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Biomedical subjects

A Leriche

Publications and source records attributed to A Leriche.

At least 19 recordsLinked to original sources
PubMed2003

[Sacral root neuromodulation for the treatment of urinary incontinence reported to detrusor hyperactivity].

BACKGROUND AND PURPOSE: This paper reviews therapeutic sacral neuromodulation for treating urinary urge incontinence related to detrusor hyperactivity. METHODS: We reported data from our department and from the international literature on topics such as the physiological basis of neuromodulation, techniques of testing, chronic implantation and clinical results. RESULTS: In an intention to treat analysis , neuromodulation results varied from 21.5 to 25% globally. On implanted patients, the response rate varied from 40 to 88% and was stable. Sub-chronic test morbidity was very rare. Surgical revision rate was reported from 6.25 to 37.7%. CONCLUSIONS: Neuromodulation strongly ameliorates approximately a third of all the patients with urge urinary incontinence due to detrusor hyperactivity. New technical improvements should lead to better results in the future.

Electric Stimulation Therapy↗
PubMed2001

Assessment of the efficacy and safety of Viagra (sildenafil citrate) in men with erectile dysfunction during long-term treatment.

Long-term efficacy and safety of sildenafil was assessed in 1008 patients with erectile dysfunction (ED) enrolled in four flexible-dose (25 - 100 mg), open-label, 36- or 52-week extension studies. After 36 and 52 weeks, 92% and 89% of patients felt that treatment with sildenafil had improved their erections. Responses to a Sexual Function Questionnaire indicated that 52 weeks of sildenafil treatment resulted in clinically significant improvements in the duration and firmness of erections, overall satisfaction with sex life, and the frequency of stimulated erections. Commonly reported adverse events (AEs) were headache, flushing, dyspepsia, and rhinitis, which were generally mild to moderate. Reports of abnormal vision were consistent with previous clinical trials. The occurrence of treatment-related cardiovascular AEs, such as hypertension, tachycardia, and palpitation, was <1%. Discontinuations due to treatment-related AEs were low (2%). Long-term therapy does not diminish the efficacy of sildenafil in patients with ED and remains well tolerated.

Administration, Oral↗
PubMed2001

Quality of life in spinal cord injury patients with urinary difficulties. Development and validation of qualiveen.

BACKGROUND: Quality of life (QoL) may be severely affected in patients with spinal cord injury (SCI) and resulting urinary difficulties (UD). There is, however, a need for instruments capable of measuring QoL in these patients. The aim of this study was to develop and validate a questionnaire suitable for use in SCI patients with urinary disorders. METHODS: Following patient interviews, a questionnaire was developed in French that was subjected to item reduction and cross-sectional validation. The resulting Qualiveen (Qualiveen is a pending registration trade mark of Coloplast A/S, DK-3050 Humlebaek, Denmark) questionnaire underwent multi-trait and principal component analysis and the test-retest reliability of the questionnaire was examined in stable patients. RESULTS: Patient interviews identified 257 concepts relevant to SCI patients with urinary disorders. Item reduction led to a 30-item questionnaire, which was psychometrically validated in 281 SCI patients with UD. The median age of patients was 41 years, 78% were male and the majority were paraplegic (55%). The construct and clinical validity of the Qualiveen was confirmed, as well as its reliability in patients whose condition was stable over a 15-day period. Patients confirmed that it was easy to understand, complete and comprehensive. CONCLUSIONS: The Qualiveen is a reliable and psychometrically validated instrument that may be used to measure the QoL of SCI patients with UD.

Adult↗
PubMed2001

Fibroblast growth factor receptor 1 (FGFR1) is over-expressed in benign prostatic hyperplasia whereas FGFR2-IIIc and FGFR3 are not.

