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Biomedical subjects

A Gelet

Publications and source records attributed to A Gelet.

At least 55 records · Page 3Linked to original sources
PubMed1993

Extracorporeal repair of primary renal artery dissection.

Four cases of isolated dissection of the renal artery were diagnosed and treated in our institution. In 2 cases, angiography showed dissection of the left renal artery with involvement of peripheral branches; in 1 case, the dissection involved the right renal artery with complete occlusion of an upper-pole branch and upper-pole infarction, and 1 patient presented a bilateral dissection, limited to the main trunk on the right side and involving prepelvic and retropelvic branches on the left side. Surgical treatment consisted in renal autotransplantation in the iliac fossa after extracorporeal reconstruction of the arterial pedicle. The results were encouraging with normalization of blood pressure and improvement of renal function in all cases.

Aortic Dissection↗
PubMed1993

Benign prostatic hypertrophy treatment by transurethral radiofrequency hyperthermia with Thermex II.

We selected 50 patients with benign prostatic hyperplasia to be treated with hyperthermia at 44.5 degrees C. The treatment was performed with Thermex II. We excluded from this study all patients with a suspicion of prostatic adenocarcinoma or other previous surgical intervention on the prostate and we also excluded patients with pacemakers or coagulation problems. The follow-up time for these patients was 6 months. They were all evaluated by flow rate, measurement of postmicturation residue. Madsen score and transrectal sonography at 1, 3 and 6 months. We did not notice any modification of the prostatic volume, no modification of the urine residue but a moderate improvement of the flow rate. A significant improvement was observed on the symptom score since subjective symptoms were seen in 68% of the patients. Our results show that this method of treatment seems to compete with other classic medical treatments especially in the case of patients with a prostatic adenoma equal or smaller than 40 g and that hyperthermia is particularly active on irritative symptoms but does not compete with classic surgical procedures.

Aged↗
PubMed1993

Treatment of primary vesicoureteric reflux by polytetrafluoroethylene injection: a middle-term follow-up study.

We have selected 38 patients (55 ureters) with primary vesicoureteric reflux successfully treated by endoscopic subureteric injection of Teflon. The success rate after 1 injection was 83.6%. Nine ureters required a 2nd or even a 3rd injection of Teflon to achieve success. The follow-up time for these successfully treated patients was 2-5 years, and results remained stable in 94.5% of cases. Endoscopic injection of Teflon seems to be a reliable alternative to open surgery in the treatment of primary vesicoureteric reflux.

Adolescent↗
PubMed1993

High-intensity focused ultrasound experimentation on human benign prostatic hypertrophy.

High intensity-focused ultrasound (HIFU) has been used transrectally to induce an intraprostatic coagulation necrosis lesion in human prostatic adenoma. The device to produce HIFU combines a firing system (power amplifier and therapy transducer) and an imaging system (ultrasound scanner). Nine patients have been treated on epidural anaesthesia with an ultrasound intensity similar to or higher than the acoustic intensity used in previous experiments on canine prostates. Intraprostatic lesions were obtained without any damage to the rectal wall. These lesions were also histologically determined to be coagulation necrosis with a complete destruction of the glandular tissue. These studies confirm the possibility of creating irreversible lesions in the prostatic tissue through the rectal wall. The destruction of localised prostatic cancer would seem to be possible in the near future by using HIFU delivered by the transrectal route.

Humans↗
PubMed1993

[A quiet revolution: the Wallstent urethral prosthesis (Urolume AMS)].

14 patients (mean age: 57 years) with posterior urethral stricture were treated by internal urethrotomy and implantation of one or several Wallsten prostheses. The stent had to be removed in 2 patients (15%), while 12 patients (85%) obtained satisfactory urethral patency (mean follow-up: 17.5 months). Complications were observed in 50% of cases. They were able to be treated endoscopically with a satisfactory result in 5 out of 6 cases (intraprosthetic calculi or stenosis of the ends of the stent; 2 patients who became incontinent after insertion of the stent regained normal continence after insertion of an artificial sphincter above the stent. The Wallsten endoprosthesis therefore appears to be a very satisfactory treatment for recurrent complex strictures of the posterior urethra.

