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Biomedical subjects

M C Ginestet

Publications and source records attributed to M C Ginestet.

16 recordsLinked to original sources
PubMed1989

Treatment of femoropopliteal stenoses by means of self-expandable endoprostheses: midterm results.

An endovascular mechanical support that can be introduced percutaneously could be an attractive approach to preventing acute occlusion and restenosis following angioplasty. The self-expandable metallic endoprosthesis is characterized by its flexibility and elasticity. The authors report the results of 40 femoropopliteal implantations in 36 patients; the follow-up period was greater than 6 months in all patients. Lesion length exceeded 7 cm in 25% of cases and was 3-7 cm in 75%. Thirty percent of lesions were total occlusions. At hemodynamic and angiographic study, two types of complications were noted. In patients not receiving orally administered anticoagulants, six thromboses occurred early; no early thromboses were noted in the nine patients treated with acenocoumarol. Restenosis occurred in 10% of cases (maximum follow-up, 2 years) and was noted even in long lesions (greater than 7 cm). The authors believe that placement of this type of prosthesis is an attractive approach to preventing postangioplasty restenosis, provided that the conditions of anticoagulation are well controlled.

Adult↗
PubMed1989

[Education of patients with arterial disease. A plan for the use of Expert System in angiology via Minitel].

We are presenting a computer program requiring the use of an Expert System accessible by Minitel, intended for patients with arterial disease and their attending physician. The objective is not to make a diagnosis, but to train the patients in applying health measures to the handling and prevention of his/her disease. While remaining anonymous, the patient may consult the program at home, without any time constraint. Only the patient's physician can authorize him/her to have access to the program. The Expert System may adjust the answers to the patients according to the past history and recent data. Contrary to a computer program, new knowledge does not impair the functioning of the system. The physician has access to simplified modules regarding his patient, and specific modules regarding the treatment. Such a system would help general practitioners in following his patient and would facilitate the Doctor-Patient relationship during consultations.

Arterial Occlusive Diseases↗
PubMed1988

[Intermittent arterial claudication. Clinical aspects--hemodynamic correlation].

INTRODUCTION: Intermittent arterial claudication is the master symptom in lower limbs arteriopathy. It is used as a reference in invasive or non-invasive arterial explorations. It allows to assess the evolutive degree of the disease and above all helps the therapeutic decision. The seat of claudication is traditionally acknowledged as being located immediately downstream of the significant arterial lesion. The purpose of our work was to verify such a notion and ascertain the relation between spontaneous and tread-mill induced claudication. PROTOCOL: 60 stage-2 arteritic patients were included in a prospective mode study. They were all taken in hospital for arteriographic check-up and vascular functional explorations: Doppler velocimetry, segment pressures, treadmill tests and pressure measurements after stress. The patients were classified according to age (table I), time of claudication record (table II) and lesions location (table III). All clinical and paraclinical data were recorded with a view to correlations interpretation. RESULTS AND DISCUSSION: The relation between spontaneous claudication and tread-mill induced claudication was studied with respect to lesion sites (table IV). Among 37 patients 46% of the claudications observed appeared at iliac stage in both cases (fig. 1). In 35 cases, femoral claudication was observed in 48% (fig. 2). As for distal claudication among 6 patients, 3 showed calf claudication in both cases, i had foot claudication and 2 showed discrepant claudication types. The relation between claudication and lesion site was not confirmed in all cases. Buttock claudication always appeared in relation with a lesion upstream or an internal iliac lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Value of combining the thermal test with laser Doppler measurement of skin hemodynamics. Study of vascular acrosyndromes].

Different exploratory investigations of vascular acrosyndromes have failed to define their physiopathology. Capillaroscopy studies the specific morphologic aspects of certain connective tissue diseases, hemodynamic tests usually determine a global parameter, and those tests investigating cutaneous physiology alone come up against difficulties limiting their diffusion. The laser Doppler flowmeter (LDF) measures global skin flow in a reproducible, continuous simple manner, and was combined with standardized provocation tests during a prospective study to assess its value in angiology. The protocol involved a prospective study of 100 subjects during the winter 1984-1985: 21 healthy volunteers, 11 cases of acrocyanosis, 9 of acrorhigosis, 48 of Raynaud's phenomenon (22 primary and 26 secondary), 11 of connective tissue disease without Raynaud's phenomenon (table I). The LDD test measures skin microcirculation flow continuously in parallel with skin thermometry. Provocation tests included a standardized thermal test (fig. 1); the temperature is automatically reduced to 0 degree C in 15 minutes and then increased to 25 degrees C in 10 minutes in a jar into which the hand and forearm of the patients and any measuring captor are introduced. Respiratory provocation and additional pharmacologic tests were also completed. Interpretation of results involved calculation of the mean skin flow, Dm, pulsatile skin flow, Dp (fig. 2 and 3), at the basal state and then during temperature variations. The reference value of Dm is 2.741 +/- 0.378 V and is decreased in acrorhigosis, acrocyanosis and severe Raynaud's phenomenon. At 0 degrees C the decrease in Dm is 33 +/- 13% in healthy subjects. Specific values for different acrosyndromes and particularly the various types of Raynaud's phenomenon do not exist.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Subungual glomus tumors. Apropos of 2 cases].

