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P Griton

Publications and source records attributed to P Griton.

At least 19 recordsLinked to original sources
PubMed1992

[Classification of varices and venous insufficiency].

The problem of the classification of varicose veins is as old as phlebology itself. A number of attempts have been made to define and assess this anatomical entity, which is progressively better investigated and better treated. Chronic venous insufficiency is a more recent pathophysiological concept, which covers both superficial venous lesions and deep lesions, regardless of their cause and their expression, especially trophic, unequivocal and dominant. A brief review of the principal classifications clearly demonstrates the difficulty of reaching a consensus. The precise definition of varicose veins and chronic venous insufficiency suggests the proposal of a simple clinical classification into five stages of chronic venous insufficiency. Beyond stage II of symptomatic varicose veins, treatment is required and complementary investigations, especially functional, are justified.

Chronic Disease↗
PubMed1992

[Endoscopic study of reflux of the saphenous valve].

Saphenous venous endoscopy, invasive and non-physiological, enables the in vivo and in situ observation of the valve system. A saphenous vein has a preferential flattening axis parallel to the outside of the skin with two walls, internal and external, and two borders. A valve is inserted on one vein wall, with the valve horns being on the borders. The free borders of a bivalve are parallel with the surface of the skin. The valve system has an antireflux function. There are three main causes of reflux in the saphenous veins: 1. Transitory functional incompetence affecting valves of normal appearance. This incompetence results from valve inertia, flattening of the valve against the sinus wall and loss of co-adaptation. Do active factors producing closure of the valve cup exist against such transitory incompetence? 2. Incongruity between the vein wall and valves. The intercorneal or commissural space allows reflux on the border of the vein. This is the commonest cause of reflux in varicose disease of the vein wall. 3. Actual valve lesions. A distinction is drawn between lesions due to thinning, elongation, stretching, splitting or tearing and those due to thickening, retraction or adhesion. Endoscopy has enabled us to discover cases of varicose disease with predominantly valvular lesions in young individuales in whom early lesions of the valve cup cannot be explained by venous wall disease and has led us to complete the classification of varicose disorders.

Endoscopy↗
PubMed1991

[Venous endoscopy].

The miniaturization of endoscopic equipment now allows exploring the superficial venous system and visualizing the endovein in situ and in vivo. This type of venous endoscopy is an ambulatory procedure, performed during a simple outpatient consultation of angiology, after which the patient is immediately discharged. Although this examination is invasive, non-physiological and expensive, it allows the video recording of the morphology, dynamics and kinetics of the values, of the endovein and of the liquid flows (blood, washing fluid and sclerosing products). The new examination has already enabled us to propose an functional classification of the parietal valves of the great saphenous vein. It makes an intraoperative three-dimensional mapping of the vessels possible, which is sometimes difficult in such particular anatomical regions as the popliteal fossa. It allows performing sclerosis with a visual control and following up the evolution of the immediate endoparietal lesions in situ.

Ambulatory Care↗
PubMedDate not supplied

[Venous pain, 30 years after the 1st International Congress of Phlebology in Chambéry].

In 1960, the first International Conference of Phlebology, organised at Chambéry by Jean Marmasse under the egis of R. Tournay included only three subjects in its programme, one of which was: "venous pain". What is the status of venous pain thirty years on? Can we compare our current concepts with work from past years? Have we advanced in knowledge and in its clinical and therapeutic applications? All these questions are even more worthy of consideration bearing in mind world-wide increased interest in Phlebology and its even richer future. The Chambéry Conference established a clear pattern with: two basic reports: "pain due to essential varicose veins and to trophic disorders" (C. Huriez, F. Desmons, M. Thoreux) and "pain in phlebitis" (R. Fontaine); three analytical and differential reports "pain due to interlinked arterial and venous disorders" (F. Piulachs), "pain in the lower limbs due to interlinked gynecological and venous disorders" (A. Bret, R. Legros) and "pain due to the association of osteoarticular and rheumatic disorders or of neuralgia in venous disease patients" (J. Forestier); and nine other studies, the following being worthy of particular attention: a very interesting report by R. Tournay: "Pain in venous disorders of the lower limbs related to their treatment"; and two papers: "pain of "cellulite" type and the metameric disposition of the lower limbs in relation to functional disorders of the ovary" (S. Bourgeois), and "exercise pain and rest pain in varicose vein sufferers" (J. Marmasse); three German reports (F. Jaeger, F. Maid-Fischer and D. Gross) on the pathogenesis and mechanisms of venous pain; and the report of M. Comel "epiesthesia and histoangeological correlations". Since that time, venous pain has no longer figured in the same format on the programme of any international conference, nor at meetings of the French Society of Phlebology. Progress has thus occurred insidiously... Mention may be made of the following with regard to essential varicose veins: some progress in knowledge of cramps, phlebalgia and venous paresthesiae; attribution to venous syndromes of "restless legs", which have been such a source of intrigue for the past hundred years, and interest in inflammatory pain of the superficial venous system and of subcutaneous cellular tissue in relation with venous insufficiency, as well as ulcer pain. However, it is in the area of acute deep venous thrombosis that everything has been disrupted. Firstly, with the established certainty that the clinical picture leads to errors in more than 50 p. cent of cases, both by excess and default.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMedDate not supplied

[Ostial valves in a patient with varicose veins. Endoscopic examination].

