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Biomedical subjects

M Vayssairat

Publications and source records attributed to M Vayssairat.

At least 19 recordsLinked to original sources
PubMed1997

Nailfold capillary microscopy in patients with anticardiolipin antibodies: a case-control study.

BACKGROUND AND DESIGN: This case-control study was undertaken to determine whether anticardiolipin antibodies (ACA) are responsible for particular abnormalities in nailfold capillary microscopy (NCM). Cases comprised 33 consecutive patients positive for ACA (24 women and 7 men). Controls comprised the same number of ACA-negative patients, with the same sex ratio, the same diagnosis and the most similar duration of disease possible. Clinical data, serum samples and NCM recordings were obtained from all patients and controls. RESULTS: In each group, 22 patients had connective-tissue-related disorders and 11 various other diseases. In ACA-positive patients, the mean IgG ACA titre was 39 +/- 58 IgG phospholipid units. Cases and controls displayed various cutaneous manifestations. In ACA-positive patients, there were Raynaud's phenomenon (54%), cutaneous vasculitis (24%), scleroderma changes (18%), photosensitivity (9%), a history of digital gangrene (6%), malar rash (6%), acrocyanosis (6%), chilblains (3%), livedo reticularis (3%) and purpura (3%). Cases and controls exhibited numerous NCM abnormalities. In ACA-positive patients, they included haemorrhages (54%), oedema (24%), bushy capillaries (21%), disordered capillaries (18%), capillary bed disorganization (12%), capillary rarefaction (9%), giant capillaries (6%) and 'desert areas' (3%). There were no correlations between the ACA titres on the one hand and the number of cutaneous manifestations or NCM abnormalities on the other. CONCLUSIONS: ACA-positive patients frequently exhibit clinical skin lesions and abnormal NCM. In this study, these lesions and NCM abnormalities resembled those of the matched ACA-negative controls.

Adult↗
PubMed1996

Single-stage management of abdominal aortic aneurysm and colon carcinoma.

We report two cases in which concurrent abdominal aortic aneurysm and colon carcinoma were treated in the same surgical procedure. In the first case both lesions were detected preoperatively but were uncomplicated. Single-stage treatment was undertaken electively. In the second case the colonic lesion was found during treatment of the aneurysm and both lesions were complicated. The decision to undertake single-stage treatment was made intraoperatively. Recovery was uneventful in both cases. Based on previous case reports and our experience in these two patients, we discuss the advantages and disadvantages of single-stage management. The principal risk is prosthetic infection. The advantages include avoidance of complications of the unoperated lesion and the ability to manage both lesions with only one operation. With a two-staged approach, complications following the first procedure and/or progression of the unoperated lesion may prohibit the second procedure. Despite the successful outcome in our patients, we recommend using single-stage management only in selected cases.

Adenocarcinoma↗
PubMed1996

[Atheromatous embolisms and cholesterol embolisms: medical treatment].

In patients with an acute arterial occlusion, identification of the type of mechanism is important, because both prognosis and treatment differ for each type. The aorta is the most frequent source of arterial atheromatous emboli. Aortic arch plaques are therefore recognized as an independent risk factor for stroke, and plaques located on the thoracoabdominal aorta embolize in the visceral arteries or limb circulation. The treatment of risk factors seems the most effective preventive treatment. When atherosclerosis is patent, an anti-platelet drug such as aspirin or ticlopidine is useful. When the embolus actually occurs, heparin avoids extension of thrombus and prevents its recurrence. Surgical treatment is logical but has not been supported by any randomized trial. Cholesterol cristal embolization evolves in 3 clinical forms: 1-the paucisymptomatic form, not diagnosed during subject's lifetime and only recognized in autopsy studies; 2-a benign form such as the blue toe syndrome or cutaneous livedo, with a spontaneous mild prognosis, and 3-a diffuse multisystemic form with a very poor prognosis. More than 80% of patients with the diffuse form die. When there is renal involvement, only 25% are still alive, with renal function after 6 months of follow up. Vascular surgery is limited to patients with aneurysms, which in themselves constitute a surgical indication. For all other patients, surgery is rarely indicated because 1-the source of cholesterol cristal embolization is not certain, 2-patients are usually too weak for a major surgical intervention, and 3-the necessary aortic clamping during surgery would induce a major risk of recurrence. Prevention is the most effective treatment because in 30% of patients, embolization is due to one of the following: anticoagulant drug, recent fibrinolysis, percutaneous angioplasty, vascular surgery, diagnosis angiography and/or coronarography. The medical treatment is mostly symptomatic: rest, warm conditions, appropriate dressing, antiplatelet drugs, hydration, and organ supply when necessary, principally to ensure renal function. In diffuse and multi-visceral embolization, either colchicine or corticosteroids adjuvant therapy might be useful Prostanoid drugs are also a possible adjuvant treatment.

