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Biomedical subjects

P Puel

Publications and source records attributed to P Puel.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Atypical compression of the humeral axial artery treated by surgical arteriolysis].

A 28-year-old man with atypical humeral artery compression presented clinical signs and results of Doppler tests suggestive of a cervicothoracic outlet syndrome: dysesthesie disorders and pain in left upper limb on active abduction. Murmurs over the vascular pathways were not elicited on clinical examination. Pulses were palpable in the upper limbs at rest but were abolished during abduction and external rotation. Data were confirmed by velocimetric studies, and dynamic arteriography showed absence of compression at the cervicothoracic outlet but its presence at the humeral head level. Axillohumeral surgical exploration provided evidence of compression of the nerve-vessel bundle, which was stretched within its sheath over the head of humerus. Incision of the fibrous sheath and freeing of the artery restored distal vascular pulsatility during abduction movements. This clinical pseudosyndrome of the cervicothoracic outlet appears to result from a rare cause of compression situated distal to this anatomic zone, and to respond to simple treatment.

Adult↗
PubMed1985

[Indications and results of combined urokinase-lys plasminogen in acute ischemic pathology of the legs].

Low dose urokinase-lys plasminogen was used to treat 10 patients with acute ischemia of lower limbs. Preliminary results are reported and indications defined, the combination producing effective relief and being very well tolerated biologically and clinically. All patients presented clear signs of ischemia provoking a short term risk for the limb. Direct femoral puncture arteriography of the ischemic limb was an essential pretreatment investigation. A thin catheter left in contact with the thrombus allowed localized fibrinolysis to be performed. Follow up arteriography examinations assessed clinicopathologic results, while biologic surveillance of principal coagulation parameters showed a lack of significant alterations during treatment. Ischemic signs were totally relieved in 7 cases, with arterial repermeabilization allowing recuperation of one (3 cases) or both (2 cases) distal pulses. Persistence of a popliteal thrombus in one case required a fogarty after a direct approach and the limb was saved. Two patients had to be amputated because of delayed treatment. These encouraging results suggest that this procedure of local thrombolysis be reserved for popliteal or infra-popliteal occlusions accompanied by sensory-motor signs and of recent (less than 72 hours) onset. Follow up for 8 months is insufficient but has shown the absence of deterioration, but this is obviously a function of the natural course of the underlying atheromatous disease.

Acute Disease↗
PubMed1984

[Introduction to Doppler laser flow measurement. Study of cutaneous vascularization].

The microcirculatory unit, which links arterioles with venules, is responsible for metabolic exchanges with the interstitial tissues and for the regulation of skin temperature. The sympathetic system controls cutaneous vascularization. A satisfactory method for dynamic clinical investigation of skin vascularization, previously not available, is now possible with the Doppler laser flowmeter which provides relative measurement of blood flow in the microcirculation. Three studies were conducted using this simple technique. Changes in skin blood flow were recorded in healthy volunteers during physiological stress: reactive hyperemia, hot and cold reaction test, respiratory changes, postural modifications. In patients with arteritis, the immediate effects of lumbar sympathectomy on skin blood flow were measured. During exploration of patients with vasomotor disorders, the cold test was performed by exposing the extremities in a thermal chamber: laser flowmeter recordings provided data on specific alterations occurring during a disease or Raynaud's syndrome. These findings will assist quantification of, and the application of predictive tests to the most useful measures to adopt for vasomotor disorders.

Doppler Effect↗
PubMed1984

[A thermal chamber for the cold test in vasomotor disorders].

The cold test represents an essential part of the functional exploration of the vascular system performed in Raynaud's disease, but its physiological nature depends upon the use of a sufficiently large area of skin. Several measurements must be conducted simultaneously and various temperature ranges used to allow for the variable threshold of vascular reactivity to cold of different individuals. A thermal chamber is presented which enables the simultaneous performance of plethysmography, digital pressure recordings and capillaroscopy at different temperature ranges. A novel use of a laser flowmeter is also described. Peri-ungual capillaroscopy enables determination of the temperature, when capillary spasm appears and then is relieved during progressive cooling followed by reheating. This apparatus can be adapted for use of all techniques for exploration of vascular function.

Cold Temperature↗
PubMed1984

[A comparative study of percutaneous transluminal angioplasty of the iliac and femoropopliteal arteries in arterial disease of the lower extremities].

