The method of spectral analysis of laser-Doppler perfusion signal measured during thermal test is proposed. During three 20 min phases with 40, 5, and 40 degrees C of thermal test laser-Doppler perfusion signal was recorded. For each signal phase frequency spectra were calculated using the FFT method. Quantitative parameter Spectral Factor for results evaluation was proposed. In total 94 patients were measured: 69 with Raynaud's phenomenon and 25 normal subjects. Additionally in 18 Raynaud's patients the influence of Nifedipine was studied. Results suggest that proposed parameter is able to differentiate between Raynaud's patients and normal subjects and that is useful for evaluation of Nifedipine effectiveness. However, further studies are needed to improve the method to differentiate between primary and secondary Raynaud's patients.

Flowmotion was characterized in healthy controls and 61 Raynaud's phenomenon (RP) patients by spectral analysis of laser-Doppler perfusion monitoring (LDPM) tracings. Healthy subjects flowmotion patterns revealed a main frequency of 3 cycles per min (cpm) with another low frequency and heart rate synchronous components. A first group of RP patients presented a low frequency and heart rate frequency component but no significant difference in blood flow. The second group presented the predominating heart rate related frequency with low microvascular perfusion. The third group presented a flowmotion pattern with overlapping of heart rate and low frequency components. Patients with primary and secondary RP show specific changes in flowmotion, probably related to increased sympathetic nervous activity or vessel wall alterations causing disappearance of arteriolar tone and impairment of microvascular perfusion. The group of patients with overlapping frequency components presents an intermediate flowmotion pattern indicating a different grade of alterations in microvasculature.

The paper presents analyses of the dynamics contained in the blood flow signals measured on healthy subjects and on subjects with primary Raynaud's phenomenon. Different signal processing methods are presented and discussed. The dynamics was evaluated in the time and frequency domains and in phase space. Additionally, changes in the basal value during temperature provocation were studied using multiresolution analysis. The analyses demonstrate differences between the blood flow dynamics in healthy subjects and subjects with Raynaud's phenomenon. Moreover, the observed decrease in the amplitude of oscillation in regions approximately 0.04 Hz and approximately 0.1 Hz suggests an impairment in the neurogenic and the myogenic regulation of the blood flow. The administration of nifedipine in subjects with Raynaud's phenomenon results in an increase in the basal value and in the amplitude of the blood flow component oscillating with the heart rate. However, it does not restore the dynamics to that found in healthy subjects.

BACKGROUNDInterest of blood flow and ankle brachial pressure index (ABPI) to evaluate result of iliac angioplasty.METHODSABPI and blood flow rates were measured before and after angioplasty in 22 lower extremities of 16 patients with iliac stenosis. Blood flow rates were determined by means of a nuclear magnetic resonance (NMR) flow meter.RESULTSThe day after angioplasty, flow and pressure were increasing significantly, whereas a month later, only blood flow was increasing significantly. In a group of patients with near-normal ABPI before angioplasty (ABPI > or = 0.8), there was, on the day following the angioplasty, a significant increase in ABPI and pulsatile blood flow rates; flow rates increased considerably a month after the operation whereas ABPI stay stable. In a group of patients with clearly abnormal ABPI before angioplasty (ABPI <0.80), there was a significant increase in ABPI and blood flow rates the day after angioplasty and again a month later.CONCLUSIONSFlow therefore seems to vary independently of pressure. The possible use of flow measurement to detect restenoses is yet to be studied.

The study was aimed at choosing an appropriate characteristic oflaser-Doppler flux (LDF) data for (1) distinguishing patients withRaynauds disease from normal controls and (2) evaluating the effectof nifedipine under different thermal conditions. We checked thereliability of three characteristics of nonlinear dynamics asstatistical dimension D_s, correlation dimension D_2 and power-lawindex PLI. Their values depended heavily on the thermal condition.The most reliable characteristics that enabled us to distinguishthe patients from normal controls and the effect of nifedipineunder definite thermal condition proved to be D_s and PLI. Thelatter is simple for computation and is thus recommendable forclinical practice. D_s and PLI were higher in patients withRaynauds compared to normal controls and diminished during thetransitions from low to high temperature. However, thecharacteristics used were unable to distinguish significantlyRaynauds I from Raynauds II patients.

