[Clinical reproducibility of the dorsal foot phlebectasic crown].
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Foot↗
Biomedical subjects
P H Carpentier
Publications and source records attributed to P H Carpentier.
[Acute erythermalgia: look for mushrooms!].
INTRODUCTION: To describe the first European observation of erythromelalgia due to mushroom poisoning. EXEGESIS: Seven cases observed and followed over 4 years are reported. All ill patients had eaten the same mushroom species, gathered in the same French alpine valley. Clinical features of erythromelalgia were observed. This syndrome was first described in Japan after Clitocybe acromelalga ingestion. It had never been observed in Europe before. Clitocybe acromelalga does not grow in Europe. Clitocybe amoenolens was identified as the possible cause of poisoning in our cases. This species can be confused with an edible mushroom, Lepista inversa. CONCLUSIONS: Even in Europe, recent mushroom poisoning is a possible cause of erythromelalgia.
Adult↗
[Physiopathology of lymphedema].
Edema is defined as an excess of interstitial fluids. Its appearance is always linked to a relative functional insufficiency of the lymphatic drainage, but the use of the word lymphedema is restricted to the conditions where the lymphatic insufficiency is the primary pathogenetic factor of edema formation. The lymphatic insufficiency may result from: 1) an incompetence of the lymphatic capillaries, either due to their aplasia (Milroy's disease) or to their destruction (lipodermatosclerosis of chronic venous insufficiency); 2) an insufficiency of the lymphatic collectors related to their hypoplasia (primary lymphedema), or their destruction by trauma, infection or carcinologic treatments; a drug related functional insufficiency of lymphatic collectors is probable, but more data are needed on this topic; 3) pathologic lymphatic nodes (surgical excision, invasion by hematological disorders or cancer) could interfere with their ability to concentrate lymphatic fluids. Local tissue changes in the lymphedematous limbs are important and should be taken into account in the care management of such patients.
Humans↗
["Vein School." A program of education for chronic venous insufficiency patients at the La Léchère Hotspring].
Chronic venous insufficiency is a frequent and invalidating condition, which also represents an important socio-economical burden. As it is a chronic disease with no effective curative therapy, the preventive and educational means are of particular interest. The present health policy insists on the education given to patients suffering from chronic disease, but contrasting with other chronic conditions (diabetes, asthma, chronic back pain), to our knowledge, there is no published structured educational training programme dedicated to people suffering from CVI. Such an educational programme was developed at the spa resort of La Léchère (Savoie, France), which is specialized in the treatment of CVI. Proposed to voluntary patients taking the waters and driven by a multidisciplinary team (doctors, nurses, pharmacists), the objective was to promote a better knowledge in venous disease by the patients and to make them adopt a more active behaviour in their treatment. Three topics were approached in interactive work-groups using a problem solving teaching technique: "anatomy and physiology of the circulatory system", "venous diseases", "practical aspects life with compression stockings". Comparison of pre and post-teaching evaluations was performed in 149 unselected patients, allowing a short-term appraisal of the knowledge improvement. It showed a 25 to 40% increase in right answers according to the tested topic. Further evaluation of long term beneficial effects is needed. However, the high interest of patients regarding this teaching method and the content of the programme provides good expectations regarding a real beneficial effect on health and quality of life.
Attitude to Health↗
[Influence of spray application of La Léchère mineral water on the cutaneous microcirculation in the lower limbs in healthy subjects].
Spa treatment is commonly used in chronic venous diseases, to the satisfaction of many patients, but no scientific validation work has been performed up to now. This pharmaco-clinical study was designed to evaluate the specific influence of topical application of the mineral water of La Léchère on the cutaneous microcirculation. It was a controlled, randomized, double-blind study comparing the effects of the water of La Léchère to distilled water applied as a spray to the ankle in ten healthy subjects. Skin temperature and laser-Doppler perfusion index (mean and temporal variability) were the evaluated parameters. Under these conditions, the results show a cutaneous cooling with a mean value of 0.3 to 0.5 degrees C, whose duration is significantly longer with the thermal water (p<0.05). During this cooling, the laser-Doppler perfusion index remained stable when distilled water was applied, whereas an increase was observed when the thermal water was employed (p=0.005). No significant changes in vasomotion were observed with either treatment (p=ns). This study demonstrates the presence of a specific effect of topical application of the La Léchère mineral water on the cutaneous microcirculation. The explanation and the potential therapeutic interest of this effect were beyond the scope of this study and remain to be investigated.
