Biomedical subjects
Albert-Adrien Ramelet
Publications and source records attributed to Albert-Adrien Ramelet.
Single-blind, randomized study comparing chromated glycerin, polidocanol solution, and polidocanol foam for treatment of telangiectatic leg veins.
BACKGROUND: A single-blind, randomized, comparative study was performed to evaluate the efficacy of pure chromated glycerin (CG), polidocanol (POL) 0.25% solution, and POL 0.25% foam (Monfreux technique) for treatment of telangiectasias and reticular leg veins. OBJECTIVE: To determine the relative efficacy and safety of two sclerosing agents and foam. METHOD: Of 150 randomized patients presenting comparable areas (lateral face of thigh) of telangiectasias and reticular leg veins, 147 could be evaluated by photographic assessment, patients' satisfaction score, and pain at injection sites. Internal and external agreement for the photographic assessment was good for two independent blinded experts. RESULTS: CG cleared vessels significantly better than POL solution or foam (p<0.002). The patients' satisfaction score was also higher in the CG group, although the difference did not reach statistical significance. CG was significantly more painful at injection sites. Other side effects were very few, precluding any statistical comparison. Foam was associated with more side effects (microthrombi, matting) than CG or POL solution. Three patients treated with POL foam experienced a transient visual disturbance. CONCLUSION: This study shows that CG is superior to POL solution and foam for sclerotherapy of leg telangiectasias.
Exercise-induced purpura.
Exercise-induced purpura (EIP) occurs on the lower legs after unusual or major muscular activity, as in marathon runners or as after long walks, especially in the mountains in hot weather. In leisure walkers, patients are otherwise healthy females. There is no relation with chronic venous disorder. Erythematous, urticarial or purpuric plaques arise on the lower leg, usually sparing the skin compressed by socks. Symptoms include itch, pain and a burning sensation. Histopathology demonstrates leukocytoclastic vasculitis. The lesions fade after some days, with frequent relapses at further muscular exercises and may be prevented in some cases by compression, intake of venoactive drugs and local application of steroids. EIP is not uncommon, even if very few descriptions have yet been published. It appears to be consecutive to venous stasis induced by an acute failure of the muscle pump of the calf and thermoregulation decompensation, after a prolonged and unusual exercise, such as running or walking in hot weather.
High risk for hyperlipidemia and the metabolic syndrome after an episode of hypertriglyceridemia during 13-cis retinoic acid therapy for acne: a pharmacogenetic study.
BACKGROUND: Administration of 13-cis retinoic acid (isotretinoin) for acne is occasionally accompanied by hyperlipidemia. It is not known why some persons develop this side effect. OBJECTIVE: To determine whether isotretinoin triggers a familial susceptibility to hyperlipidemia and the metabolic syndrome. DESIGN: Cross-sectional comparison. SETTING: University hospital in Lausanne, Switzerland. PARTICIPANTS: 102 persons in whom triglyceride levels increased at least 1.0 mmol/L (> or =89 mg/dL) (hyperresponders) and 100 persons in whom triglyceride levels changed 0.1 mmol/L (< or =9 mg/dL) or less (nonresponders) during isotretinoin therapy for acne. Parents of 71 hyperresponders and 60 nonresponders were also evaluated. MEASUREMENTS: Waist-to-hip ratio; fasting glucose, insulin, and lipid levels; and apoE genotype. RESULTS: Hyperresponders and nonresponders had similar pretreatment body weight and plasma lipid levels. When reevaluated approximately 4 years after completion of isotretinoin therapy, hyperresponders were more likely to have hypertriglyceridemia (triglyceride level > 2.0 mmol/L [>177 mg/dL]; odds ratio [OR], 4.8 [95% CI, 1.6 to 13.8]), hypercholesterolemia (cholesterol level > 6.5 mmol/L [>252 mg/dL]; OR, 9.1 [CI, 1.9 to 43]), truncal obesity (waist-to-hip ratio > 0.90 [OR, 11.0 (CI, 2.0 to 59]), and hyperinsulinemia (insulin-glucose ratio > 7.2; OR, 3.0 [CI, 1.6 to 5.7]). In addition, more hyperresponders had at least one parent with hypertriglyceridemia (OR, 2.6 [CI, 1.2 to 5.7]) or a ratio of total to high-density lipoprotein cholesterol that exceeded 4.0 (OR, 3.5 [CI, 1.5 to 8.0]). Lipid response to isotretinoin was closely associated with the apoE gene. CONCLUSION: Persons who develop hypertriglyceridemia during isotretinoin therapy for acne, as well as their parents, are at increased risk for future hyperlipidemia and the metabolic syndrome.