In a previous study, the authors demonstrated that in 17 men with ischaemic atherosclerotic disease the bone mineral density (BMD) of the femoral neck was lower than in matched control subjects. The patients with arterial disease were thinner and were heavier smokers than the controls. Osteoporosis and arterial disease of the lower limbs were perhaps due to common risk factors: tobacco consumption and a low body build index. In order to demonstrate the direct effect of atherosclerosis on bone mineral content (BMC), the authors studied by dual-energy X-ray absorptiometry the BMC of both legs in 18 men presenting symptomatic arterial disease of the lower limbs quantified by measurement of distal systolic indexes by doppler ultrasonography. The mean BMC of the leg more severely affected by arterial disease was significantly lower than the mean BMC of the leg less affected by arterial disease (512 +/- 76 g versus 495 +/- 80 g: p = 0.003). In 13 of the 18 patients, the BMC was lower in the leg more severely affected by arterial disease; in 4 of 18 the difference between the BMC of the left and right legs was less than 1%, and in a single patient the BMC was higher in the leg more affected by arterial disease. Arterial disease of the lower limbs could lead to bone mineral loss.

Summary Clot-bound thrombin proteolyses fibrinogen and amplifies the coagulation cascade at its close vicinity, thereby ensuring the growth of fibrin-rich thrombus. The present study compares the ability of various glycosaminoglycans (GAGs) to inhibit these 2 properties. Unfractionated heparin (UH), 3 low molecular weight heparins (LMWHs) with increasing antifactor Xa/antifactor Ha ratio, the synthetic pentasaccharide (PS), devoid of antifactor Ha activity, and dermatan sulfate (DS), a catalyst of thrombin inhibition by heparin cofactor II, were selected on the basis of their different properties. Proteolysis of fibrinogen by clot-bound thrombin was evaluated by measuring fibrinopeptide A (FPA) generation after an incubation of standardized washed clots in plasma for 120 min in absence or in presence of increasing concentrations of heparins or of DS. The results were compared to those obtained when free a-thrombin (0.4 nM) was added to plasma in the same experimental conditions. On the basis of equivalent antithrombin units, UH and LMWHs gave identical results. To inhibit by 70% fibrinogen proteolysis induced by clot-bound thrombin (IC 70), 5- to 9-fold higher concentrations of UH or of LMWHs were required in comparison with those required to inhibit free thrombin. For DS, only a 1.3 times higher concentration was required. PS (final concentration 1 anti Xa U • ml-1) was devoid of any inhibitory effect. The amplification of the coagulation cascade induced by dot-bound thrombin was evaluated by measuring the shortening of whole blood clotting time (WBCT) resulting from the incubation of washed clots in native blood. In absence of GAG, clot-bound thrombin reduced WBCT from 18 ± 2 min to 9 ± 1 min. Each GAG prolonged WBCT in a dose-dependent manner but these prolongations were smaller in presence of washed clots. The most potent agent to suppress the shortening of WBCT was DS. LMWH and UH were less effective and PS (final concentration 1 anti Xa U/ml) was almost ineffective. Therefore, in these in vitro experiments, DS is a more potent inhibitor of clot-bound thrombin than heparin. Whether or not these observations are relevant for the treatment of established deep-vein thrombosis requires comparative clinical studies.

La gestion de la maladie thromboembolique veineuse a des implications financières non négligeables du fait non seulement de la fréquence élevée des suspicions cliniques et donc des moyens mis en oeuvre pour faire le diagnostic positif, mais aussi de la prise en charge économique du traitement. Pour évaluer les dépenses occasionnées par les différents tests diagnostics, 511 patients suspects de thrombose veineuse profonde des membres inférieurs ont été examinés cliniquement puis à l'aide de l'échographie Duplex associée à la pléthysmographie; lorsqu'une phlébite était ainsi détectée ou par randomisation dans le cas contraire, une phlébographie était réalisée. Les 185 comparaisons phlébographie-échographie ont ainsi permis une extrapolation des résultats à l'ensemble des 511 patients permettant alors de comparer le prix de revient théorique de 4 algorithmes décisionnels en fonction des critères diagnostiques utilisés. Les conclusions ont été les suivantes: le diagnostic clinique seul n'est pas rentable, l'échographie Duplex, sûre, permet par rapport à la phlébographie une économie annuelle supérieure à 1 500 000 F dont 1 000 000 de Francs économisés sur le budget hospitalier global en France. La phlébographie indiquée pour chaque thrombose veineuse proximale dans le but de localiser précisément le pôle supérieur du caillot, augmente peu les dépenses: l'économie annuelle par rapport à la phlébographie systématique est encore supérieure à 1 200 000 F dont 800 000 F au bénéfice de l'Hôpital Public.

