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Biomedical subjects

P Puel

Publications and source records attributed to P Puel.

At least 73 records · Page 4Linked to original sources
PubMed1983

[Thrombophlebitis on intravenous cardiac stimulator electrodes].

The main feature of venous thrombosis on endocardial pacing electrodes are described with reference to 7 cases: the incidence is relatively low (0.4 to 4 p. 100) and the diagnosis obvious in the typical axillary-subclavian form associated with pain, oedema and collateral circulation. Diagnosis is mainly clinical and rehoplethysmography, rather than venography with its potential complications, is the complementary investigation of choice. Internal jugular, innominate vein, vena cava and intracardiac thrombosis may also occur. The vena cava syndromes are observed mainly in patients with multiple electrodes. Atrial or ventricular endocavitary thrombosis may give rise to hemodynamic signs of cardiac failure or to thromboembolism which may be fatal. Operational technique is an important factor in the etiology of early thrombosis especially when the approach vein is ligatured. In the late period, the loss of venous mobility due to the presence of a foreign body makes the vessel susceptible to compression in the cervico-brachial region. The mainstay of treatment is anticoagulation with intravenous or subcutaneous heparin with mobilisation and elevation of the affected arm. Fibrinolysis may be indicated in superior vena cava syndromes (case no 1), the results being better when therapy is instituted early on. Long term anticoagulation is not indicated (case no 7) and may even be dangerous in elderly patients with multiple electrodes.

Aged↗
PubMed1983

[Experimental model for hemodynamic and metabolic studies of extracorporeal circulation. Apropos of 14 cases].

The authors present an homogeneous and stable experimental model, the basic characteristics of which are: 14 extracorporeal bypass with: total bypass; normothermia; total haemodilution; beating heart; continuous flow in dogs anesthetised with chloralose. Three methods were employed: continuous recording of the venous lactate concentration; invasive electromagnetic measurement of the arterial blood flow; measurement of the tissular capillary blood flow with radioactive labelled microspheres. The statistic treatment of the informations gathered confirms that those experimentations took place in normothermia and constant: pH, venous and arterial pressure, cardiac pacing and arterial carotid blood flow. We noticed no modification of the body electrolytic repartition; blood gas variations do not modify haemodynamic conditions. Increase of the lactate concentration, as noticed in the literature, is in relation with a catecholamine hypersecretion and not with an anaerobic tissular function. Tissular capillary blood flow is constant if reported to cardiac index. This model will allow us to compare those results with new series where only one of the basic elements will be modified.

Animals↗
PubMed1982

[The place of intraluminal angioplasty in a vascular surgery department].

The advent and rapid strides made in the use of percutaneous intraluminal angioplasty (P.I.A.) in the treatment of chronic obliterating arteriopathies of the lower limbs have provoked a great deal of discussion. The exact place of this technique among the various therapies available is assessed in a different manner by radiologists, angiologists, and vascular surgeons. This report attempts to supply answers to two questions posed by certain authors in a more or less implicit manner: what is the importance of P.I.A. in relation to other therapeutic methods, and does P.I.A. have a marked diminishing effect on the need for surgery?

Angioplasty, Balloon↗
PubMed1981

Venous plethysmography applied in pathologic conditions.

The correlation between venography and SGP in 41 patients was studied. Fourteen normal subjects were used as a reference. SGP was shown to be very sensitive (97.5%), including proximal and distal DVT, and highly specific (96.4%). After some recommendations for patient positioning and technical use, it will enhance both the accuracy and the reproducibility of plethysmography for evaluation of patients with suspected deep venous thrombosis.

Acute Disease↗
PubMed1981

[Surgical revascularization of infarcted myocardial areas. Its effects on left ventricular function].

The results of twelve patients undergoing revascularisation procedures of infarcted myocardial territory alone were analysed quantitatively by planimetry in the right anterior oblique projection. Patients operated in the acute phase of myocardial infarction (2 cases) were distinguished from those with preinfarction syndromes (8 patients) and those with postinfarction angina (2 patients). Two posterior wall and ten anterior wall revascularisations were carried out by single bypass grafts (8) and double bypass grafts (2) with no operative deaths. The results were assessed 2 months to two years after operation (average: 6 months). Twelve of the fourteen bypass grafts were patent. Only one of the twelve operated patients, an anterior wall revascularisation, was considered a complete surgical failure: global left ventricular function and segmental wall movement progressively deteriorated with reduced contractility and velocity of fibre shortening. Improved contraction of both anterior and posterior walls was observed in the other 11 patients. The ejection fraction of the 9 patients with anterior wall revascularisation rose significantly from 47,1 +/- 10,5% to 56,3 +/- 3,5% and a similar rise was observed in systolic index (29,0 +/- 12,0 to 36,8 +/- 11,0 ml/syst./m2); the average akinetic end diastolic perimeter fell by 17%; segmental wall analysis of mean radial shortening and mean amplitude of excursion on the hemiaxes was improved, especially in the antero apical region: the corrected rates of mean excursion and average systolic work indices (33,2 +/- 15 to 41 +/- 13 gm/syst./m2) also increased. Surgical revascularisation of infarcted zones, made possible by new methods of cardioplagia and reliable circulatory assistance, may lead to improvement in global and segmental left ventricular function with minimal risk to the patient: this is thought to be due to an active mechanism and not to the passive process of scarring. Although a reserved attitude should be adopted in the acute phase of myocardial infarction, preinfarction syndromes and unstable postinfarction angina could well benefit from surgical management.

