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A prospective study was done in 100 patients operated on for a stenosis of the carotid artery by the eversion endarterectomy method of Van Maele (section-eversion-anastomosis) between January 1994 and August 1995. Ten patients were operated on bilaterally (thus, 110 procedures). The distribution of the patients was as follows 81 males and 19 females, mean age 71 years. Clinically, 50 patients were asymptomatic, 44 stage I, 2 stage II and 4 stage III. Arteriography of these patients showed 42 stenoses greater than or equal to 90%, 56 stenoses between 70 and 90% and 12 ulcerated plaques (according to the ESCT measurement standards). Concerning the supra-aortic vessels, 24 lesions of the vertebral-subclavian branches and 21 lesions of the intra-cerebral vessels were observed. Five endarterectomies out of the 110 (5.4%) could not be performed by this eversion method because of the immediate poor technical result before angiography. At the end of the procedure digital angiography was performed for all the patients who underwent an eversion endarterectomy (105 cases). Six images of the internal carotid artery presenting stenoses less than 30% were observed at the level of the implantation site. Two narrow stenoses of the distal part of the endarterectomy made the interposition of a PTFE graft necessary in 20% of the cases, a secondary procedure was necessary after the peri-operative angiography 2 implantations of PTFE in the internal carotid artery, 8 additional endarterectomies of the external carotid artery, 11 infiltrations with Papaverine. The immediate post-operative results were 1 death after hemiplegia, 1 hemiplegia with sequelae (mortality/morbidity approximately 2%, i.e. 2/103 eversions), 3 regressive hemipareses. Angiographic follow-ups after 1 year were performed on 100 out of 110 operated carotid arteries. With regard to the internal carotid artery, 4 patients showed a stenosis less than 30%, 1 patient a 50% stenosis, 1 patient a pre-occlusive stenosis making an operation with the interposition of a PTFE graft necessary (restenosis rate after one year 2%). All the patients followed after one year remained asymptomatic. Eversion endarterectomy is possible for the majority of the atheromatous stenoses of the carotid artery (5.4% were not possible for technical reasons). We find this method not appropriate when a shunt must be placed. Immediate results are comparable to those of classical surgical endarterectomy with or without patching. The restenosis rate at 1 year in our series is 2%. This technique provides an excellent anatomic result by peri-operative angiography and can especially be adapted to stenoses with excess of length of the carotid artery.

Pancreatic juice is naturally supersatured in calcium and bicarbonate ions. A mechanism controlling CaCO3 crystal formation and growth is therefore necessary to prevent duct clogging. Lithostathine, a glycoprotein synthesized by acinar cells and secreted in pancreatic juice, could be involved in such a control. Lithostathine significantly delayed crystal nucleation and inhibited growth of CaCO3 crystals from supersatured solutions. Lithostathine adsorbed to sites specifically inhibiting crystal growth with a dissociation constant Kd = 0.9 x 10(-6) mol/L. The glycosylated N-terminal undecapeptide generated by limited trypsin hydrolysis of lithostathine, inhibited CaCO3 crystal growth with a Kd = 3.4 x 10(-6) mol/L similar to that of lithostathine. On the contrary, the carboxy-terminal polypeptide (lithostathine H) was inactive. The N-terminal undecapeptide of lithostathine is therefore essential to the inhibitory activity of the protein on CaCO3 crystal growth.

Over a 5 year period (1988-1992), 6 patients were treated by combined carotid and subclavian artery surgery, representing 0.7% of carotid interventions practised during this period. The carotid lesion clinical stage was 0 (2 cases), 1 (2 cases) and 3 (2 cases). While for the subclavian artery 4 patients were asymptomatic and 2 had vertebrobasilar syndromes, one associated with ischemia of upper limb. Only one patient was globally asymptomatic but the diagnosis was a prethrombotic carotid restenosis. Radiographs showed that the atheromatous lesion of the cervical trunks was equivalent to 2.83 stenoses per patient. The decision to use the combined interventions was based on either the clinical condition (combined carotid and vertebrobasilar symptomatology) or hemodynamic data (improvement in subclavian flow during carotid surgery). This hemodynamic component could be determined by transcranial Doppler. Operation consisted always of initial subclavian revascularization (1 reimplantation, 5 bypasses), followed by carotid surgery (2 grafts, 4 endarterectomies). The postoperative course was uneventful in 5 patients, the 6th patient requiring recovery surgery for early carotid thrombosis without worsening of the neurologic state. Mean follow up was 9 months (range 1 to 27 months). Combining these two interventions in this small series did not appear to increase carotid surgery complication. Initial revascularization of the subclavian artery in the patient with multiple trunk lesions corrected the posterior hemodynamic supply to the circle of Willis.

