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Alain Ruffion

Publications and source records attributed to Alain Ruffion.

At least 19 recordsLinked to original sources
PubMed2006

TNF-alpha-related apoptosis-inducing ligand decoy receptor DcR2 is targeted by androgen action in the rat ventral prostate.

The apoptotic cell death process in the prostate is known to be under the control of androgens. Tumor necrosis factor-alpha (TNF-alpha)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF-alpha family of cytokines, known to induce apoptosis upon binding to its death domain-containing receptors, DR4/TRAIL-R1 and DR5/TRAIL-R2. Two additional TRAIL receptors, DcR1/TRAIL-R3 and DcR2/TRAIL-R4, lack functional death domains and act as decoy receptors for TRAIL. In this study, we examined whether TRAIL and cellular receptors expression was targeted by androgens during the apoptotic cell death process in the hormone sensitive ventral prostate. The role of androgens was investigated using two sets of experiment. (1) Androgen deprivation associated with an apoptotic process resulted in a decrease in DcR2 mRNA and protein expression in the ventral prostate 3 days after castration. Testosterone administration to castrated adult rats prevented the decrease in DcR2 mRNA and protein levels in the ventral prostate. In contrast, DcR2 expression was modified, neither in the dorsolateral nor in the anterior prostate following castration. No changes were observed in DR4, DR5, DcR1, and TRAIL mRNA and protein levels in prostate after castration. (2) A specific decrease in DcR2 expression was observed in the ventral prostate after treatment of rats with the anti-androgen flutamide. Together, the present results suggest that testosterone specifically controls DcR2 expression in the adult rat ventral prostate. Androgen withdrawal, by reducing DcR2 expression, might leave the cells vulnerable to cell death signals generated by TRAIL via its functional receptors.

Androgen Antagonists↗
PubMed2006

Discovery of a pituitary adenoma following treatment with a gonadotropin-releasing hormone agonist in a patient with prostate cancer.

We report the case of a T3 prostate cancer in a 70-year-old white man. Hormone therapy represents a prominent branch in the treatment of locally advanced and metastatic prostate cancer. Gonadotropin-releasing hormone agonists have been proven to have a double effect on androgen metabolism: an initially stimulating, followed by an inhibitory, effect on the pituitary gland. This phenomenon may be noxious in the case of gonadotroph adenoma, with subsequent symptoms of intracranial hypertension. Gonadotropin-releasing hormone antagonists (abarelix), by avoiding the flare-up reaction, might be used in such instances.

Adenocarcinoma↗
PubMed2006

Discovery of a pituitary adenoma following a gonadotropin-releasing hormone agonist in a patient with prostate cancer.

Gonadotropin-releasing hormone (GnRH) agonists have become the treatment of choice for locally advanced and metastatic prostate cancer. We report a case of prostate cancer in which this treatment led to severe symptoms of intracranial hypertension due to the concomitant presence of an asymptomatic functional pituitary adenoma. A 70-year-old white man was initially evaluated for a multifocal adenocarcinoma, Gleason score 6 (3+3) with perineural invasion suggesting an extracapsular extension. A conformational external beam radiation (74 Gy) with a concomitant GnRH agonist (leuprolide) was initiated. Almost 10 days after the administration of leuprolide the patient complained of visual disturbance, diplopia and other symptoms of intracranial hypertension. Magnetic resonance imaging (MRI) of the brain demonstrated a large sella mass lesion. To relieve the patient's symptoms, a transsphenoidal subtotal tumorectomy was necessary. The histopathological examination revealed an invasive gonadotroph pituitary adenoma. Two years later, there is no sign of progression either on his prostatic disease (prostate-specific antigen of 0.21 ng/mL) or on his pituitary disease (FSH, 4.7 UI/L, LH, 3.1 UI/L and total testosterone, 627 ng/dL) with values of the hypothalamic-pituitary axis in the normal range. We advocate that a high index of suspicion of pituitary tumor must be considered in any case of intracranial hypertension following the administration of GnRH agonist. Abarelix could have a place in such cases.

Adenocarcinoma↗
PubMed2006

The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43,000 victims.

