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Biomedical subjects

P Soula

Publications and source records attributed to P Soula.

24 records · Page 2Linked to original sources
PubMed1994

[Systemic embolism of cholesterol crystals].

Systemic cholesterol crystal emboli (SCCE) are no longer a rare complication of severe atheroma. Sixty-year old men, with many vascular problems are typically involved. SCCE, released from atheromatous ulcerated "plaques", invade one or more arteriolar beds. Clinical presentation is polymorphic: skin, muscle, kidney, digestive tract and other abdominal organs, retina, bone narrow ... may be embolized. SCCE are associated with triggering conditions: vascular surgery, anticlotting agents and fibrinolysis, femoral retrograd catheterization by radiologists or cardiologists. This last factor is presently predominant. Clinical signs depend on atheroma localization, intensity and repetition of embols and topography of arteriolar beds susceptible to be embolized: livedo reticularis, acute renal failure with high blood pressure, limbs or abdominal pain, periarteritis nodosa-like syndrome. Diagnosis is based on the discovery of ocular fundi (cholesterol crystals in arterioles) and evidence of cholesterol crystals in various biopsies: skin, muscle, kidneys. Prognosis and curative treatment are poor. Mortality is greater than 80% in systemic forms. Surgical palliative treatment was recently proposed (bypass). Prevention is essential: triggering manipulations i.e. retrograd femoral catheterism have to be avoided by radiologists or cardiologists in exposed patients. In high risk atheromatous patients symptomatic treatment including repetitive dialysis is able to induce significative survival.

Embolism, Cholesterol↗
PubMed1994

[Popliteal aneurysm and leg ischemia: thrombolysis first].

Popliteal aneurysms may threaten the viability of lower limbs, especially in the case of occlusion and poor run-off. In case of acute ischemia, thrombolysis can be used before surgery to clear the tibial arteries and enhance the results of subsequent bypasses. The procedure starts with an arteriography to show the arterial tree, then a recanalization is attempted. By means of a microcatheter pushed into the thrombosis, Heparin (1000 Units/h) and Urokinase (4,000 Units/h) are injected in situ. Arteriograms are repeated in order to control the placement of the catheter. Anticoagulant and fibrinolytic doses are biologically surveyed. Local and general complications are rare with the new techniques of fibrinolysis. Hemorrhagic complications following surgery are low despite the previous fibrinolytic treatment. Better success rates of bypasses, performed to relieve acute ischemic complications of popliteal aneurysms, should be achieved with this new modality of treatment.

Aged↗
PubMed1993

[Closure of sternotomy with Cotrel staplers].

The authors describe a new method for the closure of median sternotomies based on immediate compression with two or three Cotrel-Dubousset (CD) staples. This method was effective in a series of 100 patients. It was the curative treatment of septic sternal pseudarthrosis, and has been extended to high risk patients (age, severe sternal osteoporosis, obesity, diabetes, chronic respiratory insufficiency) or when surgery requires resection of the internal mammary arteries (IMA).

Aged↗
PubMed1990

[The surgical approach to adrenal pheochromocytoma. A plea for lumbotomy].

The authors compare two successive series of surgically treated phaeochromocytomas. The first series consisted of 18 patients treated by laparotomy. During the immediate postoperative course, one patient died, 10 patients developed complications and 11 patients required blood transfusion. One patient died later from a recurrence. In the following series, 17 patients were operated by lumbotomy, which was bilateral in three cases. The mortality was nul, two patients developed complications and three patients required transfusion. Although successive series must be compared very cautiously, lumbotomy is justified by the surgical simplicity and the decreased morbidity. It is only possible as a result of the progress in medical imaging, particularly computed tomography, meta-iodobenzylguanidine isotope scans and magnetic resonance imaging.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

[Intra-aortic covered endoprosthesis].

Because of the risk and complications related to surgery of the aorta, the development of new, less invasive endovascular techniques has resulted in a certain enthusiasm for these new treatments on the part of physicians and industry. The insertion of aortic stents allows the treatment of almost one half of aneurysm of the infrarenal abdominal aorta and descending aorta. The results appear to demonstrate the medium-term reliability and efficacy of these new techniques with a lower morbidity-mortality rate than that of conventional surgery. However, preoperative and intraoperative imaging plays an essential role in the success of these new methods. Finally, although the medium-term results are encouraging, the long-term outcome of these new materials is unknown, which justifies close surveillance of these patients and prospective comparative studies.

Aneurysm, Ruptured↗