The management of deep venous thrombosis has non-negligible financial implications due not only to the high frequency of clinical suspicion-and therefore to the methods used a positive diagnosis - but also to the overall cost of management. To evaluate the expenditure incurred for the diagnostic tests, 511 patients suspected of deep venous lower limb thrombosis were examined clinically, then by Duplex ultrasonography combined with plethysmography. Whenever a suspected phlebitis was detected by this method, or at random if it was not, phlebography was performed. The 185 phlebography/ultrasonography comparisons enabled us to extrapolate the results obtained to all 511 patients and thus to compare the theoretical cost of 4 decisional algorithms according to the diagnostic criteria utilized. Our conclusions were as follows: the clinical diagnosis alone is not cost-effective, whereas Duplex ultrasonography is reliable and, compared with phlebography, saves more than 1500,000 francs per year, including 1000,000 francs saved on the global hospital budget in France. Phlebography used in each proximal venous thrombosis for accurate localization of the upper end of the clot does not significantly increase the cost: the annual savings on systematic phlebography are still above 1200,000 francs, including 800,000 francs to the benefit of public hospitals.

471 consecutive patients, suspected clinically of a deep venous thrombosis of the lower limbs, underwent two-level ultrasonography. The reliability of the method was assessed by phlebographic comparison in 185 of them (whenever ultrasonography was positive and in one case out of five when negative). Results were striking: 94 per cent sensitivity (100% by approximation) and 86 per cent specificity. The 286 patients who did not undergo phlebography and in whom ultrasonography was negative were followed up for a period of 1 to 12 months (mean: 7.2 months). 119 were not given anticoagulants and 167 were treated with Calciparine (subcutaneous calcium heparin) at the preventive dose 0.20 ml b.i.d. for 7 days. Only two cases of phlebitis were detected: one 9 days after the investigation and the other 8 months later, following exposure to a new thrombogenic risk. There were no fatal pulmonary emboli. No difference was found between the two groups. In total, two-level ultrasonography was shown to be reliable in comparison with phlebography but, above all, when the result was negative the absence of treatment had no untoward effect on the patient.

The aim of the present study was to determine when a search for ventricular arrhythmias, by ambulatory electrocardiographic monitoring, is necessary in hypertensive patients. An electrocardiogram, an echocardiogram and a 24 hour Holter monitoring were recorded in 88 patients with essential hypertension. According to the results of electrocardiogram patients were subdivided into 4 groups: normal electrocardiogram, isolated left auricular hypertrophy (LAH), isolated left ventricular hypertrophy (LVH) and major ST-T wave changes. According to the degree of septal thickness (ST), patients were classed in 4 groups. [table; see text] For hypertensive patients with normal electrocardiogram, Holter monitoring is not necessary; in fact practically no complex arrhythmias is found in this group. On the contrary, for hypertensive subjects with ST-T waves changes, this investigation seems very interesting, nearly 75% of them present high-grade ventricular arrhythmias. For the patients with electrocardiographic isolated LAH or LVH, the realisation of an echocardiography permits to separate the subjects with mild LVH (ST less than 12 mm) where Holter monitoring is not necessary (81% Lown O-I) and the patients with mean or severe LVH (ST greater than or equal to 12 mm) where this investigation seems very interesting, nearly 65% of them present high-grade ventricular arrhythmias.