OBJECTIVE: To analyse the frequency and type of injury to the genitourinary system, by user category, after traffic accidents. PATIENTS AND METHODS: The register which forms the basis of this study is unique in Europe and includes 43,056 victims of road traffic accidents, and was compiled between 1996 and 2001. The categories of road users included: motorists, motorcyclists, cyclists, pedestrians, van and bus users, and roller skaters. The urological complication rate was analysed for each category. RESULTS: In all, 199 cases of trauma of the genitourinary system (0.46%) were recorded. The most frequent urological complications were renal (43%) and testicular trauma (24%), the former most frequent in motorists (65%) and pedestrians (29%), and the latter in motorcyclists (41%). CONCLUSIONS: An analysis of this register provides better knowledge of the urogenital injuries after traffic accidents. Renal and testicular injuries are the most frequent.

Accidents, Traffic↗
PubMed2006

What is the optimum dose of type A botulinum toxin for treating neurogenic bladder overactivity?

OBJECTIVE: To assess the effects of two doses of botulinum toxin A (Dysport, Ipsen-Biotech, France; 500 and 1000 Speywood units, SU) injected into the bladder for treating incontinence due to a neurogenic overactive bladder. PATIENTS AND METHODS: In an open-label, prospective study between October 2002 and May 2004, in two centres, we analysed the effects of successive doses of 500 and 1000 SU of Dysport, endoscopically injected into the detrusor muscle. At each step, patients (26 women and 19 men) were re-evaluated at 1 month (clinical evaluation and pressure-flow study). If there was a 'good' clinical response (complete absence of urinary leakage) the patient was observed until incontinence recurred; otherwise a further injection was administered at a higher dose. RESULTS: The mean (sd, range) follow-up was 22 (0.75, 5-31) months; 11 of the 45 patients (24%) did not respond primarily at 1 month for both doses. The analysis of the two curves of survival with no re-injection of Dysport showed a statistically longer action at 1000 SU (P = 0.016). However, in this group there was one patient with general muscle weakness and asthenia, which could have been related to the injection. CONCLUSIONS: The optimum dose of Dysport for incontinence secondary to a neurogenic overactive bladder is not yet defined; 1000 SU probably has a more prolonged effect than 500 SU but exposes the patient to major complications. Further studies evaluating the clinical effect of 750 SU of Dysport are necessary.

Botulinum Toxins, Type A↗
PubMed2006

[Management of corpus cavernosum trauma].

Rupture of the tunica albuginea of the corpus cavernosum of the penis is a rare disease, usually occurring in young adults during sexual intercourse. In Western countries, the most frequent causes is coital injuries. Ultrasound, cavernography or magnetic resonance imaging of the penis can be performed to determine the exact site of the fracture. Treatment is usually elective surgery and consists of evacuating the subcutaneous haematoma and suturing the tear of the tunica albuginea. An associated rupture of the urethra must be excluded. Complications of these fractures of the tunica albuginea especially comprise erectile dysfunction, deviation of the erect penis, development of plaques resembling those of La Peyronie disease, urethro-cavernous or urethro-cutaneous fistula or dysuria secondary to urethral stricture.

Adolescent↗
PubMed2006

[A modified IPSS score: value of a choice of qualitative answers].

INTRODUCTION: The IPSS score is a self-administered questionnaire considered to be the reference instrument to evaluate the impact of lower urinary tract symptoms in men. However; patients may encounter difficulties answering the standard questionnaire. This study was designed to analyse whether modification of these "standard" (or numerical, N) items by a choice of literal (L) answers induced any modifications of the psychometric characteristics of the IPSS questionnaire. MATERIAL AND METHODS: This prospective single-centre study compared the two questionnaires applied in the same order to a cohort of 109 patients with voiding disorders. These questionnaires were administered to the patients on two occasions at an interval of 15 days. RESULTS: Cronbach's coefficient alphas calculated on D0 were 0.78 (L) and 0.81 (N). Pearson's correlation coefficients between the two IPSS scores on D0 and D15 were high (0.89 and 0.95). The comparison of the N and L questionnaires shows a mean difference -0.25 between the scores with a normal fluctuation interval [-7.6; 7.1] on D0 and -0.89 [-6.3; -4.5] on D15. Test-retest on the 15th day showed a good correlation for the two questionnaires (0.87 for N and 0.85 for L). CONCLUSION: The proposed modification of the choice of answers to the IPSS questionnaire does not alters its psychometric qualities. Patients appear to prefer the literal version of the questionnaire compared to the standard questionnaire (62% versus 31%).

Adult↗
PubMed2006

[REMEEX: A possible treatment option in selected cases of sphincter incompetence].