We have used endoprosthesis (Palmaz Schatz) after balloon angioplasty of iliac arterial stenoses or thromboses, in order to increase the immediate patency and to prevent the recurrence of stenosis. Our series gathers 24 patients operated with endovascular procedures over a period of 2 years: 22 men, 2 women--extreme ages 42 to 78 years, average age 63.5 years--Clinical stage: 22 at stage I, 1 at stage III, 1 at stage IV. Arteriographic findings: 8 primary iliac lesions (6 stenoses and 2 thromboses), 11 external iliac lesions (stenoses). All these lesions were atheromatous. One of them had recurred after angioplasty. Usual technique: balloon angioplasty of the stenosis, assessment on a fluoroscopic screen and angioscopy of the result, decision to insert the Palmaz Stent if defects are seen on the image. Repatency of impassable lesions with a YAG laser was carried out in 2 cases. The indication of an endoprosthesis was established on the basis of the radiological image in 17 cases, of the angioscopic image in 4 and systematically in 10 cases of recurrence of stenosis, iliac thrombosis or associated surgery. Associated surgery: 2 femoropopiteal bypass grafts, 3 femorofemoral bypass grafts, 1 deep plasty, 1 superficial femoral recanalization with laser, 1 lymbar sympathectomy. Postoperative results: 1 death due to MI (78-year-old diabetic woman), 1 thrombosis treated with femorofemoral bypass. Middle-term results: after 6 to 24 months, average time lapse 13 months. The comparison of the ankle pressure indices and of the pre- and postoperative sonographic findings shows an indisputable hemodynamic improvement.

Using a directional Doppler (4 MHz) coupled to a frequency analyser, authors investigate the supra-aortic trunks on 90 patients documented by arteriography. The analyser is made of a 16 filter bank system giving a spectrum composed of 16 frequency bands within range of 160 Hz to 4,800 Hz. Data analysis is made on a computer using the comparison means test and the discriminant analysis. Authors compare frequencies on normal common carotid arteries between a group (N = 102) with internal and external carotid arteries free of lesions on one hand, and a group (N = 75) with stenosis or occlusion of internal and/or external carotid arteries on the other hand. They don't note any significant difference for each on of the 16 frequency bands. Comparison of frequencies between normal subclavian arteries (N = 115) and subclavian arteries with proximal stenosis or occlusion (N = 24) shows a significant difference concerning the following bands : F12, F14, F15, F16 (p = 0.05), F13 (p = 0.01). Comparison of frequencies between normal internal carotid arteries (N = 108) and stenosed internal carotid arteries (N = 57) shows significant difference concerning : F11 (p = 0.05), F7, F8, F9, F12, F13, F14, F15, F16 (p = 0.01). On the other side, the discriminant function distinguishes a normal internal carotid artery from a stenosed internal carotid artery in 90% of cases, whatever the stenosis degree is. A discriminant function, added to this analyser, could obtain a frequency analysis easier and less expensive than by fast Fourier transform.

To mitigate the lack of reliability of currently used flowmetry technics, an original method was developed based on a single window 15 MHz Doppler flowmeter and an Apple IIe computer with data acquisition system. Eleven successive measurements of instantaneous rate were made in an arterial section. A mean flow was determined by integration of mean rate in section. The reliability of the method was evaluated by an experimental study on a hydrodynamic bench reproducing physiologic flow conditions with an error always less than 8%. An in vivo study in 30 patients provided 100 measurements of arterial flow before and after surgical arterial reconstruction. The mean error value was less than 10%. Among the risks of error, those due to the probe was reduced by specially conceived probes. The most important factor was that of respiration, this latter factor imposing an integration time of rate of signal of 30 seconds to eliminate errors due to respiration. The conventional measurement time for other configurations is 6 seconds but this leads to a mean error of 25% which can attain 60%. The perspective of miniaturization of the apparatus in the near future with acceleration of measurements using a multi-window Doppler should allow flow measurement in 30 seconds and control of surgical reconstructions (on healthy arteries, vein grafts and prostheses but excluding PTFE). Similarly, it should be possible to improve evaluation of so-called vasoactive drugs.

