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Catheterization, Peripheral --- methods

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Peripheral nervous system diseases --- diagnosis

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Intermittent claudication is a symptom of peripheral arterial occlusive disease (PAD) of the lower limbs, often associated with atherosclerosis. It is responsible for a limitation of physical performance and walking ability and results in a quite important decreased quality of life. Its prevalence is between 1 and 4.5% of the world population, and affects 10 to 30% of individuals with PAD. The risk of progression of PAD to serious complications such as amputation is rare, but there are especially high risks of cardiac, cerebrovascular and aortic problems linked to atherothrombosis. The mechanism most often put forward to explain the characteristic pain of intermittent claudication relies on the reduced oxygen supply to muscles that follows the reduction of the arteries diameter associated with atherosclerotic plaques. However, this is not the only physiopathological mechanism, hemodynamics alterations, structural muscle changes, metabolic alterations and oxidative stress phenomena are also often found. The treatment of intermittent claudication is divided into two parts, the first one aimed at the reduction of the risk of cardiovascular events by reducing risk factors and therefore limiting the progression of atherosclerosis. The second intend the relief of IC symptoms and improvement of quality of life for the patients. The Belgian market provides several molecules capable of increasing walking distances like the naftidrofiryl, pentoxifylline or buflomedil whose effectiveness remains controversial. Cilostazol, a molecule marketed in the USA, seems to be the most effective, but there are some questions regarding its safety still without answers. That is the reason why this drug remains unavailable in Europe. Up to now, the most effective symptomatic treatment of intermittent claudication seems to be the supervised treadmill exercise. Given the lack of truly effective and safe treatment, various molecules and gene therapy are currently under study. This thesis provides an update on the subject that remains unrecognized by the health professionals La claudication intermittente est un symptôme de l’artériopathie oblitérante des membres inférieurs, une atteinte obstructive des artères des membres inférieurs (AOMI), dont la cause principale est l’athérosclérose. Elle est responsable d’une limitation de la performance physique et de la capacité de marche entraînant une baisse de qualité de vie assez importante. Sa prévalence serait entre 1 et 4,5% population mondiale et touche 10 à 30% des individus atteints d’AOML Le r d’évolution de l’AOMI vers des complications graves comme l’amputation est rare, mais il existe surtout un grand risque de complications cardiaques, vasculaires cérébrales et aortiques liées à l’athéro-thrombose. La diminution du diamètre des artères au niveau des plaques d’athérome limitant l’apport en oxygène aux muscles est le mécanisme le plus souvent mis en avance pour expliquer la douleur caractéristique de la claudication intermittente. Mais ceci n’est pas le seul mécanisme physiopathologique, on retrouve diverses altérations hémodynamiques, des modifications structurales des muscles, des altérations métaboliques et des phénomènes de stress oxydatif. Le traitement de la claudication intermittente est divisé en deux parties, la première consiste à réduire le risque d’évènements cardiovasculaires en limitant la progression de l’athérosclérose par la diminution des facteurs de risques. La deuxième partie consiste à soulager les symptômes de la CI et améliorer la qualité de vie des patients. Pour cela, il existe plusieurs molécules capables d’augmenter les distances de marche. Sur le marché belge, nous retrouvons le naftidrofuryl, le buflomédil et la pentoxifylline dont l’efficacité reste controversée. Le cilostazol, molécule commercialisée aux EUA, semble être la plus efficace, mais des questions se posent quant à sa sécurité. Face a ce doute, l’Europe ne lui a toujours pas cédé d’autorisation de mise sur le marché. Aujourd’hui, le traitement symptomatique le plus efficace de la claudication intermittente est l’exercice physique supervisé. Face à l’absence de traitement réellement efficace et sans risques, diverses molécules ainsi que la thérapie génétique sont actuellement en étude. Ce mémoire a pour but de faire le point sur ce sujet qui, encore aujourd’hui, est peu connu de la part des professionnels de la santé

Intermittent Claudication --- Peripheral Arterial Disease --- Atherosclerosis

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Peripheral nerves are biologic wires that convey the desire for motion from brain to muscle, and the experience of touch from skin to brain. When a nerve is cut, the individual fibers, or axons, must regenerate from the site of injury to reconnect with their skin and muscle targets. Nerve regeneration is a process of bewildering complexity that requires the coordinated action of multiple biologic systems. Gene expression within the neuron is altered to support axon growth, regenerating axons must cross the complex environment of the nerve injury and enter pathways that lead to functionally app

Nervous system --- Nerves, Peripheral --- Wounds and injuries. --- Regeneration. --- Surgery.

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Since the highly praised first edition of Surgical Disorders of the Peripheral Nerves was published in 1998, greater understanding of the the molecular and cellular events which underlie the response of nerves to injury, regeneration and neuropathic pain has been achieved. This second edition has been fully updated in line with new clinical knowledge, and also incorporates the extensive study of thousands of surgical case studies spanning repairs of the supraclavicular plexus in the adult, the birth lesion of the brachial plexus,compound nerve injury and iatrogenous injury. Beginning with the fundamentals of the anatomy and function of the peripheral nervous system, and working its way through various types of injury, operative methods, the regeneration and recovery of nerves, surgical reconstruction, pain, and rehabilitation, this eloquently written work provides the reader with the solid understanding required to successfully perform surgery on the peripheral nervous system. Dr Shelagh Smith, joined by Dr Ravi Knight, has rewritten the chapter Electrodiagnosis.  Professor Tara Renton has written a new chapter on injuries to the trigeminal nerve in maxilla-facial and dental work.  The drawings, by Mr Philip Wilson, are new.  Most of the 700 illustrations are also new. This thorough and authoritative look at the surgical treatment of the peripheral nerves is fully illustrated throughout with exquisite line diagrams and clear, instructive photographs.

Nerves, Peripheral -- Surgery. --- Nerves, Peripheral -- Wounds and injuries -- Surgery. --- Nervous System --- Anatomy --- Peripheral Nerves --- Peripheral Nervous System --- Surgery & Anesthesiology --- Health & Biological Sciences --- Surgery - General and By Type --- Nerves, Peripheral --- Diseases. --- Peripheral neuropathies --- Medicine. --- Neurology. --- Neurosurgery. --- Surgery. --- Medicine & Public Health. --- Nerves --- Neurosurgery --- Medicine --- Nervous system --- Neuropsychiatry --- Surgery, Primitive --- Surgery --- Diseases --- Neurology .