OBJECTIVE: To evaluate the functional results and morbidity of adjustable tension suburethral tape (REMEEX) in the treatment of urinary incontinence due to severe sphincter incompetence (MUCP < 40 cm H2O) in patients presenting a contraindication to artificial sphincter operated between December 2001 and May 2004. Twelve patients (66.7%) had already undergone incontinence surgery. Ten patients (55.5%) had mixed urinary incontinence. The efficacy of the tape was considered to be good when incontinence resolved completely, partial when incontinence was decreased by > 50% and/or PVR > 100 ml. All other cases were considered to be failures. In April 2005, after a mean follow-up of 26.3 months, retrospective evaluation of the functional results was performed by means of a pad-test and a questionnaire comprising an MHU (urinary disability) score and a Ditrovie score. Complications after each intercurrent event were recorded. RESULTS: The initial efficacy of the tape was considered to be good in 13 patients (72.2%) and partial in 4 patients (22.2%) with only one initial failure. Eight patients (44.4%) required secondary adjustment after a mean interval of 5.2 months, with a failure rate of 62.5%. In April 2005, 10 patients (55.5%) had a good result, 2 patients (11.1%) required self-catheterization (partial efficacy) and 6 patients (33.4%) were considered to be failures. In terms of morbidity, we observed 2 bladder injuries (11.1%), 6 superinfections of the device (33.3%), 2 (11.1%) of which required removal of the material. Fifteen patients (83.3%) answered the questionnaire: 6 patients (40%) had an MHU score greater than 3. The mean Ditrovie score was 2.1. 9 patients (60%) had a score less than 2 and 4 patients (26.6%) had a score greater than 3. CONCLUSION: The results of this series, in patients in whom artificial sphincter was contraindicated, are satisfactory at the price of acceptable morbidity. Before defining the place of this device in the range of treatment options for sphincter incompetence, our results must be confirmed by a longer series.

Adult↗
PubMed2005

[Is tumour grade applicable to finasteride-treated prostate cancer?].

The treatment of prostate cancer by endocrine therapy induces histological changes of benign or malignant prostate glands. Treated cancers often have a more suspicious architecture, resulting in a higher Gleason score, while their nuclear grade (WHO) appears to be more reliable due to a reduction of the size of nuclei. Most authors appear to agree that cancers discovered by biopsy in patients treated with endocrine therapy should not be graded. A review of the literature appears to indicate that finasteride has less marked histomorphological consequences than other hormone-suppressor treatments and could have a lesser effect on the Gleason score. This paper, based on a review of the literature on this subject, emphasizes: (1) the extent of histological changes after androgen deprivation endocrine therapy; (2) histological changes after Finasteride and the difficulties of histological interpretation, particularly the risk of overestimating the Gleason histoprognostic score; (3) the need for urologists to indicate any treatment by 5-alpha-reductase inhibitors or androgen deprivation when requesting histological examination; (4) the value of collecting and documenting cases observed in the Uropathology Club in collaboration with the Oncology committee of the Association Française d'Urologie.

5-alpha Reductase Inhibitors↗
PubMed2005

[Types and mechanisms of 54 cases of kidney trauma in car drivers injured by road accident].

PURPOSE: To analyse the types, mechanisms and severity of kidney trauma in injured car drivers and the effects of the presence or absence of the safety belt on the renal lesions observed. MATERIAL AND METHODS: 64,325 road accident victims were reported between 1996 and 2002. Data collection was performed in 96 primary care departments, 160 inpatient departments and 11 convalescence centres. Among the 33,431 injured car drivers, 54 presented kidney trauma (0.16%). The AAST classification was used to analyse these cases of RESULTS: The 54 cases of kidney trauma was classified as grade I and II in 39 cases, grade III in 6 cases, grade IV in 5 case, and grade V in 4 cases. Nine patients died with a kidney lesion. This lesion was never isolated, as it was associated with rupture of the spleen in 8 cases, head injury in 6 cases and chest injury in 4 cases. The mechanism of these fatal accidents was a head-on collision in every case. CONCLUSION: Kidney trauma in the car drivers of our series was rare (0.160%) and benign (72% of grade I and II lesions). Patients with a kidney lesion who died always presented multiple injuries. Renal pedicle lesions are usually observed in car drivers not wearing a

Accidents, Traffic↗
PubMed2005

[PSA doubling time and method of calculation].

