Serge Theys

External iliac artery endofibrosis: a new possible predisposing factor

External iliac artery endofibrosis (EIAE) is an uncommon disease that affects a large number of athletes. The pathogenesis of EIAE is unclear. We offer an additional possible cause, with a direct relationship between EIAE and psoas muscle hypertrophy.

Intraoperative hemodynamic assessment of gastroepiploic artery and saphenous vein bypass grafts: A comparative study

OBJECTIVE Blood flow characteristics of right gastroepiploic artery and saphenous vein conduits were compared during bypass surgery. METHODS This study is based on a consecutive series of 97 patients undergoing a bypass graft to the right coronary artery, posterior descending artery, or posterolateral branch using either a pediculated right gastroepiploic artery (n = 52) or a saphenous vein (n = 45) bypass graft. Flows and velocity profiles were measured with an 8-MHz pulsed-wave Doppler ultrasound flowmeter. Thorough flow measurements were made (1) after cessation of cardiopulmonary bypass and (2) before chest closure. RESULTS At the end of cardiopulmonary bypass, flow in the right gastroepiploic artery (59. 0 +/- 6.7 mL/min) did not differ (P =.08) from flow in the saphenous vein (46.1 +/- 2.7 mL/min). Mean trace velocity was 11.9 +/- 0.7 cm/s in the right gastroepiploic artery and 11.6 +/- 0.8 cm/s in the saphenous vein (P =.80), but peak systolic velocity was 29.4 +/- 1.2 cm/s for the right gastroepiploic artery and 23.1 +/- 1.3 cm/s for the saphenous vein (P <.001). Likewise, before chest closure, flow was 57.1 +/- 4.7 mL/min in the right gastroepiploic artery and 46.5 +/- 4.0 mL/min in the saphenous vein (P =.10), mean velocity was 12. 9 +/- 0.7 and 11.6 +/- 0.8 cm/s, respectively (P = .22), and systolic peak velocity was 30.0 +/- 1.2 and 22.3 +/- 1.2 cm/s, respectively (P < .001). CONCLUSIONS There were no flow differences between right gastroepiploic artery and saphenous vein grafts implanted into the same coronary bed in comparable groups of patients. Waveform shape of the right gastroepiploic artery grafts was characterized by a wider spectral dispersion resulting in a higher maximal frequency.

Comment briser un préjugé « contre » le tuyautage des lymphœdèmes, vieux d’un demi-siècle ?

Resume Aujourd’hui encore, il faut reconnaitre a van der Molen une influence majeure dans les bases de nos protocoles actuels de traitement des lymphœdemes. C’est a lui que l’on doit la technique des multibandes. C’est a lui aussi que l’on doit le tuyautage dont il est question ici. A propos de son tuyautage, beaucoup a ete dit, son contraire aussi. Et pourtant, depuis les annees 1960 et 1970, le tuyautage d’un lymphœdeme majeur et irreversible constitue toujours une solution des plus efficaces a tenter, surtout lorsque toutes les autres approches ont abouti a un echec. Il en est des globaux ou des segmentaires. Il en est des anterogrades ou des reetrogrades. L’indication et le choix technique sont bases sur un touche ferme, un aspect massif et l’irreversibilitedu lymphœdeme. La palpation doit etre meticuleuse. Et meme avec de l’experience, il n’est pas toujours aise de differencier la part d’œdeme de l’epaississement de la couche graisseuse. Une fois la selection bien faite, un tuyautage bien conduit peut produire un volumineux degonflement. En dehors de cette indication, le tuyautage constitue un moyen facile et efficace de degonflement des doigts et des orteils.

Venous tonus enhancement after a short cycle of intermittent pneumatic compression.

Abstract Objectives To test if intermittent pneumatic compression (IPC) used with a short cycle could reproduce and confirm the 30 min vasoconstriction effect observed after a long cycle of pressure. Methods Eighteen subjects took part in the study, 12 with venous insufficiency (VI) and six without VI (NonVI). Duplex scanner was used to evaluate the diameter of six sites of veins on each of both lower limbs before and after the treatment. The IPC was applied to only one limb. Results The control limb showed no change in venous diameter. The treated limb, showed in the NonVI group one vasoconstriction: the greater saphena at the knee level (GS) (P < 0.05). In the VI group, four sites out of six showed a vasoconstriction: the common femoral (P < 0.005), the GS at its cross (P < 0.001), the GS (P < 0.001) and the lesser saphena (P < 0.05). Conclusions Both long and short cycle of IPC are suitable to enhance the venous tone in VI patients for at least 30 min after the end of the treatment.