Administration, Cutaneous↗
Enhanced in vivo lipid peroxidation in scleroderma spectrum disorders.
OBJECTIVE: A new family of prostaglandin F2 isomers called F2-isoprostanes, produced by free radical peroxidation of arachidonic acid, has recently been described in vivo. Its quantification has been suggested to be a reliable measure of oxidant injury in vivo. The purpose of this study was to investigate urinary F2-isoprostane formation as an index of lipid peroxidation in scleroderma spectrum disorders. METHODS: Urine samples were obtained from 52 patients with systemic sclerosis (SSc; n = 37) or undifferentiated connective tissue diseases (UCTD; n = 15) and from 20 healthy volunteers. Urinary isoprostaglandin F2alpha type III (iPF2alpha-III) and 11-dehydro thromboxane B2 (11-dehydroTXB2) concentrations were determined using enzyme immunoassays. RESULTS: The urinary concentration of iPF2alpha-III was approximately twice as high in patients (mean +/- SEM 229+/-16 pmoles/mmoles creatinine) as in controls (116+/-9 pmoles/mmoles creatinine) (P < 0.0001). However, the urinary concentration of iPF2alpha-III was not significantly different among patients with UCTD, limited SSc, and diffuse SSc (mean +/- SEM 221+/-27 versus 245+/-32 versus 220+/-25 pmoles/mmoles creatinine, respectively). No significant correlation was found between the urinary concentrations of iPF2alpha-III and 11-dehydroTXB2. CONCLUSION: This study provides evidence of enhanced lipid peroxidation in both SSc and UCTD, and suggests a rationale for antioxidant treatment of SSc. Formation of F2-isoprostanes has to be investigated as a means for the evaluation of such therapy.
Adult↗
Erythromelalgia and mushroom poisoning.
OBJECTIVE: To report the first European observations of erythromelalgia due to mushroom poisoning. METHODS: Clinical features of erythromelalgia were observed in 7 cases seen over 3 years. All patients had eaten the same mushrooms species, gathered in the same French alpine valley. Erythromelalgia was first described in Japan after Clitocybe acromelalga ingestion. Clitocybe amoenolens was identified as the possible cause of poisoning in our cases.
Adult↗
[Acrocyanosis: changing concepts and nosological limitations].
Acrocyanosis is undoubtedly the most commonplace acrosyndrome, both in terms of pathogenesis and prognosis. Patients experience functional impairment and an esthetic prejudice that must not be neglected. Adopting the nosological classifications described for Raynaud's syndrome, primary acrocyanosis must be distinguished from exceptional secondary phenomena that have a radically different clinical course. Primary acrocyanosis is generally observed in a young woman who appears thin or has recently lost weight. No paroxysmal episode (syncope, cyanosis, suspicious event involving the fingers) is found. The physical examination is negative and no complementary explorations are needed. Current pathophysiological hypotheses remain insufficient but suggest that vasospasticity rather than hemorheology is involved. The hypothesis that a thermoregulation disorder could be associated with weight loss deserves further study. Symptomatic care relies on dietary and hygiene counseling, emphasizing the importance of warm clothing. The psychological element must also be considered even in the most common forms.
Adult↗
[Incidence of erysipelas of the lower limbs in a spa resort. Efficacy of a strategy of sanitation education (La Lechere: 1992-1997)].
OBJECTIVE: Erysipela is a common skin infection readily found in patients with venous insufficiency or lymphedema. The aim of this work was to measure the incidence of erysipela in a spa resort specialized in the treatment of venous and lymphatic diseases and to evaluate the influence of a preventive strategy principally based on education of patients at risk. PATIENTS AND METHODS: The measurement of incidence was based on the detection of the reasons for which the patients did not attend their thermal care sessions. Quality control was obtained from the reports of cases diagnosed by local private and public health care centers. RESULTS: The incidence of erysipela in this high risk population was 40.2 and 48.5 cases for 1000 persons per exposure-year in 1993 and 1994 respectively. The preventive strategy carried out was able to induce a reduction of 65% during the next years (p<0.01). CONCLUSION: This study confirms the high incidence of erysipela in subjects with severe venous insufficiency or lymphedema and the efficacy of an active educational preventive strategy.
Balneology↗
[Current techniques for the clinical evaluation of the microcirculation].
