Clinical evaluation of a venotropic drug in man. Example of Daflon 500 mg.

Chronic venous insufficiency (CVI) of the lower limbs is a complex and fluctuating disease by its pathogenic mechanisms and its clinical symptoms. Although symptoms are subjective, they affect the quality of life and socio-professional activity of many patients. This is why convincing demonstration of therapeutic activity of a venotropic drug should be carried out according to strict methodology.

Comparative analgesic efficacy and tolerability of ketorolac tromethamine and glafenine in patients with post-operative pain.

In a randomized, single-dose, double-blind, parallel comparative trial of analgesic efficacy, 96 adult patients received either 10 mg ketorolac tromethamine or 400 mg glafenine orally the morning after surgery if they requested pain relief medication. Each patient provided a baseline pain assessment and then received the assigned medication. Patients assessed pain intensity and pain relief and reported any adverse events in interviews held 30 minutes after drug administration and then hourly for 6 hours.

[Saphenectomy in patients over 65. Indications and results].

For 779 patients who underwent varicose vein surgery at Bicêtre, between 1981 and 1984, there were 61 elderly patients between 65 and 74 years and 15 "old age" patients over 75 years. Only one severe complication occurred. Almost all patients who were operated upon were satisfied or very satisfied to see that the functional discomfort had disappeared, the trophic disorders had regressed, the superficial phlebitis or hemorrhages had not recurred and the ulcer were healed.

[Revascularization of the 2 lower limbs from the descending thoracic aorta without laparotomy].

Arterial bypass of the lower limbs from the thoracic aorta approached through a thoracic or abdominal route has already been described. The technique reported here is original in that the descending thoracic aorta is exposed through thoracotomy, and the prosthesis is passed behind the left kidney, then, for the right leg bifurcation, through Retzius' space without laparotomy. Two patients were operated upon with this technique which is described in detail, together with its potential indications, advantages and disadvantages.

[66% glucose, a safe sclerosant. Experimental study].

Although accidents due to the intra-arterial injection of detergent sclerosant are very rarely observed, they are dramatic in their effects and often result in amputations, a risk accepted with difficulty for a treatment with a functional aim. To avoid these incidents, which may occur even when treatment is applied by the most experienced surgeons, the authors have used 66% glucose solution without accident since 1948. To confirm efficacy of the method, an experimental study compared 66% glucose (66 G) with a very commonly used product, 1% sodium tetradecyl sulfate (STD), in the rabbit.

[Peroperative sclerosis].

Complete, rapid destruction of the insufficient surface network as a one-stage procedure constitutes the best method for prevention of trophic disorders and especially pigmentation. Marked, rapid regression is obtained when these have unfortunately become installed. Combined surgery and multiple peroperative injections of a sclerosant allows the exclusive use of a gently acting sclerosant, 66% glucose solution, which is particularly well tolerated.

[Aneurysm of the trunk of the superior mesenteric artery and polyaneurysmal disease of the right paracolic arcade of fibromuscular hyperplasia type. A case].

The authors report a case of an aneurysm of the mid part of the superior mesenteric artery associated with polyaneurysmal disease of the right paracolic arterial arcade. Features of special interest in this case were the rarity of the location of the aneurysm and its aetiology: a hyperplastic fibromuscular angiodysplasia.

[Peroperative multi-sclerosis using 66% glucose. Treatment of choice and best prevention of pigmentations of venous origin].

The complete and rapid destruction, at the one time, of the incompetent surface venous network is the best form of prevention of trophic changes, in particular pigmentation and leads to a marked and rapid regression of these lesions when they are already present. The combined method, associating surgery and peri-operative multi-sclerosis, allows the use of a gentle sclerosant, 66% glucose, which is particularly well tolerated.

[Product of choice for maintenance sclerosis: 66% glucose solution].

The use of a 66% hypertonic glucose saline solution provides absolute security in sclerosant treatment. It has no side effects and does not provoke any allergic reactions and it produces a good quality sclerosis without pigmentation or thrombus. The injection can sometimes be painful, so it should be made very slowly.

[Limitation of surgical indications in postoperative recurrence of varicose veins].

Varicose disorders develop further after sclerotherapy when there is clear saphenous valvular incompetence, or when the surgical operation has been too limited, or faulty. Further surgery in these cases is simple and not dangerous, and clearly brings the same results as complete initial surgery. But about 1% of the patients undergoing correct and complete surgery relapse without there being any valid explanation for the venous redevelopment whose causes we have analysed.

[Varicose recurrence: opinion of a team].

Relapse, or the continuation of the development of varicose disorder, seems to us to be common after sclerosis when there is a manifest insufficiency of the saphenous valves. Relapse following surgical operation is rare : 0.4 p.

Reinterventions for primary varices.

Out of more than 6,000 patients operated for varices since 1949, in private practice, 281 had already been operated on once before. In 230 of these cases, the first operation performed elsewhere had been incorrect or incomplete: partial stripping, a badly performed excision of the saphenofemoral-junction, neglect of gross perforants, neglect of the saphena parva which was partly or wholly responsible for 96% of the recurrences. Moreover, a partial operation, even if correct, does not check the development of a disorder which is often bilateral (89%) and which often affects the four saphenous veins (59%).

[Arterial complications of the treatment of varices].

Surgical accidents (wounding, the inept mutilation of the fork of the femoral artery) are serious only when they are not recognized, and are treated late. If they are treated immediately, or soon after their occurrence, by an able team, recovery is usually straight-forward and successful. However, if a sclerosant solution is injected by accident intra-arterially, it causes irreparable damage to the area concerned, even if diagnosis is immediate and a strongly active treatment administered.

[Veins and rheumatism].

Stasis and venous hypertension clash with static and arthritic disorders. These conditions do not add to the risks: they multiply them (Layani). If an orthopeadic operation is considered, the venous disorder should be treated first, as completely and as soon as possible, in order to lessen the risk of thrombo-embolism and to improve the trophicity of the skin.

[Sports and veins].

General harmonious exercise, walking and swimming in moderate measure are beneficial for all forms of venous insufficiency. Running, however and violent sport or competition may worsen the condition, especially where the deep veins are involved in the sequellae to phlebitis or congenital malformation. An exact evaluation and precise discussion of the inter-relationship between sport and vein disorders as well as a discussion of the various therapeutic possibilities represent indispensable elements of the first consultation.

Obstruction of the iliac vein by mucoid cyst: successful result of surgical excision.

The third case, if the literature's survey has been exhaustive, of mucoid cyst of the venous wall is reported. Venous obstruction with palpable tumour in the iliac fossa is not always of poor prognosis.

[Philosophy of the treatment of intermittent claudication].

Everything points to the prime importance of good health habits and the prevention of risk factors. Long-term medication has only a limited and still questionable impact. Surgery will never be proposed straight off, but only if the claudication is persistent and troublesome in an active individual.