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Biomedical subjects

B Pascal

Publications and source records attributed to B Pascal.

71 records · Page 4Linked to original sources
PubMed1979

[Cutaneous urine shunts in adults (author's transl)].

The authors review 123 cases of cutaneous urine shunts in adults. - 93 cutaneous ureterostomies in 63 patients (58 malignant and 5 tuberculous lesions). There were 5 postoperative deaths (8%) and in the 36 operated cases followed-up for varying periods there was 1 death only from progressive renal insufficiency (2.7%), 10 minor incidents (27.8%) and 2 cases with kidney stones (5.5%). Not one of these patients had to be operated on again - 3 cutaneous uretero-ureterostomies with 2 excellent results and necrosis of the foot of the Y in the other case. - 45 transintestinal cutaneous ureterostomies (38 ileal loops and 7 colon grafts) for fistula of the lower urinary tract (2 cases), malignant tumors (35 cases), tuberculosis (1 case), bladder extrophia (1 case), neurological bladder (6 cases). There were 4 early postoperative deaths (8.9%) and 5 severe complications (2 eviscerations, 2 occlusions, 1 digestive tract hemorrhage). Of the 37 operated cases followed-up for varying periods, 5 (13.5%) had diminished renal function, 23 (62%) had late complications requiring further operations in 17 cases (45.9%). These complications were 7 cases of stenosis of the ureter, 1 case of fistual of the ureter, 1 ileal fistula, 4 cases of stenosis of the graft opening, 3 prolapses of the graft, 1 skin lesion, 5 kidney stones and 1 case in which reflux was poorly tolerated. - 12 transprosthetic cutaneous ureterostomies with only 2 good results. No cutaneous shunt operation is exempt from complication. Transprosthetic cutaneous ureterostomies are probably the least affected. Direct cutaneous ureterostomies are statistically better tolerated than transintestinal cutaneous ureterostomies, which appear to have the major inconvenience of deteriorating at a later stage, requiring repeated further operations.

Adult↗
PubMed1979

[Course of superficial malignant tumors of the bladder. Apropos of 135 cases].

After recalling the difficulty of comparing the various series published in the literature. in the absence of common histological criteria. the authors review the records of patients with a class III or IV carcinoma of the bladder. strictly confined to the musoca, whether or not the basal membrane was damaged (stage O or A), with the exclusion of all cases with histological invasion of the muscularis and any other clinical or radiological signs of deep infiltration: 135 records with a follow-up of at least 6 months. This study led to the following findings: - One third of the tumours progressed to deep infiltration and/or metastases. - This unfavourable course occurred. in almost 3/4 of cases. during the 2 years following the clinical presentation of the tumour. - Such a grave course may develop for tumours not affecting the basal membrane without it having always been possible to define the stage of infiltration of the chorion. - A metastasis may develop while the tumour remains superificial. - 5 out of these 135 patients developed 2 or more extra-urological carcinomas. - Two thirds of these superifical tumours did not invade the muscularis during the period of observation which in 41 cases exceeded 6 years. - The difficulty lies in detecting which superificial malignant tumours of the bladder will not recur. which will recur superficially (where preservation of the bladder is automatic) and which will recur with infiltration and/or metastases. where an aggressive therapeutic attitude should be adopted before any infiltration or diffusion of the tumour manifests itself. - Tumours which did not recur were unifocal. - All multifocal tumours treated conservatively recurred.

Adult↗
PubMed1976

[The urethra in congenital aplasia of the abdominal wall. Concerning 15 cases (author's transl)].

The authors have collected in 13 years, 15 cases of congenital aplasia of the abdominal wall. All of the patients had involvement of the urinary apparatus of varying degree of severity, megalo-ureter, megabladder and dilatation of the posterior urethra being the most constant lesions. Twelve patients with renal failure, benefited from reparatory surgery of the excretory pathway. Eleven patients had complete or incomplete retention: in 5 cases there was a urethral valve. In 6 cases the megalo-urethra was apparently idiopathic. In all of these cases, endoscopic treatment was carried out, constituted either of resection of valves, or internal urethro-sphincterotomy using a cutting electrode: 9 times, the result obtained was excellent. One patient was improved; in one case the result could not be assessed. For the authors, obstructive urethral pathology is a frequently unrecognized or badly understood fact. It is accessible to endoscopic treatment, which must precede or accompany correction of the ureteral abnormalities.

Abdominal Muscles↗
PubMedDate not supplied

[Acute acoustic trauma in military personnel. Evaluation of 1 year epidemiologic surveillance].