The authors compared the anatomo-radiologic data from a series of 100 consecutive percutaneous transluminal angioplasties (PTA), as well as the immediate and long-term results as a function of the level of the lesion--iliac or femoropopliteal. Proximal to the thigh, there were 57 PTAs, 36 of the common iliac and 21 of the external iliac. In the lower thigh, there were 43 PTAs, 9 of the upper part of the popliteal artery and 34 of the external femoral artery. Percutaneous transluminal angioplasty of the common iliac lesion was dominant in patients under 60 years of age (p less than 0.05). At the iliac level, 89% of the patients had severe claudication; at the femoropopliteal level, 39% had trophic problems. The "dominant" or "accessory" character of the lesion did not modify the indication for the procedure, regardless of the level. Segmental thrombosis accounted for 44.2% of the femoropopliteal PTA indications, compared with 7% at the iliac level (p less than 0.04). The failure rate was less at the iliac than at the femoropopliteal level. Follow-up was available for 86.6% of the patients for an average of 22 months. The systolic indices at the thigh after iliac PTA and at the ankle after femoropopliteal PTA were significantly increased (p less than 0.01). At the femoropopliteal level, 74% of the patients were totally asymptomatic. There was one failure (3.8%); amputation at thigh level was carried out 12 months after the PTA. At the iliac level, improvement was observed in 91% of the patients and 70% became asymptomatic. The overall success rate (clinical patency and improvement) was 92% +/- 0.09%, based on the life-table method.

Aged↗
PubMed1984

[Percutaneous transluminal angioplasty in chronic arteriopathies of the lower limbs. Immediate anatomo-radiological results and functional outcome].

The immediate anatomo-radiological results and functional outcome of a continuous series of 100 percutaneous transluminal angioplasties (PTA) in patients with chronic obliterative arterial disease of the lower limbs are reported. In 8 out of 10 cases, the patients had no previous surgical history. The iliac axis was more commonly affected than the infracrural arteries (57% compared to 43%). The indication of choice was the Leriche stage II (73%). The arterial lesion was responsible for the ischaemic pathology in 2 out of 3 cases. There was a higher incidence of preocclusive lesions (46%) than thromboses to be recanalised (23%) or significant stenoses (23%). The anatomo-radiological results were satisfactory in 80% of cases: a normal calibre was restored in 31% and stenosis was reduced to non-significant levels in 49% of cases. The morbidity associated with this technique was 7%: inability to dilate or thrombosis of the vessel. In 7 cases, failure was due to inability to pass the catheter across the stenotic lesion. Complementary surgical treatment was carried out on "accessory" arterial lesions in 33 cases; 32 sympathectomies for distal lower limb lesions and I femoro-popliteal bypass after iliac PTA. A total of 86.6% of PTA were followed up for an average of 22 months; 72% were totally asymptomatic; 21 were classified as stage II with improvement of their walking limits. The 3 year success rate was 0.92 +/- 0.1. Arterial surgery was necessary in 5.6% of cases for persistent severe intermittent claudication.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature].

The authors report 2 cases of thrombolytic therapy by Urokinase at the dose of 4 500 U/kg/hour, for 24 hours, in patients with thrombosis of a Bjork aortic and Lillehei mitral valve prostheses, and assess the efficacy with a review of the world literature. The first case was a 65 year old woman who received a Bjork No 25 aortic valve prosthesis for aortic regurgitation. Two years later oral anti-vitamin K anticoagulants were replaced by an association of Aspirin-Persantine. She developed acute pulmonary oedema secondary to thrombosis of her valve during the fifth postoperative year. Treatment with Urokinase was successful (4 500 U/kg/hour for 24 hours). The second cases was a 33 year old woman who received a Lillehei No 27 mitral valve prosthesis for mitral regurgitation due to infective endocarditis. Six years later, during a period of apparently ineffective oral anticoagulation, she developed subacute pulmonary oedema due to thrombosis of her prosthesis. Urokinase therapy was successful after 4 hours, but the valve surface area on cardiac catheterisation was decreased and elective reoperation to change the prosthesis was decided upon. Prosthetic valve thrombosis is a serious complication with an operative mortality of 68.6% (35 deaths out of 51 reoperations in the worl literature) whilst the efficacy of thrombolytic therapy would appear to be about 80%. When thrombosis is progressive, the valve has to be changed surgically, but when it is secondary, thrombolytic therapy at least helps the patient survive the acute phase.

Adult↗
PubMed1984

[Prospective study of the long-term permeability of the internal saphenous vein and of polytetrafluoroethylene in the lower femoro-popliteal bypass. Results after 5 years in 100 patients].

