Paget's disease of the prostatic urethra revealing a bladder carcinoma.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
B Dufour
Publications and source records attributed to B Dufour.
High-resolution CT of the chest in four patients with pulmonary capillary hemangiomatosis or pulmonary venoocclusive disease.
OBJECTIVE: Clinical differentiation of isolated pulmonary hypertensive arteriopathy from pulmonary capillary hemangiomatosis or pulmonary venoocclusive disease can be difficult on a clinical basis alone. Differentiation is important because misdiagnosis of pulmonary capillary hemangiomatosis or pulmonary venoocclusive disease may lead to severe vasodilator-induced pulmonary edema. The objective of our study was to determine whether high-resolution CT of the chest could distinguish pulmonary capillary hemangiomatosis or pulmonary venoocclusive disease from isolated pulmonary hypertensive arteriopathy. CONCLUSION: Pulmonary hypertension in patients who also have pulmonary capillary hemangiomatosis or pulmonary venoocclusive disease shows characteristics on high-resolution CT that are not seen in patients with isolated pulmonary hypertensive arteriopathy.
Adult↗
[Concurrent radio-chemotherapy in infiltrating cancer of the bladder: a new therapeutic approach?].
Until now, radical cystectomy has been considered the most effective treatment for invasive bladder cancer. However, it fails to cure more than 50% of patients and can result in a mediocre quality of life. In an effort to improve cure rates, combined modality regimens have been investigated. Despite the preliminary results of early clinical trials, randomized trials have most often failed to show any benefit from neoadjuvant or adjuvant chemotherapy or radiotherapy. One of the major progress brought by radiotherapy has been the wide use of conservative treatment in several cancer, and in the recent years promising results with concomitant radiochemotherapy have been published. Use of the conservative approach in bladder cancer now appears to be a tangible reality for selected patients, but these combined modalities have not yet been tested in randomized trials.
Antineoplastic Combined Chemotherapy Protocols↗
A proposed classification of veterinary epidemiosurveillance networks.
With the signing of the General Agreement on Tariffs and Trade and the establishment of the World Trade Organisation, the trading environment for animal products has changed. Disease control measures can no longer be applied as trade barriers unless supported by scientific epidemiological data. In this context, it has become necessary, if not obligatory, to gain accurate and up-to-date knowledge about the epidemiological status of important infectious animal diseases. The role of veterinary epidemiosurveillance networks is therefore gaining importance. Furthermore, epidemiosurveillance contributes to the protection of animal populations from exotic or emerging diseases, as well as to the development and evaluation of disease control programmes. Despite the large diversity of surveillance networks, the authors propose a method of network classification. The criteria for classification are as follows: the type of disease being monitored (i.e., surveillance of exotic versus endemic diseases). The number of diseases concerned (i.e., focused networks versus broad-based networks). The area being covered (i.e., local, national or international networks). The population being monitored (i.e., whether the network is targeted at suspect or susceptible animals). The sampling strategy of the network (i.e., sample-based networks versus exhaustive networks). The method of collecting data (i.e., passive data collection versus active collection). The type of network management (i.e., autonomous management versus that which is integrated with other programmes). This classification is discussed and illustrated by examples published in the literature. It may aid in the future development of a grid for the evaluation of veterinary epidemiosurveillance networks.
Animals↗
[Ambulatory treatment and prevention of priapism using alpha-agonists. Apropos of 172 cases].
From 1985 to 1995, 172 patients (149 on self intracavernous injection of vasoactive drugs, 16 with Sickle cell disease, 6 surgical patients under heparin therapy, and 1 after oral administration of trazodone), having experienced one or several episodes of priapism, lasting from 3 h to 8 days have been treated or submitted to self medication with alpha-agonist agents (eprephrine, phenylephrine or etilefrine) with an eventual drainage of the corporae. All episodes have disappeared and sexual function was preserved. A conservative treatment of priapism has been designed using corporal drainage and intracavernous etilefrine for acute priapism; as well as preventive treatment for those of the patients exposed to Sickle cell disease to avoid surgery and its frequent fribrotic sequelae, leading to impotence in 50% of the cases.
