and more efficiency prophylaxis. Deficiencies of coagulation inhibiting and fibrinolytic proteins are implicated in less than 10% of patients. However there are several clinical situations with an increased risk of thrombosis. Thus the characterization of blood abnormalities as screening tests for the diagnosis of patients at risk is an important goal.
Adult↗
[Phlebitis of the lower limbs: from suspicion to diagnosis].
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Humans↗
Follow-up electron beam CT for the management of early phase Takayasu arteritis.
PURPOSE: The purpose of this work was to assess typical findings of Takayasu arteritis on serial CT examinations following therapy. METHOD: Serial CT studies were performed on 16 patients with early phase Takayasu arteritis. Mural or luminal changes of the aorta on successive CT scans were compared with clinical data. RESULTS: Vascular lesions progressed during follow-up in 6 of 16 patients. In one patient, progression of lesions was symptomatic. In the other five of six patients with worsening lesions, vascular progression occurred without new clinical symptoms and was first identified on CT scans. One of these five had dilatation of the ascending aorta and required aortic repair. Four others had progression of stenotic vascular lesions leading to changes in medical treatment only or in combination with either surgery or angioplasty. For two of them, CT examinations showed decreased mural lesions after changes in medical treatment. CONCLUSION: CT examinations performed in treated patients with Takayasu arteritis demonstrate either regression, stabilization, or progression of vascular lesions. Serial CT examinations may thus be useful for evaluating response to treatment.
Adult↗
Systemic arterial compliance in patients with arteriosclerosis obliterans of the lower limbs. Observations on the effect of intravenous propranolol.
Hemodynamic parameters and systemic arterial compliance were measured in patients with arteriosclerosis obliterans of the lower limbs before and after acute administration of propranolol. Arterial compliance was evaluated from a simple viscoelastic model, enabling the calculation of diastolic drainage and diastolic blood flow as indices of the reservoir role of the larger arteries in overall circulation. In comparing basal conditions with normal subjects of the same age, patients with arteriosclerosis obliterans exhibited a significant decrease in arterial compliance (p less than 0.01) and heart rate (p less than 0.02) with a significant increase in systolic pressure (p less than 0.001). Diastolic drainage was increased (p less than 0.01) and was positively correlated with diastolic time (r = 0.73, p less than 0.001). Diastolic blood flow remained within normal ranges (52 +/- 2 vs 49 +/- 3 ml/m2/sec). After acute propranolol intravenous administration, heart rate and stroke volume decreased (p less than 0.001), while total peripheral resistance increased (p less than 0.001). Systemic arterial compliance and diastolic blood flow significantly decreased (p less than 0.01). The study provided evidence that in patients with arteriosclerosis obliterans, the diastolic blood flow was maintained in basal conditions despite the observed reduction in arterial compliance, and that intravenous propranolol administration decreased systemic arterial compliance and diastolic blood flow.
Adult↗
Regional compliance of brachial artery and saline infusion in patients with arteriosclerosis obliterans.
Simultaneous brachial artery pressure and blood flow measurements were made in 15 patients with arteriosclerosis of the lower limbs (AOLL) and in controls of the same age and sex. Blood flow was evaluated by a pulsed Doppler device with a double-transducer probe. From analysis of the pressure-flow curves during diastole, regional arterial compliance (RAC) was determined by using as a model of the forearm arterial tree a system of tubes, each with a storage capacity, in series with the arteriolar resistance vessels. In AOLL patients, RAC was significantly reduced (102 +/- 13 vs 173 +/- 14.10(-4) ml/mm Hg, p less than 0.01), and systolic pressure was significantly increased. After saline infusion, systolic pressure continued to increase and arterial compliance, to decrease; brachial blood flow did not change. Study of the baroreflex sensitivity in AOLL patients under basal conditions indicated that a higher pulse pressure was required to obtain the same heart rate as in the controls. The study provided evidence that in AOLL patients: 1) compliance was reduced in the brachial artery (a regional circulation with no clinical evidence of arterial occlusion); 2) an increase in systolic pressure resulted from the decreased arterial compliance; and 3) saline infusion exaggerated the observed reduction in arterial compliance and increase in systolic pressure.