Autogenous saphenous vein (ASV) (50 patients-group I) was compared to polytetrafluoroethylene (PTFE) (50 patients group II), in 100 below-knee femoropopliteal bypass (FPB) procedures performed for limb salvage during à 5 year-period. PTFE was used as an alternative procedure in the absence of a suitable ASV. Each group made of 50 patients was not significantly different from the other. The mean follow up period for patent graft is now 35 months (12-60 months) and the overall life table cumulative patency at 5 years, is 65% in group I and 18% in group II (P less than 0.05) whereas the limb salvage rate (LSR) is 81% with ASV and 26% PTFE (P less than 0.05). No correlation was demonstrated between patency and run-off. The graft described was used in elderly patients most of whom would have had amputation before the introduction of PTFE. Theses results advocate the use of PTFE only in secondary intention and never to shorter operation time.

Aged↗
PubMed1984

[Aorto-enteric and paraprosthetic fistulas. Apropos of 5 cases].

Five cases of aorto-enteric fistula (AEF) are reported. The first case was a primary AEF from rupture of the infrarenal section of the abdominal aorta treated successfully by an obliteration and graft. The second patient had a primary AEF from rupture of an abdominal aorta aneurysm, complicated after an obliteration and graft of the primary AEF, requiring excision of the graft and an extra-anatomical shunt (EAS): healing following parenteral hypernutrition. The third case, a patient with a primary AEF from rupture of an aortic adventitial cyst in the left colon, died from septic complications. The fourth case died with heart rhythm disorders on the 4th day after resection and EAS for an aortic fistula. The fifth patient had a secondary AEF with cataclysmic digestive hemorrhage: excision of the graft with digestive closure and aortofemoral bypass did not prevent a fatal outcome on the 20 th day. Digestive hemorrhage and septic signs may be combined or occur as isolated complications. The most valid complementary investigation is fibroscopy, bacteriological culture of arterial blood distal to the prosthesis having an orientation value. Ultrasound, computed tomography or Gallium scintigraphy imaging may detect a retroperitoneal abscess. Effective treatment of all aneurysms can prevent primary AEF and avoidance of infection and interpositioning of viable tissue between duodenum and anastomotic line reduce the risk of secondary AEF. Maximum chances of success require aggressive surgery: aortic ligature; excision of all septic material and duodenal closure or segmental digestive resection with discharge of proximal pocket. Lower limb ischemia is treated by insertion of an EAS.

Aged↗
PubMed1984

[Extra-anatomical shunts in the lower limbs. Apropos of a series of 51 consecutive cases].

Indications for extra-anatomical shunts are defined on the basis of results of 51 consecutive operations. Axillo-uni or bi-femoral (AF) shunts (36 cases) and femoro-femoral (FF) shunts (15 cases) were performed in elderly men (74% over 60 years of age). These were patients in whom multiple affections (40 cases) or contraindications to direct local operations existed. The A-F were performed in either patients with chronic arteriopathies (2/3) or acute ischemic (6 cases) or infectious (4 cases) accidents. Immediate mortality (18%) was related to the age-group. Of the 47 limbs to be saved, 36 were preserved up to the 30th day. Long-term 2-year adjusted mortality was high (85%) because of the poor condition of the patients. The adjusted permeability level was 60% in survivors. The F-F were carried out in patients with either chronic arteriopathies or acute ischemic lesions. Immediate postoperative mortality was 13% and the early failure rate 25%. The long-term 4-year adjusted permeability level was 76%. All deaths were related to the atheromatous disease. These shunting operations remain complementary to conventional surgical procedures and should be reserved for cases such as those with obstacles to the direct reconstruction route or with generally very poor condition.

Aged↗
PubMed1984

[Aneurysm of the infrarenal abdominal aorta in octogenarians. Apropos of a series of 30 consecutive cases].

UNLABELLED: The authors report a series of 30 operated consecutive infrarenal abdominal aneurysms on patients aged of 80 years old or more. The operation is necessary in emergency in 13 cases (43.3%): 10 patients with sudden severe abdominal pain and faintness and 3 with rupture. In 17 cases the indication of surgery is "elective" (56.7%): sole physical finding in 10 cases, one case of ureteral tract compression and 6 cases of recent pain. In 13 cases, the infrarenal aneurysm is associated with arterial occlusive disease. In 20% of the cases, the operation consists on aorto-aortic bypass graft; in the other cases, aorto iliac bypass is necessary; in 3 cases the distal implantation of the graft is on the groin, on the femoral artery. The hospital mortality is 20% of the cases (6 cases); after operation in emergency the mortality is higher (30.6%) than after elective surgery (11.7%). The mean of the late follow up is of 39 months (2 months to 9 years): the late mortality is 16.6% of the cases (5 cases). The actuarial percentage of survival at 4 years is 60%. CONCLUSION: The elderly is not a contraindication for surgical treatment of the infrarenal aortic aneurysm. The late survival rate is good after the operation.

Aged↗