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J J Guex

Publications and source records attributed to J J Guex.

16 recordsLinked to original sources
PubMed2000

Edema and leg volume: methods of assessment.

Various techniques may be used to assess leg edema. The value of these investigations has been discussed in depth in the consensus statement made in Vaux de Cernay in 1997 and supported by Servier Research Group. These techniques can be classified into three groups: The most simple is leg circumference measurement, which can be assessed by a tape measure, or more rigorously with a Leg-O-Meter. This device is a cheap and reproducible method that has been validated and that takes into account the height at which the circumference has been measured. However, circumference measurement is not always correlated with leg (including foot) volume measurement. The second group of techniques assess leg volume. The most simple method is water displacement volumetry, which has been validated in terms of reproducibility. Several other devices have been used: optoelectronic methods, computed tomography, magnetic resonance imaging (high resolution), dual X-ray absorptiometry. These methods are expensive and not all of them have been validated, but these might be the future investigations of choice. Some other investigations assess immediate variations in volume such as water displacement using dynamic foot volumetry, rheoplethysmography, strain gauge plethysmography, and air plethysmography. The assessment made by these methods (using postural, dynamic, or compressive maneuvers) is more an assessment of the venomuscular pump and/or venous outflow than volume assessment. In conclusion, edema, an early and frequent sign of chronic venous insufficiency (CVI), can be precisely measured by several methods. This measurement can be considered one of the most objective ways of assessing treatment efficacy in CVI-associated edema.

Absorptiometry, Photon↗
PubMed1996

Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis.

BACKGROUND: Some recent publications have emphasized the risk (up to 25%) of deep venous thrombosis (DVT) coexisting with a clinical evidence of superficial venous thrombosis (SVT). However, most papers on this topic are old and do not consider the use of the duplex scanning. OBJECTIVE: To determine what the spontaneous risk is of venous thrombosis and emboli in varicose patients, in the superficial veins, and in the deep veins; what the risk is of extension or coexistence between superficial and deep thrombosis; and whether the treatments of varicose disease are responsible for thrombosis? METHODS: Review of the literature. RESULTS: The frequency of venous thrombosis appears to be increased in patients with varicose disease. CONCLUSIONS: In all cases of clinical SVT a duplex scan examination of both deep and superficial veins is necessary in order to provide a complete diagnosis. The treatment of SVTs depends on the situation and the size of the thrombi. In case of associated DVT, the most important treatment is of the DVT. The interest of heparin or low molecular weight heparin (therapeutic doses) is proved for patients with coexisting DVT, and thought so for ascending SVT. Interest and doses have not been stated in other cases. SVT must be considered as a risk factor of DVT and treated from this point of view. Biological analysis and a complete check-up are mandatory in cases of varicose thrombosis in young patients and in cases of recurrence.

Aged↗
PubMed1994

[Physiopathology of post-thrombotic syndrome. Update 1994].

The complex physiopathology of the post-thrombotic syndrome following deep venous thrombophlebitis involves a sequence of hemodynamic and biochemical events; development of the clinical picture, which remains susceptible to change, is a late occurrence following a long free interval. Despite re-establishment of venous patency, residual valvular lesions can cause orthostatic reflux. While residual occlusion generally has few long term repercussions, failure of the calf muscle venous pump is a serious potential consequence of such reflux. The clinical picture is less severe when the popliteal vein valves are not destroyed. The responsibility of wall compliance alterations has been proved as well. The initial thrombosis and/or the reflux may lead to associated incompetency of the perforating veins, then of the superficial venous network, thus aggravating the hemodynamic disturbances. The increased venous pressure results in alterations in upstream circulation, especially in the venous capillaries; the resultant increase in intraluminal pressure reduces fluid reabsorption. Edema remains intermittent so long as the lymphatic network withstands the excess workload. Thereafter, post-thrombotic lymphedema develops; the accompanying tissue fibrosis, a classical feature of the clinical picture, is attributed to the elevated concentration of macromolecules. This stage corresponds to lipo-dermato-sclerosis. The increase in the fibrinogen concentration, the reduction in tissue fibrinolytic activity, and the formation of pericapillary fibrin cuffs have all been considered as possible causes of leg ulceration. In fact, the assumed phenomenon of secondary hypoxia has not been demonstrated, and the fibrin cuffs do not appear to constitute a true barrier.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamics↗
PubMed1993

Indications for the sclerosing agent polidocanol (aetoxisclerol dexo, aethoxisklerol kreussler)

