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Biomedical subjects

L Vaillant

Publications and source records attributed to L Vaillant.

At least 217 records · Page 12Linked to original sources
PubMed1990

[An often ignored complication of left heart catheterization: embolism of cholesterol crystals. Report of 9 cases].

Cholesterol embolism (CE) is caused by the migration of cholesterol crystals from severe atheromatous lesions. Until recently, this was considered to be a classical but rare complication of atheroma. With the upsurge in techniques of left heart catheterization there has been a regain of interest in this subject. Nine cases of cholesterol embolism occurring after left heart catheterisation are reported, 3 after coronary angioplasty, and 3 cases after associated thrombolytic therapy. Three patients developed cutaneous syndromes (livedo reticularis, the "purple toe syndrome") with a favorable outcome in a few weeks. Two patients developed segmental necrosis of the small bowel requiring surgical resection of the affected area. Finally, in 4 cases, the patients died 12 hours to 3 months after catheterization: 2 patients had polyvisceral involvement; one patient developed cardiogenic shock; one patient had intestinal necrosis involving 2/3 of the ileum and the right colon. The cases illustrate the variability of the presentation of CE and its potential gravity. At present, the only effective measures are prophylactic; curative treatment remains particularly disappointing.

Aged↗
PubMed1990

[The current role of lymphoscintigraphy in the study of lymphedema of the limbs].

After a brief review of the classical methodology and results of lymphoscintigraphy, the technique is considered in terms of an original kinetic study approach. Immediately after distal subcutaneous injection of a technetium colloid (rhenium sulfocolloid), 40 1-min serial images of the limbs are recorded followed 4 h after injection by recording of static images. The main abnormalities detected by scintigraphy concern the lymphatic vessels, nodes and interstitium. They reveal the presence of lymphedema and provide information about its mechanism, indicating, particularly in the case of primary lymphedema, whether there is predominant hyperplasia or hypoplasia in vessels or nodes. Synoptic study of the initial dynamic recording based on simple examination of serial images is difficult. Complementary data provided by activity curves determined from manually selected regions of interest (ROI'S) are of limited value since the ROI'S correspond to superimposed spatial structures. Two data-processing techniques--the condensed image (CI) and factorial analysis (FA)--were therefore applied to dynamic scintigraphic recordings in order to study lymphatic progress of the radiotracer in the legs. A complete dynamic series is described in two IC, one for each leg. The CI, obtained by mounting the 40 serial images in vertical strips 1 pixel in width, describes the spatial distribution of radioactivity along the leg during recording. Factorial analysis provides automatic extraction of pure kinetic components or factors from the dynamic series despite their spatial superposition. The factors are described by factorial curves and factorial images representing the spatial identity of the factor. Three-factor FA was applied successively to each leg.(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗
PubMed1990

[A survey of the French-speaking Association of Lymphology on the use of pressotherapy in France during the treatment of lymphedema].

116 physicians out of the 1000 who were questioned use pressure-therapy in the treatment of lymphedema of the extremities. Another 170 are interested in the technique and await this report before possibly adopting it. Overall, the devices utilized are compartmented and use discontinued pressure that is asynchronous in relations to heart beat; each session lasts 30 minutes, on average, with compression and resting phases lasting 45 seconds and 15 seconds, respectively. The usual schedule is one session daily, three days per week, in two series clustered within a single year. Although manual drainage of lymphatics is combined with pressure-therapy in 71.55% of the times, only 43.47% of physicians use elastic support following the treatment. Results are good or very good in 64.4% of cases, and the incidence of post-therapeutic events is rather low (polyuria, pain recrudescence of lymphangitis, etc.). Aside from lymphedema, venous insufficiency, hypodermitis and leg ulcers may also benefit from pressure-therapy.

Clinical Protocols↗
PubMed1990

[Skin carcinoma of the face: surgery or radiotherapy?].

Surgical exeresis and radiation therapy are effective means of treatment for facial carcinomas. In some areas that are difficult to manage (nose, ears, periorbital region), the respective importance of both approaches is discussed. We report on the retrospective study of 309 patients seen after a skin carcinology consultation in which a dermatologist, a surgeon and a radiotherapist were associated. These 309 patients, with a mean age of 73 years, presented with 375 carcinomas, i.e. 246 basal-cell (BC) and 119 epidermoid (EC) carcinomas. The most frequent sites were the nose (33.8% of BC), the inner canthus (12.7% of BC), the lower lip (23.8% of EC) and the ear (15.6% of EC). Management mainly consisted of surgery (50.8%) then Curie therapy (37%). The rate of recurrence was the same (10.5%) after surgery and radiation therapy. The study of the results leads us to advocating surgery for carcinomas of the ear (due to the occurrence of radiation necrosis in every third case after radiation therapy) and Curie therapy for carcinomas of the lower lid (except the inner canthus) because of recurrence in every second case treated with surgery. We currently prefer surgery for carcinomas of the lower lip (radiodermatitis in 11.8% of cases) and Curie therapy for the nose (lower rate of recurrence than with surgery). However, in the last two cases, the proposals for treatment should be confirmed by randomized studies. Thus facial carcinomas of the skin surrounding the orifices of the face and/or those that affect patients who are difficult to treat must be seen during a skin carcinology consultation by a dermatologist, a surgeon and a radiotherapist working together.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Epithelioma of the medial canthus. Retrospective study of 47 surgically treated cases].

