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Biomedical subjects

B Giraud

Publications and source records attributed to B Giraud.

At least 19 recordsLinked to original sources
PubMed1992

Prostate cancer treated by radiotherapy: a multivariate study.

According to respective proportions of evolutive status groups, results of multivariate studies are difficult to interpret. Among the 1099 cases of local form of prostate cancer, treated by radiotherapy from 1975 to 1982 in 16 French Anticancer Institutes, we can observe two homogeneous status groups of patients: disease-free survivors (285 cases) and patients who died of prostate cancer (278 cases). These correspond to 51% of the whole population. Among other things, they are comparable in size, for age at the beginning of radiotherapy and for delay between histologic diagnostic and radiotherapy. We chose to analyse them using multivariate analysis. To take survival into account, we used a Cox model and Kaplan-Meier curves; the group deceased of prostate cancer was further analyzed by a tree-structured regression method. The Cox model and the Kaplan-Meier curves confirmed two main explicative factors: Stage (p < 0.0001) and tumor grade (p < 0.001). Poorer evolution occurs in extracapsular forms and grade I has better survival than others. The tree-structured regression method indicates two other pejorative factors: hormonotherapy prior to radiotherapy and the presence of cardiovascular pathology. Though the pelvic dose does not appear to be a main explicative factor, it seems to improve survival and delay between radiotherapy and recurrence or metastasis in some categories of cases. Other factors such as tumor dose, age and delay between diagnosis and radiotherapy were not found to be significant. These results cannot be extended to the whole population for which they do not constitute a predictive study. We consider them as "baseline data".(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Interstitial iridium-192 for bladder cancer (a multicentric survey: 205 patients).

Interstitial irradiation is a technique currently used in the treatment of bladder cancer. We report the data on 205 patients (177 men and 28 women) treated in eight French centers. The patients had received the following treatment: a short course of pre-operative pelvic irradiation, followed by surgery consisting of partial cystectomy or tumor resection, and implantation of plastic tubes filled with inactive lead wires, which were replaced by iridium 192 wires. The tumor characteristics were: transitional cell carcinoma, 88.8%; mean size of the tumor, 29 mm; pathological stages: pTis, 1; pT1, 98; pT2, 66; pT3a, 26; pT3b, 9; pT4, 1; unknown, 4 respectively; surgical lymph node status: N+, 3; N-, 118; no node dissection, 84. The mean follow-up was 51 months. Intravesical failures were seen in 35 patients (17.0%), 25 (71.4%) of them without metastases or regional recurrences. Twenty-one patients (10.2%) presented distant metastases, 2/3 of them suffered no bladder relapse. The 5-year survival, calculated according to the Kaplan-Meier method (all causes of death taken together) was 77.4% for the T1, 62.9% for the T2, and 46.8% for the T3. Fifty-three patients had immediate side-effects and three died from surgical complications. Twenty-nine patients had delayed bladder side-effects (haematuria, fistula, chronic cystitis). Six patients presented an ureteral stenosis. Of the disease-free survivors, 96.1% retained the bladder function. Three factors were significantly predictive of delayed side-effects: partial cystectomy, pre-operative radiotherapy total dose, and linear activity of the wires (p < 0.01). Comparing our results to different authors' series interstitial irradiation is likely to provide a high local and general control of the disease and good quality of life in patients with selected tumors.

Adenocarcinoma↗
PubMed1991

Prevention of radiation enteritis by an absorbable polyglycolic acid mesh sling. A 60-case multicentric study.

Radiation-induced small bowel injury is a limiting factor to postoperative tumoricidal pelvic doses exceeding 4500 to 5000 cGy. Data from a review of the literature showed the inadequacy of medical measures and the bad reproducibility of radiation therapeutic attempts to decrease small intestine damage. Recent studies cited the benefit of a polyglycolic acid mesh to create an absorbable intestinal sling and suspend the loops above the pelvic radiation field. In 60 cases of gynecologic and rectal malignancies with a surgical intestinal morbidity of 8.3% (5 cases), the rate of radiation enteritis was 7% (4 cases) with an average follow-up of 17.8 months (range, 1 to 57 months). The quality of small intestinal elevation and the absence of loop herniation were demonstrated by the barium index. Magnetic resonance imaging was used for checking the polymer polyglycolic acid mesh position and its complete resorption at the third to fifth postoperative month. The authors conclude that this new procedure is safe in selected patients with high pelvic recurrence risk after optimal surgery, in residual disease after debulking surgery, or at the time of exploration for unresectable pelvic tumors. Clinical studies are ongoing to evaluate the long-term efficacy of this surgical technique to prevent chronic radiation enteropathy and improve locoregional control in advanced pelvic carcinomas.

