Biomedical subjects
I Lazareth
Publications and source records attributed to I Lazareth.
[Malingering in vascular disease].
Pathomimicry occurs in all fields of medicine. Although difficult to recognize, all physicians should be aware of the underlying mechanisms in order to avoid excessive ordering of complementary examinations and therapeutic propositions which may be dangerous. Pathomimesis is to be distinguished from Munchhausen's syndrome which involves simulation of severe disease and extravagant lies with false history reporting leading to successive hospitalizations in different hospitals. Pathomimesis is also distinguished by the goal of the simulation which is to obtain a precise material benefit. In vascular pathology, pathomimesis can take on several aspects:hemorrhagic syndrome by self-prescribed anticoagulants, self-induced limb edema (tourniquet), or self-inflicted skin wounds. Diagnosis is suggested by the absence of a cause, identification of the stricture groove in case of edema, imprivement with occlusive dressings for skin ulcers and by the general presentation. Pathomimesis is usually encountered in young intelligent women with some medical knowledge. This behavior has a psychopathological significance, the provoked symptoms demonstrating difficult emotional events in the past. The patient attempts to overcome an earlier tragic situation. Pathomimicry is thus expressed during acute episodes of fear and/or anxiety. For the practitioner, it is important to avoid accusing the patient or attempting to get the patient to avow as there is an important risk of exaggerated or self-destructive response. The patient should be led to realize that the physician knows what is happening. This unstated interchange allows the patient to establish a confident relationship with the physician, a relationship which should lead to an accepted psychotherapy.
[False erythermalgia].
The differential diagnosis of erythermalgia is sometimes complicated by the absence of consensus on proposed diagnostic criteria. Unwarranted diagnosis can result from any clinical situation leading to burning sensations in the limbs. This can occurs in patients with peripheral neuropathies who often experience dysesthesia when going to bed when the legs are under the covers; in such cases, redness and local warmth are missing. Venous insufficiency can also produce sensations of warm feet, often at retiring, together with edema and an increase in local heat. Algodystrophy, during the inflammatory phase can also mimic erythermalgia with intense pain and local modifications. Nevertheless, the unilateral aspect and persistence of the symptoms together with the post-traumatic situation usually directs the diagnosis. Acrodynia is a rare disease caused by excessive mercury intake and should be discussed in children. Vasomotor impairment in the limbs is the main sign. The red color of the hands and feet is accompanied by intense paroxysmal burn-type pain. The diagnosis is confirmed by high mercury levels in urine. Fabry's disease is a hereditary sphingolipidosis transmitted on chromosome X and occurs predominantly in men, often starting early in childhood with burning sensation in the limbs. The diagnosis should be entertained in children with pseudo-erythermalgia and is confirmed by chromatographic search for abnormal sphingolipids in the urine.
[Necrotic angiodermatitis: treatment by early cutaneous grafts].
INTRODUCTION: Necrotic angiodermitis is an uncommonly hypertensive ischemic ulceration. It usually occurs on the legs in elderly, hypertensive and sometimes diabetic patients. Its extensive and highly painful nature is characteristic. Currently, there is no simple effective treatment which is known to stop the development. We report the results of a patch graft method applied early before the angiodermitis develops into an advanced stage. PATIENTS AND METHODS: The technique was used in 13 consecutive patients with 16 episodes of necrotic angiodermitis. The graft was made 8 days (mean) after hospitalization. RESULTS: The analgesic effect of the graft was apparent within the first days after the graft. The violet halo of extension disappeared a mean of 8 days after the graft. A second or even third graft was required in 8 of 16 episodes. Total cicatrization was obtained after a mean delay of 33 days. CONCLUSION: Patch graft is a simple, low-cost, non invasive treatment which can be performed at the bedside and even in an outpatient clinic. This stops the extension of the necrotic angiodermitis and controls pain. Delay to cicatrization is shorter. The favourable effect of the graft could possibly be mediated by vasodilator peptides liberated by the graft tissue which would counteract the hypothetical vasospasm.
[Diabetic arteritis: therapeutic implications based on the profile of the lesion].
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[Buschke-Ollendorff syndrome].
The Buschke-Ollendorff syndrome (BOS) is a rare connective tissue disorder inherited in an autosomal dominant pattern characterized by cutaneous lesions, dermatofibrosis lenticularis disseminata, and osteopoikilosis. We report a new case of this syndrome in a 66 year old man, interesting by its association with a protein C deficiency, another rare genetically transmitted disease. Diagnosis of the BOS is difficult on the mere cutaneous lesions; it is therefore important to systematically practice bone X-rays in the presence of atypical pseudoxanthoma elasticum, disseminated collagenoma or disseminated connective tissue or elastic nevi. The radiologically detectable osteopoikilotic bone lesions, evoking Paget's disease, easily sign the diagnosis. In our case, the association of a protein C deficiency with the BOS may not be fortuitous because both the elastin and protein C genes are localized on chromosome 2q.