OBJECTIVE: Benign prostatic hyperplasia (BPH) is one of the major public health problems among men: 50% of men over 55 are concerned with this disease. Prostate growth is under the control of androgens which act by means of several growth factors such as fibroblast growth factors (FGFs), epidermal growth factor and transforming growth factor beta. Basic FGF (bFGF) has been shown to stimulate prostatic stromal growth. In BPH, bFGF concentration is two- to threefold higher than in normal prostate. In this work, the bFGF receptors (FGFR1, FGFR2-IIIc and FGFR3) genes expression was evaluated to study the correlation between the expression of bFGF receptors and induction of BPH. METHODS: The expression of FGFRs was analyzed by RT-PCR, FGFR1 was localized by immunohistochemistry and protein expression was evaluated by Western blot. RESULTS: A two- to eightfold over-expression of FGFR1 was observed in BPH compared with normal prostates. FGFR1 was localized in the stroma both in BPH and in normal prostates and 1.5- to 2.5-fold over-expression of the protein was observed. The expression of FGFR2-IIIc and FGFR3, more secondary receptors, was not significantly different between BPH and normal prostates. CONCLUSIONS: bFGF receptors and particularly FGFR1 seem to be involved in the induction and evolution of BPH and probably potentiate bFGF over-expression effects in BPH.

Aged↗
PubMed2001

[Deferred adjustment of the tension of tension-free vaginal tape (TVT) after surgical repair of stress urinary incontinence in women].

INTRODUCTION: Urinary retention is a frequent complication of repair of female urinary incontinence treated by tension-free vaginal tape (TVT). The authors report a modification of the original technique designed to decrease the risk of postoperative dysuria and retention. MATERIAL AND METHODS: One hundred and twenty four patients with pure stress urinary incontinence were treated by TVT. In 74 patients (group 1), the TVT was placed according to the original Swedish technique. In 50 patients (group 2), no tension was applied to the suprapubic extremities of the TVT during the operation, but they were preserved and buried in an antiseptic dressing. On the day after the operation, traction was applied to the suprapubic TVT in the case of persistent incontinence. The immediate postoperative results and the results at 3 months, in terms of continence and urethral obstruction, were compared. RESULTS: Perfect continence was obtained in 84 +/- 6.5% and 94 +/- 4.2% of patients in groups 1 and 2, respectively (p = 0.08). Acute urinary retention (15% vs 2%, p < 0.03) and post-voiding residual urine > 50 cc (38% vs 10% on D1 and 14% vs 2% at 3 months) were more frequent in group 1. At 3 months, the reduction in maximum and mean flow rate was lower in group 2 (p < 0.03). In group 2, deferred traction of the TVT was necessary in 20% of cases, without causing any major infectious complications or pain. CONCLUSION: Deferred traction of TVT appears to decrease the rate of dysuria and urinary retention following repair of female urinary incontinence by tension-free vaginal tape (TVT). This technical modification does not affect the results on continence, which appears to be at least as satisfactory. This technical variant appears to be associated with a low morbidity.

Adult↗
PubMed1999

Posttraumatic erectile potential of spinal cord injured men: how physiologic recordings supplement subjective reports.

OBJECTIVE: To investigate by means of a neurophysiologic model the remaining erectile function in spinal cord injured men. DESIGN: A nonrandomized control trial. SETTING: A Referred Care Center. SUBJECTS: Forty-seven spinal cord injured men and 7 noninjured controls. INTERVENTION: The subject penile responses were recorded by a penile strain gauge during two sessions--one to obtain baseline responses, and one with reflexogenic stimulation (masturbation) and psychogenic stimulation (film). MEASURES: Average tumescence, maximal tumescence, percentage rigidity, and duration of tumescence and rigidity. RESULTS: Significant results were found for subjects with lower lesions using psychogenic stimulation as their optimal mode compared with reflexogenic stimulation as an alternate mode, and for subjects with higher lesions using reflexogenic stimulation as their optimal mode, compared with psychogenic stimulation as an alternate mode. The responses with optimal stimulation modes were comparable to those achieved by controls. CONCLUSION: The findings validate the neurophysiologic model of posttraumatic erectile potential as a function of the lesion type and stimulation source. The results were comparable to those of noninjured subjects; the potential for normal function is present and may be amenable to sexual rehabilitation or use in conjunction with new oral drug treatments for impotence.