Bilateral angiographic examination of the upper limbs is performed under general anesthesia in 64 patients of a group of 138 Raynaud's phenomenons. Clinical severity of the Raynaud's phenomenon is evaluated according to the 3 grades of Porter's classification but including a grade 4 corresponding to digital gangrene. Aetiology of Raynaud's phenomenon is in relation with connective tissue diseases in 11 cases and with other aetiologies in 22 cases. Aetiology is not defined in 31 cases. Angiographic findings are: Arterial lesions are present in all 64 patients, including 11 cases of "Raynaud's disease" defined by clinical and capillaroscopic signs. Frequency of the forearm artery lesions (31% of patients), a majority concerning ulnar artery. Absence of palmar anastomosis in 55% of the cases. Frequency and severity of digital (mean 1.4/hand) and collateral digital (mean: 7.4/hand) artery lesions. Arterial lesions are in relation with the clinical severity of the Raynaud's phenomenon but generally not with its aetiology. Authors consider that angiographic examination may be indicated in Raynaud's phenomenons in relation with defined aetiology but generally not in the other cases.

An analytic study of the different techniques for non-invasive vascular exploration, used to examine cervical arteries, distinguished between hemodynamic tests (continuous and pulsed Doppler, spectral analysis of frequencies, oculoplethysmography) and imaging methods (ultrasound and real time echotomographic imaging). Best performances at the present time are obtained by combined frequency spectral analysis + real time echotomography or Doppler + real time echotomography. Selection of appropriate techniques is based on clinical findings of a symptomatic or asymptomatic patient. The decision as to the need for angiography and therapy can be made either immediately after the examination by Doppler alone or after a complete investigation, depending upon the circumstances.

The "dead finger" was first introduced into medical language in 1862 during the inaugural thesis of Maurice Raynaud: "of local asphyxia and symmetrical gangrene of the extremities". It has never ceased to stimulate interest since that date and to excite passionate speeches. Numerous reports of studies have been published since 1862 and "Raynaud's disease" has become a "syndrome", "phenomenon" or even "idiopathic disease" as a function of the author and the prevailing fashion, thus increasing the original confusion. However, it is now recognized that vasomotor disorders are not due to a single cause: apart from the primary forms of apparently purely spasmodic etiology, numerous affections accompanying these anomalies have been discovered.

Computerized processing of data from patients with venous disease concerns mainly those with chronic venous insufficiency and venous thromboembolic disease. It is of particular interest for epidemiologic studies of venous disease, explorations (functional, phlebographic) and proposed therapies. Progress in these 3 sectors requires computerized processing of data from case-reports and standardization of the noting of these data.

A series of 100 unselected patients operated on for lumbar sympathectomy were studied by digit plethysmography, thest of hyperemia, rheography, measurement of segmental pressure and dynamic tests, treadmill and Strandness test. Statistical analysis of data showed that isolated lesions of atheroma yield the best result. Increase in walking perimeter and in blood flow (rheographic quotient) were the only parameters showing statistical change. Forecasting of the effect of lumbar sympathectomy by the hyperemia test of Hillestad was confirmed. Other forms of disease : diffuse lesions, lesions of arteries in the legs or due to diabetes were followed by very numerous failures. Lumbar sympathectomy is justified as an isolate procedure for femoral lesions, and associated to reconstructive aorto-iliac surgery whenever the distal runoff consists only of a deep femoral artery.

It is now widely accepted that the clinical diagnosis of deep venous thrombosis (D.V.T.) is unreliable. Many venous thrombi are nonobstructive and not associated with vessel wall inflammation or inflammation of the surrounding tissues and consequently have no detectable clinical manifestations. Moreover, none of the symptoms or signs of venous thrombosis are unique to this condition and all can be caused by non thrombotic disorders. On the other hand, in most of the D.V.T., the calf is the site in the legs where a thrombus starts. This thrombus begins commonly in valve pockets throughout various deep veins of the leg and in saccules of soleal veins. Several non invasive techniques have been developed for diagnosing D.V.T.: 125I, fibrinogen, impedance plethysmography, Doppler ultrasound, Duplex scanning. Many publications document the correlation between venography and these non invasive tests for D.V.T. Unfortunately it appears that, excepted 125I. Fg, these techniques are poorly reliable at the level of the calf. Moreover the diagnosis of D.V.T. may occur in particular and difficult situations such as a recurrent deep vein thrombosis. Considering all above the authors believes that contrast venography remains the standard and that it is less dangerous to do unnecessary venography than not to recognize a deep vein thrombosis.

