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Biomedical subjects

M Cloarec

Publications and source records attributed to M Cloarec.

72 records · Page 4Linked to original sources
PubMedDate not supplied

[Venous pain, 30 years after the 1st International Congress of Phlebology in Chambéry].

In 1960, the first International Conference of Phlebology, organised at Chambéry by Jean Marmasse under the egis of R. Tournay included only three subjects in its programme, one of which was: "venous pain". What is the status of venous pain thirty years on? Can we compare our current concepts with work from past years? Have we advanced in knowledge and in its clinical and therapeutic applications? All these questions are even more worthy of consideration bearing in mind world-wide increased interest in Phlebology and its even richer future. The Chambéry Conference established a clear pattern with: two basic reports: "pain due to essential varicose veins and to trophic disorders" (C. Huriez, F. Desmons, M. Thoreux) and "pain in phlebitis" (R. Fontaine); three analytical and differential reports "pain due to interlinked arterial and venous disorders" (F. Piulachs), "pain in the lower limbs due to interlinked gynecological and venous disorders" (A. Bret, R. Legros) and "pain due to the association of osteoarticular and rheumatic disorders or of neuralgia in venous disease patients" (J. Forestier); and nine other studies, the following being worthy of particular attention: a very interesting report by R. Tournay: "Pain in venous disorders of the lower limbs related to their treatment"; and two papers: "pain of "cellulite" type and the metameric disposition of the lower limbs in relation to functional disorders of the ovary" (S. Bourgeois), and "exercise pain and rest pain in varicose vein sufferers" (J. Marmasse); three German reports (F. Jaeger, F. Maid-Fischer and D. Gross) on the pathogenesis and mechanisms of venous pain; and the report of M. Comel "epiesthesia and histoangeological correlations". Since that time, venous pain has no longer figured in the same format on the programme of any international conference, nor at meetings of the French Society of Phlebology. Progress has thus occurred insidiously... Mention may be made of the following with regard to essential varicose veins: some progress in knowledge of cramps, phlebalgia and venous paresthesiae; attribution to venous syndromes of "restless legs", which have been such a source of intrigue for the past hundred years, and interest in inflammatory pain of the superficial venous system and of subcutaneous cellular tissue in relation with venous insufficiency, as well as ulcer pain. However, it is in the area of acute deep venous thrombosis that everything has been disrupted. Firstly, with the established certainty that the clinical picture leads to errors in more than 50 p. cent of cases, both by excess and default.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMedDate not supplied

[Ostial valves in a patient with varicose veins. Endoscopic examination].

Twenty three endoscopies were performed, including six of the great saphenous region, fourteen of the small saphenous region and three involving the region of the medial gemellar perforators. Two types of valves may be seen on the basis of their endoscopic appearances: certain valves have a transparent appearance with very thin valvular tissue which tears easily when a catheter is passed against the direction of venous flow. These valves are located in the main saphenous veins and their collaterals, at a distance from bifurcations and the point of entry of perforating veins. The only type of lesion seen affecting these valves was tearing of their tissue. Their sole role appears to be to favourize the progression of venous flow in an anterograde direction. Other valves have an opaque appearance with valvular tissue thickened by an actual fibromuscular skeleton and strengthening of the free edge to form a lip. These resist counter-grade catheterisation and may prevent progression of the endoscope or of a stripper. These valves are located at the ostium of the terminal portions of the saphenous veins and directly proximal to the point of entry of certain collaterals and perforators. The latter, when reflux is present, behave as ostial valves, playing the role of an anti-reflux system as well as favourizing preferential hemodynamic circuits which explain certain varicose cartographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopy↗
PubMedDate not supplied

[Sclerotherapy of the external saphenous vein under endoscopic control].

