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Biomedical subjects

H Boccalon

Publications and source records attributed to H Boccalon.

At least 19 recordsLinked to original sources
PubMed1995

[Early diagnosis of arteriopathy of the legs using measures adapted to general practitioners: the systolic index and pulse perception].

Atherosclerotic lower-limb arteriopathy is a serious disease. Its prevalence often underestimated when relying only on questioning the patient. A simple early detection method is the systolic index, i.e. the ratio of systolic ankle over brachial pressure. This ratio should normally be greater than 0.9. Lower values indicate detectable arterial obstruction as revealed by reduced peripheral perfusion. Under 0.75 patients are considered as suffering from peripheral vascular disease and require further investigations and specialist opinion. With an index between 0.75 and 0.90 patients are classified as stage I or II of the disease. In a survey by 180 General Practitioners, which were trained by angiologists to measure ankle pressure, more than 1,400 patients, between 40 and 75-years old, with at least one vascular risk factor (hypertension, diabetes, lipids, tobacco) were selected. Tobacco was the most prevalent vascular risk factor, then diabetes (particularly in men). 23.8% of patients recorded values between 0.90 and 0.75 and thus suffering from peripheral vascular disease (certainly age dependent). Clinically absent pulses at the posterior tibial and the dorsalis pedis artery were found is 19 and 27% of patients respectively. Most of the patients received a pharmacological substance allowing to check this index sensitivity. Thus systolic index is a simple low cost method for early detection and care and more general utilisation is proposed.

Adult↗
PubMed1994

Comparison of the bone mineral content of the lower limbs in men with ischaemic atherosclerotic disease.

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.

Adult↗
PubMed1994

Dermatan sulfate is a more potent inhibitor of clot-bound thrombin than unfractionated and low molecular weight heparins.

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 IIa ratio, the synthetic pentasaccharide (PS), devoid of antifactor IIa 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 alpha-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 clot-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.(ABSTRACT TRUNCATED AT 250 WORDS)

Dermatan Sulfate↗
PubMed1992

[Electric stimulation of the spinal cord in arterial diseases of the legs. A multicenter study of 244 patients].

From January 1985 through January 1990, 244 patients (168 males, 76 females, mean age: 69 +/- 14 years) received epidural spinal cord stimulation for the treatment of advanced, nonreconstructable, peripheral vascular disease of the lower limbs due to atherosclerosis in 180 patients, atherosclerosis and/or diabetes in 49, and thromboangiitis obliterans in 15 patients: previous surgery included 101 bypass-grafts in 70 patients, 51% of which below the knee, and 117 sympathectomies in 113 patients as the last resource in face of distal peripheral vascular disease of the lower limbs. Mean ankle-to brachial systolic pressure ratio was .31 +/- .34 on symptomatic limbs; due to pain and advanced disease, walking capacity was assessed in only 151 patients, either on treadmill in 25, or in a metered corridor in 126; angiogram of the lower limbs was performed in every patient unless one not older than three months was readily available; pain at rest was assessed after an analogical scale; partial transcutaneous oxygen tension was measured on the dorsum of the fore-foot of 77 symptomatic limbs (mean: 13.35 +/- 14 mmHg). According to clinical and functional evaluation, 18 patients had exertional ischemia (group I), 87 had permanent ischemia with pain at rest and no tissue loss (group II), and 139 had chronic tissue loss (group III), including 93 ischemic ulcers (mean surface: 3.7 cm2, mean duration: 3.5 months) in 88 patients, 27 limited gangrene, and 24 previous limited non-healing distal amputation. After temporary spinal cord stimulation at T12-L1 level (mean duration: 9 +/- 4 days) with a percutaneous quadripolar electrode lead had allowed for selection of responders, 212 patients received an implantable neurostimulator.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Development of diagnosis and treatment of arterial diseases over the course of time].

The preoccupations of medicine vary during its history in relation to the socio-economic problems of the day and in relation to the diagnostic and therapeutic possibilities of the day. From a diagnostic standpoint, arterial claudication was described as early as 1830, i.e. almost a century before the standard classification of Leriche and Fontaine. Arterial investigations have been known for a great many years in terms of their principles (1662 for plethysmography, 1843 for Doppler effect). Their medical applications nevertheless date from only the past 20 years. Arterial imaging dates from the start of the century, but followed a very wide range of paths before reaching the technical advances of the present day. The oldest form of treatment is that of limb amputation. There has been extensive clinical and physiological discussion of hyperhemic techniques. In terms of arterial reconstruction, the debate has shifted from open access surgical reconstruction to percutaneous endoarterial reconstruction. However, the history of the diagnosis and treatment of arterial disease, although preoccupied by new and numerous techniques, has also involved the restructuring of patterns and ideas. The current attitude involves global management of all diseased arteries since the underlying problem is common and multifocal.