Recent studies have elucidated the cost-effectiveness of various diagnostic methods used to detect deep venous thrombosis (DVT) of the lower limbs. These methods include Doppler, plethysmography and labelled fibrogen tests. However, duplex scanning has recently proven to be a more reliable examination. With a view to establishing a realistic appraisal of matters as they stand, the authors have carried out a prospective study to compare the relative cost-effectiveness of purely physical examination, duplex scanning associated with strain-gauge plethysmography, contrast venography indicated for each proximal DVT, and contrast venography as a first-choice examination. 511 consecutive patients suspected of DVT of the lower limbs were examined using the various non-invasive methods cited above. 185 of the patients underwent contrast venography. When compared with those of the non-invasive tests, the results of the latter examination provided for extrapolation to the total population of 511 patients so as to better evaluate costs. We are able to conclude that physical examination alone is neither cost-effective nor risk free. Non-invasive tests, which are more reliable, provide annual savings greater than 1,500,000 FF ($ 240,000) with respect to venography. Performing venography for each proximal DVT increases spending by little: savings are again greater than 1,200,000 FF ($ 192,000).

The authors report a new case of primary chylopericardium in an asymptomatic 26 year old male. In view of the negativity of the complementary etiological investigations a surgical subxiphoid window was performed and this confirmed the diagnosis. After failure of isolated evacuatory drainage, the patient was cured by pericardectomy.The anatomo-clinical, biochemical and diagnostic features of this condition are described based on a review of the other cases of primary chylopericardium reported in the literature. Surgical pericardectomy seems to be the only effective long term treatment.

The authors report a case of leiomyosarcoma (LMS) of the second segment of the inferior vena (IVC) with liver metastasis. Treatment by surgery and chemotherapy proved to be effective, as the patient is asymptomatic 8 years after the first operation. A review of the literature shows that these tumours are rare and have a slow course. The symptoms are often relatively minor and depend on the caval segment involved. The best examination for positive and topographic diagnosis remains computed tomography, but MR Imaging is promising. The prognosis remains severe (mean survival: 2 years) and surgery is the main treatment, with various techniques according to the caval segment involved.

The aim of the present study was to determine when a search for ventricular arrhythmias, by ambulatory electrocardiographic monitoring, is necessary in hypertensive patients. An electrocardiogram, an echocardiogram and a 24 hour Holter monitoring were recorded in 88 patients with essential hypertension. According to the results of electrocardiogram patients were subdivided into 4 groups: normal electrocardiogram, isolated left auricular hypertrophy (LAH), isolated left ventricular hypertrophy (LVH) and major ST-T wave changes. According to the degree of septal thickness (ST), patients were classed in 4 groups.[GRAPHICS]For hypertensive patients with normal electrocardiogram, Holter monitoring is not necessary; in fact pratically no complex arrhythmias is found in this group. On the contrary, for hypertensive subjects with ST-T waves changes, this investigation seems very interesting, nearly 75 % of them present high-grade ventricular arrhythmias. For the patients with electrocardiographic isolated LAH or LVH, the realisation of an echocardiography permits to separate the subjects with mild LVH (ST < 12 mm) where Holter monitoring is not necessary (81 % Lown O-I) and the patients with mean or severe LVH (ST greater-than-or-equal-to 12 mm) where this investigation seems very interesting, nearly 65 % of them present high - grade ventricular arrhythmias.

The authors report a new case of primary chylopericardium in an asymptomatic 26 year old male. In view of the negativity of the complementary etiological investigations a surgical subxiphoid window was performed and this confirmed the diagnosis. After failure of isolated evacuatory drainage, the patient was cured by pericardectomy. The anatomo-clinical, biochemical and diagnostic features of this condition are described based on a review of the other cases of primary chylopericardium reported in the literature. Surgical pericardectomy seems to be the only effective long term treatment.

The authors report a case of leiomyosarcoma (LMS) of the second segment of the inferior vena (IVC) with liver metastasis. Treatment by surgery and chemotherapy proved to be effective, as the patient is asymptomatic 8 years after the first operation. A review of the literature shows that these tumours are rare and have a slow course. The symptoms are often relatively minor and depend on the caval segment involved. The best examination for positive and topographic diagnosis remains computed tomography, but MR Imaging is promising. The prognosis remains severe (mean survival: 2 years) and surgery is the main treatment, with various techniques according to the caval segment involved.