[The immediate arterial and microcirculatory hemodynamic effects of elastic support in arteritic varices].
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Biomedical subjects
Publications and source records attributed to P Puel.
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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.
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In this paper the authors try to specify the leg ulcers physiopathology. They have first studied the vascular deficits, and they are able to conclude that this deficit is not the only factor responsible for the thrombosis. They try to rediscover the factors which could lead to the thrombosis, on the created local conditions (circulatory slackening, cooling, ischemia), by using clinical and biological "check-ups" as well as an exploration of the clotting. In many patients we find an anomaly such as: clotting "check-ups" disturbance, thrombocyte hyperaggregability, fibrinolysis deficit, antithrombin III deficit, cryoprecipitate, circulating immune complexes, hepatic "check-up" alteration. It is difficult to establish an accurate relation between these anomalies and a thrombosis but the frequent existence of such anomalies makes us think that they play a part in the ulcerations coming-up.
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The results for 62 consecutive patients aged 70 or more given aortic valve replacement (A.V.R.) between 1970 and 1982 are reported. All the patients were in the New York Heart Association (N.Y.H.A.) functional class III (29%) or IV (71%); 54.8% had angina and 30.6% had experienced syncope. Forty patients had aortic stenosis (A.S.), 10 had aortic regurgitation and 12 had mixed aortic valve disease. The operative myocardial infarction rate was 6.4%. Tilting disk valves were used. Eighty percent of the patients were anticoagulated with Warfarin whilst twenty percent received only antiplatelet drugs. All the patients were followed up for a mean period of 26 months; late mortality was 22.6% with 4.8% cardiac deaths. The thromboembolic rate was 1.6% and the disinsertion rate was 3.2%. Cerebral stroke was fatal in 3 cases in anticoagulated patients but the mechanism of the accident was not known. At the termination of the study 93% of surviving patients were in N.Y.H.A. class I or II. No patient was in class IV. The probability of five year survival is 71% for the entire group.
Using radio-labelled microspheres, the authors studied bone blood flows in various segments of goose femurs (femoral head, trochanter, condyles). Experiments were conducted on three groups of geese: control, fatty liver induced and corticosteroid-treated animals. The preliminary results suggest that hyperlipemia and fatty liver conditions do not seem to obviously disturb intra osseous blood circulation in fatty geese, although corticosteroids might affect bone blood flows in condyles.
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