Angiography, Digital Subtraction↗
PubMed1992

[Lower limb arteriopathy and male osteoporosis].

There are close links between bone metabolism and bone circulation. Osteoblasts are derived from the walls of the venous sinuses. As shown by Burkardt, osteoporosis is accompanied by a decrease in the number of intra-osseous capillaries, and intra-osseous arterioles may be the site of arteriosclerosis lesions. In order to determine the existence of a possible link between arteriosclerosis and male osteoporosis, the etiology of which is often poorly defined, the authors studied phosphorus-calcium balance, X-rays of the spine, and bone density of the spine and the femoral neck in 17 male arterial disease sufferers with a mean age of 61 and at Leriche stage 2, 3 or 4. These 17 patients were compared with 15 age-paired controls. Wedge fractures, absent in the control group, were seen in 9 of the 17 patients. Bone mineral content in the femoral neck was significantly reduced in the arterial disease group.

Arteriosclerosis↗
PubMed1992

[Vascular exploration tests. Importance for the indications and monitoring of epidural medullary neuro-stimulation].

The clinical diagnosis must be enriched by quantifiable parameters when a new therapeutic method must be tested. We analyse the role of vascular explorations for epidural stimulation and limb arteriopathies. Four different fields of investigations can be defined. Accuracy of the diagnosis: The tests are useful to rule out some differential diagnoses of arterial involvement, and to establish the functional severity (stage III). 1--Treadmill test: nonischemic pain is ruled out: the evolution can be followed up. 2--Doppler velocimetry demonstrates the extent of the dominant arterial involvement in cases of associated lesions. 3--Arterial pressure gradients: their presence demonstrates significant lesions and allows detecting the affected levels. Quantification of severity: After detecting the lesions, their impact must be appreciated. From a macrocirculatory point of view, the measurement of pressures and flow rates is more sensitive than the Doppler study. From a microcirculatory point of view, the tcpO2 is very useful. 1--Arterial pressure: measured in the ankle and the first toe. There are three degrees: non-threatening ischemia (pulsatile Doppler, distal pressure exceeding 30 mm Hg), threatening ischemia (non pulsatile Doppler, distal pressure exceeding 30 mm Hg), irreversible ischemia (no more pulse, no more capillary flow). If there are arterial calcifications, the pressure in the toe must be measured. 2--Arterial flow rate: the average flow rate may be preserved in an arteriopathy, while the pulsatile rate is already degraded. Non invasive electromagnetic or nuclear magnetic resonance flowmeters measure the total muscular flow. Laser Doppler shows the cutaneous flow rate. 3--The tcpO2: normally greater than 60 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Electric Stimulation↗
PubMed1991

D-Dimers, thrombin antithrombin III complexes and prothrombin fragments 1+2: diagnostic value in clinically suspected deep vein thrombosis.

This study was performed to determine the accuracy of D-Dimer fibrin derivatives, thrombin-antithrombin III (TAT) complexes and prothrombin fragments 1 + 2 (F 1 + 2) determinations for the diagnosis of deep vein thrombosis (DVT). One hundred and sixteen consecutive patients referred to the angiology unit of our hospital for a clinically suspected DVT were investigated. They were submitted to mercury strain gauge plethysmography and to ultrasonic duplex scanning examination; in cases of inconclusive results or of proximal DVT (n = 35), an ascending phlebography was performed. After these investigations were completed, the diagnosis of DVT was confirmed in 34 and excluded in 82. One half of the patients were already under anticoagulant therapy at the time of investigation. The 3 biological markers were assayed using commercially available ELISA techniques and the D-Dimer was also assayed with a fast latex method. The normal distribution of these markers was established in 40 healthy blood donors. The most accurate assay for the diagnosis of DVT was the D-Dimer ELISA which had both a high sensitivity (94%) and a high negative predictive value (95%). The D-Dimer latex, TAT complexes and F 1 + 2 were far less sensitive and provided negative predictive values which ranged between 78 and 85%. In spite of positive and significant correlations between the levels of the 3 markers, their association did not improve their overall accuracy for detecting DVT. Therefore, with the exception of the D-Dimer ELISA, these markers were of little value for the diagnosis of DVT in this specific population.

