[Henri Reboul and vascular pathology].
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France↗
Biomedical subjects
J Marmasse
Publications and source records attributed to J Marmasse.
[Physical methods in the treatment and prevention of deep phlebitis of the leg].
By the term "physical methods" the author envisages primarily walking, wearing an elastic support, and rest with the legs raised. Physical methods for the prevention and cure of phlebitis were worked out by two French surgeons between the two wars but have been rapidly replaced by coagulant treatment. Now these methods have been reduced, in most cases, simply to a "fight against haemostasis" by means of verbal instructions and with no relation to the original methods : in many cases the methods are not known to the younger generation of physicians because they have not been taught them. Several factors are leading to renewed interest in these methods : on the one hand the undeniable dissatisfaction with anticoagulant therapy, and on the other hand the many experiments that, in the last 15 years, have led to an understanding of the mode of action of the physical methods. These experiments are reviewed in the present article. From the practical point of view, improvements in materials have led to improvements in the range of bandaging techniques. The authors looked back at the original publications, that is to say to the publications of Chalier and of Nard, who described methods, which have been much referred to, that were quite exacting. The different types of bandaging for the prevention and cure of thrombosis are illustrated by numerous pictures. In the curative treatment of phlebitis, there are three essential indications for the use of physical methods : contraindications for anticoagulants, their failure, and the prevention of sequelae. In the prevention of phlebitis, the raising of the legs when seated, a factor in a quasi-experimental stasis, must give way to mobilization - very early and very frequent walking. It is the opinion of specialists in phlebitis, who have used these methods over many years, that the physical methods, which are also physiological, are a valuable complement to biological methods. Their effectiveness is, however, a function of the rigour with which they are applied : --as regards degree : the support must be applied in the correct dosage, as, for example, must heparin and digitalin ; --as regards staff : the patient and his associates must collaborate closely, and nursing staff are indispensable ; --as regards skill : the faith of the physician alone can overcome the doubts or scepticism of others.
Bandages↗
[Vasomotor substances and anti-inflammatory agents in the treatment of phlebitis].
Intrafemoral injections of substances known as "vasodilators" are still of the utmost value in the treatment of deep phlebitis as are the anti-inflammatory drugs, particularly in their injectable forms (Butazolidine, Ketazone). The indications are : cases of phlebitis that are just developing ; failure of anticoagulants ; and contraindications to the use of anticoagulants, notably phlebitis during pregnancy. As always in the treatment of phlebitis, therapeutic results are only complete and lasting if an effective support bandage is also applied.
Anti-Inflammatory Agents↗
[Surgical approach to a leg ulcer in areas of subcutaneous calcinosis].
The medical treatment of ulceration of the legs in areas with a subcutaneous plaque of calcinosis is often unsuccessful. The phlebologists then refer the patient to a surgeon. A patient aged 58 years, with a previous history of phlebitis, presented on two successive occasions with ulceration in the area of a large calcification in the lower third of the left leg. Cicatrization was obtained by a surgical treatment. Such surgery must be preceded by local and complete vascular assessment and by appropriate pre-operative care. It consists mainly of ablation of bone sequestration in order to obtain a suitable surface on which to apply thin skin graft in strips. It is often necessary to carry out an internal saphenous crossectomy as well to treat an associated venous insufficiency.
Aged↗
[Various cases of calcinosis].
The authors report seven cases of calcinosis, two of which were intravenous (phlebolithiasis) and five subcutaneous. Radiography of the soft tissues revealed in some cases a truly calcareous shealth, the size of which would not have been suspected from a clinical examination. Extensive calcification may be surprisingly well tolerated and results only in torpid ulceration that heals with simple conservative methods. On the other hand, pain and secondary infections may necessitate surgical resection of the calcareous plaques after arteriography.
Aged↗
[Compression method throughout the ages].
The compressive method was practiced instinctively in farthest antiquity. Its development in Western Europe over the past two centuries may be artificially divided into 3 phases. The first phase, which belongs to the prehistory of Phlebology, includes two notable facts: the start of ambulatory compression in London around 1800, and the interest that the French school immediately showed in this discovery. However, this measure was soon abandoned, since around 1880, in the Paris hospitals, ulcers of the leg were being treated by mercury plasters and rest in bed. The second phase--1900 to about 1950--is marked by the empirical development of the compressive method, mainly in chronic phlebopathies. The synergic effect of walking is definitively established; the treatment of deep-set phlebites by ambulatory compression is discovered by H. Fischer in Germany and then in France by L. Nard. Beginning in 1950, this empirical data is both spread by the new Phleboloby Societies, and submitted to rigorous scientific study. Clinicians (especially H. R. Van der Mollen), assisted by physicists, physiologists and biologists, establish the laws of "therapeutic counter-pressure" and transpose them in the textile industry. New materials facilitate the use of elastic pressure. Underestimated or little known by most physicians, ambulatory elastocompression remains for Phlobologists a fundamental therapy. At a time when sedentary living and excess use of drugs are being widely denounced, it still has a promising future.
Bandages↗
[Hypodermitis of venous origin].
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Adrenal Cortex Hormones↗
[Is sclerosing using salicylate or iodine forbidden in France?].
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France↗
[2 recent cases of ambulatory phlebitis].
The author describes two cases of ambulatory iliac phlebitis occurring in young women, one pregnant, the other taking synthetic oestrogen-progestogen drugs. Anti-coagulants were contraindicated because of the pregnancy in the first case, and because of practical obstacles to their correct use in the second. In consequence both cases were treated as outpatients by physical compression (Nard's method), without any anticoagulant medication : the results were striking and lasting.
Adult↗
[Therapeutic indications in 4 cases of hemangioma].
The author presents four cases of flat, diffuse angiomatosis with metameric distribution on the external surface of the leg, with ipsilateral varicosis. The first patient was cured by sclerosis of a sinous network of varicose veins; the second by atypical stripping of an abberant varicose collector on the external surface of the leg. The other two cases presented typical ipsilateral varicosity of the internal saphenous; simple in the third case, complicated by arterio-venous fistulas in the fourth: the latter subject will be cured durably by stripping of the internal saphenous, resection of the arterio-venous communication and permanent support.
Adolescent↗