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P Pheline

Publications and source records attributed to P Pheline.

7 recordsLinked to original sources
PubMed1996

[Paresthesia, pain, coldness of the arm and possible responsibility of the thoraco-brachial outlet syndrome].

Paresthesia, pain and coldness of the upper limb strongly suggest ischemia. The questions raised concern the etiology and treatment. 1) Treatment is based on confirmation of the unilateral nature of the disorder requiring search for the a locoregional cause (examination of the subclavian outlet) and on elimination of a cardiac or general origin. Two noninvasive examinations are indicated. An X-ray examination of the upper chest bones is performed to search for an abnormal formation, usually a cervical rib. Presence of a cervical rib indicates a possible damage to the sub-clavian artery in the thoraco-brachial outlet and, inversely, absence of a cervical rib suggests either arterial damage or a fibromuscular cause. Ischemia of the upper limb results from repeated microtrauma to the sub-clavian artery due to a bone-ligament anomaly resulting in thickening and parietal ulceration, and sometimes post-stenosis embolism or in situ thrombosis. Duplex Doppler may be able to identify the nature of the cause without dynamic manoeuvres. An arteriography is essential to confirm the level of the obstacle, its nature, the status of the downstream bed and possible relationship between a bone anomaly and the sub-clavian artery. Several incidences may be required. 2) Therapeutic modalities must take into account the ischemia and its cause. Surgery is required to remove the obstacle and repair the arterial damage, and possibly to remove an embolus. It is relatively easy to remove a cervical rib or repair a bone muscle anomaly, allowing arterial repair with or without venous bypass. Embolectomy of an earlier embolus may require major reconstruction vascular surgery.

Arm↗
PubMed1994

[Idiopathic periaortic fibrosis: a difficult diagnosis in internal medicine].

Peri-aortitis retroperitoneal fibrosis is characterized by a reaction of a variable inflammatory nature while constricting the organs crossing the retroperitoneal space, notably the ureters and the blood vessels. It is difficult to diagnose such a rare disease. We bring about here six cases of periaortic retroperitoneal fibrosis diagnosed from systemic, digestive, urinary or vascular signs. Early diagnosis is often difficult and is shown to be established after an average of three months investigation. The average age of these patients, all of the male sex, is 58 years old (54 to 90). In the six cases this disease appears to be idiopathic even though in two cases it is associated to giant temporal arteritis and polymyalgia rheumatica. TDM remains the best diagnostic tool to point out the existence of this fibrosis, to observe its evolution and to investigate for any extension of the disease. The etiology of this fibrosis remains a mysterious one; however an immunologic origin has been suggested. Medical treatment by corticosteroids is often successful but the long term evolution of the disease is still uncertain.

Aged↗
PubMed1994

[Antheor percutaneous endocaval filter. Multicenter evaluation based on 300 cases].

The authors report a follow up from 6 months to 2 1/2 years concerning 300 Antheor caval filters. This multicenter study was brought about so as to assess the effectiveness of the interruption barrier as well as possible complications stemming from features of the filter. The biomechanical parameters and the specifications for the filter are presented: filtration principle, nature of the alloy and biocompatibility, self-centered doubly fixed mechanism and antimigration clipping system. The main indications taken into account are pulmonary embolism (65% of cases), floating femoro-ilio-caval thrombus (33%) and contraindications of anticoagulants. Insertion conditions are analyzed as is the technique employed almost constantly percutaneous, and somewhat more often femoral than jugulo-sub-clavian. The authors then expose the modalities of the surveillance protocol. Controls are made after 1 week, 2 months, 6 months, 12 months, 18 months, and 24 months an half. They consist of a clinical evaluation, an analysis of the nature of the anticoagulant or anti-aggregation treatment, a plain abdominal radiology, a venous duplex scan examination of the lower limbs and the inferior vena cava and, in some case, a phlebographic and scanographic examination. In terms of the effectiveness, the reported results are convincing, with a rate of only 1% of recurrent embolism and 98% of vena cava patency.

Adult↗
PubMed1994

[Retroperitoneal Castelman disease. Apropos of a new case].

A retroperitoneal localization of Castleman's disease was characterized by angiolymphoid hyperplasia. This rare disease (58 cases of abdominal localization reported to date) raises a question of nosology. The clinical features are not specific. Localized forms in young patients involve deep lymph nodes and have a good prognosis after complete surgical exeresis. Inversely, the clinical picture is much more aggressive in multiple localizations involving preferentially superficial nodes with associated plasmocyte proliferation. The prognosis is mediocre in these forms. Although transition stages have been described due to the lack of any known aetiology, the question of nosology remains open: should the different forms be separated or identified simply as two pathological forms?

Aged↗
PubMedDate not supplied

[Chronic course of rupture of subrenal aortic aneurysms. Apropos of two cases].

We report two new cases of aneurysms of the sub-renal aorta in which rupture was followed by a chronic clinical course. In the first, there was an atheromatous aneurysm which led to chronic lombo-sciatic pain over a period of 15 months before exact diagnosis. The second concerned an aneurysm probably related to Yersinia enterolitica infection which led to abdominal pain over a period of 3 weeks. In both cases, the diagnosis was made on the CT scan and the operation led to the immediate disappearance of the symptomatology. Although a particular entity of sub-renal aorta aneurysms is still under debate, identifying an identifiable subset appears to be justified. Indeed, cases in which a chronic course follows rupture have particular characteristics including the absence of effect on general haemodynamics and an operative risk identical to nonruptured aneurysms. These characteristics differentiate this subset from non-sealed retroperitoneal aneurysms of the aorta.

Aged↗