[Are angiotensin-converting enzyme inhibitors the treatment of choice for arterial hypertension in patients with arteritis?].
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[Study and treatment of varicose veins. Truths and counter-truths].
Varicose veins are not the only symptomatology of chronic venous insufficiency of the lower limbs, which has other clinical manifestations: purely symptomatic problems, varicosities, edema and trophic skin lesions. The management of varicose veins is base upon thorough clinical examination. Doppler and ultrasonography are useful in cases of varicose veins in which radical treatment is envisaged. Ultrasound investigation is essential in the presence of cutaneous ulceration in order to avoid mistaking a trophic lesion due to incompetence of deep veins, most often of post-thrombotic origin, for a varicose ulcer. The treatment of varicose veins varies according to the precise nature of the preoccupations of the patient concerned. Elastic support is useful regardless of the clinical form of the disease. Vasculoprotective and venotonic drugs can be used when venous insufficiency is symptomatic. Radical treatment of varicose veins, whether by sclerosing injections or surgery, depends upon the anatomical nature of lesions, the degree of venous incompetence and the extent of signs, but also the wishes of the patient, properly informed of the advantages and limitations of each technique.
[Cutaneous necrosis: collaboration between clinicians and biologists is absolutely necessary].
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[Cutaneous manifestations of cholesterol embolism: a marker of atherosclerosis].
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[Phlebitis of the upper limbs: causes and current treatments. Apropos of 17 cases].
A review of 17 consecutive patients in whom deep venous thrombosis of the upper extremity had developed was conducted. The major causes identified were related to thoracic outlet syndrome and venous catheterization. Venogram was necessary for the diagnosis in two patients. No pulmonary embolization occurred. Thirteen patients were treated by low-molecular-weight-heparin complication.
[Prevalence of anatomic renal artery stenosis in hypertensive patients with arteritis].
Atherosclerosis is a diffuse disease that can affect renal arteries. An important point for the management of hypertensive patients is the prevalence of anatomical renal stenosis when lower-limb peripheral vascular disease coexists with hypertension. From Sept 1, 1987, to Aug 31, 1990, 252 consecutive hypertensive adults with peripheral vascular disease were referred to our clinic. For each patient a standardised collection of information was checked and registered with a computerised system. The evaluation included the search for a curable cause of hypertension, the investigation of cardiovascular risk factors, and a complete clinical review. Peripheral vascular disease was confirmed at least by clinical observation, including and ankle/brachial systolic blood pressure ratio of less than 0.90 at rest. In 117 patients (73 males, 44 females, mean age 66), renal arteriography was performed because clinical history, initial diagnostic work-up, or duplex Doppler examination suggested renal artery stenosis. Finally, 89 anatomical renal artery stenoses were detected in 64 patients (54.7%). Stenosis was judged mild (25 to 50%) in 12 patients and severe (> 50%) in 52 patients including 5 occlusions of the renal arteries. Artery stenosis was found bilateral in 23 patients. Even if none patient without renal arteriography would have an anatomical renal artery stenosis, the prevalence of anatomical renal stenosis in this study would reach 25.4% (64/252). These results confirm that lower-limb peripheral vascular disease is an excellent marker for the presence of anatomical artery renal stenosis in hypertensive patients.
[Treatment of diabetic arteriopathy. Importance of transluminal angioplasty].
Results are reported of a retrospective analysis of transluminal angioplasty (TLA) interventions in 20 diabetic patients, 16 men and 4 women, mean age 56 years (range 32 to 82 years), with 24 dilated lesions, 16 patients having insulin-dependent diabetes. In 12 cases the lesions were at the intermittent claudication stage, trophic lesions being present in 8 cases. Stenotic lesions were iliac (12 cases), superficial femoral (2 cases), popliteal (6 cases) and tibial (4 cases). One patient developed an acute occlusion following popliteal-anterior tibial recanalization, the only direct complication of the angioplasty. Angiography showed immediate satisfactory results in 22 of the 24 dilated lesions. Functional and hemodynamic improvement was a constant finding in patients with intermittent claudication, trophic lesions being healed in 4 cases (50%) the other patient showing either no change or requiring an unavoidable amputation (2 cases). These overall findings suggest that at the intermittent claudication stage no differences exist in the results of TLA when compared with a non diabetic population; inversely, in the presence of trophic disorders, the local conditions (distal bed, infection, gangrene) interfere considerably in the course of the dilatation. Transluminal angioplasty should therefore be carried out as early as possible in diabetics; arteriography should be performed as soon as even minimal claudication appears and, a fortiori, even at the onset of a trophic lesion.
Treatment of radiation-induced renal artery stenosis: reconstructive surgery or angioplasty?
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[Absence of microalbuminuria in CREST syndrome].
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