Adolescent↗
[Comparison between spiral x-ray computed tomography and endosonography in the diagnosis and staging of adenocarcinoma of the pancreas. Clinical preliminary study].
OBJECTIVE: To determinate in a retrospective clinical study the benefit of helical-CT for the diagnosis and staging of pancreatic carcinoma compared with endoscopic ultrasonography. METHOD: Results of helical-CT and endoscopic ultrasonographic investigations relative to 24 cases of histologically proved adenocarcinoma were reviewed. The criteria studied were: a) existence of a pancreatic mass, b) diagnosis of malignancy, c) existence of vascular involvement, d) lymph node involvement. Statistical analysis (binomial test) was performed in 24 patients for the assessment of mass and malignancy and in 10 patients for the assessment of vascular involvement (9 patients who underwent surgery and one patient with a positive arteriography). RESULTS: For diagnosis of pancreatic mass both methods were equivalent: 91.5% (22 cases out of 24) for helical-CT and 87.5% (21 cases out of 24) for endoscopic ultrasonography. Two pancreatic masses were seen only with endoscopic ultrasonography. Their size was under 3 cm. Two of the 3 masses not seen with endoscopic ultrasonography were infiltrative lesions measuring more than 3 cm. Helical-CT was significantly superior to endoscopic ultrasonography for the diagnosis of malignancy (96% vs 71%) (P = 0.035). The accuracy of helical-CT for vascular involvement was significantly superior to endoscopic ultrasonography (90% vs 40%) (P = 0.031). Endoscopic ultrasonography underestimated vascular involvement in 5 cases: mesenterico-portal confluence (3 cases), superior mesenteric artery (2 cases). In the 6 cases with histologically proved lymph node involvement, endoscopic ultrasonography (6 correct assessments) was superior to helical-CT (3 correct assessments). CONCLUSION: This study confirms the complementarity of helical-CT and endoscopic ultrasonography for the diagnosis of pancreatic carcinoma. It suggests that helical-CT is superior to endoscopic ultrasonography for diagnosis of malignancy and assessment of vascular involvement and endoscopic ultrasonography is superior to helical-CT for diagnosis of lymph node involvement. These preliminary results have to be confirmed by a prospective study including a large number of patients with surgical correlation.
Adenocarcinoma↗
[Treatment of von Hippel-Lindau disease with renal involvement].
OBJECTIVE: To try to define when and what type of operation should be performed in von Hippel-Lindau disease (VHL) with renal involvement. MATERIAL AND METHODS: Between 1985 and July 1996, 43 patients with renal involvement of VHL disease were followed in our department. We decided to operate on patients with one or several solid or complex tumours greater than 2.5 cm in diameter, by means of conservative surgery (tumour excision removing a layer of healthy parenchyma) when the kidney did not contain more than 5 or 6 tumours or radical nephrectomy in the other cases. Subsequent follow-up consisted of CT, chest x-ray and renal function tests every 6 months. RESULTS: Twenty-nine patients with a mean age of 33.6 years were operated. 21 patients (29 kidneys) were treated by conservative surgery: in situ in 20 cases and ex vivo in 9 cases; 3 cases were treated by bilateral radical nephrectomy, 4 by unilateral radical nephrectomy and 1 by resection of the prominent dome for urinary tract obstruction. Four cases of acute arterial thrombosis were observed following ex vivo surgery, requiring nephrectomy in every case. No serious complications were observed with in situ conservative surgery. A new lesion in the renal parenchyma remaining after conservative surgery was observed in 5 cases during follow-up (mean: 29 months). No local recurrence was observed after radical nephrectomy. Two nonoperated patients developed metastatic disease. CONCLUSION: Conservative treatment is usually possible: either simple surveillance, in the absence of any solid or complex tumours larger than 2.5 cm in diameter, or conservative surgery for tumours larger than 2.5 cm in diameter, with no more than 6 tumours per kidney; this attitude requires six-monthly follow-up by CT of the renal parenchyma.
