[Superficial thrombophlebitis].
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Decision Trees↗
Biomedical subjects
M A Pistorius
Publications and source records attributed to M A Pistorius.
[Management of deep venous thrombosis of the lower limbs].
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Bandages↗
[Determination of reference temperatures for a cold test in digital plethysmography].
BACKGROUND: The purpose of this study was to determine optimal warm and cold temperatures for performance of a cold test. METHODS: Thirty-six healthy volunteers (22 women and 14 men; mean age 40, 94 years, range: 20-58) were included in the study. Plethysmographic signal amplitudes were evaluated at different temperatures (47, 45, 43, 40, 35, 20, 15, 13, 11 and 9 degrees C) under standardized conditions, using digital strain-gauge plethysmographic (Perivein Janssen). Reproducibility was assessed by repetition in the same subject of six digital plethysmography signal measurements at 45 degrees C performed at different times and days. Clinical tolerance was estimated according to an analogue scale. RESULTS: Maximal warm amplitude was obtained at 45 degrees C and maximal vasoconstriction at 13 degrees C. The thermal test was well tolerated for the temperature range between 11 and 45 degrees C. Reproducibility of the measurements was satisfactory. CONCLUSIONS: 45 degrees C is the non-nociceptive reproducible vasoparalyzing reference temperature, allowing measurement of maximal digital circulatory capacities. 11 degrees C should be adopted as the optimal vasoconstriction temperature for performance of a cold test.
Adult↗
[Coarctation of the subrenal abdominal aorta revealed by aortic thrombosis].
The authors report the case of a 44 year-old female patient with no particular history who presented with a suddenly occurring severe ischemia of the lower limbs during exercise which revealed a total thrombosis of the subrenal abdominal aorta. Angiography confirmed the diagnosis and demonstrated a partial compensation of the lesion by an important collateral network developed from the parietal and mesenteric arteries. Ultrasonography and computerized tomography showed an extensive coarctation of the abdominal aorta. The main visceral (particularly renal) arterial branches were not involved. The pathologic subrenal aortic segment was surgically resected, and a prosthetic aortobifemoral bypass provided. The further course was marked by several occlusions of the low anastomoses by fibrous hyperplasia. Coarctation of the abdominal aorta is briefly reviewed. This disorder is infrequent, and its infrarenal form can be compatible with a normal life. It can be revealed late, particularly when a thrombotic complication occurs.
Aorta, Abdominal↗
[Respective evaluations of mechanical and vascular factors in the pathogenesis of neuroacropathy].
The purpose of this study was to determine the respective contributions of microcirculatory dysfunction and mechanical stresses to the pathogenesis of neurogenic trophic lesions. All patients with polyneuropathy complicated by cutaneous or osteoarticular trophic lesions (perforating forefoot ulcers, neurogenic osteoarthropathy) were eligible for the study. Patients with vascular, articular or neurological disorders other than the polyneuropathy were excluded. Digital photoplethysmography was used to evaluate microcirculatory reactivity. Electronic podometry was performed for static and dynamic foot pressure studies. A technetium-99m bone scan was done to look for evidence of neurogenic osteoarthropathy. The study included 35 patients (16 with alcohol abuse, 7 with diabetes mellitus, 10 with both disorders, one with Charcot-Marie-Tooth disease, and one with neuropathy of unknown etiology). Cutaneous or osteoarticular trophic lesions were correlated with the presence of static podoscopic abnormalities (dynamic abnormalities apparently had no influence per se). Digital vasoplegia was found in 8 of 35 patients (23%) and was closely correlated (p < 0.0001) with severity of the osteoarthropathy. These data suggest that mechanical factors play the central role in the production of neurogenic trophic lesions and that microcirculatory dysfunction may be a marker for severe neurogenic osteoarthropathy rather than a causative factor.
Adult↗
[Deep venous thrombosis and cancer. A one year evaluation of etiologic screening of patients hospitalized in Internal Medicine].
