[The value of studying the ocular conjunctiva in case-finding in prediabetic states].

Capillaroscopy, the only method available for the study of the microcirculation, without modifying its hydraulics, often provides a wealth of information in certain systemic diseases in which the microcirculatory involvement precedes clinical manifestations and of course, macrovascular complications. The prospective study of a healthy population is particularly demonstrative and the authors proposed scores on which diabetic microangiopathy could be suspected. The latter was confirmed by detailed laboratory investigations on one hand, and by the course of the disease on the other.

[Ecchymotic patches of the fingers and Gardner-Diamond vascular purpura].

Ecchymotic patches on the fingers and vascular purpura in Gardner-Diamond syndrome are two benign but recurrent clinical disorders occurring chiefly in young women. They involve superficial cutaneous hemorrhagic signs. Both disorders testify to microvascular fragility without perturbation of general hemostasis.

[Drug therapy of angiolopathies].

The treatment of angiolopathies is rather difficult, at this time, at least concerning functional angiopathies. It is a fact that protection against cold represents, in all angilopathies, one of the main elements of the treatment besides medications which are essentially vasoactive drugs, myorelaxants or alpha-blockers, and possibly venous tonics. Fluorescein or Sodium fluoresceinate at 5%, administered in slow intra-venous injections, represents one of the best treatment of acrocyanosis, in combination with vitamins A and D, given at the beginning of fall.

[Flushes, blushing or hot flushes].

Apart from physiological flushes represented by emotional or prudish blushing, post-prandial flushes and menopausal hot flushes, various pathologic flushes exist of various etiologies: endocrine, dysmetabolic, histaminic and iatrogenic. Their pathogenicity is based mainly on local metabolites secretion provoking vasodilatation of the intermediary microcirculation rather than of the terminal microcirculation. Treatment is a function of etiology and therefore of the patient's history and results of clinical examination, functional exploration and standard biologic tests.

[Aging of veins and venules].

There is a distinction between natural ageing and excessive ageing. The problem is not only vascular, it is above all interstitial conjunctival; it is located in the trunk wall and in the initial collector walls; the capillary-venular section is, from this point of view, just a unit of structure and function. The clinical and anatomopathological aspects of venous ageing are known: they are those of phlebosclerosis and deposits of proteoglycanes, the lesions are non-homogenous, dispersed and constantly changing.

[Microcirculation in white atrophy].

There are two clinical phenomena which, owing to the French School, are still subject to violent criticism: the phenomenon described by M. Raynaud (1862) and the white atrophy termed Milian's (1929). Perhaps badly defined by the authors, the facts have been reviewed, but microcirculation - that of gauges less than 30 to 50 m - does not occupy the whole picture.

[Chilblains].

Chilblain is a frostbite, it belongs to the vascular acrosyndromes by the mere fact of symmetrical lesions and to the dystrophic group by its organic obstructive and thrombotic microangiopathy, especially of venules. Chilblain is conditional on a dysesthesia for cold, diagnosis is easy if in the know, prognosis as usual good and treatment must be more preventive than curative.

[Microvascular disorders of adipose tissue].

The microcirculation of adipose tissue is poorly understood either because of the absence of histological documents or because they fail to explain pathological conditions. However, disturbances of blood flow and parietal lesions of the microvessels are the basis for these disorders. Although we speak of disturbances of the vascular control mechanisms, these mechanisms are poorly understood and although we speak of arteriovenous short-circuits, the existence of these lesions has not been proven.

[The connective tissue component and its connections with the terminal circulatory unit in macrophlebopathies].

We forget too often that the primitive mesenchyme cells are at the origin of healthy microvessels, lymphatic canaliculi and the conjunctival interstitium. In our different disciplines we tend to study in isolation the terminal circulatory unit, the lymphatic system, and the conjunctival tissues. Why not refer from the outset to histangiopathy in clinical situations as common as varicose illness, certain post-thrombotic syndromes and, in its classic form, to histangiopathy of stasis? In varicose illness, the conjunctival component of the vein wall is quantitatively differentiated from the normal wall; it is responsible for histochemical anomalies, and the inhomogeneities encountered are determined by the variable conditions of mechanomorphosis.