Aged↗
Intermittent treatment with streptokinase in arterial disease of the limbs.
Sixty-two patients with arterial disease of the lower limbs were treated with streptokinase by intermittent administration. All patients had experienced recent aggravation of their arterial disease, and 22 had thrombolysis confirmed by arteriography. In 20 cases clinical study showed repermeation--in 8 cases during the first perfusion and in 8 cases during the third perfusion. During the first perfusion the fall in fibrinogen was significantly greater in the 8 patients with thrombolysis. Further, the third perfusion corresponded to a new phase of fibrinogenolysis. These results support the possibility of the relationship between plasminemia and thrombolysis, and emphasize the limits of the classic theory of Sherry, Fletcher, and Alkjaersig. Permitting phases of repeated but limited plasminemia, the interruption method used here is a compromise between the risk of hemorrhage and the efficacy of treatment at low dosage.
Angiography↗
[Psychological factors associated in smoking cessation in patients with arterial occlusive disease of the legs].
Few studies have focused on psychological factors involved in the course of peripheral atherosclerosis, particularly in smoking cessation, which is a major point in the outcome of the disease. In this view, we assessed in 19 men hospitalised for intermittent claudication, some personality and emotional characteristics associated with the patients' recent smoking behaviour. Patients included tend to have high scores of state-anxiety and alexithymia (with difficulty to identify and express their emotions), and to benefit from an efficient social support made of few persons. Concerning the smoking behaviour from the past six months, only 8 subjects stopped smoking and 13 subjects made an effort in this way, despite relatively low nicotine dependence scores, severe peripheral atherosclerosis with frequent erection disorders, and awareness of the importance to stop smoking to improve the outcome. Presence of erection disorders, and eventually higher alexithymia scores, may facilitate the smoking cessation. The main reasons explaining the difficulty to stop smoking don't seem to be pharmacologically induced, neither a denegation of the bad effects of smoking on outcome, but more surely a psychological and complex dependence. It would be essential to assess more precisely the psychological characteristics of the patient to propose more efficient treatment.
Adult↗
[Round table on the methodology of clinical evaluation of prostaglandins in the treatment of arteriopathies].
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Clinical Trials as Topic↗
[Antithrombin III in 86 patients with venous thrombosis (author's transl)].
Antithrombin III concentration was studied in 86 patients with recurrent or extensive venous thrombosis. Two of them were found to have an hereditary antithrombin III deficiency. 25 patients receiving heparin therapy had low antithrombin III concentration. After stopping heparin treatment antithrombin rose to a normal level. Pathological antithrombin III modifications are recalled (synthesis decrease in liver diseases, intra vascular consumption during active venous thrombosis). Antithrombin III decreased activity induced by heparin treatment is pointed out.
Antithrombin III↗
[Treatment of deep venous thrombosis. Comparative study of a low molecular weight heparin fragment (Fragmin) by the subcutaneous route and standard heparin by the continuous intravenous route. A multicenter study].
This open, randomised multicenter trial compares the efficacy and safety of Fragmin administered subcutaneously twice daily with standard heparin administered by continuous infusion in the treatment of deep vein thrombosis (DVT). The initial dose of Fragmin is 100 U anti-Xa/kg/12 h and the further doses are adjusted according to the anti-Xa activity between 0.5 and 0.8 U/ml, 3 hours after the morning injection. The initial dose of standard heparin is 240 UI/kg/12 h. The dose adjustments are based on the daily results of APTT (1.5 - 3 times the control). Treatments efficacy are appreciated when comparing the venography performed before and after 10 days of treatment. The safety is evaluated on clinical parameters and iterative biological tests. Sixty-six patients have been included in this study. Efficacy of the two treatments is equivalent with a phlebographic improvement in respectively 79.3 p. 100 (Heparin Group) and 71.0 p. 100 (Fragmin Group) of the cases and an aggravation in 3.4 p. 100 and 6.4 p. 100 (NS) respectively. The frequency of dosage adjustments is lower and the stability of biological tests is better in the Fragmin group. In conclusion, the administration of Fragmin twice daily by subcutaneous route seems to be equivalent at least to standard heparin continuous infusion in the treatment of recent DVT. The better convenience and safety of Fragmin have to be verified on a larger panel of patients.
