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H Guidicelli

Publications and source records attributed to H Guidicelli.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Leg ulcer and Klinefelter syndrome].

We report a case of 47 years old patient who was admitted to hospital because of bilateral leg ulcers for 6 years. Chromosome analysis revealed XXY karyotype, confirming the clinical diagnosis of Klinefelter's syndrome. Testosterone level was low and Plasminogen Activator Inhibitor (PAI-1) was elevated. The patient was given androgen therapy which resulted in a normalization of the PAI-1 activity. The frequency of leg ulcers in patients with Klinefelter syndrome is between 6 and 12% according to studies. Different causes would explain the tendency towards leg ulcers in Klinefelter's syndrome: conjunctive tissues abnormalities were revealed in some studies. A higher frequency of venous insufficiency is reported in patients with Klinefelter's syndrome, either due to the particular morphology (obesity, taller size) or due to an androgen deficiency. A few arterial dysplasias cases of arteries's legs were described in patients with leg ulcers and Klinefelter syndrome. Haemostasis disorders presented in this case and normalized after androgen therapy will contribute to the physiopathologic discussion.

Adult↗
PubMed1994

[Evaluation of the analgesic effect of naftidrofuryl in permanent ischemia in patients with arterial diseases. Double-blind versus placebo study].

Ischemic rest pain, with or without trophic disorders and occurring very frequently at night, is responsible for insomnia and complications such as positional oedema. The pathophysiological mechanisms underlying the analgesic effect of naftidrofuryl led us to evaluate the efficacy of this treatment. 37 selected patients were given 2 daily infusions of 400 mg of naftidrofuryl for 8 days, under double-blind conditions. Evaluation criteria were pain assessment using a visual analogue scale, analgesic consumption considering both the power (WHO scale: level I paracetamol, level II dextropropoxyphene, level III morphine) and the dosage of the analgesic used (analgesic score), index of therapeutic success including the level of pain reduction and the absence of analgesic use. The results showed a significant difference in favour of naftidrofuryl for: reduction of pain, difference in the course of the analgesic score, the distribution of the population according to the index of therapeutic success. Three patients discontinued treatment due to inefficacy, but all 3 belonged to the placebo group. This study demonstrates the benefit of naftidrofuryl in pain reduction which was assessed, in particular, by the reduction of analgesic consumption.

Aged↗
PubMed1994

[Sub-adventitial arterial cysts of the popliteal artery. Results from the vascular group of AURC].

A retrospective multicentric study conducted by the vascular group of the AURC (University association of surgical research) included 36 sub-adventitial cysts of the popliteal artery. This is a rare cause of claudication in the young male and usually involves the adventitia of the arterial wall. There is usually only one localization. Echography of the cyst may wrongly suggest partial thrombosis of a popliteal aneurysm. Angiography and CT scan provide the correct diagnosis. The results of surgical treatment were analyzed after a follow-up ranging form 3 months to 20 years (mean 9 years). The reports in the literature confirm that these are rare lesion of a poorly understood origin (congenital or acquired?). Simple complete surgical excision gives excellent results with the exception of initially complicated forms which require resection and grafting.

Adolescent↗
PubMed1994

[Popliteal aneurysm and leg ischemia: surgery first].

The treatment of symptomatic popliteal aneurysms is debated should local fibrinolysis or surgery first be used first? The authors report their experience in the treatment of 90 popliteal aneurysms in 66 patients. In this series were only examined those aneurysms with either acute ischaemia 12 (27%) or sub-acute ischaemia 21 (45%). The treatment of those cases with acute ischaemia was surgical for all, allowing salvage in all cases. Sub-acute ischaemia was treated with either: a surgical bypass with exclusion of the aneurysm in 7 cases, or lumbar sympathectomy in 7 cases, or medical treatment in 6 cases or local fibrinolysis for distal ischaemia in one case only. There was no peri-operative mortality, only one amputation was required (5%) (J Mal Vasc 1994; 19, Suppl. A: pages 150-153).

Adult↗
PubMed1994

[Ostial stenosis of the renal arteries: results of surgery].

Surgery and percutaneous balloon are two contrasting methods for the treatment of renal artery stenosis. Surgical revascularizations offer excellent long term results with a 70% to 90% five year patency rate wherever the location of the lesion on the renal artery. Long term results of transluminal angioplasty are strongly correlated with the anatomo-radiological features of the lesions. From their own experience and after a literature review, the authors conclude that: For lesions located on the trunks of the renal artery, results of surgery and transluminal angioplasty are equivalent. For lesions involving the ostium of the renal artery, the failure rate is high and restenosis are frequent with angioplasty. In that case, surgery is a proper choice which offers better immediate and long term results.

