Biomedical subjects

B Doré

Publications and source records attributed to B Doré.

At least 37 records · Page 2Linked to original sources

PubMed1995

[Treatment of renal and ureteral lithiasis].

The advent of extracorporal shock wave lithotripsy has entirely changed management of patients with renal or ureter calculi. It is indicated in all types of calculi and generally used as first line treatment. Contraindications are exceptional: pregnancy, uncorrectable coagulation disorders. For staghorn calculi in the kidney, lithotripsy alone is only effective in 50% of the cases and is often completed or preceded by percutaneous nephrolithotomy. Classical surgical procedures may be required in complex cases. Success rate (complete stone free with none residual) with lithotripsy is higher for pelvic stones (70%) and small residual fragments are usually asymptomatic and rarely infected. There is still some debate over indications for ureteral calculi although use of in situ lithotripsy with an ureteral probe. The ureteroscopy is more effective for stones in the distal ureter. In all cases, the final factor in the management decisions is cost-effectiveness.

Cost-Benefit Analysis↗

PubMed1995

[Hot flushes in men after surgical or pharmacologic castration].

Hormone therapy for prostate cancer is associated with a number of adverse effects including hot flushes, which constitute a significant problem as they sometimes interfere with everyday life. Every effort must be made to relieve patients complaining of this symptom. Several different therapeutic modalities are proposed.

Androgen Antagonists↗

PubMed1995

[Tumors of the Bellini collecting tubules. Apropos of a case].

Based on a personal case and a review of the literature, the authors describe the particular features of renal tumours arising from the papillary ducts of Bellini. The most remarkable feature of this rare lesion, which has a very poor prognosis, is that it arises in the medullary zone of the kidney. The histological diagnosis is often difficult to confirm and immunohistochemical techniques are essential. The possible role of adjuvant chemotherapy following nephrectomy and the type of regimens used are discussed.

Adenocarcinoma, Clear Cell↗

PubMed1995

[Simplified vesico-urethral anastomosis after radical retropubic prostatectomy for cancer. A preliminary comparative study].

The authors have done a prospective non randomized study to compare two methods of radical retropubic prostatectomy, without bladder neck preservation (Group 1 = 30 patients) or with bladder neck preservation (Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure. A comparative urodynamical study was performed with each group. Selection for one or the other technique was made by the personal choice or every surgeon. Results were similar for pre operative clinical staging, Gleason score with both groups. There was no significant difference in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no difference between the 2 groups regarding operative time, blood loss, urethral catheterization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative transfused blood units in the Vest suture group (p < 0.001). There were no positive margin on the preserved bladder neck in group 2, even if there was finally an understaging or another apical positive margins. Complications were not significantly different in the two groups with 10 bladder neck strictures in the group 1 (33%) and only 2 in the group 2 (14.2%) (NS). Complete continence rate was 73.3% and 64.2% respectively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both were similar but there was a tendency to a higher urethral pressure in group 2. Comments pointed out that bladder neck preservation and simplified Vest traction suture did not give more post operative nor carcinological complications than classical technique with direct separate stitches sutures. Disease progression, continence and bladder neck stricture rates were compared to literature. The urodynamical results were the same as those observed by others studies.

Aged↗

PubMed1995

[Experimental study of urinary calculi fragmentation with pulsed laser shockwave, based on their chemical composition].

