Biomedical subjects
Publications and source records attributed to J R Dumas.
Capillaroscopy is a very simple examination which allows good evaluation of the superficial micro-circulation of the skin. The authors consider that this new examination constitute a method to evaluate the risks of skin necrosis after facelift and abdominoplasty and, may possibly change the strategy of operations.
Capillary blood ATP assay was performed in 2 groups of patients (diabetic and non-diabetic) with disorders of microcirculation, before and several minutes after 2 mg I.V. of Coenzyme A (CoA 1000). Values obtained showed a significant increase in both groups. The hypothesis advanced, based on previous experimental data indicating an action of CoA on intracellular calcium movement, is that CoA 1000 acts by elevation of the membrane ATP/Ca+ ratio of red corpuscles, and possible activation of their deformability and flow rate in the microcirculation.
The basis for the study conducted was a clinical observation: the fairly stereotyped microcirculatory disorders occurring during "affective" neuroses. Examinations were performed initially with the capillaroscope alone and then this was combined with plethysmography and Doppler tests in the hands and the fingers (9.2 MHz sound). Fifty-two patients were examined (30 by capillaroscopy alone and 22 with associated plethysmography and Doppler to the hands). A more psychiatrically orientated consultation with 51 of these patients indicated that an affective shock had preceded the onset of the acrosyndrome in 27 cases. The syndromes provoked may be severe and may lead to pseudo-necrotic lesions. High doses of vascular tonics are necessary, the condition being made worse by the tricyclic antidepressants.
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The new compounds such as Prazosin are antihypertensive agents. Their action on blood pressure are a consequence of a direct action on vascular smooth muscle with little or no effect on cardiac output. This action is very important to reduce total peripheral resistance. In our Vascular Laboratory, we study 14 patients treated by Prazosin. They were all studied by capillaroscopy, ultrasonic investigations and plethysmography. Since Prazosin is primarily an alpha receptor blocker, it might be expected to have an action in microcirculation and in vasospastic diseases. We don't find modifications of microcirculation in seven people treated for hypertensive disease. Among seven patients with Raynaud phenomenon, we have only a good result in one case (Buerger disease) and two cases with a little increase of the fingertips blood flow.
Sex hormones have an effect on venous "content" and "container" according to their chemical nature, their dosage and their mode of administration: 17 beta-estradiol (endogenous): protective effect; synthetic estrogens, at normal or low doses: thrombogenic; oral natural estrogens: thrombogenic; extra-digestive natural estrogens: non thrombogenic; non steroid progestagens (androgenic): thrombogenic; non androgenic progestagens: non thrombogenic. Clinically, the venous disease si characterized by sudden episodes occurring at key-periods of the hormonal life: puberty, pregnancy, menopause, oral contraceptives intake, substitute treatments of menopause, premenstrual syndrome. Evaluation of these different situations shows that an early treatment is possible and needed, which, although not providing a new venous wall for these constitutionally fragile patients, may act effectively at two levels: 1) correction of the haemodynamic disorder (venous reflux in the saphenous arches and the perforators; 2) resorption of tissue infiltration. As primary prevention, in a patient with hormonal disorders or who must be treated with estrogens or progestagens, the objective of our treatment is to protect the venous wall and encourage the return circulation. One must: 1) reinforce the vaso-constrictive effect and the parietal tone, 2) limit collagen and elastin alteration, 3) reinforce capillary permeability and decrease the interstitial edema, 4) normalize the haemorheological constants, 5) restore the balance hemostasis-fibrinolysis. The opinion of a phlebologist seems essential before prescribing a hormonal treatment and monitoring the effects of the treatment. Cooperation between gynaecologists and phlebologists is particularly essential in the interpretation of the clinical disorders as well as discussing the venous risk, the dosage and the administration route of sex hormones.
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