Adult↗
Peripheral artery thrombolysis with urokinase-lys-plasminogen. A disappointing experience.
Thirty-five patients with peripheral arterial occlusion were treated by intra-arterial infusion of low dose urokinase associated with bolus of lys-plasminogen. Systemic fibrinolysis was moderate, thrombolysis was achieved in 26 patients (74%). Only one patient required blood transfusion, five patients (14%) had distal emboli. Infection at the catheter entry site occurred in 2 patients, 3 patients experienced proximal embolism. Six patients required leg amputation, 4 died, in 2 of them deaths were related to arterial catheterization. Local thrombolysis with limited systemic fibrinolysis is associated to a high rate of catheter-related complications.
Adult↗
[Anticoagulant treatment with fluindione. Relation between the decrease of vitamin K-dependent factors and blood fluindione].
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Adult↗
[Results of thoracic sympathectomy in the treatment of Raynaud's phenomenon].
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Adolescent↗
[Multiple arterial lesions in von Recklinghausen's disease. A case].
Arterial lesions are thought to be rare in neurofibromatosis. In the case reported here full vascular exploration demonstrated diffuse lesions of the aorta, splenic artery, renal arteries, left internal carotid artery, right common iliac artery and arteries of the legs. This underlines the usefulness of thorough angiographic exploration when arterioplasty is envisaged in a patient with neurofibromatosis. Microscopic examination of an arterial biopsy specimen showed fibrodysplasia of the media associated with hyperplasia of the periarterial nerves, thus confirming that the lesions involved tissues of both mesodermal and neuroectodermal origins.
Adult↗
[Spontaneous pneumoperitoneum in scleroderma].
A spontaneous and asymptomatic pneumoperitoneum was observed in two women presenting with pseudoileus resulting from severe gastrointestinal involvement in progressive systemic sclerosis. In the first case, pneumoperitoneum was associated with pneumatosis cystoides intestinalis and remained unchanged during 3 years. As obstruction resisted to medical management, surgery was performed; however at laparotomy neither perforation nor obstruction of the bowel could be found; the patient died during the postoperative course. In the second case, pneumoperitoneum disappeared after medical management of low-grade intestinal ileus but the patient died 6 months later because of cardiac failure. Autopsy revealed major distention of the bowel but failed to show any signs of perforation. These findings show that, in progressive systemic sclerosis, pneumoperitoneum can occur in the absence of digestive perforation and that surgery is not required. However this complication seems to carry a very poor prognosis.
Aged↗
Streptokinase after late failure of reconstructive surgery for peripheral arteriosclerosis.
After the failure of reconstructive surgery for arterial occlusions of the lower limbs, 25 patients with severe ischemia were treated with streptokinase (SK) to avoid amputation of the limbs and sometimes death, in the absence of any other possible treatment. In 16 subjects, thrombolysis, assessed by the Doppler ultrasound technique, occurred rapidly; in 12 cases, SK combined with surgery or with symptomatic medical treatment gave good results saving limbs and improving the quality of life. Three of the 16 patients died from a cerebral vascular accident which occurred before the 10th hour. Whatever the type and the number of surgical operations performed before the use of SK, the indications and the results of the treatment are governed by the condition of the vascular tree below the arterial lesions. SK seems to be justified in endarterectomy or venous grafts with severe ischemia less than two months old. For dacron by-passes, the possibility of prosthesis dissection makes SK debatable in spite of frequent lysis. In axillofemoral by-passes, the risk of embolism of the upper limbs makes the use of SK inadvisable.
Adult↗