OBJECTIVES: To attempt to classify the resistance of urinary calculi to shock waves according to the chemical composition of the calculi most frequently treated in clinical practice. METHOD: Seventy four urinary calculi obtained after surgery were submitted to shock waves produced by an experimental neodyme glass phosphate pulsed laser, at a frequency of 532 nanometres, delivering impulses of 4.8 Joules lasting 25 nanoseconds with a recurrence of 1 second. The calculi (25 homogeneous: 90% of one constituent, 49 heterogeneous: > 45% < 90% of one constituent) had to be fragmented down to 2 mm fragments. The total fragmentation energy (TFE) required was the parameter adopted to classify calculi and to compare the fragmentation of various chemical compositions studied by infrared spectrophotometry. The TFE of 25 homogeneous calculi were compared to a microhardness study performed on calculi with the same chemical composition. The fragmentation thresholds energy (TFE) was used to compare the fragmentation thresholds of each type of calculi. Statistical analysis by ascending multiple regression was performed to classify the various factors likely to influence fragmentation. RESULTS: Two groups were able to be significantly distinguished according to whether the TFE required to obtain 2 mm fragments was greater than 200 Joules (cystine, weddellite, brushite, uric acid) or less than 200 Joules (weddellite, carbapatite, struvite). Only cystine and whewellite significantly increased the fragmentation threshold. For the 125 homogeneous calculi, the correlation with microhardness demonstrated an inverse relationship between friability and increased microhardness. A crossover between microhardness and friability to shock waves was only observed for whewellite and cystine. For the 49 heterogeneous calculi, this study showed that when weddellite was the predominant component of a stone, the friability tended to increase. Struvite and whewellite significantly facilitated and decreased fragmentation of heterogenous calculi, respectively. CONCLUSIONS: This study allowed urinary calculi to be classified into three groups: friable (weddellite, carbapatite, struvite), intermediary (brushite, uric acid, whewellite) and resistant (cystine). Although this laser cannot be used clinically, the constants were similar to those of pulsed lasers available in clinical practice and the results of the study corresponded to those already observed empirically by other teams or observed experimentally on a single stone corresponding to each type of chemical composition. The clinical application of this study would be to prospectively compare the results with those observed in clinical lithotripsy.

Humans↗

PubMed1995

[Results of extracorporeal lithotripsy with ultrasonography-guided hydroelectric lithotriptor: study on 546 patients, prognosis factors].

OBJECTIVE: To investigate the existence of simple radiographic prognostic criteria, applicable on an outpatient basis, predictive of the result of extracorporeal lithotripsy (ECL). METHODS: This study was based on 546 patients treated by ECL using a hydroelectric apparatus. The results were evaluated on plain nephrotomographies and ultrasonography performed at the third month. Success was defined as the elimination of all residual fragments, regardless of their size, without fragments (WF). Analysis concerned 485 files after exclusion of patients lost to follow-up. Prognostic factors were evaluated criterion by criterion, and then by multiple ascending regression multivariate analysis. RESULTS: The fragment-free rate according to our criteria was 57.5%. Significantly poorer results were obtained for stones denser than bone (p < 0.001), smooth (p < 0.001, larger than 12 mm (p < 0.01), situated in the inferior calyx (p < 0.005), despite an increased (p < 0.005) number of ECL sessions and the number of shocks received. A correlation was established between the radiographic appearance of the stone, its predominant spectrophotometric nature (> or = 50%) and the results of ECL. Good results were obtained in 65% of spiculated, low-density Weddellite stones versus 41% of cases of dense, smooth Whewellite stones. Multivariate analysis of the predominant radiographic appearance of the stones showed that spiculated, low-density stones were completely eliminated in 79.4% of cases, and dense, smooth stones were completely eliminated in 33.6% of cases (p < 0.001). CONCLUSION: In this study, smooth, dense stones larger than 12 mm, situated in the inferior calyx appear to be particularly resistant to ECL. On the basis of this result, the authors propose a prospective clinical trial to compare the results of ECL and primary percutaneous nephrolithotomy in this type of stone with a high risk of failure.

Adolescent↗

PubMed1995

[Multiple myeloma of the testis].

The testis is a rare site of multiple myeloma. The authors report such a case in a patient with a 7-year history of multiple myeloma. Transinguinal castration was performed. Six months after the operation, the patient did not have any other extramedullary sites, but the disease progressed rapidly with diffuse bone pain and end-stage renal failure. The diagnosis and management are discussed in the light of a review of the literature.

Humans↗

PubMed1993

[Percutaneous nephrolithotomy after failure of extracorporeal shockwave lithotripsy. Indications, results, perspectives].