Three main types of approaches are currently used for the exploration of the microcirculation in man: Clinimetric measurements of the cutaneous temperature (thermometry), skin color (chromametry) and tissue volume (leg or foot volumetry) allow a quantification of clinical indexes of skin blood flow, blood volume and edema that are useful in therapeutic trials. Global parameters evaluating the hemodynamic or nutritional efficacy of the microcirculation in a tissue sample (laser Doppler and TcPO(2)) are easy to perform in clinical routine. TcPO(2) measurements through Clarke electrodes or fluorescence lifetime imaging technology evaluate the nutritional efficacy of the microcirculation. Laser Doppler devices are producing a semi-quantitative index of superficial tissue perfusion, that can be split into a volumic and a velocimetric components; its high sensitivity makes it a valuable tool for clinical research, mainly for dynamic measurements of reactivity of the superficial microcirculation to various stimuli. New instruments are able to use two different frequencies in order to compare tissue perfusion at different depths beneath the skin surface. The combination of a laser probe and a small automate can produce a two-dimensional image allowing the evaluation of spatial heterogeneity in tissue perfusion. Visualization of the skin capillary bed, i.e. capillaroscopy, was recently improved by the emergence of flexible videomicroscopes easily allowing the exploration of the whole body skin surface and not only the classical site of the nailfold. The use of the method was therefore broadened from vascular acrosyndromes and connective tissue diseases to the whole spectrum of skin trophic changes of the extremities. Combination with digital image analysis systems allows the quantification of the microvascular and microlymphatic structure (quantitative appraisal of microangiopathies) and function (capillary hemodynamics and exchange). Laser-doppler and capillaroscopy can also be combined for the measurement of red blood cell velocity in single capillaries.
Capillaries↗
[Epidemiology and physiopathology of chronic venous leg diseases].
Chronic venous disorders of the lower limbs include a wide range of clinical manifestations involving more than one half of the population in the industrial countries. Varicose veins have a multifactorial origin, linked to ageing, environment (life habits, pregnancies...) and heredity. Their development is related to an increased distensibility of the venous wall and to haemodynamic dysfunction secondary to valvular incompetence. Cutaneous trophic changes and leg ulcers are the final result of severe primary varicose disease or post-thrombotic disease. Elder people are mostly concerned. Skin disease results from ambulatory venous hyperpressure due to several types of reflux involving superficial, deep and perforator veins. Its development is linked to a cutaneous microangiopathy, the central element of which is a decreased capillary density. Venous symptoms are quite widespread and women are more concerned than men; they are also of a multifactorial origin, varicose veins being only one of the causative factors. Their pathogenesis remains unclear, involving venous stasis and probably a functional insufficiency of the lymphatic system.
Chronic Disease↗
[Teaching targets in vascular medicine].
The reference list presented here is a selection of educative objectives performed by the French "Collège des Enseignants de Médecine Vasculaire" for the different levels of the medical initial education course. It was produced through a collective procedure, after selecting the most relevant topics and setting up writing rules based upon docimology, and favoring practical rather than theoretical objectives. The main topics are peripheral obstructive arterial disease, polyatherosclerosis, atherosclerosis risk factors, venous thromboembolic disease, thrombophilia, chronic venous insufficiency, lymphatic insufficiency, leg ulcers, vascular acrosyndromes, cerebrovascular diseases and connective tissue diseases, vascular occupational diseases, vascular adverse effects of drugs, diabetic vascular disease, the vascular consequences of hypertension, vascular malformations and angiodysplasia, inflammatory arterial diseases, and vascular explorations. As a whole they include about 300 objectives for the five teaching levels. We hope that this list will help stimulate production of training courses and documents strongly needed in this field.
Education, Medical↗
[Morphometric analysis of erythrocyte aggregates in vitro: pharmacological application with buflomedil].
Erythrocyte aggregation is usually evaluated through indirect measurements such as the sedimentation rate and rheometric measurements of aggregation and disaggregation thresholds. The aim of this study was a preliminary evaluation of a morphometric approach of aggregates in vitro. A sample of blood (on EDTA) was examined under the microscope, and a picture with magnification X 640 was obtained after stabilization of the cellular structure. The digital image was analyzed with a home made dedicated software that allows the measurement of the cellular density and the evaluation of several shape parameters. Ten samples obtained from different donors were analysed within one hour after blood withdrawal and 24 hours later (preservation temperature: 4 degrees C), with and without adjunction of Buflomedil (4 microg/ml). Results showed an important anti-aggregant effect of Buflomedil administrated in these conditions, both on fresh and preserved blood (p<10(-3)). These results illustrate the potential interest of a morphometric approach to erythrocyte aggregation. They show new pharmacological properties of Buflomedil administered in vitro, which have to be confirmed with a therapeutic administration of the compound.
