J Mal Vascul
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The questions which an expert opinion should answer are presented in the first part of this article: evaluation of the physical or functional handicap, evaluation of the occupational handicap, analysis of any cause and effect between the trauma and the arterial injury. Four criteria are studied: the former status of the patient, the nature of the injury, the time of onset of the signs or delay to onset of disorders, and certain diagnosis. ⋯ The four levels of medical responsibility are recalled: penal, civil, administrative and ordinal. Finally the physician's management of vascular injuries can also lead to legal pursuits.
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Several classifications have been proposed for erythermalgia according to causality (primary or secondary) or age of onset (presuming that all early-onset are primary). Recently a classification in three types of erythromelalgia have been proposed. Erythromelalgia and erythermalgia are defined as two independent and completely different disease entities. ⋯ We recently observed 19 cases of erythermalgia; nine had primary erythermalgia; in 6 of 9, symptoms were relieved with aspirin. Ten of them had a secondary erythermalgia: 5 due to myeloproliferative disorders (erythromelalgia), 2 systemic lupus erythematosus and 3 to drugs. We used a two-level classification with a first level of primary or secondary erythermalgia, and a second level for primary erythermalgia, of familial or nonfamilial primary and for secondary erythermalgia, of thrombocythaemia disorders or other.
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We report three cases of erythermalgia associated with systemic lupus erythematosus corresponding to different clinical situations in such an association. The first patient developed erythermalgia during the course of systemic lupus erythematosus. In the second, erythermalgia preceded other symptoms of systemic lupus erythematosus by four years. ⋯ These cases permit a discussion on terminology and classification of erythromelalgia and erythermalgia. However, more than terminology or classification into three types or into adult-onset and early-onset (childhood) erythromelalgia, the important is to consider primary and secondary forms. We used a classification into two types: primary (or erythermalgia) with subdivision into sporadic and familial subtypes, and secondary with subdivision into erythermalgia related to myeloproliferative disorders and erythermalgia related to other diseases, such as systemic lupus erythematosus, or to drugs (erythermalgia-like syndrome).
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The aim of this study was to assess results of surgery for aneurysms of the abdominal aorta in patients over 70 years of age. Survival and quality of life were used as assessment criteria. Files of 277 patients over 70 years of age who had undergone surgery for an aneurysm of the subrenal abdominal aorta between 1974 and 1992 were examined retrospectively. ⋯ Quality of life after the operation was unchanged in 56.1%, improved in 19.3% and worse in 24.6%. Surgery for aneurysm of the subrenal abdominal aorta is justified in patients over 70 years of age. It can provide satisfactory survival in good quality of life conditions.
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The treatment of symptomatic popliteal aneurysms is debated should local fibrinolysis or surgery first be used first? The authors report their experience in the treatment of 90 popliteal aneurysms in 66 patients. In this series were only examined those aneurysms with either acute ischaemia 12 (27%) or sub-acute ischaemia 21 (45%). ⋯ There was no peri-operative mortality, only one amputation was required (5%) (J Mal Vasc 1994; 19, Suppl. A: pages 150-153).