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Biomedical subjects

P Priollet

Publications and source records attributed to P Priollet.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Comprehensive management of chronic venous insufficiency].

The choice among the therapeutic options available for chronic venous insufficiency of the lower limbs is based on a precise analysis of the disease itself and the exact nature of the patient's complaints and expectations. Comprehensive care requires a careful clinical examination and complementary exploration with ultrasonography when required for decision making and knowledge of the personal, social and professional situation as well as a documented evaluation of the treatment methods, their theoretical or real value and their assumed mechanism of action, their long-term effects when known and their limitations. Elastic support, if prescribed correctly is useful whatever the degree of clinical expression: simple functional manifestations, varicose veins or impaired trophism. Vasculoprotective or venotonic drugs have various actions. They can be used for the treatment of all degrees of symptomatic chronic insufficiency. More radical treatment of varicose veins, whether surgical or by sclerosis, depend on the anatomic presentation, the degree of venous stasis and the importance of the symptomatology but also on the desires of a patient well informed of the advantages and limitations of each technique. Comprehensive care for chronic venous insufficiency requires personalized care.

Bandages↗
PubMed1994

[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.

Aged↗
PubMed1994

[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.

Edema↗
PubMed1994

[Subclavian vein thrombosis: medical treatment].

Thromboses of the subclavian vein are rare. However there is a higher incidence due to the increasing use of central venous catheters and pacemakers. Thoracic outlet syndrome is no longer the main cause. Thromboses may be clinically apparent, however when they are caused by the insertion of a catheter, thromboses may be symptom-free. Phlebography is the gold standard for the diagnosis. B mode ultra-sounds may give false results in that particular location. The optimum treatment of subclavian thromboses should prevent the occurrence of pulmonary embolisms, and the development of post-thrombotic syndrome. Heparin followed by anti-vitamin K meets these two objectives in the majority of cases. The risks of thrombolytic therapy is, in our opinion, unacceptable to promote thrombolysis to treat upper limb venous thrombosis. Surgery is indicated in cases of phlematia caerulea which are extremely rare, and in cases of septic thrombosis. The preventive treatment of the opposite side of a symptomatic thoracic outlet syndrome, is questionable, except in the case where the findings of the clinical examination, B mode ultrasound and phlebography results, are in favor of a intermittent compression of the vein with a risk of thrombosis.

Arm↗
PubMed1993

[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.

Adult↗
PubMed1993

[The diabetic foot: prognosis in a series of 75 patients].

Prognosis for 75 diabetic patients with foot ulcers. The aim of the study was to evaluate the prognosis regarding amputation and mortality in 75 consecutively presenting diabetic patients admitted because of foot ulcers. Median follow-up was 16 months. The amputation rate was 69% but only 4 major amputations were done. The mortality rate was 10.6%. Peripheral vascular disease was present in 69 patients. These finding stress the poor short-term prognosis of diabetic patients with foot ulcers and peripheral vascular disease.

Adult↗
PubMed1993

[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.

Aged↗
PubMed1993

[General principles of medical care of the diabetic foot].

In diabetic patients the foot is the focal point of neurologic, arterial and infectious complications. Affections of the foot are generally synonymous with a diabetic trophic disorder: the risk of gangrene is 17 times greater in diabetics than in non diabetics. Trophic disorders can affect the functional prognosis when they lead to amputation with subsequent altered weight bearing. They can provoke worsening of a subjacent arteriopathy, until then partially or totally asymptomatic, when the excision wound lacks the hemodynamic capacity for healing because of the associated arteriopathy. They can also induce local, regional (cellulitis) or even general (septicemia) infectious complications. They have a major socio-economic effect, by the loss of quality of life, the inability to work, and the cost of hospital and general care they engender. Finally, they have to be experienced by the patient and the treating team as a failure since, in the majority of cases, they imply an insufficient a priori knowledge of the predisposing factors: arteriopathy of legs and neuropathy with loss of sensitivity depriving the patient of the pain alarm signal if cutaneous lesions develop, and a delay in the recognition of triggering factors represented by microtrauma caused by shoes, particularly burns, frostbite or infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1993

[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.

Adult↗
PubMed1993

[Foot equipment of diabetic arteriopathy].

Surgical appliances have a place of choice in the care of the foot with trophic lesions in diabetics, after partial amputation and as a preventive measure when it is free from trophic disorders. The type of appliance will depend on the footwear and the possibility of wearing orthopedic soles, whatever the stage of the affection. For the foot free from trophic disorders the shoes should be wide fitting, in soft leather and of the seamless type. Made to measure shoes should be reserved for badly deformed feet. The soles should be molded in silicone or polyurethane to distribute weight bearing and to avoid it over zones at risk. Appliances for the foot with trophic lesions should allow the resumption of walking. If the lesions are too extensive an orthosis is performed or a specific type of slipper with molded soles is worn to avoid pressure on the wounds. After amputation of toes a silicone orthoplasty is used to fill the interdigital space to avoid deformity of the other toes. If a front of foot has been amputated a corrected silicone molded sole with false extremity is applied. For a back of foot amputation an orthoprosthesis is made, preferentially in silicone introductible in a regular high sided shoe. In order to fulfil its preventive or temporary role, the appliance should evolve with time and be followed up regularly with close collaboration between the diabetic specialist the podologist and the orthotist.

Amputation, Surgical↗
PubMed1992

Renal revascularization in high-risk patients: the role of iliac renal bypass.

Between 1984 and 1989, 29 iliac renal artery bypasses were performed in 29 patients (mean age 67.8 years) with severe renovascular disease due to atheroma. The indication for renal artery reconstruction was hypertension in all patients, which was associated with kidney failure in 16 cases. In six cases, reconstruction was performed after failure or complications of percutaneous transluminal angioplasty. The bypass was constructed with polytetrafluoroethylene in 24 cases (83%) and vein graft in five cases (17%). There was no postoperative mortality. All bypasses were found to be patent on duplex scanning or digital subtraction arteriograms. One patient was lost to follow-up. Mean follow-up was 23.2 months. One patient died of acute kidney failure, probably related to occlusion of the bypass. Hypertension improved in 22 cases (79%), was cured in two cases (7%), and remained unchanged in four (14%). Renal function remained unchanged in six cases (40%) and improved in nine (60%). Iliac-to-renal artery bypass seems to be the surgical renal revascularization modality best adapted to high-risk patients or those who have severe atheroma. Additionally, this technique enables rapid treatment of failures or complications of percutaneous transluminal angioplasty of the renal artery.

Aged↗