The contribution of investigative venous endoscopy is essential. This out-patient endoscopic technique visualises the venous endothelium, valve systems and collaterals. For example, this technique enabled J.F. Van Cleef and C. Ribreau to draw up an anatomo-physiological classification of the parietal valves of the long saphenous vein on the basis of video films. From a therapeutic standpoint, venous endoscopy has yet to show its value. We chose the short saphenous since treatment of incontinence of this vessel is difficult and controversial: difficult because of anatomical variations, notably its ending and because of its course in the popliteal fossa; controversial because of its relations with the gemellary veins. Treatment of the short saphenous, whether medical or surgical, is not always entirely satisfactory. In case of surgical treatment, together with J.P. Hugentobler, we had already noted the value of three-dimensional localisation by transcutaneous illumination of the precise course of a vein using the cold light of the distal tip of the endoscope. "Venous ligatures" which can be placed intravenously are not currently available. In case of medical treatment by sclerosing injections of the short saphenous junction under endoscopic control, the product used can be injected with great topographical precision and strictly intravenously. Large amounts of product can easily be injected. However, this technique has at least three disadvantages: it is expensive; there is no parallel between endovenous lesions immediately visible by endoscopy and the mid-term results of sclerosing injections; the relations between the gemellary veins and the short saphenous can be identified precisely only by prior ultrasonography. As a result, sclerosing injections under endoscopic control remain within the domain of research.

Catheterization, Peripheral↗
PubMedDate not supplied

[The value of venous endoscopy in sclerosing therapy].

The sclerosing treatment of varices of the legs is based on palpation. Endoscopic palpation can be useful in the treatment of insufficiency of the territory of the external saphenous vein. A penetrating ulcer on the posterior surface of the thigh, with an intramuscular pathway linking the deep femoral vein with the external saphenous arch can lead to venous reflux in addition to that in the external saphenous arch. If this penetrating ulcer is overlooked, post-surgical recurrence may result within a brief period. However, a penetrating ulcer of this type cannot be detected by palpation and therefore cannot be treated by conventional sclerosis. Venous endoscopy offers a solution by permitting per-operative catheterization of the ulcer from the saphenous arch and the injection of sclerosing agents at the site of the reflux. Venous endoscopy of the saphenous arch can be of value if it makes it possible to avoid the repeated injection of rising doses. The use of chemical glues and fibrotic compounds has been discontinued due to the risk of damaging the deep veins. The future lies in a mechanical process, laser, electrocauterization or ligature.

Endoscopy↗
PubMedDate not supplied

[Angioscopy and the surgical treatment of varices in the area of the external saphenous vein].

The study of post-surgical relapses, by ultrasound and phlebographic examinations, shows that the difficulties in the treatment of varices of the external saphena territory are of two types: anatomical and haemodynamic. The venous endoscopy answers precisely to the requirements of the surgical treatment of varices of the popliteal space. It offers an acceptable compromise between aesthetics and efficacy, thanks to the incisions centred on the transcutaneous luminal point. It enables a per-operative control of the ultrasound-Doppler marking and the visualization of the small calibre perforating veins (less than 2 mm), not visible by ultrasound. It especially locates the deep non palpable refluxes situated above the anastomosis of the external saphenofemoral junction. The technique used is very simple thanks to the miniaturization of the equipment and the use of flexible small calibre endoscopes adapted to venous explorations.

Catheterization↗
PubMedDate not supplied

[Post-heparin LPL and HL activities after two months' treatment with gemfibrozil. Study in 6 normolipemic volunteers].

Post-heparin lipolytic activities and lipidic parameters (cholesterol, HDL-cholesterol, triglycérides, Apo B) were studied in 6 human volunteers submitted to gemfibrozil treatment (900 mg once a day) during two months. Though lipidic parameters were not modified after treatment, gemfibrozil increased the LPL and HL plasmatic activities measured 10 minutes after heparin injection.

Adult↗
PubMedDate not supplied

[Hormones and venous system].