Twenty three endoscopies were performed, including six of the great saphenous region, fourteen of the small saphenous region and three involving the region of the medial gemellar perforators. Two types of valves may be seen on the basis of their endoscopic appearances: certain valves have a transparent appearance with very thin valvular tissue which tears easily when a catheter is passed against the direction of venous flow. These valves are located in the main saphenous veins and their collaterals, at a distance from bifurcations and the point of entry of perforating veins. The only type of lesion seen affecting these valves was tearing of their tissue. Their sole role appears to be to favourize the progression of venous flow in an anterograde direction. Other valves have an opaque appearance with valvular tissue thickened by an actual fibromuscular skeleton and strengthening of the free edge to form a lip. These resist counter-grade catheterisation and may prevent progression of the endoscope or of a stripper. These valves are located at the ostium of the terminal portions of the saphenous veins and directly proximal to the point of entry of certain collaterals and perforators. The latter, when reflux is present, behave as ostial valves, playing the role of an anti-reflux system as well as favourizing preferential hemodynamic circuits which explain certain varicose cartographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopy↗
PubMedDate not supplied

[Sclerotherapy of the external saphenous vein under endoscopic control].

The contribution of investigative venous endoscopy is essential. This out-patient endoscopic technique visualises the venous endothelium, valve systems and collaterals. For example, this technique enabled J.F. Van Cleef and C. Ribreau to draw up an anatomo-physiological classification of the parietal valves of the long saphenous vein on the basis of video films. From a therapeutic standpoint, venous endoscopy has yet to show its value. We chose the short saphenous since treatment of incontinence of this vessel is difficult and controversial: difficult because of anatomical variations, notably its ending and because of its course in the popliteal fossa; controversial because of its relations with the gemellary veins. Treatment of the short saphenous, whether medical or surgical, is not always entirely satisfactory. In case of surgical treatment, together with J.P. Hugentobler, we had already noted the value of three-dimensional localisation by transcutaneous illumination of the precise course of a vein using the cold light of the distal tip of the endoscope. "Venous ligatures" which can be placed intravenously are not currently available. In case of medical treatment by sclerosing injections of the short saphenous junction under endoscopic control, the product used can be injected with great topographical precision and strictly intravenously. Large amounts of product can easily be injected. However, this technique has at least three disadvantages: it is expensive; there is no parallel between endovenous lesions immediately visible by endoscopy and the mid-term results of sclerosing injections; the relations between the gemellary veins and the short saphenous can be identified precisely only by prior ultrasonography. As a result, sclerosing injections under endoscopic control remain within the domain of research.

Catheterization, Peripheral↗
PubMedDate not supplied

[The value of venous endoscopy in sclerosing therapy].

The sclerosing treatment of varices of the legs is based on palpation. Endoscopic palpation can be useful in the treatment of insufficiency of the territory of the external saphenous vein. A penetrating ulcer on the posterior surface of the thigh, with an intramuscular pathway linking the deep femoral vein with the external saphenous arch can lead to venous reflux in addition to that in the external saphenous arch. If this penetrating ulcer is overlooked, post-surgical recurrence may result within a brief period. However, a penetrating ulcer of this type cannot be detected by palpation and therefore cannot be treated by conventional sclerosis. Venous endoscopy offers a solution by permitting per-operative catheterization of the ulcer from the saphenous arch and the injection of sclerosing agents at the site of the reflux. Venous endoscopy of the saphenous arch can be of value if it makes it possible to avoid the repeated injection of rising doses. The use of chemical glues and fibrotic compounds has been discontinued due to the risk of damaging the deep veins. The future lies in a mechanical process, laser, electrocauterization or ligature.

Endoscopy↗
PubMedDate not supplied

[Angioscopy and the surgical treatment of varices in the area of the external saphenous vein].