Densitometry↗
Plasma D-dimer testing improves the management of thromboembolic disease in hospitalized patients.
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Adult↗
Association between cigarette and alcohol consumption and Raynaud's phenomenon.
The association between alcohol and cigarette consumption and Raynaud's Phenomenon (RP) was examined by using data from an American-French collaborative, cross-sectional, epidemiological study in five geographically varied regions (Charleston, South Carolina, USA; and Grenoble, Tarentaise, Nyons, and Toulon, France). Using logistic regression models that take into account the sampling weights, the association was examined stratified by gender and adjusted for age, body mass index, self-perceived health, and education. Overall, neither cigarette nor alcohol consumption showed a significant association with RP. In men, however, a V-shaped relationship between drinking and RP was observed, with mild consumption (1 to 7 drinks per week) exhibiting a protective effect over abstinence, whereas occasional (less than 1 drink per week), moderate (8 to 18 drinks per week) and heavy consumption (more than 18 drinks per week) did not. Among the participants with RP, no significant association was observed between RP attack frequencies and the amount of either alcohol or cigarette consumption. These negative findings suggest that having RP is not strongly affected by alcohol or cigarette consumption.
Alcohol Drinking↗
Respective role of lipoxygenase and nitric oxide-synthase pathways in plasma histamine-induced macromolecular leakage in conscious hamsters.
1. Intravital microscopy technique was used to determine the distribution of a fluorescent plasma marker (fluorescein-isothiocyanate-dextran, 150 kD; FD-150) into venular and interstitial compartments of dorsal skin fold preparations in conscious hamsters. 2. One mg kg(-1) histamine (i.v.) caused a biphasic decrease in venular fluorescence due to FD-150 extravasation in all organs (general extravasation). Immediately after injection, the venular fluorescence decreased and plateaued in 60 min. Ninety minutes after histamine injection, venular fluorescence further decreased until 180 min. Prior treatment with indomethacin (0.1 mg kg(-1), i.v.) did not modify the time-course of general extravasation but prevented histamine-induced venule dilatation. 3. Prior treatment with the 5-lipoxygenase activating protein (FLAP) inhibitor, 3-[1-(p-chlorobenzyl)-5-(isopropyl)-3-t-butylthioindol-2-yl]-2,2-d imethyl-propanoic acid sodium (MK-886)(10 microg kg(-1), i.v.), the leukotriene receptor antagonist, benzenemethanol a-pentyl-3-(2-quinolinylmethoxy) (REV-5901)(1 mg kg(-1), i.v.), or the glutathione-S-transferase inhibitor, ethacrynic acid (1 mg kg(-1), i.v.), delayed by 60 min the onset of general extravasation caused by 1 mg kg(-1) histamine. 4. Prior treatment with lipoxygenase pathway inhibitors and N(G)-nitro-L-arginine-methylester (L-NAME)(100 mg kg(-1), i.v.) abolished the general extravasation and venule dilatation induced by 1 mg kg(-1) histamine. 5. Injection of 1 microg kg(-1) (i.v.), of leukotriene-C4 (LTC4) or -D4 (LTD4) induced immediate and sustained general extravasation and reduction in venule diameter, these effects being blocked by REV-5901. 6. Histamine (1 mg kg(-1), i.v.) induced biphasic decline in mean arterial blood pressure (MAP). An initial phase (from 0 to 60 min) was followed by a late phase beginning 90 min after histamine injection. L-NAME (100 mg kg(-1), i.v.) and aminoguanidine (1 mg kg(-1), i.v.) prevented the late phase of histamine-induced hypotension. 7. Thus, plasma histamine can trigger both an immediate cysteinyl-leukotriene (Cys-LT)-dependent and a late nitric oxide (NO)-mediated inflammatory cascade. Although the cyclo-oxygenase (COX) pathway might account for histamine-induced venule dilatation, it would not influence histamine-induced extravasation.
Animals↗
Plasma D-dimers: comparison of ELISA with a new, rapid, quantitative latex assay.
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Biological Assay↗