Adenocarcinoma↗
Phase II study of the oral cyclophosphamide and oral etoposide combination in hormone-refractory prostate carcinoma patients.
BACKGROUND: Hormonotherapy temporarily controls symptoms in 80% of patients with metastatic prostate carcinoma. Once progression occurs, no consensus exists on further therapy. Oral etoposide (VP-16) has shown clinical efficacy in advanced small cell lung carcinoma, breast cancer, germ cell tumors, and lymphomas, A synergistic effect between etoposide and alkylating agents such as estramustine was recently reported. We began a prospective Phase II study of an oral combination of cyclophosphamide (CPM) and VP-16 in patients with hormone-refractory [correction of refactory] prostate carcinoma (HRPC). METHODS: Patients were orally treated with CPM (100 mg/day) and VP-16 (50 mg/day) for 14 days every 28 days. Therapy continued until there was evidence of disease progression. RESULTS: From November, 1992, to February, 1995, 20 patients with HRPC were entered into the study. Patients were eligible if they had an ECOG performance status (PS) of 0 to 2. All of the patients presented with bone metastasis, and 70% presented with bone pain. Seventy-five percent had failed at least two hormonal manipulations. The mean duration of treatment was 5 months (range 2-12). Performance status improved in 26% of the patients, and bone pain was relieved in 71%. An objective response was defined as a decrease of 50% or more in the prostate-specific antigen (PSA) level. One patient demonstrated a complete response, and six patients had partial responses assessed by PSA plasma levels (objective response rate: 35%). The mean duration of response was 8 +/- 6 months (range: 2-24). Median survival was 11 months. Toxicities were minimal. CONCLUSIONS: The combination of oral CPM and VP-16 may be an active and well tolerated regimen for patients with HRPC.
Administration, Oral↗
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↗
Interleukin-2 in outpatients with renal cell carcinoma: SCAPP1 trial.
Explore the source record for details and available documents.
Adult↗
Subcutaneous recombinant interleukin-2 (rIL-2) in out-patients with metastatic renal cell carcinoma. Results of a multicenter SCAPP1 trial.
BACKGROUND: This multicenter phase II trial was conducted in order to evaluate the efficacy and toxicity of the subcutaneous route of administration of rIL-2 in the treatment of patients with metastatic renal cell carcinoma and to check whether an increased cumulative dose of rIL-2 increases efficacy. PATIENTS AND METHODS: Thirty-nine patients with metastatic renal cell carcinoma were included in this study. During the induction period, rIL-2 was administered subcutaneously 5 days a week for 8 weeks. The weekly dosages were 90 MIU during weeks 1 and 6;63 MIU during weeks 2 to 4 and 7 to 9. After evaluation, responders and patients with stable disease received maintenance treatment which was discontinued upon the appearance of disease progression or unacceptable toxicity. During the maintenance period, rIL-2 was administered 5 days a week for 4 weeks followed by a 2-week rest period. The weekly dosages were 90 MIU in week 1 and 63 MIU in weeks 2 to 4. RESULTS: After completion of induction treatment, 7 of 39 evaluable patients (18%) had objective responses (95% CI: 9% to 37%) with one complete response. Treatment was interrupted or reduced due to toxicity for seven patients: Neuropsychiatric symptoms (3 patients), joint pain (1 patient), major asthenia and anorexia (1 patient), stroke (1 patient), and septicemia (1 patient). Other systemic side effects in the remaining patients were acceptable. Seventeen patients received maintenance treatment. In none of the patients did the response status improve during this maintenance period. The median follow-up of all of the patients included was 19 months. The one- and two-year survivals were 65% and 33%, respectively, ad the median duration of response was 11 months (5 to 16+). CONCLUSIONS: This multicentric study confirms the efficacy of subcutaneously-administered rIL-2 in patients with metastatic renal cell carcinoma in terms of both response rate and survival. The role of a maintenance therapy needs further evaluation.