Adult↗
PubMed1993

[Fragmentation of urinary calculi using the Lithoclast EMS. Technique and results].

The Lithoclast is an endoscopic lithotriptor which uses the ballistic energy produced by a small hand-held apparatus, by the movement of a small metal part (the projectile) driven by a jet of compressed air. The energy is transmitted to a metal rod whose diameter is selected according to the application: 0.8 or 1 mm in the ureter; 2 mm in the bladder and kidney. We have used this apparatus to treat 40 stones in 39 patients (25 ureteric stones, 11 renal stones, 4 bladder stones). Satisfactory fragmentation was obtained for 39 of the 40 stones (97.5%). The apparatus is very easy to use in the kidney and bladder (the risk of urinary tract perforation is very low at this level). The risk of perforation of the ureteric wall by 0.8 mm or 1 mm rods is considerable (12% of cases), but these punctate lesions heal rapidly over a double J stent. Special techniques should be used in the ureter to limit the risk of pushing the stone towards the renal pelvis.

Adult↗
PubMed1993

[Treatment of intradiverticular lithiasis by percutaneous methods (19 caliceal diverticuli)].

The main technical procedures in percutaneous nephrolithotomy are the direct puncture of the diverticulum (precise puncture may be required to place the tract directly on to the stone), and treatment duration the diverticulum could be coagulated and a large nephrostomy catheter could be left in place two days. No complication was encountered. One patient refused the treatment after unsuccessful puncture. The nephrostomy tube was left open for two days of drainage. Mean hospital stay was 5 days. Three patients required E.S.W.L because of persistent symptoms. One month after treatment 13 of 18 patients intravenous urography showed obliteration of the diverticulum (72%); Three months after 84% (15/18) of our patients were stone free and 94% (17/18) symptom free. Percutaneous nephrolithotomy should be performed for symptomatic patients, it has low complication rate and should be reserved for patients with persistent symptoms after E.S.W.L.

Adult↗
PubMed1992

In vivo effects of high-intensity ultrasound on prostatic adenocarcinoma Dunning R3327.

High-intensity ultrasound has been used to treat Dunning R3327 prostatic adenocarcinoma implanted s.c. in Fischer Copenhagen rats. Focused ultrasound was generated with a 1-MHz transducer and energy was provided by a 7.5-kW power amplifier. Seventy-four rats were treated using two different sublines of Dunning tumor. Study 1 dealt with 49 rats with the Mat-Ly-Lu subline, treated with acoustic intensities ranging from 300 to 2750 W/cm2. Of the 49 rats in Study 1, 30 had complete tumor necrosis and 19 had no effect; of the 30 who had complete local tumor necrosis, 14 had local relapse, 9 had distance metastases to lung and nodes without local occurrence, and 7 remained free of tumor and were still alive 12 months after treatment. In Study 2, 25 rats with AT2 subline were treated with an intensity of 820 W/cm2. Similarly for Study 2, there was complete local tumor necrosis in 24 of 25 animals, with local regrowth in 7 of 24 and no recurrence of metastasis in the remaining 16 after a follow-up of 3 months. These results suggested that high-intensity focused ultrasound could be useful for the treatment of small localized cancerous tumors such as low-grade prostate carcinoma.

Adenocarcinoma↗
PubMed1992

Endoscopic treatment of vesicoureteral reflux prior to renal transplantation.

Endoscopic subureteral injection of Teflon was done in 34 potential renal transplant recipients to correct vesicoureteral reflux. Follow-up ranged from 6 to 24 months. After one injection reflux was corrected in 53.7% of the patients; this increased to 64.8% after a second injection. The procedure is simple, effective, without major morbidity, and avoids the risk of nephroureterectomy. However, efforts must be made to find an ideal substance with a higher biocompatibility and without risk of migration.