Sclerotherapy: old- or new-fashioned?
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Removal of blue periocular lower eyelid veins by ambulatory phlebectomy.
BACKGROUND: Prominent periocular veins, primarily of the lower eyelid, are a relatively frequent cosmetic problem. Reported treatment techniques have included electrosurgical, sclerotherapy, and longer-wavelength lasers. OBJECTIVE: Ambulatory phlebectomy can be performed on reticular veins of the leg. This technique has been applied over the past few years to periocular reticular veins in order to observe the results and side effects. METHODS: Using a hook specifically designed for reticular veins, we treated 10 patients who had larger reticular periocular eyelid veins. One or several punctures with an 18-gauge needle were made in the center of the targeted length of vein. The reticular vein was then gently dissected by undermining with the stem of the Ramelet phlebectomy hook. RESULTS: All 10 patients tolerated the procedure well. In 8 of 10 patients there was complete elimination with a single procedure. Surprisingly, no significant hematoma was seen in any patient, although two patients had a small hematoma lasting less than 1 week. Two patients had only partial success, as a small segment of vein was difficult to extract. This was eliminated with a second phlebectomy performed 2 months later in both cases. Edema that is usually seen after sclerotherapy was not noted in any of these patients. CONCLUSIONS: Ambulatory phlebectomy appears to be a safe and effective means of permanently eradicating periocular veins.
International clinical recommendations on scar management.
Many techniques for management of hypertrophic scars and keloids have been proven through extensive use, but few have been supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article reports a qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal. The article provides evidence-based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicone gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations. A number of other therapies that are in common use have achieved acceptance by the authors as standard practice. However, it is highly desirable that many standard practices and new emerging therapies undergo large-scale studies with long-term follow-up before being recommended conclusively as alternative therapies for scar management.
Daflon 500 mg: symptoms and edema clinical update.
Patients suffering from any class of the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of chronic venous disease (CVD) may be symptomatic (C0s-C6s). Leg heaviness, discomfort, itching, cramps, pain, paresthesia, and edema (C3) are the most frequent manifestations of CVD and a major reason for medical consultation. Daflon 500 mg (micronized purified flavonoid fraction [MPFF]) is an effective treatment for symptoms and edema in CVD as demonstrated in several randomized controlled studies. A 2-month, double-blind study in 40 patients established the superiority of Daflon 500 mg over placebo with regard to symptoms and objective signs. This was confirmed in another double-blind, placebo-controlled trial (2 months' treatment, 160 patients), and in the Reflux assEssment and quaLity of lIfe improvEment with micronized Flavonoids (RELIEF) study. The latter included 5,052 patients in 23 countries, using a visual analog scale for evaluating pain, leg heaviness, cramps, and a sensation of swelling. All symptoms showed significant and progressive improvement. The quality-of-life results (scores on the ChronIc Venous Insufficiency quality of life Questionnaire [CIVIQ]) paralleled those of symptoms. The decrease in the ankle and calf circumferences was significantly greater (p < 0.001) in the group of patients treated with Daflon 500 mg in two studies, and correlated well with the improvement in the sensation of swelling (p < 0.001). This was confirmed with more sophisticated measurement techniques as in the RELIEF study or in a trial assessing edema with an optoelectronic volumeter in 20 patients. A further double-blind, randomized, controlled study established a statistically significant difference in favor of Daflon 500 mg in comparison with diosmin, both on symptoms and edema. The therapeutic efficacy of Daflon 500 mg on CVD symptoms and edema has been demonstrated in double-blind, randomized, controlled studies. Further studies using a new approach may define the most precise and validated methodology for application in future research in phlebology.