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Biomedical subjects

P Puel

Publications and source records attributed to P Puel.

At least 37 records · Page 2Linked to original sources
PubMed1987

[Subungual glomus tumors. Apropos of 2 cases].

Glomus tumours are uncommon, though not exceptional, benign growths developed from the constituents of the "neuromyoarterial glomus" initially described by Masson. Two cases of subungual glomus tumours of the hand in middle-aged women are reported. In spite of characteristic symptoms, with paroxysmal episodes of pain triggered off by cold and the most minute traumas, and of the finding in both cases of a violine++ tumour under the nail, the condition was belatedly diagnosed (7 and 27 years respectively after the onset of symptoms). Diagnosis rested not so much on standard radiography, which showed erosion of the distal phalanx in both patients, as on arteriography of the hand which displayed a small vascular pool at the arterial stage. Tumoral excision was successful.

Angiography↗
PubMed1987

[Variations in venous physiology in the healthy subject. Postural and venous occlusion plethysmography studies].

The principal characteristic of the venous network is its distensibility, the reason for its role as blood reservoir and cardiovascular adaptation system. This distensibility varies continuously as a function of venous tone, of neurocardiovascular adaptation and of the method used for its determination. The importance of variability of venous physiology was investigated by postural and venous occlusion plethysmography. Two series of tests were performed in 3 healthy volunteers, each being treated over one month: one series involved 19 determinations during May 1985, the other 14 determinations in December 1985. Two plethysmographic methods were employed: conventional venous occlusion plethysmography in decubitus with compression of 50 mm Hg and postural plethysmography with venous occlusion only, using gravity force during variations in position of subjects. Venous filling, a function of venous distensibility, varied between 16.7 and 17.8% during venous occlusion and 23.9 and 31.7% during postural plethysmography. Emptying half-life was from 20.7 to 40.7%. Emptying rate was, by the 6th second, 17.3 to 21.6% for venous occlusion and 27.3 to 32.3% for postural plethysmography. A relation was not found between results for the two methods, suggesting that they explore different phenomena. Variability of venous physiology parameters is marked, modulations being due to general or local factors, the former acting on both legs simultaneously: exterior temperature, neurocardiovascular physiology, digestion, stress, relaxation. Factors can have their effects reduced by differential study of the two limbs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1986

[Endocarditis on cardiac pacemaker endocavitary electrodes. Apropos of 7 cases].

The authors report 7 cases of endocarditis on cardiac pacing catheters observed out of a total of 2 950 primary implantations and 1 600 pacemaker replacements. This is a rare condition (0.15%) but carries a poor prognosis as it usually occurs in elderly patients and demands aggressive management. The presence of multiple pacing catheters and surgical contamination due to manipulation of the pulse generator (reimplantation, pacemaker replacement) are predisposing factors. The infecting organism in these cases was a staphylococcus. One case of metastatic infection was also observed (acinetobacter). Ablation of the septic endocarditic material under effective, prolonged, double antibiotherapy is essential. Recently implanted electrodes were withdrawn by simple traction in 2 cases. This manoeuvre was attempted initially in all cases but stopped when chest pain or runs of ventricular extrasystoles occurred. Open heart explantation of pacing electrodes adherent to the ventricular apex was performed in 5 patients. Cardiopulmonary bypass without cardiac standstill enabled dissection of the fibrous rings surrounding the catheter after purging the blood from the atrial and ventricular cavities. In one patient, associated tricuspid valve endocarditis was found and valvular replacement was performed with a bioprosthesis. Endocardial pacing was replaced by epicardial pacing in patients with permanent AV block. The prognosis of this condition is poor; there were 2 deaths in this series of 7 patients.

Acinetobacter Infections↗
PubMed1986

[Thrombosis of the superior vena cava disclosing Behçet's disease].

The authors report the case of a 29 year old North African patient with Behçet's disease presenting with sudden thrombosis of the superior vena cava. Venous disorders are the fourth major sign of this disease. Although superficial thrombophlebitis is a common presenting sign, caval thrombosis is rare and usually occurs after several years' evolution. Superior vena caval thrombosis may be life threatening due to complications such as pulmonary embolism and haemoptysis. The anatomical substrate of this form of vascular disease is the same as that of the other visceral lesions of Behçet's disease: predominantly venous vasculitis with perivascularitis and secondary thrombosis. The pathogenesis of this thrombotic diathesis is discussed.

Adult↗
PubMed1986

[Aorto-iliocaval fistula caused by rupture of an aneurysm. Apropos of 3 cases].

Three cases of aorto-iliocaval fistula are reported. Two cases were diagnosed during operation, an emergency laparotomy being indicated by the picture of hemodynamic shock unimproved by intravenous fluids, and without reduction in number of circulating red cells, associated with a painful abdominal aorta aneurysm. Recovery occurred after surgical closure of fistula and grafting of the aneurysm. In one case a caval stenosis required the insertion of a prophylactic subrenal clip. The third case was original in that a paradoxical pulmonary embolus developed in a patient with a primary left iliac aneurysm complicated by phlebitis. The hemodynamic state was such that a first stage operation. allowed insertion of a Greenfield's filter by the jugular route. Arteriography confirmed the diagnosis of a fistula and surgery was successful. Possible clinical manifestations of aortocaval fistula and surgical therapeutic measures are discussed.

Aged↗
PubMed1986

Cancer of the kidney invading the vena cava and heart. Results after 11 years of treatment.