Adult↗
PubMed1992

Effects of high-energy focused ultrasound on kidney tissue in the rat and the dog.

In vivo tissue destruction was performed on 124 rat and 16 canine kidneys by focusing high-intensity ultrasound with a 1- and 2.25-MHz transducer. A precise tissue lesion was obtained in both models which varied in size according to the number of firings and the acoustic intensity. In the rat experiments, which were used to define the constants necessary to produce a localized tissue lesion at the focus of the transducer, the lesions obtained were either coagulating necrosis or a 'punched out' cavity which represented the threshold of tissue ablation. In the canine experiments, a kidney lesion was achieved in 10 animals (63%) extracorporally. These lesions were also histologically determined to be coagulation necrosis. These lesions are created by highly focused ultrasound and are caused most likely by a combination of cavitation and thermal effects, depending on the duration and frequency of the ultrasound bursts. Exact mechanism of this effect is explored as well as potential clinical applications in treating kidney, liver, and prostate tumors in humans.

Animals↗
PubMed1992

Horseshoe kidney: the impact of percutaneous surgery.

Six patients with a stone disease and/or ureteropelvic junction obstruction in a horseshoe kidney underwent percutaneous surgery. No major complications were observed and only 1 patient presented residual fragments in the lower calyx 3 months after treatment. The special features of the use of percutaneous nephrolithotomy and endopyelotomy for this anomaly are described.

Adult↗
PubMed1992

[Endoscopic treatment of vesico-ureteral reflux after reimplantation of the ureter (transplants excluded)].

O'Donnell's technique was used to treat 9 refluxing ureteric units after surgical reimplantation of the ureter in 8 patients (mean age: 45 years) between May 1986 and January 1991. The reimplantation was performed according to Cohen's technique in 5 cases (including ureteric remodelling in one case), Leadbetter's technique in 2 cases (including ureteric remodelling in one case), the Campos Freire technique in 1 case and a direct reimplantation in 1 case (with Boari). The reflux was grade II for 1 ureter, grade III for 54 ureters, grade IV for 2 ureters and grade V for 1 ureter. A single injection was performed in 5 patients and multiple injections were required in 3 patients. An associated bladder neck incision was performed in 2 male patients. No complications were observed. Correction of reflux was obtained for 8 ureteric units, i.e. 87% success with a mean follow-up of 28 months. The failure corresponded to the case of grade V reflux in a megaureter reimplanted with remodelling. The authors recommend that endoscopic treatment of reflux be performed as first-line treatment for reflux of reimplanted ureters because of the simplicity and efficacy of this technique.

Adult↗
PubMed1992

[Tumor ablation with focalized ultrasound. In vivo experiment with prostatic adenocarcinoma R3327 Mat-Ly-Lu].

Ultrasound can induce tissue lesions by a combination of thermal and mechanical effects related to the tissue absorption of the energy emitted at the focal point of the transducer. The effects of focused ultrasound were studied in vivo in Fisher/Copenhagen hybrid rats bearing Dunning R3327 experimental prostatic carcinoma. The experimental tumour was transplanted by subcutaneous injection into the abdomen of 20 mg of tumour tissue derived from the Mat-Ly-Lu strain. Treatment was performed under general anaesthesia. The animal, maintained in a sarcophage exposing the tumour, was immersed in degassed water ensuring the interface between the tumour and the 1 MHz transducer. The displacements of the transducer were guided by computerised ultrasound screening, allowing irradiation of the entire tumour. The energy was supplied by a 7.5 kW amplifier in the form of series of impulses of variable duration. 77 rats were treated and the tumour growth was compared to that of non-irradiated control rats. Comparative series demonstrated the following results: 1. Immediate tumour destruction was obtained with a very high acoustic intensity (9,000 Watts/cm2) and a brief exposure time. 2. A transient slowing of the tumour growth rate was observed for an acoustic intensity of between 3,500 and 5,500 Watts/cm2. 3. Partial or total necrosis of the tumour was obtained with intensities of between 300 and 2,750 Watts/cm2 and a long exposure time. Total tumour destruction was obtained in 30 of the 49 rats treated under these conditions. 14 animals developed a local recurrence, 9 animals did not develop a local recurrence but developed metastases and 7 animals obtained long-term survival without local recurrence or metastasis. Under certain experimental conditions, focused ultrasound, without any adjuvant treatment, was able to destroy the Dunning R3327 Mat-Ly-Lu strain experimental tumour and, in certain cases, induced complete cure of this experimental cancer.