The aim of this study was to evaluate over one year the minimal etiologic screening carried out on each patient hospitalized in Internal Medicine for a deep venous thrombosis (DVT) and to search for clinical features possibly relating thrombosis to neoplasia. 53 patients (27 male and 26 female; mean age 63.6 years, range: 18-19) with DVT of the lower limbs were included in the study. The initial etiologic screening consisted of a complete clinical examination, a biological assessment (blood cell and platelet count, Activated Partial Thromboplastin Time, inflammation and liver investigations), a radiography of the thorax and abdomino-pelvic ultrasonography. This etiologic screening was evaluated one year after the thrombotic event. The initial assessment was positive in 44 cases (83% of the patients), 9 thrombosis remained unexplained. Neoplasia was identified in 8 cases (15% of the patients), the diagnosis being often evoked at the time of interrogation or during the clinical examination; the systematic biological assessment only revealed an etiology in one case: this was a primary thrombocythemia discovered by platelet count. On evaluation one year later, amount the 9 DVT unexplained by the initial screening, 8 remained totally unexplained. On the other hand, a cancer of the colon revealed by proctorrhagia during oral anticoagulant treatment, had been undiscovered. No significant difference was found between the two groups (cancers and noncancerous etiologies) as concerns age, sex, thrombus topography, the side affected or the embolic events. However, the occurrence of subsequent thrombosis under well controlled anticoagulant treatment clearly characterises thrombosis associated with neoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Cerebral atrophy of vascular origin in the course of neurofibromatosis].
The authors report the case of a 39-year-old woman with type I neurofibromatosis who presented a right incomplete proportional hemiplegia which progressively worsened over a 6-month period. Left hemispheric atrophy with heterogeneous features, predominant in the temporoparietal region, was revealed by computerized tomography. Atrophy was associated with diffuse vascular lesions in the distal part of the left sylvian and anterior cerebral arteries, leading to major cortical hypoperfusion. Vascular examination showed no hypertension nor any sign of arterial involvement in another region. This case illustrates the nature of vasculopathy associated with neurofibromatosis. Its expression is polymorphous, with lesions inducing stenosis (the most common ones), aneurysmal lesions or veritable angiodysplasias (either hypo- or hyperplastic). The vascular expression of neurofibromatosis is often overlooked. However, in the presence of an inexplicable occlusive or aneurysmal vasculopathy, it is advisable to search for signs of neurofibromatosis since ill-defined forms exist.
Adult↗
[Importance of the Allen test in the diagnosis of distal arteriopathy in Raynaud's phenomenon. Prospective study on a continuous series of 576 patients].
From a prospective study concerning 576 patients with Raynaud's phenomenon, the authors studied the results of Allen's clinical test and their etiologic significance. These results were compared to those obtained by the instrumental technique using the Doppler probe to locate and compress radial and ulnar arteries and digital plethysmography to measure the effects of this compression. This instrumental technique makes it possible to investigate hand vascularization when Allen's clinical test is non interpretable or impossible which corresponds to 30% patients. A pathological Allen's test, whether it be clinical or instrumental, rather favors a Raynaud's syndrome (p < 10(-4)). The absence of ulnar vascularization was the abnormality most often noted and was rather found in severe Raynaud's phenomena, the sclerodermatous particularly (p < 10(-4)).
Adult↗
[Comparative study of the efficacy of a low dose of antivitamin K and a preventive dose of low molecular weight heparin in the prevention of relapses of deep venous thrombosis after curative treatment in the aged subject].
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4-Hydroxycoumarins↗
Plethysmographic cold test for diagnosis and evaluation of the severity of Raynaud's phenomenon. Validation of the method by factorial analysis of correspondences in 541 patients.