Jean Pecquet : de la citerne au drainage du canal thoracique

En 1647, Jean Pecquet decouvre la convergence des vaisseaux absorbans des intestins vers le conduit thoracique (CT). Il decrit chez le chien la zone de la naissance du CT qui s’appellera la citerne de Pecquet (CP). Il demontre la terminaison du transport lymphatique dans les jugulaires. Les auteurs font le point sur les techniques physiques envisagees pour stimuler la CP et le CT. La physiologie du CT ne permet pas d’avoir une action sur la resorption de l’œdeme.

Protective effect of glove on median nerve compression in the carpal tunnel.

Objectives: To determine the protective effect of gel padded glove on median nerve compression in the carpal tunnel.Methods: Median nerve conduction parameters, skin temperature, laser Doppler flowmetry and pain modifications were measured during and after a 30-min carpal tunnel external compression protocol performed with and without glove in a random order on six healthy volunteers.Results: Compression induced a rapidly reversible increase in sensory and motor distal latencies, a decrease in sensory amplitude, finger laser Doppler flowmetry and hand skin temperature supporting the hypothesis of a reversible conduction block of ischemic origin. There was no statistical difference between the tests (with or without glove) except for pain that was significantly reduced by glove protection.Conclusion: Gel padded glove does not seem to have a protective effect on the carpal tunnel syndrome induced by compression but provides significant comfort.Spinal Cord (2001) 39, 215–222.

Drainage manuel: Recommandations pour une pratique basée sur les faits☆

Resume Le drainage manuel a fait l’objet de differentes experimentations afin d’evaluer son efficacite. Les mesures centimetriques cliniques, reoplethysmographiques et lymphoscintigraphiques permettent d’etablir des recommandations sur la maniere de l’appliquer. L’evaluation de l’effet du drainage manuel a distance, de la traction de la peau pendant les manœuvres, du sens de deroulement des manœuvres et de la pression appliquee, justifie ou non leur utilisation dans le traitement des œdemes.

Does retrojugular route for carotid endarterectomy increase the risk of internal jugular vein thrombosis

Abstract Two different approaches are available to perform carotid endarterectomy: the traditional antejugular or the retrojugular route. With retrojugular route, direct access to the carotid arteries necessitates median retraction and often collapse of the internal jugular vein (IJV). Therefore, we have prospectively evaluated the potential incidence of IJV thrombosis.

Venous calibre reduction after intermittent pneumatic compression

Objective: To evaluate the effect of intermittent pneumatic compression (IPC) on venous calibre. Methods: A total of 28 subjects were divided into three groups: 15 with venous insufficiency (Var), six with lymphoedema (Lym) and seven healthy (Hlt) subjects. One of each patients lower limbs were treated with IPC. Both limbs were assessed by a duplex scanner, before and after the treatment, and the calibres were then compared. Results: A significant decrease in the venous calibre was observed only on the treated limbs. The veins affected were: in the Lym group, the lesser saphena (P<0.05); in the Var group, the greater saphena at its cross (P<0.01), the lesser saphena (P<0.02) and the superficial femoral vein (P<0.05). Conclusion: A 40 mmHg IPC was sufficient to enhance some venous tonus, especially in subjects with venous insufficiency, for 15–30 min after the 30 min of treatment.

DLM cherche de l’envergure !

Resume Le Drainage lymphatique manuel (DLM) est apparu evident pour lutter contre l’œdeme avant meme d’avoir ete prouve. Or, pour obtenir un resultat, faut-il debloquer l’embouchure du systeme lymphatique ? Non, le blocage se trouve au sommet de l’œdeme. Doit-on faire de la place en aval ? Non. Generalement, l’œdeme s’evacue par un circuit profond, difficilement accessible aux mains. Le DLM peut-il aspirer l’œdeme a distance ? Non. Pour s’en convaincre, tentez d’aspirer du gel a l’aide d’une paille. Doit-on toujours aborder l’œdeme a reculons ? Tant que l’œdeme est reversible, rien ne sert de partir de son sommet, mieux vaut y monter. La manœuvre doit-elle coulisser la peau vers le haut ? Uniquement lorsqu’il n’y a plus d’œdeme dessous. Tant qu’il y en a, le coulissage se fait vers le bas. Le DM doit-il toujours etre leger ? Non, la pression sera legere chaque fois que l’œdeme est reversible. Elle sera proportionnee a la consistance de l’œdeme dans les autres cas.