Computerized processing of data from patients with cerebro-vascular disease should improve interpretation of results of complementary examinations by allowing their comparison with arteriography and operative findings. It should also allow comparison of postoperative clinical and angiographic findings in order to analyse results obtained in an identical manner, and to provide a basis for discussion of therapeutic indications. Spontaneous evolution of atheromatous lesions can finally be compared with the course after surgery.

A national survey involving 131 centres was conducted in 1982 to assess the extent of use of data processing in angiology in both medical and surgical departments. Findings demonstrated the recent nature of its employ, this being for less than 2 years in 2 out of 3 teams. There was evidence for the need for data processing reporting forms in as compact a lay-out as possible. Each team should estimate its possibilities as a function of the personnel, time, and financial means available, and determine its objectives before discussing the data processing programme.

Investigation of 102 patients with arteriopathy and aged under 40 years show two groups as a function of course of disease: inflammatory and stasis arteriopathies. The course of the former disease is practically unaffected by surgery and repair is impossible, the common denominator in this group being amputation. Prognosis is better in patients with high lesions of stasis arteriopathy, but comparison with patients operated upon at "typical" age (58-62 years) showed increased progression of juvenile arteritis as seen by reduced permeability of repair procedures after 5 years. These findings suggest the need for extreme caution before conducting repair operations in this age group, and for maximum use of medical treatment.

A series of 100 unselected patients who had undergone low lumbar sympathectomy were studied using vascular function tests (digital plethysmography, hyperaemia test, rheography, measurement of segmental pressures and dynamic tests, walking tolerance on a conveyor belt, Strandness test). Statistical study of the results obtained showed that, above all, isolated lesions of atherosclerotic origin gave excellent results. Increase in walking tolerance and circulatory flow (rheographic quotient) were the only statistically valid parameters. Prediction of the effects of lumbar sympathectomy by Hillestad's hyperaemia test was confirmed. There were many failures amongst the other cases (diffuse lesions, leg artery involvement, diabetic type lesions). Lumbar sympathectomy is hence justified only in the presence of femoral lesions and in association with reconstructive aorto-iliac surgery in all cases when the distal bed consists of the deep femoral only.

During ovarian development in adult females of Locusta, an important biosynthesis of ecdysteroids is observed at the end of the maturation process of the terminal oocyte. This phenomenon occurs regularly during the different ovarian cycles. No synthesis is observed in allatectomized or ovariectomized female adults.

Of 51 patients treated for digestive tract arterial lesions, 35 concerned the superior mesenteric artery. Long-term (up to 12 years) results showed that the quality of the reconstruction had not deteriorated. As technical problems have now been resolved, preventive reconstructive surgery can be proposed for those cases in which an ectatic or thrombogenic aorto-iliac lesion requires correction, without increasing operative risks.

The diagnosis of near total occlusion of the internal carotid artery was made on a group of 122 patients (90 symptomatic - 32 asymptomatic) by Doppler examination on one hand and carotid phonoangiography and oculoplethysmography, used together, on the other hand. The angiographic examination, including the study of the extra cranial arteries and the intra cerebral vessels, was performed. It has shown that a stenosis (greater than or equal to 90% of an internal carotid artery was the only lesion on 65 patients (53.3%) and that in 57 cases (46.7%) there were multiple lesions. 96 patients (76 symptomatic - 20 asymptomatic) were operated on. 4 patients (4.2%) died but the mortality was none in the group of 20 asymptomatic patients. 19 patients refused the operation and we have noted 7 occlusions of the internal carotid artery and 2 patients died (10.2%). On 7 patients with a surgical contra indication we have noted 1 secondary occlusion. We have to consider a near total occlusion of the internal carotid artery as an emergency. Its diagnosis by non invasive techniques must be followed by heparin therapy and angiographic examination. The carotid endarterectomy will respect the external carotid artery patency.