Adult↗
Postoperative radiation therapy in 26 patients with invasive transitional cell carcinoma of the upper urinary tract: no impact on survival?
PURPOSE: To evaluate the role of adjuvant radiation therapy in invasive transitional cell carcinoma of the upper urinary tract, we retrospectively reviewed a series of 26 patients who underwent radical surgery plus postoperative prophylactic irradiation for such a tumor. MATERIALS AND METHODS: Between February 1980 and October 1993, 18 men and 8 women (mean age 65 +/- 9 years, standard deviation) were treated for an invasive transitional cell carcinoma of the upper urinary tract. Tumor location was the renal pelvis in 15 patients (58%). The tumor was pathological stage B in 11 patients (42%) and stage C in 15 (58%). Tumor grade was 2 in 10 patients, 3 in 15 and unknown in 1. One patient had epidermoid metaplasia of urothelial cancer and 9 had node involvement. All patients underwent surgery followed by radiation therapy to a total dose of 45 Gy. to the tumor bed (23) and/or regional nodes (18). RESULTS: After a mean followup of 45 months 13 patients (50%) were alive and 11 were disease-free at analysis. Local tumor relapse, nodal recurrence and metastasis were noted in 1, 4 (15%) and 14 (54%) patients, respectively. All patients with nodal recurrence had metastasis. A secondary location was noted frequently (6 bladder, 1 contralateral renal pelvis and 1 urethral tumors). Overall 5-year survival rate and 5-year survival rate with no evidence of disease were 49% and 30%, respectively. Overall 5-year survival rates were 60% for stage B and 19% for stage C disease (p = 0.07), 49% for node-negative versus 15% for node-positive cancer (p = 0.04), and 90% for grade 2 and 0% for grade 3 tumors (p < 0.01). CONCLUSIONS: In our trial using a radio-surgical approach, local control of disease and survival rates were similar to those reported previously in surgical series. Prophylactic postoperative radiation therapy is not recommended except in prospective randomized studies.
Aged↗
[Infiltrating cancer of the bladder: can radiochemotherapy be an alternative to cystectomy?].
In order to improve the results obtained by cystectomy alone and to determine the possibilities of conservative treatment in invasive bladder cancer, we designed a prospective study using a combination of 5-FU--Cisplatin and concomitant radiation therapy, followed either by cystectomy or additional chemoradiotherapy. Sixty six patients (pts) with T2-T4 operable untreated invasive bladder cancer were entered into the study. Treatment was begun in all patients by trans-urethral resection (complete in 30 pts) and followed by 5-FU-Cisplatin combination with concomitant bifractionated split course radiation therapy. The neo-adjuvant irradiation dose was 24 Gy delivered in 8 fractions over 17 days, according to a modified bifractionated split course schedule. Each fraction delivered 3 Gy, twice on day (D1, D3, D15 and D17. The patients received concomitant Cisplatin (15mg/m2/d) and 5-FU (400mg/m2/d) on day D1, D2, D3 and D15, D16, D17. A control cystoscopy was performed six weeks after completion of the neoadjuvant program. Patients with persistent tumor underwent cystectomy. Complete responders were treated either by additional chemoradiotherapy (group A) or cystectomy (group B). At control cystoscopy, 51 of the 66 patients (77%) had histologically documented complete response. Among the 51 patients with complete tumor regression 31 were treated by conservative chemoradiotherapy and 20 underwent cystectomy. With a mean follow-up of 35 months, five responders developed recurrent pelvic disease (4/31 in group A and 1/20 in group B). Metastatic disease, which developed in 22 patients, occurred more frequently in the non responders (93%) than in responders (16%). Disease free survival at 5 years was 51%; it was significantly better in responders than in non responders. There was no difference in survival between groups A and B. This neoadjuvant chemoradiotherapy combination, easy to implement and well-tolerated even in elderly patients, provides a high CR rate. It may prove to be effective in inoperable patients and may be proposed as conservative treatment in patients with a complete response to the initial course of chemoradiation.