The authors report a retrospective study of 47 cases of carcinoma of the medial canthal area which were operated on between 1982 and 1987. Patient age and the histological frequency of basal cell carcinoma were similar to those of studies previously reported. Local extension must be evaluated at the initial clinical examination and computed tomography can be very useful. Frozen section for histopathologic study should be done if there is the least doubt. The surgical treatment and different methods of local reconstruction are discussed.

Adult↗
PubMed1990

[Cicatricial pemphigoid disclosed by superficial desquamative gingivitis. Clinical and immuno-electron microscopic study of a case].

Six months before consulting, a 71-year old man developed buccal and genital erosions which gradually became worse. Physical examination showed signs of superficial desquamative gingivitis, wide erosions on the bony palate, erythemato-erosive balanoposthitis and 7 bullae or skin erosions on the upper part of the back. At histopathological examination of a cutaneous bulla there was dermoepidermal cleavage and an inflammatory infiltrate without eosinophils. At direct immunofluorescence, linear deposits of IgG and C3 were present along the basement membrane. A search for anti-skin autoantibodies was negative at indirect immunofluorescence but positive at immunoblotting (240 Kd band). The cicatricial pemphigoid was treated with dapsone alone in doses of 100 mg/day. Treatment was continued for 6 months, resulting in complete cure of the mucosal and cutaneous lesions. An immunoelectromicroscopic study, performed according to the technique described by Prost et al., on a fragment of skin from around the bullae, showed deposits of granular IgG in the lamina lucida and the lamina densa and deposits of C3 in the lamina densa. This case of cicatricial pemphigoid exhibited 3 features which are not usually found in bullous pemphigoid. Clinically, the buccal lesions were located on the gums and on the hard palate, i.e. where the mucosa adheres to the underlying bone through the periosteum. This location is habitual in cicatricial pemphigoid and differs from that of the bullous pemphigoid lesions which affect the free mucosa lining the cheeks and the soft palate. Treatment with dapsone was dramatically successful in our patient whose lesions disappeared in 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS.

A 30-year-old homosexual man developed multiple skin umbilicated lesions resembling molluscum contagiosum. Initially the lesions were on his face but they rapidly spread. Histopathology and mycologic cultures of a skin biopsy revealed cryptococcus neoformans which was also identified in cerebrospinal fluid and in bronchoalveolar washings. The patient had fever, weight loss, generalized lymph node enlargement, depletion of the T helper subpopulation and positive HIV-1 serology. During treatment with flucytosine and amphotericin B, the skin lesions regressed in 3 months (cryptococcus neoformans disappeared in the cerebrospinal fluid and skin within one and five weeks, respectively). Our case demonstrates that molluscum contagiosum-like skin manifestations may be caused by cryptococcal infections. So it is necessary to perform skin biopsy in HIV seropositive patients with skin lesions resembling molluscum contagiosum, to diagnose mycotic infections, and especially cryptococcosis. Cutaneous cryptococcosis was, in this case, the first symptom of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Factorial analysis in radionuclide lymphography: assessment of the effects of sequential pneumatic compression.

The effects of intermittent pneumatic compression (IPC) in 12 patients with lower or upper limb lymphedema were studied using a computer-based technique (factorial analysis) of dynamic lymphoscintigraphy. After subcutaneous injection of radiocolloid into the first interdigital web space of the arm or leg, scintigraphic recordings consisted of 40 consecutive one-minute frames of both lower extremities or an edematous upper extremity. Pneumatic compression by Euroduc (6 patients) or by Lymphapress (6 patients) was applied during the final 20 minutes of the recording. A three factors factorial analysis (FA) was performed successively for each extremity. FA allowed "uncontaminated" curves to be displayed distinct from neighboring structures and corresponded to dynamic tracer activity in the interstitium, at the injection site, and within lymphatic vessels. Based on the results of lymphatic vascular factorial analysis, a beneficial effect of IPC was detected in 18 of 22 limbs examined. FA processing suggested that IPC facilitated radiocolloid transport in the proximal portion of the limb and also propelled tracer from the injection site toward the lymphatics. The effect of IPC was evident as soon as external compression therapy began and was similar with either mechanical unit. Residual tracer activity in peripheral lymphatics 20 minutes after application of IPC was higher in the edematous as compared with the normal limbs. FA processing is a new and potentially valuable method to evaluate the effects of external pneumatic compression in the management of peripheral lymphedema.

Arm↗