Biomedical subjects
Publications and source records attributed to R Gautier.
The treatment of intermittent claudication by physical training includes walk and more specific exercises stopped before ischemia. Progresses are followed each week by the measurement of walking distance, and recognised by the majority of the authors. Physical training has thus far proved to be one of the best non surgical treatment of intermittent claudication.
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The "Sion" study, a part of the Swiss National Research Program on Cardiovascular diseases, investigated the relationships between parents' and children's cholesterolemia, blood pressure and relative weight. After a health control at school 101 fathers and 108 mothers of ten year old children have been examined. The representativeness of these parents was studied using twice as many adults of the same age from Nyon and from Aarau. Direct significant statistical associations are then demonstrated between fathers' and children's blood pressure, cholesterolemia and relative weight. Analogous associations were found out for the last two variables only between mothers and children. Available data suggest that environmental determinants of risk factor exposure are more likely to explain these relationships. It then appears that the family represents a proper setting for primary prevention.
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The results of treatment of intermittent claudication by a physical training programmed during 30 to 45 days in a rehabilitation center, are assessed on 148 patients of whom 105 have followed a full program at first (32 cases) or after surgery (73 cases). Ankle pressures are not altered. Irrigraphy shows a significant increase of 10 to 14% of the proximal indexes. Walking distance is greatly increased. 13 patients had a walking distance of about 900 m at the beginning and 31 patients at the end of the course ("functional remission"). Out of 105 patients, 98 showed improvement, 4 remained unchanged and 3 slightly worsened. The appreciation of his own progress is a strong psychological stimulation for the patient, this helping him to accent his illness, and to fight the corrigible risk factors of atherosclerosis, all significantly reduced. The interpretation of the results is discussed and shows the importance of non-hemodynamic factors in the achieved progress. The programmed exercise training is one of the best non surgical symptomatic treatments of intermittent claudication.
The choice between rehabilitation and surgery must be made for each case after attentive consideration, and depends largely on the experience and the means of each therapeut. The proximal level represents the best field for surgery, above all in the case of instable or embolized atheroma. At medial level, both therapeutics may be discussed. At distal level, surgery is seldom indicated apart from lumbar sympathectomy. Practically, rehabilitation is most often indicated alone or associated with surgery.
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The authors report their experience of isotopic angiography as means of post-operative control in peripheral vascular surgery in 200 cases. This investigation is very simple and non-traumatic. It gives very satisfactory morphological information and a good idea of the hemodynamics of the acts carried out.
Anthropometric measurements of newborns, mothers and placentas were taken in 204 consecutive deliveries at Adjamé Maternity Hospital in Abidjan. Aclinical assessment of gestational age was made. Low mean birthweight can be attributed to a higher incidence of pre-term newborns in the present sample. Incidence of small for gestational age and large for gestational age babies is similar to that found in developed countries. Detailed analysis of correlations between maternal, placental and neonatal variables show that birthweight is dependent on nutritional status of the mothers and on size of the placenta. Young primiparae are shown to become pregnant before reaching full growth. Their weight and weight for height are significantly lower than for multiparae. The main group at risk for impaired foetal growth, prematurity and low birthweight are the children born to primiparous mothers.
In 198 consecutive deliveries in a region holoendemic for malaria, 39.4% of the mothers had malarial parasitaemia. Cord blood parasitaemia was found in 43 cases (55% of infected mothers). The incidence of malaria decreased with increasing parity possibly related to age. Malaria is partly responsible of the low birthweights and of the genesis of pre-term and small for date babies. A correlation between nutritional status and malarial infection was shown. According to IgM concentrations in cord blood, 2.5% of newborns had an intrauterine infection of unknown origin.
This study based on hospital records is an analysis of 7433 deliveries in Adjamé Maternity Hospital, Abidjan, Ivory Coast. The incidence of low birthweight babies is 14.1%. Mean birthweight and height were shown to increase significantly from parity 1 to 9. Lowest mean birthweight and highest incidence of low birthweight babies were observed in primiparae. Incidence of stillbirths and abortions according to parity are described and an estimate of infant mortality rate has been attempted.
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A review of 81 cases of vascular trauma of the limbs in 75 patients treated at the Grenoble University Hospital from 1967 to 1975 confirms the classical etiological, pathological and clinical findings. Analysis of the results led us to emphasise the necessity of bone and vascular repair which should be complete from the start, verified by peroperative radiological control. The application of now well-established rules to the treatment of vascular trauma should lead to a better prognosis in the case of popliteal lesions (76 p. cent of good results out of 17 revascularisations).
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