Arteriosclerosis↗
PubMed1996

Controlled multicenter double blind trial of an oral analog of prostacyclin in the treatment of primary Raynaud's phenomenon. French Microcirculation Society Multicentre Group for the Study of Vascular Acrosyndromes.

OBJECTIVE: To compare the efficacy and tolerance of beraprost sodium, an oral prostanoid prostaglandin I2 analog, with a placebo in patients with primary Raynaud's phenomenon (RP). METHODS: 125 patients with disabling primary RP participated in a multicenter, randomized, double blind trial in 2 parallel groups, lasting 8 weeks, and conducted during the winter months only; a meteorological survey was also conducted for each patient. Main outcome measures were frequency and severity of attacks of RP, overall disability, and digital cold challenge tests. RESULTS: The number of attacks decreased significantly in both groups (confidence intervals of improvement: 35-53% in beraprost group and 25-49% in placebo group), but did not differ significantly in the 2 groups. Similar results were found for the severity of RP attacks and overall disability. No severe side effects occurred, but headache was more frequent in the beraprost group (p = 0.001). Cold tests remained equally abnormal in both groups throughout the study. CONCLUSION: Although we observed 37% improvement in the number of attacks of RP in the beraprost group, prostanoid treatment proved no more beneficial than placebo.

Administration, Oral↗
PubMed1995

Raynaud's phenomenon together with antinuclear antibodies: a common subset of incomplete connective tissue disease.

BACKGROUND: The frequency of incomplete connective tissue disease (ICTD) is unknown. OBJECTIVE: Our purpose was to determine the frequency of Raynaud's phenomenon (RP) and antinuclear antibodies (ANA) in patients without definite connective tissue disease. METHODS: A series of 165 consecutive patients with RP was investigated. RESULTS: Fifty-one patients had primary RP; 60 had secondary RP; 54 patients were classified as having ICTD, 35 of whom had ANA and 19 of whom did not. Of the 35 patients who had ICTD with ANA, 29 were women and six were men. Their clinical findings were as follows: 17 had nonerosive arthritis, 14 had a nailfold capillary scleroderma pattern, 12 had puffy fingers, 10 had anticentromere antibodies, nine had sicca syndrome, seven had pernio, seven had esophagitis, six had fingertip ulceration, five had telangiectasia, four had malar eruption, four had myalgia, four had weight loss, four had exertional dyspnea, and three had photo-sensitivity. No patient exhibited life-threatening visceral complications or antitopoisomerase antibodies. CONCLUSION: In this series ICTD was more frequent than definite connective tissue disease. Many patients with RP have ICTD that is sometimes chronic.

Antibodies, Antinuclear↗
PubMed1995

Primary systemic Sjögren syndrome (SS) preceding systemic lupus erythematosus: a retrospective study of 4 cases in a cohort of 55 SS patients.