Glomus tumours are uncommon, though not exceptional, benign growths developed from the constituents of the "neuromyoarterial glomus" initially described by Masson. Two cases of subungual glomus tumours of the hand in middle-aged women are reported. In spite of characteristic symptoms, with paroxysmal episodes of pain triggered off by cold and the most minute traumas, and of the finding in both cases of a violine++ tumour under the nail, the condition was belatedly diagnosed (7 and 27 years respectively after the onset of symptoms). Diagnosis rested not so much on standard radiography, which showed erosion of the distal phalanx in both patients, as on arteriography of the hand which displayed a small vascular pool at the arterial stage. Tumoral excision was successful.

Angiography↗
PubMed1987

[Variations in venous physiology in the healthy subject. Postural and venous occlusion plethysmography studies].

The principal characteristic of the venous network is its distensibility, the reason for its role as blood reservoir and cardiovascular adaptation system. This distensibility varies continuously as a function of venous tone, of neurocardiovascular adaptation and of the method used for its determination. The importance of variability of venous physiology was investigated by postural and venous occlusion plethysmography. Two series of tests were performed in 3 healthy volunteers, each being treated over one month: one series involved 19 determinations during May 1985, the other 14 determinations in December 1985. Two plethysmographic methods were employed: conventional venous occlusion plethysmography in decubitus with compression of 50 mm Hg and postural plethysmography with venous occlusion only, using gravity force during variations in position of subjects. Venous filling, a function of venous distensibility, varied between 16.7 and 17.8% during venous occlusion and 23.9 and 31.7% during postural plethysmography. Emptying half-life was from 20.7 to 40.7%. Emptying rate was, by the 6th second, 17.3 to 21.6% for venous occlusion and 27.3 to 32.3% for postural plethysmography. A relation was not found between results for the two methods, suggesting that they explore different phenomena. Variability of venous physiology parameters is marked, modulations being due to general or local factors, the former acting on both legs simultaneously: exterior temperature, neurocardiovascular physiology, digestion, stress, relaxation. Factors can have their effects reduced by differential study of the two limbs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1985

[Exploration of the cervical arteries within the framework of an angiology service. Our experience using Doppler spectral analysis].

Diagnosis and quantification of severity of carotid lesions were assessed by different procedures. Oculoplethysmography was of value only in cases of significant occlusive lesions. Ultrasound methods possessed enhanced sensitivity: Doppler velocimetry, ultrasound imaging and particularly spectral analysis of the Doppler signal. Efficacy of this exploratory method was assessed in a department of angiology, spectral analysis being rated as 5 different grades as a function of degree of arterial stenosis (fig. 1). It was routinely combined with Doppler velocimetry and ultrasound imaging in 35 patients, a total of 64 carotid bifurcations being analyzed. Digital subtraction venous angiography was performed in 28 of these cases. Study of the reading effect on interpretation of the spectral analysis showed 37 agreements and 27 divergences; among the latter the definition of normality in relation to grades I or II appears to be responsible. Greater significance was noted for the reading effect in cases explored by Doppler velocimetry and ultrasonography. Positive findings were obtained with spectral analysis in 41 of 64 patients, either by detection of non-significant lesions or by precise quantification of stenotic lesions. Results of digital subtraction angiography were debatable in 8 of 28 patients and were unconfirmed on ultrasound imaging. Spectral analysis of the Doppler signal has therefore an advantage over Doppler velocimetry and ultrasonography in that more precise data is obtained on stenotic lesions and that those of little significance are detected. It supplies an effective means of diagnosis and surveillance and it establishes the need for angiography. Lack of sensitivity and reproducibility of ultrasound and digital subtraction venous angiography raises the problem of an effective reference test.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Diseases↗
PubMedDate not supplied

[Photoplethysmography (PPG) or photoreflexometry (PRM): principle and reproducibility (study of the validity of the method in healthy subjects)].

Photoplethysmography, a non-invasive vascular exploratory test, has recently made great in the evaluation of venous haemodynamics. The principle of Photoplethysmography uses the cutaneous reflection of infrared light in the intradermal venous plexi. Then methods are presented for a reliable implementation of the tests. Validity of the method is verified by applying statistical tests to measurements carried out in two healthy subjects. In conclusion, Photoplethysmography may be produced, providing that the method used is strict, that three successive measurements are carried out, so that only the mean value is considered; because of the low value of the variability index of the total filling time, this parameter is used in the interpretation of the method.