Arteriosclerosis↗
PubMed1992

[Diagnosis of bacterial infections on vascular prosthesis. Histological and microbiological analysis].

A retrospective study of 212 vascular graft failures, using different criteria of infection evidenced a relatively high incidence of infectious complications. Vascular graft infection was assessed on one of the following criteria: clinical infection, positive bacteriological and/or virological examination of the graft, presence of characterized micro-organisms and of microstructures 0.1 to 0.5 micron in size at the blood/prosthesis surface at scanning electron microscopy, and presence of foci of persistent polymorphonuclear cells and lymphocytes at histological microscopy. In the absence of overlapping between these criteria, the present results raise the question of the adequacy of conventional bacteriological sampling on explanted artificial surfaces.

Blood Vessel Prosthesis↗
PubMed1992

[Cervical branchiomeric paraganglioma. Report of 21 cases].

Over the last 24 years the authors operated 21 branchiomeric paragangliomas in 18 patients. They emphasize the difficulty of making the diagnosis and the importance of completing a thorough work-up before deciding surgery. Adequate imaging is particularly important (neck sonography, computed tomography, arteriography) to avoid making the diagnosis by exploratory neck dissection and to assess the vascular risk. Biological studies have regained importance, especially in the context of complex neuro-cristopathy. Treatment is essentially surgical and must be considered with prudence in patients with bilateral lesions. The surgical removal of branchiomeric paragangliomas necessitates preparation of a small saphenous vein bypass in case it is not possible to avoid sacrificing the internal carotid artery.

Adult↗
PubMed1991

Human vascular graft failure and frequency of infection.

Among 212 vascular prostheses collected in a vascular explant retrieval program, 50 exhibited one or more criteria of graft infection i.e., (a) clinical evidence of graft infection, (b) positive bacteriological analyses of the graft, and (c) presence at the blood-prosthetic interface of characterized microorganisms. Whereas each of these criteria was noted respectively in 25, 26, and 20 cases, there was no complete overlapping among the three criteria, but their combination led us to consider 50 cases of infected vascular grafts among the 212 collected. These results, and the occurrence in two cases among six investigations for viral infection, suggest that extensive bacteriological investigations of vascular explants should be included in an implant retrieval program, and that infection may represent a high risk in graft failure.

Aneurysm↗
PubMed1991

[The value of nuclear magnetic resonance in the study of iron overload in thalassemia patients].

In patients with thalassemia treated by long-term chronic blood transfusions who survive beyond the first ten or twenty years of life but received no or inadequate chelating therapy during the first years, evaluation of iron overload and its consequences on tissues may prove an arduous task. MRI is a non-invasive means of measuring the amount of iron in the liver and the consequences of the iron overload on the heart and other tissues. For this purpose, MRI is more satisfactory than CT scan studies. In this investigation, 20 patients with thalassemia major underwent MRI. Multiple spin echos were used to allow determination of the transversal relaxation constant T2. This constant, expressed in ms, is related to the concentration of iron in the liver as in the following expression: (C) = 5 410/T2-110. MRI studies disclosed a discrepancy between the severity of hepatic hemosiderosis and development of decompensated iron overload cardiomyopathy. In a unique case, in which a heart transplant and two MRI studies were performed, the severe iron overload that failed to respond to several years of subcutaneous chelating therapy was more than halved by intensive intravenous chelation through a central catheter. MRI studies of the heart provide valuable morphologic and functional data. Although the amount of iron in the myocardium cannot as yet be quantified, modifications of the transversal relaxation time provide information on the severity of the overload and the presence of other myocardial alterations.

Adolescent↗
PubMed1990

[The Dacron vascular prosthesis in men. Mechanical performance, lesions and molecular stability].

The causes of failure of vascular prostheses implanted in man were investigated by means of histological, ultrastructural and scanning electron microscopic techniques as well as mechanical performance and macromolecular structure studies. These investigations concerned 22 out of 212 explanted prostheses from about 10 vascular surgery departments, examined over a 3-year period. The changes observed in the mechanical properties of the explanted prostheses (2 to 75 per cent reduction of resistance to rupture) and the finding of broken fibers and migrating polyester particles were confirmed by the presence of structural alterations in the polymer with, in particular, diminution of its crystalline structure. No correlation was found between the occurrence of these lesions and the type of prosthesis used and/or the duration of implantation.

Blood Vessel Prosthesis↗
PubMed1990

[Villonodular synovitis. An uncommon localization: the ankle. Apropos of a case].

