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Biomedical subjects

P Puel

Publications and source records attributed to P Puel.

At least 19 recordsLinked to original sources
PubMed1992

Cardiac surgical aids: heart cup and stentless valve holder.

We present two new cardiac surgery instruments that we perfected in our department. The heart cup holds the donor's heart vertically within a cold saline solution, thus allowing adequate preparation of the heart for transplantation, as well as the excision of valvular homografts from the recipient's heart. The stentless valve holder is used to hold valvular homografts to ease both their preparation and implantation.

Cardiac Surgical Procedures↗
PubMed1992

[Lower limb arteriopathy and male osteoporosis].

There are close links between bone metabolism and bone circulation. Osteoblasts are derived from the walls of the venous sinuses. As shown by Burkardt, osteoporosis is accompanied by a decrease in the number of intra-osseous capillaries, and intra-osseous arterioles may be the site of arteriosclerosis lesions. In order to determine the existence of a possible link between arteriosclerosis and male osteoporosis, the etiology of which is often poorly defined, the authors studied phosphorus-calcium balance, X-rays of the spine, and bone density of the spine and the femoral neck in 17 male arterial disease sufferers with a mean age of 61 and at Leriche stage 2, 3 or 4. These 17 patients were compared with 15 age-paired controls. Wedge fractures, absent in the control group, were seen in 9 of the 17 patients. Bone mineral content in the femoral neck was significantly reduced in the arterial disease group.

Arteriosclerosis↗
PubMed1991

Early postoperative sternal approximation after ITA harvesting: computed tomographic evaluation.

Between November 1989 and February 1990, 66 randomized sternotomized patients underwent aortocoronary bypass and were subjected to a sternal scanner in the early postoperative period. Each examination included a manubrial and a sternal body print. At each level, we studied the occurrence of spacing or misalignment of the sternal layers. The 66 patients were subdivided into four groups according to the type of conduit harvested (single left internal thoracic artery or saphenous vein) and the type of material used for the sternal closure (steel wires or nylon yarns). In all cases, adequate early sternal approximation, which is represented by a good alignment as well as by an excellent contact of the sternal layers, was infrequently demonstrated. Moreover, the two abnormalities most often observed were manubrial spacing and sternal body misalignment. The sternal closure technique and internal thoracic artery harvesting had no significant effect on the sternal approximation. To minimize manubrial spacing and sternal body misalignment, we propose that the surgeon should apply three threads through the manubrium, withdraw the shoulder roll beforehand, elevate both of the patient's shoulders, and maintain the two xyphoid layers in the same plane and in fairly close contact during the tightening of the wires.

Aged↗
PubMed1991

[Malignant fibrous histiocytoma of the right ventricle and pulmonary artery. Apropos of a case. Review of the literature].

The authors report a case of malignant cardiac fibrohistiocytoma involving the right ventricular infundibulum and the pulmonary artery and responsible for a pseudo-thromboembolic right heart failure syndrome. Following discovery of the tumour mass on ultrasonography and catheterisation, wide excision of the pulmonary artery, pulmonary valve and the roof of the infundibulum as far as the middle part of the ventricle was performed under cardio-pulmonary by-pass. Reconstruction was performed with a valveless woven Dacron tube. The postoperative course was uncomplicated and the patient was still alive after 18 months. Histology revealed malignant fibrohistiocytoma. The authors also present a review of the literature of these rare tumours of the right-sided cavities (5 cases reported).

Aged↗
PubMed1991

[Heart-lung preservation: historical evolution and current research data].

Over the past decade, combined, heart-lung transplantation has been established as a therapeutic modality for many patients with end stage cardiopulmonary disease. However, the scarcity of suitable donors and the lack of a reliable and simple technique for distant organ procurement have somewhat limited its practice. The normothermic autoperfusion preparation has been utilized in a few satisfactory distant heart-lung preservation and subsequent transplantation, but this method is rather cumbersome. Single cold flush perfusion of the pulmonary artery with infusion of prostaglandin E1, a powerful vasodilator of the pulmonary bed, has been used successfully in heart-lung preservation for transplantation. Donor core-cooling through cardiopulmonary bypass without pulmonary artery flush perfusion appears to provide longer and better graft protection since it improves its function. The production of oxygen radicals after reperfusion of ischemic tissues has important implications in organ preservation and transplantation. Recent studies in the prevention of reperfusion injury indicate that enzymatic scavenger and iron chelator therapy may play an important role in the reduction of reperfusion injury in the clinical setting of heart-lung transplantation.

Cryopreservation↗
PubMed1990

[A large vascularized allograft of the femoral diaphysis in man].