Adolescent↗
PubMed1998

Sympathetic skin responses and psychogenic erections in spinal cord injured men.

Sympathetic skin responses (SSR) are a simple procedure to investigate sympathetic activity. More specifically, SSR elicited from median nerve stimulation and recorded from the feet and genitals assess sympathetic activity resulting from thoracic-lumbar (TL) innervation. Since TL innervation is also involved in the mediation of psychogenic erection in spinal cord injured men, this study investigated the relationship between SSR and psychogenic erection in spinal cord injured subjects. The results support a general association between SSR and psychogenic erection and show that subjects who maintain SSR responses in the feet and genitals generally maintain psychogenic erections as well. Inconsistent cases are discussed from a theoretical and clinical perspective and overall results are discussed in terms of their clinical application in the evaluation of sexual function in spinal cord injured men.

Adolescent↗
PubMed1998

Patterns of messenger RNA expression for alpha1-adrenoceptor subtypes in human corpus cavernosum.

PURPOSE: The present study evaluated the expression of alpha1-adrenoceptor subtypes in human corpus cavernosum. MATERIALS AND METHODS: The mRNA encoding alpha1a, alpha1b and alpha1d subtypes were assessed by RNA-directed complementary cDNA synthesis followed by Taq DNA amplification. The level of alpha1 mRNA was calculated in arbitrary optical density units and normalized with respect to the length of the respective cDNA fragments. RESULTS: We found that alpha1a, alpha1b and alpha1d adrenoceptor subtypes are expressed in human corpus cavernosum, with a predominant expression of the alpha1a subtype. CONCLUSION: These results suggest that alpha1a-adrenoceptor subtype is important and that understanding the biochemical and functional characteristics of this subtype may lead to the development of specific antagonists in the treatment of impotence.

Actins↗
PubMed1997

[Adjuvant radiotherapy after radical prostatectomy. Apropos of a series of 73 patients in Lyons (France)].

PURPOSE: Descriptive analysis of adjuvant radiation therapy after radical prostatectomy. MATERIALS AND METHODS: From 1986 to 1993, 73 patients (median age, 64.5 years; Gleason score > or = 7 : 36 pts; T1:22; T2:40; T3:11) were included into the study. On the operative specimen, the cancer grades were pT2:5 (involvement of the apex), pT3:67, pT4:1, pN1-2:8. Radiation therapy was performed after a mean resting period of 112 days. The target volume was the prostatic area. The technique used was a four-field box with an 18 MV-X photon beam. The dose was 50 Gy/20 fractions/5 weeks. No hormonal treatment was administered, except for 5 patients for a short duration. RESULTS: The median follow up was 46 months. One anastomotic local failure was salvaged by trans-urethral resection, three distant metastatic failures. Out of 72 patients with a PSA < 3 ng/mL at the end of radiotherapy, 13 showed an isolated elevation. The 5-year overall survival rate was 93%. The event-free survival was 72% after 5 years. Pathological differentiation and Gleason score were significantly correlated with the survival. There was no complication related to radiotherapy. CONCLUSION: Elective adjuvant radiation therapy for pT3 prostate adenocarcinoma after radical prostatectomy provides a good local control with minimal morbidity.

Adenocarcinoma↗
PubMed1995

[Paraclinical explorations of urination disorders in men].

The uroflowmetry is still the only criteria to show and analyse a dysuria unknown by the patient two times out of three. This analysis will allow us to appreciate the follow-up of the desobstruction regarding the therapeutic which has been chosen. The ultrasonography (renal ultrasonography and prostate) can easily detect bladder and renal failures. It provides good information on anatomical and shape of the prostate but less information on urethral obstruction because dynamic ultrasonography is carried out in a few cases. The intravenous pyelography seems to be out of date but it will give the most important parameters to appreciate the urinary problems allowing the analysis of the physiological micturation by voiding urethrography. The retrograd urethrography provides good imaging diagnosis but gives a better image of urethral stenosis in a very important dysuria. It is not appropriate to say that it is an invasive procedure. The endoscopy is very convenient. It could be used during an examination and need no anesthetic to be performed with an optical fibroscope. The urodynamic examination is needed only in a major dysuria without real obstruction or detrusor instability. First the obstruction has to be evaluated by the previous examinations. It could point out that some bladders are hypocontractile and in these cases, surgery will be inappropriate. Also it allows us to test the effectiveness of external sphincter pressure to determine the prognostic of continence and even to treat the incontinence by biofeedback.

