Mercury Strain-Gauge Plethysmography Venous Mode: Non-Invasive Technique of Choice in Vascular Pathology

Mercury strain-gauge plethysmography venous mode is a non-invasive technique for exploration of the haemodynamics of the extremities. The plethysmographic parameters used are: (1) the venous inflow (in ml/100 ml/min); (2) the venous outflow (in ml/100 ml/min); (3) the venous capacity in ml/100ml; (4) the venous distensibility index in ml/100 ml/ mmHg; and (5) the venous pressure measured by ‘hysteresis curve’. This method permits us to analyse the venous haemodynamics of both extremities simultaneously (the normal limb serving as the control), to obtain a precise diagnosis and to appreciate the efficacy of treatment at follow-up.

The aetiology of the swollen limb can be precisely identified in 95% of the studied cases: oedema in superficial venous insufficiency, oedema in the deep venous insufficiency, oedema of inflammatory origin, oedema in the arterial insufficiency, oedema of cardiac origin, lymphoedema.

During the last 3 years, we have followed up 580 patients with this method.

Anomalies of thoracic lymph duct drainage demonstrated by lymphoscintigraphy and review of the literature about these anomalies

AIMS

To determine the frequency of supradiaphragmatic lymph nodes that receive lymph from the lower limbs and the intraabdominal organs.

METHODS

Three hundred and thirty-four bipedal lymphoscintigraphy results of the lower limbs were reviewed.

RESULTS

Lymph nodes were visualized in only the supraclavicular/retroclavicular (SRC) area in 113 cases (33.2%, 109 on the left and 4 on the right), in only the mediastinum in 5 cases (1.5%), in the mediastinum and the left SRC area in 18 cases (5.5%), in the mediastinum and right SRC area in 2 cases (0.6%), in the mediastinum and both SRC areas in 6 cases (1.8%), and in the mediastinum and as 1 chain draining in the left axilla in 2 cases (0.6%).

CONCLUSIONS

Supradiaphragmatic lymph nodes associated with the thoracic duct and receiving lymph and/or chyle from the infradiaphragmatic body were demonstrated in 43.2% of our patients and in 11.1% of the cases these lymph nodes were not located in the left retroclavicular area. These data should be taken in mind by surgeons when confronting an intrathoracic and even extrathoracic supradiaphragmatic chylous effusion after surgeries which imply lymph nodes and/or lymphatic vessels.

[Lower limb edema and steatorrhea: value of scintigraphic technics]

The authors report the case of a young woman with right lower limb edema who also presented one steatorrhea. Her clinical history is typical for one primary lymphedema and the lymphoscintigraphic investigation of the lower limbs confirms the diagnosis. The scan showed the absence of the right iliac and lomboaortic lymph nodes but also that the thoracic duct was normally present. One C14-triolein breath test is pathological and proves the malabsorption of the fats. The authors discuss the interest of the scintigraphic techniques in such case and review the problem of the association between lower limb lymphedemas and fatty malabsorption.

[Limb edema and lymphoscintigraphy]

Lymphoscintigraphic investigations represent techniques of nuclear medicine very contributive for the management and treatment of the limb edemas, either primary or secundary. Their principle is presented and methodologies proposed in the literature are reviewed. Their diagnostic contributions are detailed. The sensitivities and specificities of several protocols of investigation are reported. Some limitations of these examinations are analyzed and discussed. Clinical indications for their use are proposed and their interest with regard to the various treatments that can be applied to these limb edemas is discussed.

Popliteal artery pseudo-aneurysm and hereditary multiple exostoses

We describe a rare case of a 21-year-old man presenting with hereditary multiple exostosis and a pseudoaneurysm of the popliteal artery caused by femoral osteochondroma. Principles of management and surgical technique are discussed.

[Cutis marmorata telangiectatica congenita. Apropos of 4 new cases]

Cutis Marmorata Phlebectasica is a rare congenital disorder characterized by persistent erythrocyanotic mottled areas associated with superficial phlebectases with cutaneous atrophy and ulcerations. The anomaly is present at birth. Spontaneous improvement is the rule. Four cases are described with vascular investigations, coloured echo-Doppler and phlebography. The deep venous tracts are shown to be dilated. Reflux is shown to the superficial veins.

[Effect of "anti-thrombosis" stockings on the venous hemodynamics of the lower extremities. Study using mercury gauge plethysmography]

Study by plethysmography with mercury gauge. The authors have analyzed the effects of "anti-thrombosis" stockings on venous hemodynamics of 18 lower extremities, by plethysmography with mercury gauge (Periflow J.S.I.). With this method, they delineate the limits of efficacy of the use of only elastic stockings as prophylactic treatment of the thrombo-embolic disease in immobilized patients.

[Management of mycotic aneurysms. Apropos of 3 cases]

The diagnosis of mycotic aneurysms remains rather difficult. When a mycotic aneurysm is found, two therapeutic measures should be taken without delay: on the one hand an antibiotherapy which is started preoperatively and continued at least six weeks postoperatively, and on the other hand a surgical intervention. In this review, the authors present three types of operations: ligation and excision of the aneurysmal mass, restoration of the arterial tree with a venous graft or extra-anatomical bypass with prosthetic material.

[Microbial contamination of the bile and its effects on the course of the surgical wound after cholecystectomy]

From a series of 58 cholecystectomies for chronic cholecystitis or for asymptomatic cholelithiasis, the authors have retrieved: 1) gall microbial contamination in 15,5% of the samples under study; 2) a complicated evolution--according to criteria defined for this research--of the operative wounds in 37,5% of the cases with positive gall cultures, and in 11% when the gall was sterile. It is the authors' opinion that cholecystectomy shows an actual septic risk, even in a non-acute clinical stage.