Prostate Specific Antigen (PSA) is currently the best marker for prostate cancer, although it is not very specific for this disease. The use of the PSA kinetic, in addition to its absolute value, is theoretically very attractive in a large number of clinical situations. Based on a review of the literature, the authors report the various methods used to study this kinetic, with particular emphasis on the most reliable method: the PSA doubling time. After describing the definitions and the methods used to calculate this parameter, the authors discuss the various clinical situations in which it could be useful: surveillance of prostatic tumours after the initial diagnosis in high-risk patients or patients refusing treatment, prognostic factor before curative treatment, evaluation of the efficacy of curative treatment, prognostic factor of tumour aggressiveness at the time of biochemical recurrence after curative treatment or during endocrine therapy.

Humans↗
PubMed2005

[Comparison of the response to I-PSS according to the mode of administration of the questionnaire: by the doctor or self-assessment by the patient].

OBJECTIVE: To compare the response to I-PSS according to its mode of administration (by the doctor versus self-assessment). METHODS: 388 patients were included during the 3 months following a diagnosis of benign prostatic hyperplasia. The general practitioner completed the I-PSS and gave an I-PSS questionnaire to the patient to be completed at home and returned in a reply-paid envelope to the data entry centre. The Bland & Altman method was used to visualize individual differences and to quantify the bias between the two modes of evaluation. RESULTS: The doctor overestimated the I-PSS by an average of 1.3 points [95% CI: 0.9-1.7]. In 42% of patients, these individual differences were 3 points or more. Significant overestimation was confirmed at 6, 12 and 18 months of follow-up. CONCLUSION: A significant bias was demonstrated according to the mode of administration of the I-PSS. We therefore recommend that the same mode of administration should be maintained during clinical trials.

Data Collection↗
PubMed2005

[Well differentiated paratesticular liposarcoma in adults].

The authors report a case of well differentiated paratesticular liposarcoma in a 41-year-old patient. This is a rare tumour (about one hundred cases have been reported in the literature), which essentially arises from the spermatic cord. Clinical and radiological signs are nonspecific and the diagnosis is generally based on histological examination of the operative specimen. Due to the histological similarities, all specimens of benign lipoma must be examined for the presence of well differentiated liposarcoma. Treatment consists of transinguinal radical orchidectomy, sometimes with resection of adjacent structures. The prognosis is generally better than that of other paratesticular sarcomas. Adjuvant radiotherapy may be indicated in locally advanced masses or in the case of incomplete resection.

Adult↗
PubMed2004

Activation of caspases-3, -6, and -9 during finasteride treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) results from an increase in both epithelial and stromal compartments of the human prostate. Although inhibitors of 5alpha-reductase such as finasteride have been shown to reduce the size of BPH tissues by inducing apoptosis, their mechanisms of action still remain unknown. The present study supports that such a process triggered by finasteride is caspase dependent with a possible involvement of two effector caspases (caspase-3 and 6) and two initiator caspases (caspase-8 and 9). Indeed, by using tissues from patients affected by BPH and treated by finasteride (5 mg/d) for 2-3, 6-8, or 27-32 d, we observed that the 5alpha-reductase inhibitor induced apoptosis in epithelial cells (evaluated through cell number positive for terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) as early as 2-3 d of treatment, with a maximal activity (250-fold increase, P < 0.0001) at 6-8 d of treatment. However, after 27-32 d of treatment, the number of apoptotic cells was reduced and was close to control. Caspases-3, -6, -8, and -9 were immunolocalized to (basal and secretory) epithelial cells and to a lesser extent to stromal cells. Activated caspase-3 immunoexpression was restricted to epithelial secretory cells, and its immunostaining intensity appeared to be higher in BPH tissues from patients treated for 2-3 or 6-8 d. Consistently, in Western blotting analyses, activated caspases-3 and -6 were detected as early as 2-3 d of treatment in BPH tissues, and their levels were increased after 6-8 d of treatment. In real time quantitative PCR experiments, caspase-3 and -6 mRNA levels were found to be unchanged after finasteride treatment. Activated caspase-8 was not detected in the different conditions tested, whereas activated caspase-9 protein levels were maximally enhanced after 2-3 d of finasteride treatment. In conclusion, we report here that finasteride treatment of BPH tissues induced a caspase-dependent apoptotic process restricted to epithelial cells by activating effector caspases-3 and -6 and exhibited a transient action because the apoptotic process was no longer observed after 27-32 d of treatment.

Aged↗