BACKGROUND: Polidocanol is a widely used sclerosing agent that was first developed as a local anesthetic. In France it is used in varicose veins as well as in telangiectases. OBJECTIVE: To improve the knowledge of the effects of polidocanol and provide recommendations for better use. METHODS: Based on 12 years of experience in treating nearly 11,000 patients with polidocanol, the author reviews his observations. A theoretical model of dilution of sclerosing agents in injected veins is provided. RESULTS: The author observed: seven cases of minor urticaria, occurrence of grey veil when used under the air-block technique, one case of cutaneous necrosis (5 cm3), and some small epidermic necrosis (1-mm diameter) and neither shock nor severe adverse reaction. CONCLUSION: Polidocanol is characterized by its spasmogenic action on veins, excellent local tolerance, and a very low incidence of general reactions. Low concentrations (0.3 to 0.6%) can be used for the treatment of quite large varicose veins if an adequate volume is injected.

Adult↗
PubMed1993

Microsclerotherapy.

The full text of the course given at the European School of Phlebology (Paris, France, November 27, 1990), presenting all the aspects of pathology and microsclerosing treatment is offered. Practical technique, material, and hints are presented to help young (or new) practitioners. These protocols are widely used in France and they are based on the works of the Ecole Française de Phlébologie founded by Raymond Tournay. Some differences may appear between our methods and other methods proposed in Europe and the United States but the results are, in fact, proven to be very good with very little postsclerotherapic matting and pigmentation. For instance, we do not recommend compression in these cases because it does not improve the results. In this article, the sclerosing agents we discuss are different from those available in the United States but our reflections remain valid and we hope these products will soon be approved for use outside of France.

Glycerol↗
PubMedDate not supplied

[Phlebologic management of seropositive patients].

There appears to be an increase in the number of HIV-positive patients seeking treatment for varicose veins. This is due to the increase of the incidence of the disease in the population, its spread amongst non-marginalized people and because the patients known that although their long-term prognosis is poor, they do have a latency period during which they can live a normal life. Should HIV-positive varicose patients be considered in the same way as other varicose patients or should they be refused treatment unless this is really indispensable? This is the main pratical question, because many patients are refused treatment, whereas the authors make no distinction in principle. The authors ask what impact will this attitude have on the work of the consultation service and try to give some guidelines.

Clinical Protocols↗
PubMedDate not supplied

[What can a neurophysiologic examination contribute to phlebologists?].

After a theoretical summary and account of current techniques, the authors describe the 'electric symptomatology' of the lower limbs and suggest the pathologies in which the anomalies are to be located. The analysis of some personal clinical cases enables them, finally, to draw some practical conclusions: an NP check-up can easily be requested, is not traumatic, and should be considered (except in cases where a primary neurological pathology is suspected) when the clinical and paraclinical symptoms on the one hand, and functional disorders on the other, are dissociated. Emphasis should be placed on reduction of speed of conduction, provided that the examination is carried out by a trained specialist, preferably always the same one. Finally we think that metabolic disorders engendered by venous stasis are likely to be accompanied by neuritic-type degenerations which then develop on their own account; this will be the subject of a further study.

Aged↗
PubMedDate not supplied

[Complicated lymphatic lesions following extensive venous surgery. Various questions apropos of 2 cases].

In reference to two rather representative cases, the author describes an clinical picture consisting of repeated attacks evoking a masked erysipelas this type of attack, in a context of repeated or extensive venous surgery with incisions in the areas of projection of the lymph collectors must be the indication lymphography showing partial lesions of the lymphatic network. This implies that the etiology is the persistence of streptococci, in dead-end collectors and their occasional awakening. The treatment proposed, justified by frequent recurrences, their progressive aggravation and the possible risks for the general condition, must be, as in chronic streptococcal infections, penicillin V therapy in prolonged but continuous doses (500,000/day) associated with a thorough hygiene of the feet and a regularly worn elastic contention.

Adult↗
PubMedDate not supplied

[Ambulatory dermo-epidermal patch graft. Its advantages to the phlebologist in his office].

By way of analysing the leg ulcers treated at his consulting rooms during six months, the author introduces the dermo-epidermal graft, simplified in a way that makes it practicable in the framework of an ambulatory treatment, with maximum ease for both practitioner and patient. The results, altogether satisfactory, prompt him to suggest that this technique be used in the context of routine treatment of leg ulcers of all aetiologies and sizes. The time gain is considerably more significant than the simplicity of the technique would lead one to suppose. The incidence of the method is quite high as it has been used in 15% of cases, but this frequency could easily be increased further with more daring. To all accounts there are no significant accidents to be feared and the author, describing the technique, urges those of his colleagues who have not yet tried the ambulatory dermo-epidermal patch graft to familiarize themselves with it.

Aged↗