Adult↗
PubMed1991

[Drainage of the upper urinary tract in gynecologic cancers with renal involvement].

Urinary tract obstruction often occurs during the evolution of gynécologic malignancies and its management should be carefully taken in account during treatment of the primary tumor. Authors' experience is based upon 154 urinary drainages undertaken among 119 patients. Causes of urinary tract obstruction are analysed with the different technics of drainage and with the corresponding long term follow up. An original technic called "nephroneo-cystostomia" is described.

Adolescent↗
PubMed1990

Node exploration in prostatic cancer.

Lymph node invasion is an important stage in the development of metastases; it is exceptional for metastases to be found in the absence of lymph node invasion. Radiological investigations have been developed, but lymphangiography, echography and scanners can only be used when invasions have attained a certain volume and they do not recognize microscopic modifications. The use of localized histological samples has been shown to be reliable and not to be as inconvenient as laparotomy, which is a relatively major operation in prostatic cancer patients, who tend to be elderly.

Humans↗
PubMed1990

Interim report of a large French multicentre study of efficacy and safety of 3.75 mg leuprorelin depot in metastatic prostatic cancer.

A study carried out in 470 patients with metastasized adenocarcinoma of the prostate confirmed the efficacy of 3.75 mg leuprorelin acetate depot given subcutaneously once monthly. Bone pain was rapidly decreased and the general condition of patients and urinary signs improved. Sexual activity was maintained in 50% of patients. After 3 months' treatment, there was no progression in 95% of patients, complete regression in 39% and partial regression in 49%; 17% of cases were stabilized. Improvement in clinical signs was directly related to a decline in amounts of prostate-specific antigen and was associated with a decline in serum testosterone concentrations within 3-4 weeks of starting treatment. Leuprorelin acetate depot was well tolerated and was easy to store and use.

Adenocarcinoma↗
PubMed1989

[Microanatomy of the female urethra].

The author presents a description of the microscopic anatomy of the bladder neck and female urethra based on reconstructions derived from microscopic sections performed in 3 planes. He describes the horizontal and vertical fibres. The horizontal fibres form 2 opposed, arched layers encircling the upper part of the bladder neck and derived from the detrusor. Inferiorly, there is a very small, annular, smooth muscle sphincter which surrounds the middle part of the urethra like a cuff. The vertical fibres arise from the detrusor mostly terminate in the periphery of the circular fibres. Several fibres also pass in the urethral lumen.

Female↗
PubMed1988

[Organ procurement. The Clermont-Ferrand experience].

The authors report the experience of a new kidney collection centre organised at Clermont-Ferrand, which rapidly became involved in the collection of multiple organs. The difficulties encountered during the collection of organs from the first 30 cadavres are presented: 19 kidneys were not grafted, sometimes for anatomical reasons, but especially because of surgical reasons (during the following period, this number fell to 3 for a series of 21 cadavres). 13 hearts and 2 livers were also removed. In conclusion, the authors stress that such organ collection centres can only be created when transplantations are also performed, because of inevitable psychological reasons affecting both the health care team as well as the population of the region.

Adolescent↗
PubMed1988

[Medical treatment of urothelial tumors of the bladder].

Intravesical chemotherapy is widely used in the management of superficial urinary bladder tumors. A complete response rate of 30 to 50% is observed in unresected tumors. Prophylactic instillations of the drugs after transurethral resection of the tumors seem able to delay recurrences. BCG can also be as effective, particularly in carcinoma in situ. Confirmation of efficacy of retinoids needs further studies. Invasive or metastatic bladder carcinoma can be responsive to systemic chemotherapy in about 40% of the cases for a period of 6 to 12 months. The value of adjuvant chemotherapy remains to be proved. Enhancement of radiation therapeutic effects by CisPlatinum in an interesting field of clinical research.

Administration, Intravesical↗
PubMed1988

[Natural history of arterial hypertension due to primary hyperreninism].

This case report deals with an eight-year duration severe high renin hypertension and its consequences. In 1975, a 13 years old girl was found to have blood pressure (BP) levels of 240/150 mmHg with bilateral papilloedema. Hypokalemic alkalosis, a 45 mm Sokolow index (SI) and very high peripheral renin activity (PRA) were also noticed. Renal vein renin sampling (RVRS) suggested secretion from the left kidney but intravenous pyelography and renal arteriography were normal. BP levels were first controlled by triple treatment but rose one year later, despite adjunction of beta-blockers. High PRA was again found, but without hormonal gradient on a second RVRS. From 1977 to 1982, BP never fell to normal levels despite quadruple treatment. In 1982, a stage II optic fundus, a 58 mm SI and 2 g/day proteinuria are noticed, so that a new complete etiologic work up is undertaken in 1983: PRA is still high, with a dramatic acute BP fall after captopril and no gradient on a third RVRS, but intravenous pyelography, tomodensitometry and selective arteriography disclose a 4 cm diameter poorly vascularized tumour on the surface of the lower pole of the right kidney. BP levels are controlled for three months by captopril + chlorothiazide. The tumour is removed in january 1984. RVRS by direct peroperative punction indicates (a posteriori) hormonal secretion from the right kidney lower pole. Histologic examination and immunofluorescence with antirenin serum corroborate the juxtaglomerular origin of the tumour. Eighteen months later, BP is permanently normal, SI is 30 mm, and there is no proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Kidney pelvis perforation due to a Greenfield intra-caval filter].

