[Venous diseases and pregnancy].

The pregnancy and the puerperium are critical conditions for the venous system of the lower limbs. The risk of venous thromboembolism is important in the presence of contributing factors. The management of the disease (diagnosis, treatment, prophylaxis) has to be tailored to each individual patient.

The quantitation of blood flow/metabolism coupling at rest and after exercise in peripheral arterial insufficiency, using PET and 15-0 labeled tracers.

Regional blood flow and oxygen uptake of the lower limbs were studied in 11 patients with arterial insufficiency (10 with severe unilateral, 1 with bilateral intermittent claudication). Regional muscle blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) were evaluated by positron emission tomography (PET) and bolus inhalation of C15O2 and 15O2 by the patient. Tomograms were recorded at the greatest diameter of legs, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected leg.

[Effect of the frequency of neuromuscular electric stimulation of the leg on femoral arterial blood flow].

In a previous work we have demonstrated that the transcutaneous neuromuscular electrical stimulation of the muscles of the leg in the human increases largely the arterial femoral blood flow. This elevated flow is stable during the stimulation. The present work deals with the influence of the frequency of the stimulation on the level of this hyperaemia.

[Musculo-venous pump in the elderly].

We study the musculo-venous pump in an elderly population, free of venous disease, by use of a digitized photoplethysmograph. We measure the venous refilling time (To) and the venous drainage (Vo) during active and passive movement. In the first part, we measure Vo and To during active and passive ankle flexions among 17 patients (34 limbs) aged 82.

Pathological aspects of carotid plaques. Surgical and clinical significance.

We examined 134 carotid plaques microscopically in 125 consecutive patients, and found 21 (15.7%) had simple fibrous plaques versus 113 (84.3%) complicated plaques.

Assessment of flow and oxygen delivery to the lower extremity in arterial insufficiency: a PET-scan study comparison with other methods.

The authors studied muscular blood flow (F), oxygen consumption rate (R), and oxygen extraction fraction (E) in 5 patients suffering from severe intermittent claudication (stage II). They applied the bolus technique of H2150 and 1502 with a detection by positron emission tomography (PET). Tomograms were recorded at the greatest diameter of the calves, at rest and ten minutes after a treadmill walk test leading to the development of ischemic pain in the affected extremity.

Giant cell arteritis (Horton's disease) of the axillary artery--case reports.

The authors recently observed 2 elderly female patients with ischemic pain of the upper extremity as the first manifestation of giant cell arteritis. They presented with rest pain of both upper extremities and even gangrene of the thumb in 1 case. Subclavian and radial pulses were absent while peripheral pulses in the lower limbs were preserved.

[Arterial pathology of the limbs. Tests for hyperemia].

We consider the walk test on the treadmill (ET), and the postocclusive reactive hyperemia (HR). The determinations are limited to the peripheral pressures measured by the sphygmomanometric-Doppler technique. It is the method of choice for diagnostic purposes, but is necessary only for selected cases.

Effect of exercise on the leg distribution of C15O2 and 15O2 in normals and in patients with peripheral ischemia: a study using positron tomography.

In order to evaluate regional muscle blood flow and oxygen utilization, we study with positron emission tomography (PET) the distribution of C15O2 and 15O2 in 17 subjects: 5 normals (24 +/- 3 years) and 12 patients (63 +/- 13.5 years). C15O2 and 15O2 are inhalated with a steady-state technique.

[Clinical approach to the patient with polyvascular disease].

The history and the physical examination are important steps in the clinical approach to the polyvascular patient. They are the foundation of a rational diagnostic and therapeutic management. Complementary investigations are nevertheless necessary.

[Regional blood flow and oxygen consumption in the leg muscles of normal subjects and in those with arterial insufficiency. Study of the distribution of C15O2 and of 15O2 using positron emission tomography].

We first studied the distribution of radioactivity during continuous inhalation of C15O2 and 15O2 in traverse tomograms of the greatest diameter of legs, at rest and immediately after exercise (ankle flexions). C15O2 and 15O2 were distributed homogeneously and symmetrically in both legs of normal subjects at rest. The activity accumulated in the anterolateral region after exercise.

[Venous plethysmography in a sitting position].

We studied the venous capacity of the lower limbs by strain gauge plethysmography during venous occlusion (delta v60) and by a dependency test (delta v postural) (from the supine to the sitting position). We were also interested by the performance of the calf musculovenous pump, assessed in two positions: sitting and standing (delta v exercise). The volume changes are increasing when we consider limbs with sequelae of deep vein thrombosis, normal lower limbs and extremities with primary varices.

[Scintigraphic study (81mKr) of venous return activation using intravenous dihydroergotamine].

We study by 81mKr radionuclide phlebography 13 normal lower limbs and 22 limbs suffering from sequelae of deep vein thrombosis. We assess the spontaneous venous return and the effect of an intravenous injection of 0.5 mg dihydroergotamine (DHE), a powerful venoconstrictor agent.

[Medical treatment of the Raynaud phenomenon].

The medical treatment of Raynaud's phenomenon must be adapted to each particular case. Benign cases do not require drug therapy. Various substances seem able to relieve the most severe cases (calcium blockers, alpha-blockers).

Dynamic isotopic phlebography using soluble krypton-81m.

Intravenous peripheral injection of krypton-81m in an isotonic solution permits venous scintigraphy of the lower limbs to be carried out. An anatomic definition of the obstructions and the collateral pathways is therefore easily displayed from the popliteal vein to the vena cava. The physical characteristics of the radionuclide permit iterative or sustained perfusions without accumulation of an excessive background noise and the method is used to obtain scintigraphic images in changing physiological conditions.

The assessment of chronic venous obstructions by non invasive haemodynamic studies and imaging with Kr-81 m venography.

We study the sequelae of venous obstructions (from 15 days to several years after the thrombosis) by non invasive haemodynamic methods: Doppler velocimetry and leg plethysmography. We describe a simple physical model which permits the calculation of the leg outflow resistance from the venous occlusion plethysmography data. A radionuclide imaging of the veins is also recorded by a gammacamera during the perfusion of the limbs with Kr-81 m.

[Value of the treadmill exercise test for long-term monitoring of lower-limb arteriopathies].

The use of the treadmill exercise test is envisaged only as a means of chronic surveillance of the arteriopathy. The walking distance measured in this way is a complex factor to analyze due to interference of non-vascular phenomena and the effect of training. Manometric data (distal arterial pressure, normalized by determination of the distal pressure/central pressure quotient expressed as percent) were collected during recuperation.

[Arterial and venous circulation of the leg after intermittent venous occlusion].

We study the arterial and venous circulation of the normal leg by strain gauge plethysmography and venous occlusion (thigh tourniquet). We propose the application of a simplified linear physical model of the venous circulation. It helps to analyse the plethysmographic data recorded during and after the congestion.