[Successive ischemic encephalic accidents disclosing a arterial disseminated entity].
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Biomedical subjects
Publications and source records attributed to J F Merlen.
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The underlying concepts of the study of subcutaneous and intramuscular tissue pressure, which began in 1952, have been highly modified. Three types of methods are now used: direct needle puncture, the perforated capsule, and the microcatheter. The capsule and the catheter are sensitive to osmotic and hydrostatic tissue pressure, and the needle indicates an interstitial hydrostatic T.P. We prefer the latter method, which allows the total T.P. to be measured.
Certain forms of claudication are due to excess tissue pressure of the muscles of the aponeurotic chambers of the leg. These have been well described by Reneman, especially in their chronic form and for the anterior and lateral chambers. The claudication is due to an overworking of the muscles caused by walking, running or effort. It has its own characteristics, with direct measurement of the tissue pressure and phlebography aiding the diagnosis and attention being drawn by the presence of a "muscular hernia of the leg". Fasciotomy is the corrective treatment for cases of hyperalgia and beginning with a certain gradient of muscle pressure. The pathogenic reasons for this are discussed.
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While the term cellulitis is incorrect, it is commonly used and deserves a nosological classification. "Cellulitis is a dermohypodermosis and an oedemato-sclerous panniculopathy- It is indeed a true histangiography in which the fibroblastic reaction predominates over capillaro-veinular changes. Adipocytes of exaggerated size interpenetrate into micro- and later into macronodules marked off by more or less structured conjunctive fibrilla, thereby making treatment difficult.
Following a nosological discussion of the varicose vein, its histological, biochemical and immunological elements are detailed. The hydraulic conditions are described, and attention is drawn to the microvasculartissue consequences of the stasis, the degree of constraint exercised by the interstitial tissue, and the role played by the intricate "micro fiber" network of the microcirculation: only a part of the capillaries reconnect with the veinlet of the same circulatory unit, the others having to flow toward the veinlet of other units and only one initial lymphatic vein contributing to the evacuation of 3 to 4 veinlets. The slightest hydraulic imbalance due to the stasis, sets of a whole series of chain reactions that can rapidly become harmful, with chronic veinous deficiency setting in.
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