That SS and SLE can coexist is well established. The time relationship between the two diseases is however not well known. To determine whether SS can precede SLE, we reviewed the charts of 55 patients with SS diagnosed in our department between 1975 and 1985. All 55 patients fulfilled at least four of the six preliminary criteria for SS developed by the European Study Group for SS. At entry, none met four ARA criteria for SLE and none had anti-double-stranded DNA or anti-Sm antibodies. The mean follow-up was 12 years (range 8-18 years). Four of the 55 patients developed SLE (7.5%). High titres of anti-native DNA antibodies (> 35 IU RIA, normal < 7 IU) appeared in four patients (2-11 years after the diagnosis of SS). Two of these patients fulfilled at least four ARA criteria for SLE; two others had only three criteria. Two additional patients developed anti-Sm antibodies without anti-native DNA antibodies 1 and 10 years after the initial diagnosis of SS, respectively. Both patients fulfilled six ARA criteria for SLE. At entry, anti-SSA and/or anti-SSB antibodies were present in all six SS patients and persisted subsequently. The main clinical events suggesting progression to SLE were pleuropericarditis, glomerulonephritis and focal central nervous system disease. In conclusion, SS with extraglandular components can antedate SLE by many years. Anti-native-DNA and anti-Sm antibodies should be measured when atypical clinical manifestations occur in a patient with systemic SS.

Adult↗
PubMed1995

[Medical treatment of aortic aneurysms using beta-blockers].

There is no known treatment capable of avoiding extension and rupture of aneurysms of the abdominal aorta. There has however been much work recently suggesting a favourable effect of beta-blockers. Early work with experimental animal models of aortic aneurysms showed that Propranolol has a protective effect on extension and rupture of these aneurysms. Studies of the biochemistry of the aortic wall have shown that Propranolol has an independent effect on blood pressure, stimulation lysyl-oxidase and production of intermolecular elastin bridges which strengthen the arterial wall. In man, Propranolol slows the progressive dilatation of the aorta in Marfan's disease. These data on atherosclerosis aneurysms are only part of the picture, but 3 studies have shown that slower widening of the aorta diameter is related to treatment with beta-blockers. In conclusion, the surgical indications for aneurysms in 1995 are unchanged from those in 1994. In cases where surgery is not indicated (patient refusal, operative risk too high, small aneurysms) could comprise a study group for a randomized evaluation against placebo of the effect of beta-blockers. A controlled study is required before therapeutic strategies can be modified.

Adrenergic beta-Antagonists↗
PubMed1994

[Hemodynamic effects of chronic treatment by cilazapril in normotensive patients with obliterative arterial diseases of the lower limbs].

OBJECTIVE: To determine whether long-term treatment with cilazapril (CIL) may improve pulse pressure (PP), arterial compliance and ankle-arm systolic index (AAI) in patients with lower-extremity arterial disease (LEAD). Indeed, in both systolic hypertension and LEAD, the increase in pulse pressure has been attributed to a reduced compliance. DESIGN AND METHODS: Thirteen patients (age: 65 +/- 5 yrs; AAI: 0.78 +/- 0.15; m +/- SD) were included in a double-blind randomized parallel study to compare the effects of a 6 month treatment with CIL (10 mg per day; n = 6) to those of placebo (PL; n = 7) Blood pressure, AAI and arterial compliance were determined at baseline (MO) and after 3 (M3) and 6 months (M6). Common carotid (CC) and common femoral (CF) artery compliances were noninvasively determined from pulsatile changes in arterial diameter (Wall Track System, Hoeks et al., 1990) and pressure (PP). RESULTS: Both groups were comparable at MO. Compared to PL, CIL significantly reduced PP (-22 +/- 4 vs -2 +/- 9 mmHg) and MAP (-16 +/- 11 vs -4 +/- 7 mmHg) and improved CC (+54 +/- 34 vs +5 +/- 21 mm2.mmHg-1.10(-3)) at M6. Weaker effects were observed at M3. No significant changes in AAI and CF compliance were observed. CONCLUSIONS: A direct effect of CIL on the large artery wall was suggested by 1) a greater reduction in PP than in MAP and 2) a disproportionately greater improvement in CC compliance compared with the reduction in distending pressure (MAP). These results indicate that long-term treatment with CIL may improve large artery function in patients with LEAD.