A fresh vascularised femoral allograft was used to replace a 27 centimetre section of the diaphysis of the femur following a crush injury in a 35 year old man. The technique of operation and details of management are described. After nine months the graft junctions were incorporated, and vascular perfusion was satisfactory.

Adult↗
PubMed1990

[Malignant fibrous histiocytoma of the right ventricle and pulmonary artery. Apropos of a case. Review of the literature].

The authors report a case of malignant cardiac fibrohistiocytoma involving the right ventricular infundibulum and the pulmonary artery and responsible for a pseudo-thromboembolic right heart failure syndrome. Following discovery of the tumour mass on ultrasonography and catheterisation, wide excision of the pulmonary artery, pulmonary valve and the roof of the infundibulum as far as the middle part of the ventricle was performed under cardio-pulmonary by-pass. Reconstruction was performed with a valveless woven Dacron tube. The postoperative course was uncomplicated and the patient was still alive after 18 months. Histology revealed malignant fibrohistiocytoma. The authors also present a review of the literature of these rare tumours of the right-sided cavities (5 cases reported).

Aged↗
PubMed1990

[Cardiac tumor mass. Diagnostic and therapeutic approach. Apropos of 46 cases].

The authors analyse a series of 46 operated intracardiac tumours (0.4% of all cases of cardiac surgery). The predominant symptoms were episodes of heart failure and pseudo-valvular disease. Peripheral emboli and pericardiac syndromes with tamponade occurred more rarely and constituted surgical emergencies. Non-invasive investigations, dominated by echocardiography, allow early diagnosis. The majority of tumours were situated in the left atrium and consisted, histologically, of myxomas, the surgical treatment of which consists of wide excision of the pedicle. Malignant tumours (17.7%) were dominated by cardiac sarcomas. When possible, extensive resection of these tumours may improve the chances of medium-term and long-term survival. The operative mortality was 8.8%. The delayed mortality was due to malignant tumours (17.3%). Myxomas must be followed in the long-term by systematic echocardiography. The authors observed 11% of recurrences occurring after a interval of 12 to 144 months (3 cases).

Adolescent↗
PubMed1989

New helper instrument in cardiac surgery.

A new instrument has been designed for cardiac surgery. It frees the hands of the surgical assistant and is effective either for valve replacement or coronary graft anastomosis. The use of this instrument makes the operation quicker and easier.

Anastomosis, Surgical↗
PubMed1989

[Interventional radiology and vascular pathology].

Percutaneous transluminal angioplasty (PTA) has been an important step in the therapy of arterial diseases. Nowadays, it opens the way to new techniques which main goals are to improve the PTA results and to enlarge the indications. This article review these new techniques. The principles, the therapeutic possibilities, the advantages and the inconvenience of each are evaluated, based upon the personal experience of the authors, the bibliography of current literature and the proceedings of a meeting organized on this topic (Toulouse, February 1988). All these procedures are encouraging and let foresee new possible therapy in vascular pathology.

Angioplasty, Balloon↗
PubMed1988

Mechanical circulatory assistance in the management of patients in coronary care unit.

Mechanical circulatory assistance was attempted in 73 patients at our coronary care unit from January 1, 1983, to January 1, 1987. Of these, 62 were men and 11 were women. The intra-aortic balloon pump (IABP) was successfully inserted by percutaneous femoral puncture in all cases. Indications for an IABP included: acute infarction and haemodynamic deterioration (23 cases), refractory congestive heart failure (2 cases), hypotension, ST-T changes and chest pain complicating coronarography or coronary angioplasty procedures (16 cases), unstable angina pectoris resistent to medical therapy, treated by coronary angioplasty (16 cases) and preoperative haemodynamic coverage (16 cases). The overall major complication rate of IABP was 1.5%. Our experience supports aggressive management of cardiogenic shock, i.e. early angioplasty or cardiac surgery, which considerably influences the functional status and the long-term survival rate (7/9 cases) over medical therapy combined with IABP (2 of the 14 patients are alive). The IABP was also effective in managing other high-risk patients when it was combined with some form of definitive cardioprotective mechanical correction, i.e. aneurysmectomy, valve replacement, coronary recanalization procedure. When the counterpulsation was used prophylactically, no interventional myocardial infarctions or deaths occurred; the survival rate was 27/32 patients for a 22 month average follow-up. It is suggested that the clinical results and late survival were improved by use of IABP in selected patients undergoing coronary angioplasty or open-heart surgery.

Adult↗
PubMed1988

[Emboligenic calcification of posterointernal chordae of the mitral valve. Apropos of a surgically treated case].