Arterial stenoses of moderate extent may involve modifications of the blood flow. Arterial shading is not always examined at the best incident angle to assess the extent of the stenosis. Spectral frequency analysis by Doppler examination is a good means of evaluating the effect of moderate arterial lesions. The present study was carried out with a Doppler effect having an acoustic spectrum, which is shown in a histogram having 16 frequency bands. The values were recorded on the two femoral arteries. A study was also made of 49 normal subjects so as to establish a normal envelope histogram, taking into account the following parameters: maximum peak (800 Hz), low cut-off frequency (420 Hz), high cut-off frequency (2,600 Hz); the first peak was found to be present in 81 % of the subjects (at 375 Hz) and the second peak in 75 % of the subjects (2,020 Hz). Thirteen patients with iliac lesions of different extent were included in the study; details of these lesions were established in all cases by aortography. None of the recorded frequency histograms were located within the normal envelope. Two cases of moderate iliac stenoses were noted ( Less Than 50 % of the diameter) which interfered with the histogram, even though the femoral velocity signal was normal.

The essential clamping during carotid artery surgery requires different procedures for cerebral protection. Most surgeons prefer the use of an intra-luminal shunt allowing conservation of a part of the proximal carotid artery. A study was conducted to compare two statistically similar series of 50 patients (with a residual pressure of less than 50 mmHg) treated or not by intra-luminal shunts. Results showed a significant difference with respect to early postoperative neurologic accidents between the groups operated without (8% accidents) and with (0%) shunts. Precise indications for the use of this procedure are discussed in relation to pre- and peri-operative findings, with the aim of reducing the incidence of postoperative neurologic complications.

Clamping of the carotid artery made necessary by surgery of that vessel produces haemodynamic disturbances which may result in a neurological deficit accident at recovery from anaesthesia. Evaluating the patient's tolerance to carotid clamping and using brain protection methods during clamping increase the safety of the operation. The different methods of protection used in France were examined in an enquiry conducted among members of the French college of vascular surgery, with special attention to measurement of residual pressure in the clamped internal carotid artery (performed by 60 p. 100 of surgeons) and its corollary which is intraluminal shunting in case of hypotension. This type of enquiry concerning controverted technical procedures should provide information on the best way of improving surgical results.

The hemodynamic significance of the arcade of Riolan has been analysed. This arterial arcade provides an anastomosis between the territories of the superior and inferior mesenteric arteries. The arcade is only clearly visible on arteriography when an obstacle is present at one of its extremities or when it is being used for revascularization of the lower limbs. The discovery during surgery or on X-ray of a dilated arcade of Riolan presents a hemodynamic problem when the continuity of a digestive artery must be reestablished. In addition, when a patient known to suffer from arteritis has to undergo surgery involving the rectosigmoid area, a preliminary arteriography is necessary: the presence of a hypertonic arcade of Riolan requires special therapy since untimely ligature of this artery would provoke lethal ishcemia of the colonic wall. Examination of the arteriogram affords the surgeon some indication of the state of the splanchnic circulation, and he can then take the necessary precautions to prevent any risk of postoperative development of necrosis of the left colon.

It was shown by gas chromatography/mass fragmentography and radio-immunology that moulting hormone is present in great quantity during the second cycle of the embryonic life of Blabera and that the hormone concentration changes during this cycle. The loss of the regenerative capacity corresponds to a beta-ecdysone peak.

Cerebral angiography and CT brain scan are performed on a group of 174 patients (28 asymptomatic patients; 109 patients with symptoms of stroke in relation with a clinically defined vascular territory; 37 patients with symptoms in relation with a clinically uncertain vascular territory). Angiographic findings are: cervical artery lesions in 143 patients, brain artery lesions in 6 patients, both extra and intra cranial artery lesions in 22 patients, and non atheromatous artery lesions in 3 patients. CT brain scan shows: hypodensity in 19 cases, hyperdensity in 1 case, cortical and/or sub cortical atrophy in 141 cases. Only 13 patients have normal CT brain scan. Authors also note: 4 infarction areas in asymptomatic patients and only 4 hypodensities out of 21 cases of internal carotid artery occlusion. Ulcerated cervical artery lesions seem to be the main cause (73%) of cerebral infarction.

Computerized processing of data from patients with chronic arterial disease of lower limbs has been an unsuccessful venture in many cases. This is due essentially to the complexity of the case-reports to be analyzed. In addition, the objectives are not the same if it concerns an angiologist or a vascular surgeon, or relates to an outpatient or hospital sector. Certain exploratory procedures such as Doppler and arteriography have not yet been the object of an agreement with respect to their results. An approach to the problem is proposed with respect to the polyvalent basic elements and then the more specific features as a function of the specific activity of the doctor concerned.