Between October, 1973, and October, 1983, 18 patients with cancer of the kidney or adrenal gland that had invaded the vena cava, and in 11 cases had reached the heart, were operated on by seven surgical teams. The surgical excision in all patients was performed with extracorporeal circulation, circulatory arrest and deep hypothermia. No deaths occurred. If there are no detectable metastases before operation, the 5 year survival rate is 75% as compared to 6 months with medical treatment. This clinical situation is not uncommon, as 3% to 10% of cancers of the kidney invade the inferior vena cava and 40% of them reach the heart. The possibility of curing the cancers with minimal operative risk should prompt a systematic search for venous invasion with any cancer of the kidney.

Adolescent↗
PubMed1985

[Raynaud's phenomenon, laser Doppler, isothermal chamber. Exploration of normal and pathologic subjects].

The investigation of Raynaud's phenomenon in angiological practice has not yet been standardized. Two points need to be resolved. The cold test is either too empirical and inaccurate or non-uniform. None of the tests of functional vascular exploration have been proven to be reliable, except, perhaps, for capillaroscopy. Laser Doppler studies the cutaneous microcirculatory velocity and its response to thermal stimulation. An isothermic chamber can be used to chill the skin and reheat the skin according to a simple and standardized technique. This protocol was performed in 14 normal subjects, 28 patients with Raynaud's disease and 19 patients with Raynaud's phenomenon, which is clearly individualized. In Raynaud's disease, there appears to be an exageration of cutaneous sympathetic tone compared to normal subjects. This methodology is simple to perform and it provides rapid diagnostic results in the consulting rooms.

Blood Flow Velocity↗
PubMed1985

[Exploration of the cervical arteries within the framework of an angiology service. Our experience using Doppler spectral analysis].

Diagnosis and quantification of severity of carotid lesions were assessed by different procedures. Oculoplethysmography was of value only in cases of significant occlusive lesions. Ultrasound methods possessed enhanced sensitivity: Doppler velocimetry, ultrasound imaging and particularly spectral analysis of the Doppler signal. Efficacy of this exploratory method was assessed in a department of angiology, spectral analysis being rated as 5 different grades as a function of degree of arterial stenosis (fig. 1). It was routinely combined with Doppler velocimetry and ultrasound imaging in 35 patients, a total of 64 carotid bifurcations being analyzed. Digital subtraction venous angiography was performed in 28 of these cases. Study of the reading effect on interpretation of the spectral analysis showed 37 agreements and 27 divergences; among the latter the definition of normality in relation to grades I or II appears to be responsible. Greater significance was noted for the reading effect in cases explored by Doppler velocimetry and ultrasonography. Positive findings were obtained with spectral analysis in 41 of 64 patients, either by detection of non-significant lesions or by precise quantification of stenotic lesions. Results of digital subtraction angiography were debatable in 8 of 28 patients and were unconfirmed on ultrasound imaging. Spectral analysis of the Doppler signal has therefore an advantage over Doppler velocimetry and ultrasonography in that more precise data is obtained on stenotic lesions and that those of little significance are detected. It supplies an effective means of diagnosis and surveillance and it establishes the need for angiography. Lack of sensitivity and reproducibility of ultrasound and digital subtraction venous angiography raises the problem of an effective reference test.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Diseases↗
PubMed1985

[Valve replacement associated with aorto-coronary bypass in ischemic mitral insufficiency].

26 cases of ischaemic mitral regurgitation (MR) were treated by combined surgery: mitral valve replacement (MVR) and coronary bypass grafting (CBG). This type of operation is not common (1.3 p. 100 of all operations) and is usually reserved for men (21 cases) of middle age (average 59 years). A half of the cases had suffered previous myocardial infarction (MI), an average 5 months before surgery (range 20 days to 2 years). The other half had severe angina or ECG changes of myocardial ischaemia. 23 patients were in Class IV (15 patients) or Class III (8 patients) of the NYHA classification. 6 of the cases required intraaortic balloon pumping. Mitral regurgitation was severe () in half of the cases with a raised pulmonary capillary (mean V wave = 52 mmHg) and systolic pulmonary artery pressures (mean = 47 mmHg: exceeding 60 mmHg in 7 cases). The coronary lesions were severe in 18 patients (12 cases of double and 6 of triple vessel disease including 2 cases of left main stem stenosis). Ruptured chordae were found in 11 cases and papillary muscle necrosis in 4 cases. Surgery comprised MVR with 12 bioprostheses and 14 mechanical prostheses. 33 CBG were performed (anterior wall: 15 cases, posterior wall: 11 cases). In addition, one tricuspid annuloplasty and 3 ventricular aneurysmectomies were carried out. The hospital mortality was 15.4 p. 100. The main causes of morbidity were low output states and postoperative MI (2 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

[Hypoplasia of the abdominal aorta. Review of the literature apropos of 4 cases].

The authors report 4 cases of abdominal aortic hypoplasia and, reviewing the literature, recall the anatomical classifications and the clinical aspects predominated by arterial hypertension and arterial claudication. Pathogenesis does not seem to be univocal and some arguments are in favor of a congenital origin when others plead for an acquired inflammatory disease. But above forty one must consider the possible responsibility of added atheroma. The numerous operative techniques point out the difficulties encountered in the treatment of the aortic lesions and associated arterial, mainly renal lesions. The polymorphism and complexity of these lesions oblige to vary the choice of indications.

Aorta, Abdominal↗