We report the case of a 74-year old man who experienced two transient cerebral ischaemic accidents at 24 days' interval, showing that the isolated calcifications on chordae of the mitral valve posterior leaflet responsible for these accidents were exceptionally malformed. Two-dimensional echocardiography was the key examination, as it revealed a left intraventricular mass beneath the smaller mitral valve leaflet. Having excluded other cardiac causes of cerebral ischaemic accident, and faced with the recurrent character of these accidents, we decided to operate. Surgery confirmed the diagnosis. It consisted of resection of the calcified and ulcerated mass, combined with repair of the smaller mitral valve leaflet. Isolated calcifications of the mitral valve chordae are an exceptional cause of embolic accidents of cardiac origin.

Aged↗
PubMed1988

[Intermittent arterial claudication. Clinical aspects--hemodynamic correlation].

INTRODUCTION: Intermittent arterial claudication is the master symptom in lower limbs arteriopathy. It is used as a reference in invasive or non-invasive arterial explorations. It allows to assess the evolutive degree of the disease and above all helps the therapeutic decision. The seat of claudication is traditionally acknowledged as being located immediately downstream of the significant arterial lesion. The purpose of our work was to verify such a notion and ascertain the relation between spontaneous and tread-mill induced claudication. PROTOCOL: 60 stage-2 arteritic patients were included in a prospective mode study. They were all taken in hospital for arteriographic check-up and vascular functional explorations: Doppler velocimetry, segment pressures, treadmill tests and pressure measurements after stress. The patients were classified according to age (table I), time of claudication record (table II) and lesions location (table III). All clinical and paraclinical data were recorded with a view to correlations interpretation. RESULTS AND DISCUSSION: The relation between spontaneous claudication and tread-mill induced claudication was studied with respect to lesion sites (table IV). Among 37 patients 46% of the claudications observed appeared at iliac stage in both cases (fig. 1). In 35 cases, femoral claudication was observed in 48% (fig. 2). As for distal claudication among 6 patients, 3 showed calf claudication in both cases, i had foot claudication and 2 showed discrepant claudication types. The relation between claudication and lesion site was not confirmed in all cases. Buttock claudication always appeared in relation with a lesion upstream or an internal iliac lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Value of combining the thermal test with laser Doppler measurement of skin hemodynamics. Study of vascular acrosyndromes].

Different exploratory investigations of vascular acrosyndromes have failed to define their physiopathology. Capillaroscopy studies the specific morphologic aspects of certain connective tissue diseases, hemodynamic tests usually determine a global parameter, and those tests investigating cutaneous physiology alone come up against difficulties limiting their diffusion. The laser Doppler flowmeter (LDF) measures global skin flow in a reproducible, continuous simple manner, and was combined with standardized provocation tests during a prospective study to assess its value in angiology. The protocol involved a prospective study of 100 subjects during the winter 1984-1985: 21 healthy volunteers, 11 cases of acrocyanosis, 9 of acrorhigosis, 48 of Raynaud's phenomenon (22 primary and 26 secondary), 11 of connective tissue disease without Raynaud's phenomenon (table I). The LDD test measures skin microcirculation flow continuously in parallel with skin thermometry. Provocation tests included a standardized thermal test (fig. 1); the temperature is automatically reduced to 0 degree C in 15 minutes and then increased to 25 degrees C in 10 minutes in a jar into which the hand and forearm of the patients and any measuring captor are introduced. Respiratory provocation and additional pharmacologic tests were also completed. Interpretation of results involved calculation of the mean skin flow, Dm, pulsatile skin flow, Dp (fig. 2 and 3), at the basal state and then during temperature variations. The reference value of Dm is 2.741 +/- 0.378 V and is decreased in acrorhigosis, acrocyanosis and severe Raynaud's phenomenon. At 0 degrees C the decrease in Dm is 33 +/- 13% in healthy subjects. Specific values for different acrosyndromes and particularly the various types of Raynaud's phenomenon do not exist.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Subungual glomus tumors. Apropos of 2 cases].

Glomus tumours are uncommon, though not exceptional, benign growths developed from the constituents of the "neuromyoarterial glomus" initially described by Masson. Two cases of subungual glomus tumours of the hand in middle-aged women are reported. In spite of characteristic symptoms, with paroxysmal episodes of pain triggered off by cold and the most minute traumas, and of the finding in both cases of a violine++ tumour under the nail, the condition was belatedly diagnosed (7 and 27 years respectively after the onset of symptoms). Diagnosis rested not so much on standard radiography, which showed erosion of the distal phalanx in both patients, as on arteriography of the hand which displayed a small vascular pool at the arterial stage. Tumoral excision was successful.

Angiography↗