Eighty-one of the 579 extracorporeal lithotripsies (ECL) performed between 1987 and 1992 with an ultrasound-guided hydroelectric lithotriptor required the use of another treatment modality. 53 percutaneous nephrolithotomies (PCNL) were performed in these 81 patients after failure of ECL (21 for non-fragmentation, 32 for residual fragments). The authors analyse the factors responsible for failure in order to select the more appropriate type of treatment for different types of stones. The site of the stones, their size, their radiographic appearance, their chemical composition, the number of ECL sessions and the number of days spent in hospital were compared between the PCNL and ECL groups. Smooth, homogeneous stones denser than bone and larger than 15 mm in diameter were significantly more resistant to ECL, despite an increased number of shock waves. PCNL was successful in 92% of cases of non-fragmented stones (with no residual fragments). The success rate for multiple residual fragments was 64%. In view of the risk of complications associated with residual fragments, regardless of their size, the potential risks of ECL and cost imperatives, the authors recommend that these stones, considered to be resistant, should be treated immediately by PCNL, as the results of PCNL after ECL are less satisfactory.

Adult↗

PubMed1993

[Ectopic ureteral orifice into the seminal duct with homolateral renal agenesis: contribution of ultrasonography].

Based on an incidental case of ectopic ureteric orifice in the seminal tract associated with homolateral renal agenesis, the authors demonstrate the value of ultrasonography, particular transrectal, both for diagnosis and follow-up. Digital rectal examination is the key to the diagnosis, combined with ultrasonography and urography. The indications for surgery depend on the clinical symptoms and signs.

Abnormalities, Multiple↗

PubMed1990

Carcinoma of the penis in lichen sclerosus atrophicus. A case report.

Three cases of glans penis epidermoid carcinoma after lichen sclerosus et atrophicus (LSA) or balanitis xerotica obliterans are discussed. Relationships between both diseases are analyzed but remain unclear. Balanitis xerotica obliterans causes foreskin and urethral meatus stenosis that requires circumcision. Glans penis carcinoma can be observed many years later even after circumcision. The knowledge of LSA is important to do circumcision at the beginning of the disease with a long-term follow-up of these patients to realize a glans penis biopsy if necessary. Most cases of LSA are not recognized, and the frequency is higher than reported.

Balanitis↗

PubMed1990

[Effect of the chemical nature of urinary calculi on the results of extracorporeal shockwave lithotripsy].

137 patients were treated by ESWL with a Sonolith 2000 lithotriptor using ultrasonography localization. 132 patients were eligible for review. Calculi were caliceal in 85 cases, pelvic in 51 cases, in the upper ureter in 1 case; 26 stones were treated by the "push and bang" technique with ureteric stent. Fragmentation rate was 83.9% and stone free rate at 3 months was 68.5%. Failure cases were reviewed: non fragmentation (16.1%) and insufficient fragmentation (15.6%): 14 calculi were analysed by infra red spectrophotometry and correlated with radiodensity on pre ESWL plain X-ray. Hardness and friability criteria were described. Calculi with different radiographic appearances respond differently to shock wave fragmentation. Some stone compositions such as calcium oxalate monohydrate pure or mixed with apatite and calcified uric acid are difficult to break by ESWL. These calculi represented almost 30% of the series. Another treatment should be proposed to improve the results of ESWL.

Adolescent↗

PubMed1990

[Wegener's granulomatosis with urethral-penile location. Apropos of a case].

The authors report a case of Wegener granulomatosis presenting as a necrotizing urethral tumor in a 44 year-old man. Involvement of the urethra by Wegener granulomatosis in unusual which explains the delay in diagnosis particularly when the urethral localization is isolated. The prognosis is severe despite urinary diversion and appropriate therapy. Five cases from the literature are reviewed. Prednisone and cyclophosphamide therapy for Wegener granulomatosis now gives dramatic results, but an urethral localization could occur in the subsequent course of the disease with the same severe prognosis.