Animals↗
PubMed1992

[Does magnetic resonance imaging allow the assessment of the loco-regional extension of cancer of the prostate? Report of 27 anatomo-radiologic comparisons].

27 patients with histologically proven prostatic carcinoma were investigated by magnetic resonance imaging (MRI) (0.5 Tesla) in order to determine the local spread of the cancer. These patients then underwent ilio-obturator lymph node dissection with frozen section examination, followed by radical prostatectomy. Histological examination of the resection specimens was performed on slides prepared from large transverse sections every 5 mn. The MRI examination was especially designed to confirm the diagnosis of capsular effraction based on the signals of the periprostatic fat (PF), periprostatic venous plexuses (PVP) and seminal vesicles (SV). An abnormality of at least one of these structures was considered to indicate the diagnosis of capsular effraction. The MRI data were compared to the histological findings. The results demonstrated a sensitivity of 62% for the PF signal, 52% for the PVP signal and 40% for the SV signal. The overall MRI-Histology correlation was found to be exact in 23 out of 27 cases (Accuracy = 85%). All of our four errors represented understaging (Sensitivity = 81%). When a rigorous methodology is respected, the high accuracy and sensitivity of MRI makes this modality an investigation of choice for the study of the prostatic capsule, as part of the routine staging of prostatic cancer. It should allow a better selection of patients with intracapsular cancer (T1-2), who constitute candidates for radical treatment.

Adenocarcinoma↗
PubMed1991

Pancreas transplantation in Lyon: overall results.

A total of 182 pancreatic transplantations were performed between 1976 and 1990. Survival of the grafts was 45% at 5 years. Major causes of graft loss have been rejection and venous thrombosis. Death occurred in 24 patients and was usually related to vascular complications. The techniques of duodenopancreatic transplantation with enteric drainage, bladder drainage and the technique of segmental duct obstructed grafts were compared. A higher rate of surgical complications was observed with enteric drainage, whereas it is unclear from the data whether segmental grafts or duodenopancreatic grafts drained into the bladder lead to different results.

Adult↗
PubMed1991

Cystine stones: the impact of new treatment.

The hardness and frequent recurrence of cystine stones present a special challenge to the urologist. In this study, 15 cystinuric patients (11 males, 4 females; mean age 36 years, range 17-54) were treated and followed up over a period of 30 months (range 2-40). Most patients had previous history of open surgery. The diagnosis of cystinuria was confirmed by metabolic studies and infrared spectrometry of stones. Over the follow-up period recurrence was observed in 23 instances in 11 patients, leading to 38 "stone treatments" on 74 cystine stones. The percutaneous approach was used alone in 9 cases and in association with extracorporeal shock wave lithotripsy (ESWL) in 9 cases. ESWL was used alone in 18 cases. Medical treatment included high fluid intake, alkalinisation and Thiola (tiopronin, N-(2-mercaptopropionyl)glycine) in 6 patients. The overall stone-free rate assessed 3 months after treatment was 44.7%, which compares poorly with the rate for non-cystine stones. The recurrence rate is very high and instrumental treatment should not therefore be used excessively; it is indicated only for stones that are symptomatic or refractory to intensive medical therapy.

Adolescent↗