Cystoscopy↗
PubMed1995

Clinical approach to erectile dysfunction in spinal cord injured men. A review of clinical and experimental data.

Despite the many developments in the area of sexual dysfunction, rehabilitation settings seldom investigate the remaining sexual function following spinal cord injury, or offer differential diagnoses of sexual dysfunction in spinal cord injured men. This article attempts to show how sexual rehabilitation should begin with a thorough assessment of the sexual function of paraplegic and tetraplegic men. Assessment includes a basic neurological examination of the perineal area and an extended clinical interview on sexual function and visceral function. The interpretation of patient evaluation is discussed in terms of a classification system adapted to sexual purposes and in terms of the differential diagnoses between sexual dysfunctions of organic, and those of predominantly psychogenic origin in the spinal cord injured patient. The organic or psychogenic contribution is discussed in terms of sophisticated procedures, where assessment of nocturnal penile tumescence (NPT) is critically evaluated and where alternatives such as urodynamic findings and skin potentials are discussed. Treatment strategies, such as intracavernous injections and cognitive-behavioural strategies adapted to different lesion types, are discussed.

Erectile Dysfunction↗
PubMed1994

[Urethroplasty using polyglactin mesh in urethral fistula caused by decubitus ulcer of the perineum in spinal cord injuries. Apropos of 7 cases].

Seven paraplegic patients, presenting with urethro-cutaneous fistulae due to a loss 4 to 10 cm of urethral tissue, due to decubitus ulcer of the anterior perineum, were cured. Urethroplasty was performed by wrapping the urinary catheter in a resorbable polyglactin net, covered on top by a flap of a well vascularized musculocutaneous biceps femoralis flap. The follow-up of several years proved the reliability of this technique which can be perfectly applied to others kinds of urethroplasty.

Adult↗
PubMed1993

Sexual function in spinal cord injury men. I. Assessing sexual capability.

Precise diagnoses are seldom made upon complaints of sexual dysfunction by spinal cord injured men. The dysfunction is inevitably attributed to the neurological condition and available treatments are offered with little knowledge of the individual residual capacity or other contributing factors. Current practice emphasizes these treatment approaches, but the high rejection rate associated with the most widely used technique of intracavernous injections suggests that remaining sexual function should also be investigated. This study explores remaining function using physiological recording techniques and classifying the subjects according to the innervation of the reproductive system. The results show that, with objective measurements and proper classification of the subjects, 100% of individuals with high lesions maintain penile responses to reflexogenic stimulation and up to 90% of those with lower lesions maintain penile responses to psychogenic stimulation. These latter subjects also show naturally occurring emissions in 100% of the cases when they suffer from lesions to the conus terminalis and when they use psychogenic stimulation as a means of inducing erection and emission. Results from subjective reports reveal that spinal cord injured men underestimate their sexual capacity, while diagnoses based on clinical findings are better predictors.

Coitus↗
PubMed1991

[Sexual examination of spinal cord injured males].

This article describes the sexual examination of spinal cord injured males. It comprises a clinical interview followed by a neurological exam which purpose is to distinguish the lesion level with respect to sacral and thoracic-lumbar innervation of the genitalia. It also comprises a physiological recording of sexual responses to reflexogenic and psychogenic stimulation. The neurological exam allows prediction of sexual responses in 83% of the cases, while the clinical interview only allows a prediction in 47% of the cases. With this sexual examination it has been possible to determine the sexual capacity of spinal cord injured males, a capacity which is discusses with respect to the lesion level and the type of stimulation inducing erection.

Humans↗