OBJECTIVES: Acute acoustic trauma (AAT) refers to damage to sensitive cochlear structures caused by excessive exposure to impulse noise. The aim of this study was to 1) assess the incidence of ATT in French soldiers and 2) to clarify the circumstances under which AAT occurs. PATIENTS AND METHODS: We carried out a prospective study of AAT events reported to medical officers in 1998. RESULTS: The incidence of AAT was 156 per 100,000 person-years (150-161). It was higher in conscripts and in soldiers aged under 31 years. Fifty-seven percent were wearing hearing protectors when the accident took place. CONCLUSION: According to these results, specific preventive programs were planned and should be assessed by epidemiological surveillance of exposed populations.

Adult↗
PubMedDate not supplied

[Suicide and attempted suicide in the armed forces in 1998].

UNLABELLED: Little data exists concerning suicides and attempted suicides on professional duty. Now that the French Army is becoming professional, it is necessary to describe methods of self-destruction, in order to facilitate preventive measures. METHODS: The French Army operated a surveillance system to record all instances of suicide and attempted suicide. Under this surveillance system, all suicidal acts and attempts must be reported through an anonymous standard form completed by a military physician. This form records demographic data, the circumstances and known motives. For the epidemiological analysis, we used the chi square test and the Student test. A method of indirect standardization was employed to enable comparisons between military suicides and those within the general French population in 1996. We chose a risk of error of 5%. RESULTS: During the course of 1998, 145 forms were gathered for professional armed forces. Of these, 40 were recorded as actual suicides and 105 as attempted suicides. The suicide rate corresponded to 14p 100,000. Suicides were limited exclusively to males, the average age at death was 36. Comparisons with the French male population at large (using the indirect method of standardization) showed a standardized mortality rate of 0.43 (p > 0.05). Methods of self-destruction employed were mostly hanging and using firearms. Attempted suicide rate was 31.5 p 100,000, with a relatively even balance between males and females. The average age was 30. Methods of self-destruction employed were mostly drug ingestion and laceration. Difficulties with personal relationships were the principal motive recorded, whilst instances of psychiatric diseases were rare. Previous suicide attempts were known in 21% of recorded suicide attempts in 1998 and in 10% of actual suicide. There was no suicidal act during or linked to an outside army operation. The ratio suicide-attempted suicide was 0.38. DISCUSSION: The fact that the rate of suicide in the French Army is lower than the national average could be explained by the medical criteria used to select army personnel on active duty. These results should be interpreted with caution: our data only covers a single year. Moreover, there is a certain bias in the surveillance system used. Measures in the French Army to prevent suicide are based on a significant medical component within units, particularly during operational tours where there is sometimes a psychiatrist. Although the military physician is constrained by professional secrecy, he must execute his duty as an advisor to the commanding officer to signal human factors that need to be taken into account. Responsibility for knowing men and living conditions lies with the commanding officer. Epidemiological surveillance is a key element of analyzing the risks of suicidal. Its contributing role should be regularly reevaluated.

Adult↗
PubMedDate not supplied

Removal of completely perforating IUDs by explorative laparotomy.

Nine patients with completely perforating intrauterine contraceptive devices are presented. In all cases, the device was removed by explorative laparotomy. In eight out of the nine women, the device was found to be embedded in the omentum or vesical peritoneal plica. The advantages of explorative laparotomy over laparoscopy or colpotomy are emphasized.

Adult↗
PubMedDate not supplied

[Results of radical surgery for renal cancer in adults].

For thirteen years, between 1963 and 1976, 120/139 patients with renal cancer were operated. 45 were stage I, 20 were stage II, 45 were stage III and 12 were stage IV (Robson's classification). Of the 45 stage III cancers, 13 had lymphatic invasion and 37 had venous invasion ranging from microscopic stages to invasion of the inferior vena cava. Treatment included: preoperative teleirradiation with cobalt most often a single dose of 500 rads on the day before the operation. Wide excision with primary ligation of the vascular pedicle and node dissection via a lumbar abdominal transperitoneal route remaining the minimum strictly necessary. Sequential monthly chemotherapy over two years of Vincristine and CCNU (chloroethyl cyclo hexylnitroso urea). Postoperative mortality was considerable (14%) but involved patients with advanced cancers, poor general condition (o% stage I, 10% stage II, 22% stage III and 40% stage IV). The long range survival remains excellent in spite of the postoperative losses: 65 p. cent 5 years all stages. However, stage determines the prognosis: 85 p. cent 5 year survival stage I and II and 53 p. cent 5 year survival stage III. Severe affection of the general state of the patient carries a very poor prognosis. Fever does not indicate a worse value except in stage III tumors. In stages I and II it can have value in the paraneoplastic syndrome (terme non familier). The authors, uncertain of the efficacity of preoperative radiotherapy and postoperative chemotherapy, concluded that wide excision with node dissection is the proper fundamental treatment of renal cancer in the adult.

Aged↗