Adult↗
[Infiltrating cancer of the bladder. Is concomitant radiochemotherapy an alternative to cystectomy?].
Infiltrating bladder cancer is an extremely severe condition causing death within 5 years due to metastatic extension in one-half of the patients whatever the treatment. It is well known that radiotherapy is successful in treating some patients while partial exeresis (open surgery or laparoscopic surgery) is effective in others. Current chemotherapy protocols (usually well-tolerated) increase the efficacy of radiotherapy but it is surprising that over the last 10 years, total cystectomy has become the first line treatment proposed for patients with infiltrating bladder cancer. The operation is a major procedure leading to an important morbidity and mortality. Since 1988, we have decided not to rely on total cystectomy for such patients, but rather to use a treatment protocol associating endoscopic exercise of the tumour and radiochemotherapy. Our results allow confirmation that this protocol can provide curative treatment in certain cases without removing the entire bladder. We thus suggest that systematic amputation of the bladder for cancer is an obsolete procedure and raise the question as to the usefulness of total cystectomy in this disease?
Adult↗
[Value of postoperative radiotherapy in malignant tumors of the upper urinary tract. Apropos of a series of 26 patients].
To evaluate the role of adjuvant radiation therapy in invasive transitional cell carcinoma of the upper urinary tract, we retrospectively reviewed a series of 26 patients who underwent radical surgery plus post-operative prophylactic irradiation for such a tumor. Between 1980 and October 1993, 18 men and eight women (mean age: 65 +/- 9 years) were treated for an invasive transitional cell carcinoma of the upper urinary tract. Tumor location was the renal pelvis in 15 patients (58%). The tumor was pathological stage B in 11 patients (42%) and stage C in 15 patients (58%). Tumor grade was 2 in ten patients, 3 in 15 and unknown in one. Nine patients had node involvement. All patients underwent surgery followed by radiation therapy to a total dose of 45 Gy to the tumor bed (23 patients) and/or regional nodes (18 patients). After a mean follow-up of 45 months, 13 patients (50%) were alive and 11 were disease-free. Local tumor relapse, nodal recurrence, metastasis and second urothelial location were noted in one, four (15%), 14 (54%) and eight patients (30%) respectively. Overall 5-year survival and 5-year disease-free survival were 49% and 30% respectively. Overall 5-year survival rates were 60% for stage B and 19% for stage C disease (P = 0.07), 43% for node-negative versus 15% for node-positive cancer (P = 0.04) and 90% for grade 2 and 0% for grade 3 tumors (P < 0.01). In this study using a radio-surgical approach, local control of disease and survival were similar to those reported previously in surgical series. Prophylactic post-operative radiation therapy is not recommended.
Adult↗
[Zonal anatomy of the prostate using endorectal MRI].
The development of an endorectal surface coil now permits a partial study of the anatomical model developed by McNeal. Axial and coronal views, which were used to establish the model can be obtained in a short period of time with fast spin echo sequences. Axial views are performed along the proximal urethra and coronal views are performed along the axis of the distal urethra and the ejaculatory ducts. Anatomical boundaries of the transitional zone are well delineated on axial views, illustrating the concept of "inner gland". The prostatic capsule and the neuro-vascular bundles, pathways of extension of the cancer out of the prostate are also well delineated. Coronal sections allow a very good anatomical study of the caudal junction of the vas deferens and the seminal vesicles (the so called weak space), pathway of tumor extension to the seminal vesicles. Differences in signal of the prostatic zones make the outer gland cancers very conspicuous as well as some transitional cancers which can show, in some cases, an homogeneous hyposignal.
Humans↗
[Vaccination in the sanitary and economic context of animal production].
Explore the source record for details and available documents.
Animal Husbandry↗
[Pyelo-ureteral junction syndrome. Diagnosis].
Explore the source record for details and available documents.
Adult↗