Adult↗
PubMed1981

[The value of spectral frequency analysis by Doppler examination (author's transl)].

Arterial stenoses of moderate extent may involve modifications of the blood flow. Arterial shading is not always examined at the best incident angle to assess the extent of the stenosis. Spectral frequency analysis by Doppler examination is a good means of evaluating the effect of moderate arterial lesions. The present study was carried out with a Doppler effect having an acoustic spectrum, which is shown in a histogram having 16 frequency bands. The values were recorded on the two femoral arteries. A study was also made of 49 normal subjects so as to establish a normal envelope histogram, taking into account the following parameters: maximum peak (800 Hz), low cut-off frequency (420 Hz), high cut-off frequency (2,600 Hz); the first peak was found to be present in 81 % of the subjects (at 375 Hz) and the second peak in 75 % of the subjects (2,020 Hz). Thirteen patients with iliac lesions of different extent were included in the study; details of these lesions were established in all cases by aortography. None of the recorded frequency histograms were located within the normal envelope. Two cases of moderate iliac stenoses were noted ( Less Than 50 % of the diameter) which interfered with the histogram, even though the femoral velocity signal was normal.

Adult↗
PubMed1980

[Continuous assay of blood lactates. Application to the study of muscular work in the arteritis patient].

Ten normal and twenty arteriosclerotic patients underwent two successive static continuous exercise tests: - 4 minutes holding of 30% maximum power - 1 minute holding of 60% maximum power. Simultaneous recordings were made of: - The Xenon 133 washout curve of the anterior tibial muscle, to assess the ischaemia induced by exercise and to measure the duration of the hyperaemic phase; - The continuous lactate level in the femoral vein, using an original electrode specific for these enzymes. The following parameters were retained; - Resting, peak and the surface of accumulation of lactate after exercise; - The appearance time and the duration of accumulation of lactate with respect to the length of the hyperaemic phase. The following conclusions are drawn: - The differences in the height of the peak of the serum lactate. The duration and the surface of accumulation of lactate were only significant in obviously arteriosclerotic patients in whom exercise had induced ischaemia. - From the dynamic point of view: the hyperaemic phase always preceded the phase of venous accumulation of lactate, in all groups, peak lactates levels always occured during the hyperaemic phase and the length of the accumulation phase was 2 to 3 times that of the hyperaemic phase; in this respect, there was a significant difference between obvious arteriosclerotic patients in whom exercise induced ischaemia, and a group of other arteriosclerotic and normal patients.

Adult↗
PubMed1980

[Contribution of different methods for vascular investigation of arteriography of the limbs. Examinations in ambulatory patients and use of the vascular laboratory (author's transl)].

Various techniques are presently employed for noninvasive investigation of vascular function. The problem arises as the place of each method as a function of the medical surroundings and the pathological condition to be explored, and a multicentre survey was therefore conducted in 38 teams who were asked to define their activities. The most frequently used method is continuous ultrasonography (2 apparatuses per team), an 20 centres had available a mercury gauge plethysmograph. Lower limb resting pressure was measured in only 73% of centres, and an effort test conducted in 42%. Apart from medical staff, 58% of the teams included a laboratory technician, and 60.5% employed members of the nursing staff. The specialist (vascular surgeon, cardiologist...) is responsible for confirming the nature and effects of the vascular lesion, which requires the use of ultrasonography and distal pressure measurement. The laboratory for vascular exploration intervenes if surgery is contemplated or if diagnosis is not certain. Blood velocity and segment pressures are then determined. Effort and hyperemia tests can assist the decision to undertake reconstructive surgery.

Ambulatory Care↗
PubMed1979

[False aneurysm associated with mitral insufficiency due to rupture of the heart at the point of insertion of the anterior papillary muscle. A successfully operated case].

Although rupture of a mitral papillary muscle during myocardial infarction is well known, and post-infarction transmural ruptures causing false aneurysms occasionally reported, the association of rupture of the anterior papillary muscle and a underlying transmural parietal rupture giving rise to a false aneurysm is quite exceptional, and, to the best of our knowledge, has not previously been reported. Despite the serious nature of the disease, surgical cure of the aneurysm with mitral valve replacement was successful, due to the limitation of the anatomical disruption by early pericardial symphysis.

Aneurysm↗
PubMed1979

[Local osseous blood flow measured with radioactive microspheres: correlations with intra-medullary pressures].

The authors studied in the dog, using radioactive microspheres, the blood bone outputs of the trochanter, the femoral diaphysis and the tibial diaphysis, and measured, in a simultaneous fashion, the intra-medullar pressures in these bone regions. A same hierarchy of outputs is consistently found in all animals : the trochentarian outputs are always the highest, and next come, in decreasing order, the outputs of the femoral diaphyses and the tibias. On the other hand, the intra-medullar pressures, although differing according to the bone regions, always have rather superposable rates, so that the neighboring intra-medullar pressures always correspond to radically different outputs. It is thereby demonstrated that the intra-medullar pressures, as an isolated parameter, cannot accurately reflect the rate of bone output.

Animals↗