Antithrombin III↗
PubMed1991

Prothrombin fragment 1 + 2, thrombin-antithrombin III complexes and D-dimers in acute deep vein thrombosis: effects of heparin treatment.

Plasma levels of prothrombin fragment 1 + 2 (F 1 + 2), of thrombin-antithrombin III complexes (TAT) and of D-dimers were evaluated at several time intervals in 15 patients affected by acute proximal deep vein thrombosis, complicated or not by pulmonary embolism, and treated by conventional heparin therapy for 9 d. The mean levels of the three markers remained significantly increased throughout the period of observation, except for F 1 + 2 on day 9, when compared to normal values established in a population of normal healthy blood donors. However, whereas heparin significantly decreased the plasma levels of F 1 + 2 and of TAT complexes in less than 3 d. D-dimer levels were not significantly altered. Significant correlations were observed between the plasma levels of the three markers but they were not correlated to the actual intensity of heparin treatment evaluated as the activated partial thromboplastin time prolongation. These results indicate that heparin improves the hypercoagulable state associated with a deep vein thrombosis within the first days of treatment as indicated by TAT and F 1 + 2. They also account for the performances of D-dimer assay for the diagnosis of deep vein thrombosis in patients already receiving heparin, a common situation in routine hospital practice.

Acute Disease↗
PubMed1991

[Diagnostic strategy of vascular diseases of the lower limbs].

Peripheral arterial disease requires different diagnostic strategies according to the clinical presentation: tissue ischemia, asymptomatic disease or polyarterial disease. In the presence of resting or effort ischemia, complementary investigations are indicated: arteriography should be reserved for indications of arterial reconstruction: ankle systolic pressure may be measured by all physicians to quantify the distal repercussions of the lesions. Asymptomatic peripheral disease is becoming more widely recognised and may be detected with flowmeter tests. Polyarterial disease is associated with increased mortality of patients with peripheral arterial disease. Symptoms of coronary artery disease are an indication for coronary angiography and myocardial scintigraphy. Patients with cerebrovascular events will require ultrasonic, CT scanning and cardiac investigations. The diversity of the diagnostic approach to peripheral arterial disease is creating a need for a new profile of vascular physicians.

Blood Flow Velocity↗
PubMed1991

Cost effectiveness of non-invasive tests including duplex scanning for diagnosis of deep venous thrombosis. A prospective study carried out on 511 patients.

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).

Adolescent↗
PubMed1991

[Venous echography. What value should be attributes to a negative result?].

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.

Adolescent↗
PubMed1990

Treatment of stage II chronic arterial disease of the lower limbs with the serotonergic antagonist naftidrofuryl: results after 6 months of a controlled, multicenter study.

A study was carried out in patients with intermittent claudication (Fontaine's stage II). The atheromatous origin of the disease was confirmed and localized by angiography or Doppler. One hundred eight-three patients were selected initially (day -30) with a pain-free walking distance on a treadmill (at a speed of 3 km/h and a slope of 10%) ranging from 150 to 300 m. During the first month (washout period) all patients received two placebo tablets daily. At the end of this run-in period (day -30; day 0) and after checking walking distance stability (allowed variation: 20% between the two measurements), patients were included in the study. According to this criterion, 112 patients were selected and 94 remained during the whole study. The study was designed in double-blind, using two parallel, randomly selected groups. Fifty-two patients received naftidrofuryl (2 x 316.5 mg tablets daily with meals) for 6 months; 42 patients received placebo under the same conditions. During this period, clinical and paraclinical examinations were carried out every quarter (day 90 and day 180). After checking the initial homogeneity of the naftidrofuryl and placebo groups, the comparison between the two groups indicates a significant improvement in the naftidrofuryl group after 3 months and 6 months of treatment, for the pain-free walking distance. For the maximal walking distance, a significant improvement was found at day 180. Nonparametric analysis (chi 2 test) also indicated a significant improvement for the naftidrofuryl group. These results confirm that naftidrofuryl is beneficial in the treatment of patients with chronic arterial disease.

Adult↗