Adult↗

PubMed1989

Bilateral traumatic renal artery rupture: emergency surgical repair and long-term evolution.

In one case of bilateral traumatic renal artery rupture, the role of clinical and radiographic explorations is discussed to reduce the duration of renal ischemia. The diagnosis of bilateral traumatic renal artery rupture requires the performance of pyelography if the patient is oliguric or exhibits microscopic hematuria, or of conventional aortography if there is no renal secretion. Renal artery repair must be done as soon as possible, but a review of the literature shows that delay in treatment is not rare. Everything must be done to reduce this delay in order to improve renal function after surgery.

Adult↗

PubMed1989

[Penile metastasis disclosing cancer of the rectum. Apropos of a case].

A case report of penile metastasis from a rectal cancer in a 58 year old man is described. The authors insist on the rarity of this penile metastatic localization. Many primary tumors can be involved in this penile localization, mainly urinary tract tumors such as bladder or prostate, but rectal cancer is very rare and only 47 cases have been reported to date. The modalities of extension are analysed: direct invasion or venous extension. The prognosis of such metastases is very poor, but some long-term survivals (from 21 months to 9 years) have been seen after aggressive surgical treatment when the primary tumor was rectal cancer. Radiotherapy and are not effective.

Adenocarcinoma↗

PubMed1988

[Is the Gil-Vernet advancement procedure for reflux legitimate? Considerations apropos of 22 cases in adults and children].

We discuss 22 patients who have undergone surgical antireflux plasty with Gil-Vernet's technique. In 19 patients, success was obtained with an average follow-ip of 12 months. In 3 cases, a persistent reflux remains and the children have not been reoperated. This technique is very simple and has a number of advantages, such as bilateral simultaneous correction of reflux, without any lower ureteral dissection. Subsequent ureteral catheterisation is easy which is important for any further ureteroscopy. Nevertheless, a longer follow-up has to be studied to be sure of the reliability, of the technique in comparison with older but safe techniques such as Cohen's advancement.

Adolescent↗

PubMed1987

[Contusion on horseshoe kidney. Apropos of 2 cases].

Based on the personal observation of two cases and a series of 40 patients reported in the literature, the specific problems related to injuries to horseshoe kidney are evoked. The first case involved crushing of the isthmus against the spine recognized at operation on the 5th day and suggested by urography, CT scan and arteriography data. Abstention from surgery in the second case was decided on initial urography and ultrasound findings and the rapid, spontaneously favorable course. A literature review failed to provide much original data related to the anatomical anomaly, too frequently detected during emergency surgery. The only particularity is related to rupture of isthmus which may damage upper excretory pathways; this explains the interest for the authors of pyelostomy in case of conservative surgery in this context. When surgery is indicated this should be reserved to severe forms and postponed. It is important to carry out arteriography in addition to urography and a CT scan because of the particularity of the vascularization of this type of kidney: the anterior transperitoneal approach appears to be the best adapted.

Adult↗

PubMed1986

[Resection of the inferior vena cava and tumor of the excretory duct: diagnostic and prognostic problems].

The authors present a case of transitional cell carcinoma of the renal pelvis with inferior vena cava involvement. Two types of vena cava involvement are discussed: thrombus or nodes. The CT scan appears to be the best examination to preoperatively diagnose the type of invasion in order to be able to select the optimal treatment. However, these two types of involvement have a poor prognosis and surgery abstention may be justified. Chemotherapy may be useful in these cases.

Adult↗

PubMed1986

[Parotid metastases of clear-cell adenocarcinoma of kidney. Apropos of 2 cases].

Two patients presented parotid metastases from adenocarcinoma of kidney. These metastases are rare and may reveal or develop during the course of a cancer of kidney. In the former case diagnosis presents certain difficulties. Treatment of single metastases is by parotidectomy and nephrectomy, prognosis being similar to that of the renal adenocarcinoma.

Adenocarcinoma↗