The purpose of this study was to analyze the reactivity to cold in a series of 541 patients with Raynaud's phenomenon and to search for possible correlations with the functional severity and the etiologic diagnosis of the acrosyndrome. Digital reactivity to cold was quantified by a plethysmographic cold test performed under standardized conditions, using mercury-strain-gauge plethysmography. The functional severity of Raynaud's phenomenon was assessed by the weekly frequency of attacks during winter. Topographic evaluation of the acrosyndrome sought to determine the possible extension of attacks to the thumb. Factorial Analysis of Correspondences indicated a high correlation between the intensity of reactivity to cold and the frequency of thumb involvement (p = 0.0001) or the weekly frequency of attacks during winter (p < 10(-4)). There was also a close dependence between reactivity to cold and the etiologic diagnosis of the acrosyndrome (p < 10(-4)). Significant correspondences were found between mild or major types of reactivity and primary Raynaud's disease, between very severe reactivity to cold and scleroderma. This study contributes to a clinical validation of the plethysmographic cold test. During Raynaud's phenomenon, it is indicative of clinical severity and can in a certain way guide the etiologic diagnosis, particularly concerning the risk of scleroderma.
Adolescent↗
[Comparative study of digital vascular reactivity as a function of sex].
The authors have studied the vasomotor status and digital vascular reactivity to cold in a series of 37 healthy volunteers (18 women and 19 men; mean age 30.6 years, range: 24-34) using digital mercury strain-gauge plethysmography. Correlations between digital blood flow and sex or other individual parameters (height, weight, smoking habits ...) were particularly looked for. Women's digital vascular tone evaluated under standardized conditions was found superior to men's, thus corroborating clinical and experimental data reported in literature. On the other hand, vasculotropic digital reactivity to local cooling was found similar in women and men. Moreover, no visible effect of local cooling was evidenced on the non-tested contralateral hand, suggesting the absence of significant general sympathetic influence during local cooling test.
Adult↗
[Evaluation of posturally-induced vasomotor reflexes of the leg in the healthy subject].
The authors' aim was to assess, using a routinely usable methodology, the distal vasomotor reflexes induced by postural changes of the lower limbs in 36 healthy volunteers (18 women and 18 men, mean age: 22.3 years, range 19-26). These distal vasomotor changes were recorded on the great toe using mercury-strain-gauge plethysmography. In the first step, the authors have measured the veno-arterial reflex obtained by elective lowering of the leg, the subject lying strictly horizontally under standardized conditions. Secondly was assessed the distal vasomotor reflex due to orthostatism (seated position, legs hanging). Correlations between these postural reflexes and height, weight, sex, length of the lower limbs, femoral venous diameters assessed by echography were studied. The veno-arterial reflex obtained by elective verticalization of the leg (0.68 +/- 0.21) corresponds to a 32% mean decrease in the amplitude of the plethysmographic recording as compared to the initial amplitude in horizontal position. It is all the more marked as the subject is male and the leg is long, thus inducing a equivalent change of hydrostatic venous pressure during verticalization of this part of the limb. On the other hand, this adaptative reflex appears all the more intense as the basal vascular tone in horizontal position is low. Passing to orthostatism induces a distal vasoconstriction corresponding to a 51% mean decrease in the amplitude of the plethysmographic signal as compared to the initial basal amplitude. This general reflex, playing a part in the keeping of hemodynamic conditions when passing to orthostatism, appeared significantly correlated to the diameter of the common femoral vein when the subject is lying horizontally.
Adult↗
[Pelvic phlebitis presenting as paradoxical arterial embolism].
The authors report the case of a 24-year-old woman with paradoxical embolism of the right arm subsequent to childbirth. Patent foramen ovale was diagnosed by right cardiac catheterization and contrast echocardiography. On the basis of clinical, immunoscintigraphic and radiologic data, the pelvic region was the only possible origin of the embolic process. The main interest of this case is that arterial ischemic signs were indicative of an embolic process of pelvic origin diagnosed by scintigraphy using radiolabeled antifibrin antibody.
Adult↗
[Arterial embolic manifestations in the legs revealing isolated aorto-iliac Takayasu's disease].