[Incidents and accidents due to sclerotherapy. Prevention of pigmentation].

Even though sclerotherapy is a method which, in careful and experienced hands, is entirely harmless, the assault on the venous endothelium can, nevertheless, precipitate incidents and accidents, which the authors enumerate briefly in order to pinpoint that of pigmentation. The authors consider that, although this is not certain, venous stasis is responsible for this, venous stasis causing erythrodiapedesis followed by the formation of haemosiderin and the increased activity of the dermic melanocytes, a process which is exacerbated by subjacent inflammation. An axon reflex releasing P substance (Van Euler and Gaddum) modulating the chemical influx on the endothelial receptors in the microcirculation.

Capillaroscopy at the nail bed in functioning people aged 70 and over.

A long survey in an homogenous population of 150 healthy and functioning male and female subjects 70 years of age and over is reported. In vivo capillaroscopic patterns observed at the nail bed, besides the lips, the gums, the tongue and the bulbar conjunctiva, are described and sometimes compared with fingertip biopsy. Three patterns are distinguished: (1) type I the most frequent similar to the children's one (2) type II less frequent but rather peculiar to senescence (3) type III rather typical but intermediate.

[Evolution of vasomotor tone in chronic obstructive arteriopathy of the lower limbs].

Progressive degradation in the appearance of digital plethysmogram tracings occurs during acute episodes of occlusive arteriopathies, and is of importance for establishing the diagnosis and the choice of therapy. The distal microvasculotissular score is of major interest during the stages defined by R. Fontaine in 1966.

[The nail in vascular pathology].

The nail is part of the ungual unit; it is affected indirectly and late in vascular disease. The authors recall the anatomy and the blood supply of the ungual unit and describe the alterations in terms of the level of the lesion. They describe the changes seen in systemic diseases such as the collagen disease, in vascular disease, venous, arterial and lymphatic disease and in vascular acrosyndromes.

[Microvascular consequences of low distal blood perfusion rates].

It is classical, in obstructive arterial disease, to be most concerned with the truncal arteries, although nutrition and exchanges occur at the level of the terminal vessels. The most important events occur in the muscles and in the skin, at the extremity of the limb and one wonders whether "ischaemic disease" could perhaps be summarized as the result of low perfusion rates. The laws of hydraulics are unusual in this situation, the microcirculation is autonomous and autoregulated.

[Juvenile distal cerebral ischemia: value of pulp biopsy].

Juvenile distal cerebral ischemia has been attributed to small artery atherosclerosis (Arnold, Benoit, Merlen, Dobbelaere, Delandsheer, 1979), based on clinicopathologic findings in one male patient and results of big toe pulp biopsy in three other cases. Pathological findings were obstruction of small artery lumens by hypertrophic endothelium and loose fibrocellular bands, their origin being the result possibly of partial intimalization of media by elastic neogenesis. Appearances were similar to those described by Dahl in human cerebral atherosclerosis in 1976, and approached those of the initial stages of experimental atheroma (Ross, Glomset, 1976).

[Postphlebitic disease, stasis microangiopathy].

The terminology of this is incorrect, but hallowed by usage; it is an old thrombosis of the deep veins, and therefore part of the venous zone; it terminates distally in the zone of the terminal circulatory units, that is, at a microangiopathy of interstitial and lymphatic venous stasis, and the interstitium is involved. There is a polyangiopathy, all the vascular systems being involved, and there is a panangiopathy, every coat of the wall being damaged. The hydraulics of the blood, tissular liquids and lymph are progressively and permanently thrown into disorder; losses of head, pressure surges, choking and failure of the pumps, obliteration of the valvular canal all follow one another and tractage occurs.

[Pigmentation and venous stasis].

Local pigmentations can occur in the course of venous diseases and are said to be secondary to venous stasis and due to blood pigment. Most often, the pigment is haemosiderin and more rarely melenin pigments. Haemosiderin is a result of dermal biligenesis of extravasated red blood cells, the erythrodiapedesis being due to alterations in the vessel wall.