Female↗
PubMedDate not supplied

[Diagnostic value and significance of photoplethysmography in venous insufficiency].

In this study, including 62 patients, or 104 lower extremities, the author demonstrates first, with the chi-2 test, that the method based on Photoplethysmography has a good diagnostic value (sensitivity: 92%, specificity: 88%). Then, with the Student t-test, he demonstrates that the advantage of Photoplethysmography in venous insufficiency is to differentiate easily normal subjects from subjects affected with valve insufficiency, and to establish the differential diagnosis between superficial valvular insufficiency and deep valvular insufficiency. On the contrary, in analyzing the discrepancies between clinical examination and the results of Photoplethysmography, he demonstrates that the diagnosis obtained with Photoplethysmography is limited in the presence of edema, isolated varicose veins, Phlebitis and arterial disease, or during an ineffective compression of the reflux of the superficial venous system. Finally, the author suggests an approach in patients with chronic venous insufficiency, based on clinical examination, Doppler examination and Photoplethysmography.

Aged↗
PubMedDate not supplied

Laser Doppler flowmeter and standardized thermal test in normals and Raynaud's phenomenon.

The diagnosis of Raynaud's phenomenon alone requires clinical investigations. To determine the stage of the disease, its etiology and pathophysiology, it seems desirable to perform noninvasive tests. Conclusions regarding control o the skin or muscle components of hand blood flow rely on evidence from separate measurements of skin or muscle blood flow. We described a standardized thermal provocation test, then respiratory maneuvers and pharmacological trials, to stimulate the microcirculatory control. The total cutaneous blood flow was continuously registered using a laser Doppler flowmeter. We conducted a prospective study on 100 subjects: 21 normal, 22 primary Raynaud's phenomenon (PRP), 26 secondary (SRP), 31 various microcirculatory diseases. The basal blood flow was lower in cases of severe SRP and acrocyanosis. In comparison with normals, RP cases present a less noticeable reaction to cold. Mild SRPs are more sensitive to cold and do not recover during warming up. Severe RPs are less sensitive to cold as they have a lower basal blood flow. Acrocyanosis cases are not sensitive to thermal variations. Post ischemic reactive hyperemia leads to a constant peak flow. Pharmacological assays were performed (nitroglycerine, Nifedipine) during permanent control of skin and muscle blood flow. Laser Doppler and provocation tests have no etiologic value in a Raynaud's phenomenon investigation; this methodology tries to elucidate the pathophysiology, the prognosis and the therapy of Raynaud's phenomenon.

Adult↗
PubMedDate not supplied

[Measurement of capillary permeability in chronic venous insufficiency using sodium fluorescein video-densitometry].

The measurement of capillary permeability in chronic venous insufficiency (CVI) requires techniques able to modify local microcirculatory hemodynamics and therefore the results. As for instance, venous occlusion in the Landis test or occlusive plethysmography. We are presenting a selective method which visualizes and quantifies capillary permeability without modifying the hemodynamics. A skin area on the lower extremity is observed on a microscope with blue filters. This optical device is linked with a camera transmitting information to a TV monitor and a video cassette recording system. When focusing is done, the patient's brachial vein is injected with an IV bolus of 1 ml if sodium fluorescein (Na flu). This dye diffuses rapidly from the intra toward the extra-capillary compartment. A densitometer connected to a graph measures the capillary permeability selected dynamics. The capillary permeability to Na flu is evaluated qualitatively on the TV screen (pericapillary halo), and quantitatively by the densitometric curve. In practice, this technique is advocated in the physiopathological study of any edema, especially in early CVI.

Capillary Permeability↗
PubMedDate not supplied

[The value of postural plethysmography in the study of venous physiology and in the evaluation of vasotonic agents].

Venous physiology is generally neglected and badly studied. Knowledge of it is nevertheless essential in pathological cases such as venous incompetence and its treatment. It is this which is principally responsible for cardio-vascular adaptation after positional changes. Mercury gauge venous occlusion plethysmography has contributed certain progress. Postural mercury gauge plethysmography without venous occlusion answers the chief physiological preoccupations. No artefact impedes the physiology. The positional adaptation is tested. A DV/DP diagram is established and compared in normal subjects and patients with venous incompetence. A complementary procedure for a microcirculatory study is proposed: the measurement of cutaneous flux using laser Doppler or photoplethysmography and a study of the permeability of the capillary walls using fluorescein videodensitometry. This veritable testing stand of the venous system can serve as reference for procedures of therapeutic tests for all medication for venous tropism (vasotonics, vasodilators of venous location) or in studies on spatial medicine.

Humans↗