The authors report the case of a 30-year-old woman with Takayasu's disease revealed by acute leg ischemia and complicated by abortion during the fourth month of pregnancy. Clinically suspect lesions were confirmed by angiography showing a severe stenosis at the aorto-iliac bifurcation complicated by overlying mild ectasic lesions and a large thrombus. A total occlusion of embolic origin was noted in the right popliteal artery. An attempt to open up the thrombosis at the bifurcation led unfortunately to massive rethrombosis requiring implantation of an aorto-iliac prosthesis. Histopathological examination of the aortic surgical specimen indicated Takayasu's disease; the placenta showed multiple infarcts. The complete angiographic study revealed no arterial involvement in any other region. Five months after the initial operation, rapid development of claudication in both lower limbs suggested stenosis at the prosthesis implantation sites which was confirmed by angiography. Initiation of general corticosteroid therapy led to partial remission in less than two weeks. The unusual feature in this case was the revelation of the affection by distal arterial embolic manifestations, which have been reported only exceptionally in the literature. Moreover, isolated involvement of the aorto-iliac bifurcation constitutes a rare form of Takayasu's disease. With respect to therapy, the implantation of a prosthesis was complicated by severe stenoses of the junction zones, which is unfortunately an event in the course of this affection. The normality of biologic inflammation studies did not suggest an initial need for corticosteroid therapy, especially in the case of an isolated arterial manifestation.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Spontaneous↗
[Aortic thrombosis during acute endocarditis caused by Staphylococcus aureus].
The authors report a case of acute bacterial (Staphylococcus aureus) endocarditis in a 70-year-old woman, revealed by a febrile cerebral ischemic accident. Ultrasonography confirmed the presence of a large posterior mitral valve vegetation interfering with left ventricular filling. The sudden onset of complete paraplegia and acute ischemia of the lower limbs suggested thrombosis of the abdominal aorta, which was confirmed by aortography. These features indicated that a vegetation fragment had migrated, obstructing the aortic bifurcation and causing secondary thrombosis. This led in turn to involvement of the medullary arteries and the onset of paraplegia. Unfortunately, acute renal insufficiency and major left heart failure rapidly developed, and the patient died. Autopsy confirmed the diagnosis of aortic thrombosis with involvement of the renal arteries. Multiple visceral infarcts were noted as well as the large mitral vegetation. This case illustrates the potential severity of systemic embolism complicating endocarditis due to Staphylococcus aureus. The accident was remarkable because of the aortic acute occlusion and the association with paraplegia, an unusual neurologic complication.
Acute Disease↗
[Ehlers-Danlos syndrome type IV, revealed by a primary dissecting aneurysm of the left subclavian artery].
The authors report an unusual dissecting aneurysm of the left subclavian artery occurring in a patient suffering from the Ehlers-Danlos syndrome. Clinical history and skin biopsy permitted this diagnosis. Surgical treatment associated resection of the aneurysm, ligation of the proximal part of the subclavian artery and a prosthetic bypass between carotid and subclavian artery. Spontaneous dissecting aneurysm is a rare disease and one must think before surgery to arterial dysplasia. Technical features of the surgical treatment are discussed.
Adult↗
[Results of 81 supra-articular femoro-popliteal bypasses using PTFE].
The indications for supra-articular prosthetic bypass is still a controversial subject in cases where the internal saphenous vein can be used, or in stage II cases. These bypasses cannot be performed unless they are as permeable as venous bypasses and do not greatly increase the risk of exaggerating the symptomatology in case of thrombosis. In order to evaluate the outcome of these bypasses, we evaluated retrospectively our series of 81 surpa-articular femoro-popliteal prosthetic bypasses performed between 1987 and 1989. The man age of the patients was 64 years and 38% of them had coronary artery disease. Forty-six bypasses (57%) were performed in advanced stage II patients, 20 in stage III patients (25%) and 15 in stage IV (18%). Mean follow-up is 42 months. At 36 months, primary overall permeability was 65%. This level of permeability is in agreement with the data in the literature and is independent of the initial clinical stage, the downstream arterial network and the size of the prosthesis. The outcomes observed in our series would favour use of P.T.F.E. in the first intention operation to save the vein for possible subsequent use at stages III and IV. Inversely, for stage II, prospective randomized studies should be conducted in order to compare endovascular techniques and medical treatments.
Adult↗