J Mal Vascul
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Despite 25 years of clinical practice, concerning chronic epidural spinal cord stimulation (SCS) for pain control, the mechanisms underlying the beneficial effects are still poorly understood. The main indications for SCS are intractable chronic pain secondary to neurogenic origin (essentially neuropathies by lesion of peripheral nerve or roots) or to ischemic origin. ⋯ In peripheral vascular disease, the analgesic effect appears as the consequence of the vasodilatory effect of SCS. The actual experimental data indicate that SCS produce its influence on peripheral microcirculation via a transitory suppression of the sympathetic vasoconstrictor control.
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Review Case Reports
[Chylothorax and chylous ascites following surgery of an inflammatory aortic aneurysm. Case report with review of the literature].
Chylous ascites complicating surgery on the abdominal aorta is infrequent: we report one case associated with right chylothorax, secondary to the surgical cure of an inflammatory aortic aneurysm. Surgery for aneurysms causes 81% of all chylous ascites caused by injuries to the intestinal lymphatics or to their recipients, the left latero-aortic lymph nodes or the cisterna chyli. Upper or extensive dissections of the retroperitoneal space and difficult dissection of ruptured or inflammatory aneurysms are the cisterna chyli. ⋯ An early diagnosis must be established with paracentesis before any compressive, metabolic, immunological or septic complications occur. Continuous parenteral feeding and selective paracenteses dry out 80% of the postoperative chylous ascites. If the ascites persists after 4 to 6 week's conservative treatment, a peritoneojugular derivation or a direct lymphostasis may be contemplated, according to the patient's condition.
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Plasma measurement of D-dimers (DD) with the Elisa technique is very useful in the diagnostic approach of venous thromboembolic diseases: a low level of plasma D-dimers (500 micrograms/l when using the Elisa from Stago) allows to exclude the diagnosis of deep venous thrombosis or pulmonary embolism with predictive values of 94% and 98%, respectively. Such a diagnostic potential is particularly useful in the group of patients with inconclusive perfusion-ventilation scintigraphy (low or indeterminate probability of pulmonary embolism) which represent more than 50% of the patients with suspected pulmonary embolism. Presence of pulmonary embolism is suggested by levels above 4.000 micrograms/l in the collective of outpatients who are urgently referred because of clinical suspicion of embolism.