PubMed Health⌕ Search

Biomedical subjects

B Debré

Publications and source records attributed to B Debré.

At least 37 records · Page 2Linked to original sources
PubMed1998

Image based renal stone tracking to improve efficacy in extracorporeal lithotripsy.

PURPOSE: We describe a method to reduce the number of shocks necessary to fragment renal stones during extracorporeal shock wave lithotripsy by automatically taking into account stone movements. MATERIALS AND METHODS: Echotrack computer software was developed and implemented on a lithotriptor. One software module uses image processing to detect instantaneous stone location based on ultrasound images generated by the lithotriptor. A second module uses the detected location to control the shock wave generator position, and automatically adjusts it to improve coincidence between the focal volume and stone. The reliability of the tracking algorithm was clinically tested in 65 patients with renal stones. These in vivo tests were qualitative and the goal was to assess software ability to track stones during actual treatments. A quantitative evaluation of the reduction in shocks necessary for fragmentation was performed in vitro. Artificial stones were moved according to computer generated trajectories. Each trajectory was applied once with and once without automatic adjustment of the generator position. RESULTS: The in vivo tests demonstrated software ability to track stones as far as they were visible in the images. During in vitro tests automatic adjustments of the generator position reduced the number of shocks necessary to fragment stones completely by a factor of 1.64. CONCLUSIONS: Image based renal stone tracking software that automatically adjusts the shock wave generator position according to the displacement of renal stones is useful during extracorporeal shock wave lithotripsy. Treatment time was significantly shorter with this software.

Humans↗
PubMed1997

Positive prostate-specific antigen circulating cells detected by reverse transcriptase-polymerase chain reaction does not imply the presence of prostatic micrometastases.

OBJECTIVES: Detection of circulating tumor cells may improve the preoperative local staging of prostate cancers. The aim of this study was to perform enhanced reverse transcriptase-polymerase chain reaction (RT-PCR) of prostate-specific antigen (PSA) mRNA to define the predictive value of PSA-positive circulating cells in a large series of patients. METHODS: The study included 46 patients with Stage T1 to T2 prostate cancer, 94 with benign prostatic hyperplasia (BPH), and 51 (including 9 women) with nonprostatic disease. PSA-positive cells from peripheral blood samples were detected by Southern blot analysis of the RT-PCR products. Original oligonucleotide primers were defined to exclusively detect the three PSA mRNA splices. RESULTS: Circulating PSA-positive cells were observed in 8 (8.5%) of 94 patients with BPH, 10 (22%) of 46 with Stage T1 to T2 prostate cancer, and 9 (17.6%) of 51 with nonprostatic disease. The detection rate of PSA-positive circulating cells was significantly increased in patients with prostate cancer versus patients with BPH (P = 0.03). Among clinically localized prostate cancers with a Gleason score less than 8, a correlation was observed between PSA-positive circulating cells and Stage pT3 cancer (P = 0.038), capsular penetration (P = 0.04), and a positive margin (P = 0.038). The specificity of the assay for Stage pT3 cancer detection was 84.6%, with a positive predictive value of 60%. CONCLUSIONS: Although RT-PCR assay may have a role in preoperative local staging, this study demonstrated the absence of tissue and tumor specificity of PSA-positive circulating cells, accounting for the weak positive predictive value of this technique.

Aged↗
PubMed1997

IL-6 is a survival prognostic factor in renal cell carcinoma.

It has been reported that a high plasmatic concentration of interleukin-6 (IL-6) is correlated to a lack of response to immunotherapy in several malignancies, suggesting that IL-6 was either a marker of tumour aggressiveness or had only a predictive value of response to immunotherapy. To discriminate between these two possibilities, a retrospective study was performed in a series of 19 patients with metastatic renal cell carcinoma who did not respond to IL-2/IFNalpha/5-FU treatment. Serum levels of IL-6, C-reactive Protein (CRP), soluble IL-2-receptor (sIL-2R), M-CSF and neopterin were assayed before treatment. IL-6 showed a significant correlation with patients median survival time (P < 0.016), suggesting that serum concentration of IL-6 before treatment is a marker of tumour aggressiveness rather than a predictive parameter for an immunological response.

Adult↗
PubMed1996

Local staging of prostate cancer by endorectal MRI using fast spin-echo sequences: prospective correlation with pathological findings after radical prostatectomy.

OBJECTIVE: To evaluate the accuracy of endorectal magnetic resonance imaging (MRI) with fast spin-echo sequences in the local staging of clinically localized prostate cancer. PATIENTS AND METHODS: Seventy-one patients with a clinical T1 (18 patients) or T2 tumour (53 patients) underwent endorectal MRI 2-12 weeks before radical prostatectomy. Extraprostatic tumour was diagnosed if MRI showed signs of capsular penetration and/or invasion of the seminal vesicle and/or distal urethra or bladder neck. If the pathological examination showed a single positive margin with no periprostatic tissue, the tumour was classified as indeterminate and not as a T3 tumour. RESULTS: Of the 25 cases of capsular penetration. MRI correctly identified 10 (sensitivity 42%, specificity 100%). Of the 14 cases with seminal vesicle invasion, MRI correctly identified six (sensitivity 43%, specificity 100%), but showed other signs of extraprostatic tumour spread in seven of the eight unidentified cases. Overall, MRI identified 16 of the 30 patients (53%) with occult extraprostatic spread of tumour; there was only one false-positive result. The sensitivity, specificity and accuracy of MRI were 53, 96 and 74%, respectively. CONCLUSION: Endorectal MRI can reduce the rate of preoperative understaging from 42% to 22% and it can be used for a given individual because it can detect extraprostatic invasion with 96% specificity, ensuring that very few, if any, patients will be deprived of curative surgery.