The study of post-surgical relapses, by ultrasound and phlebographic examinations, shows that the difficulties in the treatment of varices of the external saphena territory are of two types: anatomical and haemodynamic. The venous endoscopy answers precisely to the requirements of the surgical treatment of varices of the popliteal space. It offers an acceptable compromise between aesthetics and efficacy, thanks to the incisions centred on the transcutaneous luminal point. It enables a per-operative control of the ultrasound-Doppler marking and the visualization of the small calibre perforating veins (less than 2 mm), not visible by ultrasound. It especially locates the deep non palpable refluxes situated above the anastomosis of the external saphenofemoral junction. The technique used is very simple thanks to the miniaturization of the equipment and the use of flexible small calibre endoscopes adapted to venous explorations.

Catheterization↗
PubMedDate not supplied

[Hyperplasia of the saphenous vein and the initial signs of varicose disease in children].

The systematic examination of 237 children, aged between 2 and 17 years, and whose mothers suffer from varicosis, has revealed the absence of varicosis in 10 of these children. Some of them belonged to the same more or less affected family. The 227 others, that is 96%, had 1 to 4 saphenae which were pathological, palpable, with hyperplastic wall, more or less turgescent outside all effort. All the 4 saphenae of 129 children, that is 54%, were hyperplastic. 35 had only three (15%), 53 had only two (22%) and 9 had only one pathological saphena (4%). The saphenous hyperplasia starts on the terminal segment and progresses, with age, from top to bottom towards the distal end to finally reach the ankle. At this level, the observation of a "signal vein" reveals the presence of a pathological hyperplasia covering all the saphena. Out of these 227 children with pathological saphenae, only 88, that is 2 out of 5, complained of functional problems of veinous insufficiency of classical or infantile nature. Moreover, 16 children, that is 7%, had visible veinous or venular dilations. Neither the Doppler nor the ultrasound examination has revealed any clear signs in the 50 children examined.

Adolescent↗
PubMedDate not supplied

[Hormones and venous system].

Sex hormones have an effect on venous "content" and "container" according to their chemical nature, their dosage and their mode of administration: 17 beta-estradiol (endogenous): protective effect; synthetic estrogens, at normal or low doses: thrombogenic; oral natural estrogens: thrombogenic; extra-digestive natural estrogens: non thrombogenic; non steroid progestagens (androgenic): thrombogenic; non androgenic progestagens: non thrombogenic. Clinically, the venous disease si characterized by sudden episodes occurring at key-periods of the hormonal life: puberty, pregnancy, menopause, oral contraceptives intake, substitute treatments of menopause, premenstrual syndrome. Evaluation of these different situations shows that an early treatment is possible and needed, which, although not providing a new venous wall for these constitutionally fragile patients, may act effectively at two levels: 1) correction of the haemodynamic disorder (venous reflux in the saphenous arches and the perforators; 2) resorption of tissue infiltration. As primary prevention, in a patient with hormonal disorders or who must be treated with estrogens or progestagens, the objective of our treatment is to protect the venous wall and encourage the return circulation. One must: 1) reinforce the vaso-constrictive effect and the parietal tone, 2) limit collagen and elastin alteration, 3) reinforce capillary permeability and decrease the interstitial edema, 4) normalize the haemorheological constants, 5) restore the balance hemostasis-fibrinolysis. The opinion of a phlebologist seems essential before prescribing a hormonal treatment and monitoring the effects of the treatment. Cooperation between gynaecologists and phlebologists is particularly essential in the interpretation of the clinical disorders as well as discussing the venous risk, the dosage and the administration route of sex hormones.

Catecholamines↗
PubMedDate not supplied

[The limits of effective sclerotherapy in the obese].

The sclerosant treatment of varices in the obese patient is generally approached with apprehension, and regarded as ineffectual. In its clinical reality, however, despite some particular problems, sclerosis of distended saphenous veins in their terminal section does not pose a problem in a patient whose overweight is less than 50% of the ideal weight per height. Between 50% and 100%, the realisation of effective sclerotherapy demands particular and rigorous examination, treatment and control techniques, as are described. Over 100% of excess weight, an effective sclerosis is only very rarely possible, and will prove to be uncertain in both execution and follow-up. This mode of treatment no longer occupies the forefront of therapeutic problems.

Adult↗
PubMedDate not supplied

[Clinical aspects and etiology of lymphedema of the lower limbs in adults].

Classical lymphedema, more than the most frequent complications, is the clinical manifestation of decompensated lymphopathies of the lower extremities. These edemas are supra-aponeurotic and always completely painless, when isolated. There are three types:distal lymphedema occurring on congenital lymphopathy, the most frequent, with are sudden onset with lymphangitis, usually insidious, intermittent, soon characterized by fibrosing edema of the toes and the ankle. Proximal lymphedema secondary to iliac nodes blocking, rarely benign, most of the time malignant and/or iatrogenic (surgery and/or radiotherapy), predominantly at the origin of the thigh, respecting the foot. Post-traumatic hanging lymphedema after extended impairment of the superficial paths, most often transient.

Humans↗