The authors report an uncommon soft tissue tumor, a diffuse giant cell tumor of tendon sheath. The location is uncommon too, the ankle, behind tibial shaft and forward achilleus tendon. The primary diagnosis of ankle and leg lymphoedema, has been for a long time. But CT Scan and MRI allowing the discovery of a firm and multinodular mass, have permitted surgical excision and histological diagnosis. This case agrees with the literature review. The pigmented villonodular synovitis is rather uncommon in comparison to localized form. Young people and lower extremities are more affected; symptoms are of relatively long duration. Histological examination gives diagnosis but surgical excision has to remove the tumor completely as possible because of local recurrence rate of about 50%.

Adult↗
PubMed1990

[Acute aortic dissection and peripheral ischemia. Diagnostic and therapeutic problems. Remote control using nuclear magnetic resonance].

This study concerns 7 cases of acute aortic dissection associated with visceral and/or lower limb ischemia. Only those cases are included which raised diagnostic and therapeutic problems. Patients were excluded who had purely angiographic involvement of an aortic branch and minor rapidly resolving ischemic syndromes. Five of the 7 patients presented type B (type III or distal) and 2 type A (type I or proximal) dissection. All patients received anti-hypertensor medical treatment. All but one had undergone surgery at least once at the acute stage. Five had been followed up and monitored by magnetic resonance imaging (MRI). One type A and 4 type B dissections were thus reviewed between the 15th month and the 9th year. Diagnostically, aortography was found to be inaccurate twice because of incomplete exploration of the thoracoabdominal aorta. Therapeutically, a case of intraoperative death occurred during replacement of the ascending aorta. Thus, out of the 6 patients who survived the acute stage, 4 are alive and asymptomatic, one has been lost sight of and the other died in year 5 after surgery for chronic dissecting aneurysm of the aortic arch. Among the 5 patients examined by MRI, 4 presented aortic ectasia, chronic dissecting aneurysm of the aortic arch and/or a descending aorta with a diameter between 45 and 65 mm. The patient with subnormal aortic diameter had his ascending aorta replaced (the follow-up period at this writing is only 27 months). Among 3 patients who were examined twice, one showed improvement after a year's interval, with a 5-mm increase in the caliber of the dissected aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

[Heterotopic hepatic transplantation in fulminating hepatitis].

Based on a rare case of heterotopic hepatic transplantation (HHT) carried out in a 24 year old woman for fulminant hepatitis of viral origin, the authors present the technique used and the principal post-operative events (rejection, resistant large volume ascites and the clinical course for the liver itself). They discuss the rarity of success in this type of graft, where the causes of failure in man have not been entirely elucidated: the venous pre-existing portal hypertension is probably a very unfavorable factor. The place of this particular type of HHT in cases of acute severe hepatic failure is then proposed: this may produce a smaller operative insult than orthotopic transplantation and, in this respect, deserves consideration when advanced hepatic encephalopathy is present, notably due to delay in finding a suitable graft.

Adult↗
PubMed1988

Stability of performances of vascular prostheses retrospective study of 22 cases of human implanted prostheses.

Twenty-two cases of vascular graft failures (thrombosis, pseudoaneurysm, dilation, infection) were investigated by means of physicochemical, histological, and ultrastructural studies. A general decrease of mechanical resistance to stress of the prostheses was observed. Its magnitude ranged from 2 to 75% of the values of identical virgin prostheses and there was no relation with the duration of implantation. In addition to the breakage of yarn filaments (SEM), migration of fiber debris (histology) was observed in 7 cases. The structure of the polyester molecule had evolved after implantation. A decrease of crystallinity (x-ray diffraction and differential scanning calorimetry) was noted. These observations raise the question of the established stability of vascular prostheses and emphasize the need for further investigations in human graft retrieval programs.

Biocompatible Materials↗
PubMed1986

[Aneurysm of the popliteal vein. A rare cause of recurrent pulmonary embolism].

Popliteal vein aneurysm, a rarely observed, apparently benign lesion may nevertheless be the cause of disabling pulmonary emboli. Two personal cases and 13 reported in the literature are reviewed. Detected during phlebography of lower limbs during investigation of a pulmonary embolus, the aneurysm, of a sacciform shape, was located above the interline of the knee and often contained a thrombus: this site of onset facing the calf "venous pump" makes it an "experimental" emboligenic focus. The pulmonary embolus is a serious affection since it is repetitive: a pulmonary scan showed dissemination in the two fields of the hypovascularized zones. Identification of an acute or chronic cor pulmonale was a routine finding and a paradoxical embolus in the arterial territory was observed twice. Local surgery (venous repair or exclusion of the aneurysm) can be performed in association with anticoagulant therapy, but partial interruption of inferior vena cava appears to be the safer method of avoiding a recurrent embolus, which may be fatal.

Adult↗