The authors report a case of renal pelvic perforation discovered three months after insertion of a Kimray Greenfield filter on an IVP in the form of a contrast leak. This complication was favoured by the initial malposition of the filter. Computed tomography was essential in the understanding of the pathology and in the investigation of associated lesions (uric acid stone). Treatment was conservative.

Aged↗
PubMed1988

[Technic and results of lymph node excision using pelvic lymphadenoscopy].

The authors report their experience of a surgical approach to pelvic lymph nodes based on a series of 24 patients with prostatic cancer (20 patients) or bladder cancer (4 patients). After making a short iliac incision, this technique consists of detaching the peritoneum with a finger and introducing a retractor (modified Cusko speculum) allowing removal of the lymph nodes. The authors discuss the indications for this technique in comparison with other methods of investigation of lymph nodes and present their results.

Endoscopy↗
PubMed1988

[Extracorporeal lithotripsy. Apropos of 145 initial patients treated in Clermont-Ferrand].

Between April and July 1987, 145 patients (presenting with a total of 178 renal and ureteric stones) were treated by extracorporeal lithotripsy (EDAP LT 01) in the Urology Department of Clermont-Ferrand hospital. No anaesthesia was performed during the 186 sessions required, except for 1 patient who underwent neuroleptanalgesia. Fragmentation was obtained in 86% of cases; the complete success rate was 70%, the partial success rate was 16% and the failure rate was 14%.

Adolescent↗
PubMed1987

[Current role of oncostatic chemotherapy in malignant testicular tumors].

Recent results with the therapeutic strategy for malignant testicular tumors are presented. Nearly 80% of these tumors can be cured by the coordinated therapeutic efforts of a surgeon and medical oncologist. Cis-platinum chemotherapy regimens are widely used and intensive chemotherapy followed by autologous bone marrow transplantation should enable to cure poor prognosis forms in the near future.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Complications of abdominal hysterectomy for benign gynecologic lesions. Apropos of 1,000 cases].

The authors present a retrospective study of 1,000 total abdominal hysterectomies performed between 1969 and 1975, and they report the main complications. Early complications are dominated by: rare thrombo-embolic accidents (2.2%) since the advent of prophylactic heparin therapy; infectious complications, dominated by the abscess of the abdominal wall and asymptomatic urinary infections, and for which simple measures prevent resorting to prophylactic antibiotherapy. The role of the hysterectomy seems minimal in the occurrence of a prolapse or a stress-related urinary incontinence: prolapses after hysterectomy (1.4%) seem more related to tissue aging than to the procedure which modifies very little the supporting system of the pelvis. A post-operative urinary incontinence is, most of the time, the result of an incomplete pre-operative work-up: failure to recognize a potential stress-related incontinence, or an incontinence secondary to an unstable bladder. Prolapse and incontinence must always be treated independently. In the psychological and sexual repercussion, age, ovariectomy and the distress related to the procedure, involving the heart of womanhood, seem to be the most important factors.

Adult↗
PubMed1987

[Ureteral dosimetry during gynecological curietherapy. Possible effects on the occurrence of postoperative ureteral complications].

The dosage of radiations delivered during gynaecological brachytherapy is usually calculated for the bladder and the rectum. A new technical approach is described in order to known the dose of radiation received by the terminal portion of the ureter. During placement of the Fletcher suit one of the ureters is catheterized by a special stent which appears on the X-rays control used for dosimetry. Data of 16 pre-operative brachytherapies for carcinoma of the cervix were studied. In half of the cases, the dose debit was higher on the ureter than on the bladder and the rectum. In 7 cases, the dose delivered was also higher on the ureter rather than on the bladder and the rectum. And in 3 cases this dose was higher than 50 grays. It is concluded that the ureter is frequently the most irradiated organ in the pelvis during brachytherapy for carcinoma of the cervix. This may be a physiopathologic explanation for some ureterovaginal fistulas occurring after radical hysterectomy.

Brachytherapy↗