Aged↗
PubMed1996

[Results of endorectal MRI in local staging of prostatic cancer. Correlation with specimens from prostatectomy. Apropos of 47 cases].

Endorectal surface coil magnetic resonance imaging (MRI) was used in the local staging of prostate cancer in 47 patients. We used an 1.5 Tesla General Electric magnet. Fast spin echo sequences were acquired in all cases. All pathological specimen were reviewed by one pathologist. Pathological study showed that 19 patients had a locally confined cancer of the prostate (pT2), and 28 had an extraglandular extension (pT3). MRI correctly predicted a pT3 tumor in 15 of 28 cases, and a pT2 tumor in 18 of 19 patients. MRI was 70% accurate in the differenciation of stage pT2 from stage pT3 cancer. One case was overestimated and 13 cases were underestimated. The latter 13 patients had microscopic extracapsular invasion only.

Aged↗
PubMed1996

[A rare variety of urothelial carcinoma. Apropos of 2 cases].

We report two cases of grade 1 papillary transitional cell carcinoma which have a distinct pathological. The tumor was infiltrating the lamina propria in the first case (pT1) and the superficial muscle in the second case (pT2). These tumors were composed by nests and tubules with few cytological atypias, making the diagnosis of cancer difficult. The prognosis of these tumors is not well defined.

Carcinoma, Transitional Cell↗
PubMed1996

[Electroconductive extracorporeal lithotripsy with Sonolith 4000+. A prospective study of the ECG desynchronization using a fixed-rhythm simulator].

INTRODUCTION: Electrohydraulic lithotripters use a R-wave triggering system as episodes of cardiac arrhythmia were observed during early clinical experiments. This study was designed to assess the safety of non triggered shock wave treatments using an external fixed rate device (120/min) on the Sonolith 4000 Plus (*), a non bathtub electroconductive lithotripter. METHODS: Our study is the first prospective evaluation of non-EKG-gated lithotripsy where the patient under continuous Holter monitoring served as his own control during a randomized alternation of periods with or without R-wave triggering. This design allowed for a direct comparison of the effect of EKG-gated and non-EKG-gated lithotripsy respectively. The sequence of the different periods was randomly assigned. The recordings were compared to a pre-treatment recording, the cardiologist ignoring the randomization. RESULTS: 25 consecutive patients without cardiac history have been treated for urinary stones. Ventricular and supraventricular excitability disorders have been noted in 7 patients, always during a non-EKG-triggered period. There was no correlation with stone location. No cardiac rhythm disturbances have been observed during triggered periods in the 25 patients. Auricular extrasystoles (0.1-0.5/min) were observed in 6 patients, and auricular couplets (0.5/min) in one. Ventricular extrasystoles were noted in 4 patients, and ventricular couplets in one. One patient had an asymptomatic non sustained ventricular tachycardia which resolved spontaneously. No clinically significant disorder occurred. Treatment time and analgesics requirements were reduced by non-EKG-triggering. CONCLUSIONS: Non-EKG-triggering lithotripsy has a definite potential for cardiac disturbances, but appeared to be clinically safe in these patients with no cardiac history.

Adult↗
PubMed1996

[Stress urinary incontinence in women caused by severe sphincter hypotonia. Goebbel-Stoeckel intervention as alternative to artificial sphincter. Apropos of 26 cases treated between January 1985 and January 1994].

Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation. 13 patients were continent (68.4%) in the sling procedure group and 5 in the sphincter group. Continence remained stable with a mean follow-up of 77 months (range: 39-110 months). 2 patients had urgency and none had dysuria. The sling procedure gave us the same results as sphincter with less morbidity.

Adult↗
PubMed1996

[Severe algoneurodystrophy of the right foot associated with prostatic cancer].

The authors report 1 case of particularly severe reflex neurovascular dystrophy whose clinical course was marked by the discovery of a carcinoma of the prostate. There was improvement in the reflex neurovascular dystrophy despite hormonal therapy of the cancer. Reflex neurovascular dystrophy cannot be considered as a form of a paraneoplastic syndrome.

Adenocarcinoma↗
PubMed1995

[Urinary calculi, consisting of dehydrated calcium phosphate. Clinical, biological, radiologic aspects, clinical course and management].

Seventeen cases of urinary calculi analyzed by infrared spectrophotometry were found to be composed entirely or nearly entirely of bihydrated calcium hydrophosphate. The observations are summarized here. This type of stone occurs with a frequency of about 1% (0.85% in our experience) of all urinary calculi, predominantly in men (14 of our 17 cases). Diagnosis is based on the physical and chemical analysis of the stone and on infrared spectrophotometry. Most of these stones are pure or nearly pure compounds. The macroscopic aspect of the stones or fragments of stones can guide diagnosis. These stones are cream coloured stones with a smooth regular outer surface. Broken fragments show the same cream colour, sometimes with strips radiating from the centre of the fracture surface. Radiologically, these stones are homogeneously radio-opaque, often oval-shaped with a regular outline. Blood tests can demonstrate suspected or proven hyperparathyroidism (4 out of 10 cases in our 17 observations) with hypercalcemia, hypophosphatemia and hypercalciuria. Complementary examinations may be needed to search for a parathyroid adenoma. With or without hyperparathyroidism, 24-h urinalysis usually shows hypercalciuria up to ro over 500 to 600 mg/24 h. Crystallization usually occurs in the upper urinary tract, in the bladder or in indwelling catheters. These stones are extremely hard and are difficult to break in vitro. To be successful, lithotripsy requires prolonged treatment: up to 3000 to 6000 shockwaves at 22-23 kv with the Dornier apparatus. Despite the notion of hypercalciuria, the pathogenesis of bihydrated calcium hydrophosphate calculi remains to be elucidated.

Adult↗