Sex hormones have an effect on venous "content" and "container" according to their chemical nature, their dosage and their mode of administration: 17 beta-estradiol (endogenous): protective effect; synthetic estrogens, at normal or low doses: thrombogenic; oral natural estrogens: thrombogenic; extra-digestive natural estrogens: non thrombogenic; non steroid progestagens (androgenic): thrombogenic; non androgenic progestagens: non thrombogenic. Clinically, the venous disease si characterized by sudden episodes occurring at key-periods of the hormonal life: puberty, pregnancy, menopause, oral contraceptives intake, substitute treatments of menopause, premenstrual syndrome. Evaluation of these different situations shows that an early treatment is possible and needed, which, although not providing a new venous wall for these constitutionally fragile patients, may act effectively at two levels: 1) correction of the haemodynamic disorder (venous reflux in the saphenous arches and the perforators; 2) resorption of tissue infiltration. As primary prevention, in a patient with hormonal disorders or who must be treated with estrogens or progestagens, the objective of our treatment is to protect the venous wall and encourage the return circulation. One must: 1) reinforce the vaso-constrictive effect and the parietal tone, 2) limit collagen and elastin alteration, 3) reinforce capillary permeability and decrease the interstitial edema, 4) normalize the haemorheological constants, 5) restore the balance hemostasis-fibrinolysis. The opinion of a phlebologist seems essential before prescribing a hormonal treatment and monitoring the effects of the treatment. Cooperation between gynaecologists and phlebologists is particularly essential in the interpretation of the clinical disorders as well as discussing the venous risk, the dosage and the administration route of sex hormones.

Catecholamines↗
PubMedDate not supplied

[Hypercoagulable ulcers. Apropos of a recent case].

We describe the case of a cafe waiter aged 38, with an extensive sub-malleolar left internal varicose ulcer, which was chronic and very painful. This ulcer had been developing for 17 years and had not cicatrized for two years, which meant professional invalidity despite repeated attempts at therapy (qualified local care in a special department, hospitalizations, stripping, and filament graft). In the absence of any arterial, deep venous or lymphatic affection, deep biological disturbances meant this ulcer was classed in the category of hypercoagulable ulcers. A heparin treatment transformed the local situation and made it possible for a complementary surgical graft. Vascular ulcers resistant to properly administered local, vascular and general treatments, should lead us to investigate the possibility of hypercoagulability, whose best parameter is the high index of potential thrombodynamic (I.P.T.) calculated according to the thromboelastogram on the total blood. These hypercoagulable ulcers can be cured with a prolonged heparin treatment, in doses sufficient to normalize the I.P.T. without having to investigate true hypercoagulability with the T.C.K. It seems to us that this treatment is most effectively carried out in hospital, where it is possible to achieve constant heparinization by electric syringe and reequilibration of the biological constants.

Adult↗
PubMedDate not supplied

[Cross-over study of benfluorex and a hypolipemic agent in diet-resistant types IV and II b hyperlipemia (author's transl)].

The effects of benfluorex and a hypolipemic agent were compared in 24 patients with types IV or II b hyperlipoproteinemia unimproved after 4 months diet, by means of a cross-over study with two periods of two months treatment separated by two months without treatment. Results showed similar efficacy for each treatment against lipid parameters; statistically significant variations in body weight (-0,8%; p < 0,0001), fasting blood sugar (-11,7%; p < 0.001), and of uric acid (-8,3%; P greater than or equal to 0,001) with benfluorex VS., respectively (-0,1%; P: NS), (+ 3,4%; P < 0.05), and (+ 1,3% PP: NS) with the hypolipemic agent; statistically significant reductions in VLDL electrophoretic levels; (29,7%: P < 0,001) with benfluorex VS., (17,3%; P < 0.001) with the hypolipemic agent; and an increase in HDL electrophoretic levels; benfluorex (10,7%; P < 0,001) VS., (0,9%; P: NS) with the hypolipemic agent.

Adult↗