Adult↗
PubMed1994

[Leg volumetry: a precise method for quantification in phlebology].

UNLABELLED: Chronic venous insufficiency is usually quantified by venous pressure measurement, which is an invasive method. Air plethysmography has also been used, but it is expensive, time consuming and only suitable for sophisticated research laboratories. Leg volumetry might be suitable for routine use, as it is simple, inexpensive, fast, non invasive and can be performed by non medical personnel. Here, we only evaluated its practicability, accuracy and reproducibility. PATIENTS: The study group included 28 legs of 14 healthy volunteers, and 22 legs of 11 patients suffering from varicose veins. METHOD: The device used was a plexiglass boot, 50 cm high, 20 cm wide. It was filled with water at 24 +/- 2 degrees C. The leg was immersed and the volume of water displaced recorded. RESULTS: Normal legs displaced a volume of 2,449 +/- 153 ml (mean +/- SD), range: 2,080-2,720, and variability 6.2%. Patients' legs displaced a volume of 2,576 +/- 290, range: 2,110-3,120, (p = 0.05 vs normals) and variability 11.2%. Accuracy was 0.7%, as from 2 consecutive measurements of the same patients' legs by 2 different observers. Intra-individual variability was 1.3%, as recorded in 12 repeated measurements of the same leg on different mornings. In normal legs, the difference between morning and evening volumes was statistically significant (18 +/- 15 ml, p = 0.0001), a finding consistent with the deterioration of the venous function in normal extremities during daily activities. CONCLUSION: This simple, cheap, objective, non-invasive reproducible and accurate method of leg volume measurement might be useful in routine practice for chronic venous insufficiency quantification.

Adult↗
PubMed1994

[Distal arteritis of the legs: lumbar sympathectomy].

Among atheromatous occlusive arterial disease of the lower limbs, chronic sub-popliteal arterial occlusions refer an heterogenous group of patients. In this medical condition, lumbar sympathectomy constitutes a classical possible treatment. Actually, the beneficial effect of sympathectomy has never been confirmed by controlled randomised trials. In this particular and uncomfortable situation, it is only possible to list non indications for sympathectomy: asymptomatic patient, claudication, critical ischemia, limb salvage, and combination with vascular surgery. Lumbar sympathectomy deserves a controlled evaluation in patients with a small foot ischemic ulceration without hemodynamic critical ischemia i.e. systolic toe pressure > 30 mm Hg and/or ankle systolic pressure > 50 mm Hg.

Arterial Occlusive Diseases↗
PubMed1992

Long-term follow-up study of 164 patients with definite systemic sclerosis: classification considerations.

To evaluate the usefulness of recently proposed schemes of classification for systemic sclerosis an extensive cross-sectional study of a series of 164 consecutive patients with long-term systemic sclerosis was undertaken. There were 47 cases of proximal sclerosis, 93 of distal sclerosis and 24 of complete CREST syndrome. The study included clinical, visceral, immunological and follow-up data. In addition, a quantitative clinical score was calculated for each patient, thus providing indications for prognosis. Data were expressed according to three conventional systems of classification: The ARA system, the diffuse versus limited systemic sclerosis system and the early cutaneous involvement system. The most reliable indications of severe outcome were: proximal sclerosis, trunk skin involvement, presence of anti Scl 70 autoantibody, pulmonary and/or heart involvement and age. Diagnosis and prognosis were not generated by the same items. Prognosis indicators proved more accurate for groups than for individuals. Mortality was 1 death per 149 patient X years of follow-up from diagnosis. We conclude that the ARA criteria for classification should be recognized as a standard, but patients with complete CREST syndrome should be included in the distal group. Other systems of classification, principally 2-way versus 3-way criteria, allow different subsets of patients that correlate with prognosis and the severity of the disease, and could be used for therapeutic purposes.

Adolescent↗