PubMed Health⌕ Search

Biomedical subjects

Bernard Debré

Publications and source records attributed to Bernard Debré.

At least 19 recordsLinked to original sources
PubMed2006

Identification of risk factors for voiding dysfunction following TVT placement.

OBJECTIVE: To determine preoperative risk factors of postoperative voiding dysfunction after tension-free vaginal tape (TVT) procedure. METHODS: In 2004, 100 patients with genuine stress urinary incontinence underwent surgery by the TVT procedure. Preoperative and postoperative urodynamic study was performed for each patient. Postoperatively, patients' perception of result and quality of life were assessed on two validated scales, namely, Mesure du Handicap Urinaire (MHU) and Ditrovie. Voiding dysfunction was defined by a postoperative peak flow rate of <15 ml/s at 3 mo. Clinical and urodynamic parameters were compared and analysed. RESULTS: At 3 mo, 20 patients (20%) showed evidence of voiding dysfunction despite the absence of clinical symptoms in 14 of them (70%). Multivariate analysis showed that age (p<0.038) and preoperative peak flow rate (p<0.001) were independent risk factors for voiding dysfunction. Parity, menopausal status, body mass index, and maximal urethral closure pressure were not statistically related to the risk of voiding dysfunction. CONCLUSIONS: This study confirms the existence of an important rate of postoperative voiding dysfunction, mostly asymptomatic, and identifies age and preoperative maximal peak flow rate as independent preoperative risk factors. Identification of voiding dysfunction in patients may lead to better follow-up and early detection of late potential complications of suburethral procedures.

Female↗
PubMed2006

Can pT0 stage of prostate cancer be predicted before radical prostatectomy?

OBJECTIVES: To report our experience with biopsy-proven pT0 prostate cancer over the last 10 yr. METHODS: We retrospectively analysed a series of 1950 consecutive patients treated with radical prostatectomy (RP) for clinically localized prostate cancer between 1996 and 2005 at our institution. The patients without residual tumour on RP specimen were defined as pT0 patients. The group of pT0 patients was compared with a control group of 295 patients operated consecutively during the same period. RESULTS: Overall, 11 (0.5%) patients were classified as pT0 on pathologic examination of the RP specimen. There was no pT0 tumour in the control group. Among the pT0 patients, five characteristics were particularly frequent: T1c clinical stage (90.9%), prostate-specific antigen (PSA) or=60 g (100%). All these characteristics were present in 8 of the 11 (72.7%) pT0 patients, while they were present in only 12 of the 295 (4.1%) controls. These parameters, when combined together, had a sensitivity of 72%, a specificity of 96%, and an accuracy of 99% for the prediction of pT0 stage. With a mean follow-up of 30 months after RP, no pT0 patient had clinical or biologic evidence of prostate cancer. CONCLUSIONS: In our experience, the rate of pT0 tumours after RP is 0.5%. The combination of clinical stage, preoperative PSA, number of positive biopsy cores, Gleason score, and prostate weight could help to predict pT0 stage after RP.

Aged↗
PubMed2006

Is quantitative real-time RT-PCR an adjunct to immunohistochemistry for the evaluation of ErbB2 status in transitional carcinoma of the bladder?

OBJECTIVE: To test different approaches of evaluation of the ErbB2 status in a large series of human transitional cell carcinoma (TCC) of the bladder with the prospect of finding targeted therapies. METHODS: ErbB2 status of 73 human TCC samples was analyzed by both immunohistochemistry (IHC) and by quantification of mRNA levels of expression using real-time reverse transcription-polymerase chain reaction (RT-PCR). Additionally, 18 bladder samples were studied for ERBB2 gene amplification by real-time quantitative PCR. RESULTS: Twenty-five tumors (34.2%) overexpressed ERBB2 mRNA compared to normal bladder samples; this alteration appeared in low-grade and low-stage tumors (pTaG1). Twenty-four (32.9%) tumors showed moderate (++) or strong (+++) immunostaining. A very strong agreement was found between the two methods (kappa = 0.97, 95% confidence interval, 0.90-1). ErbB2 status was not associated with tumor stage. Of the 18 bladder samples tested for ERBB2 gene amplification, only one showed ERBB2 DNA amplification. CONCLUSIONS: ErbB2 overexpression occurs in about one third of bladder TCCs. This overexpression can be detected by RT-PCR with a very good correlation with IHC. RT-PCR can therefore be used for cases considered doubtful on IHC rather than gene amplification studies because, in TCC, gene amplification is not the predominant mechanism of both mRNA and protein overexpression. Accurate quantification of ErbB2 status is mandatory for the use of anti-ErbB2-targeted therapies in bladder TCC.

Adult↗
PubMed2006

Age difference between patient and partner is a predictive factor of potency rate following radical prostatectomy.

PURPOSE: We evaluated the influence of partner age on postoperative erectile function in patients who underwent bilateral nerve sparing radical prostatectomy for localized prostate cancer. MATERIALS AND METHODS: The study group was a cohort of 240 consecutive patients treated with radical prostatectomy with a minimum 1-year followup. None had received adjuvant therapy. Evaluation was done by questionnaires mailed to a third party. Potency was defined by erection sufficient for sexual intercourse with vaginal penetration. A total of 200 patients were evaluable. RESULTS: The postoperative potency rate in 189 preoperatively sexually active patients was 59%. On univariate analysis patient age and the age difference between patient and partner were significantly associated with the potency rate following surgery, that is 60.8 and 6.8 years in the preserved potency group and 63.3 and 4.2 years in the impotent group (p <0.001 and p = 0.02, respectively). On multivariate analysis age difference was a predictive factor of postoperative potency independent of patient age (p = 0.008). Age difference was also an independent predictor of potency with and without aid (p = 0.037 and 0.002, respectively). CONCLUSIONS: To our knowledge this is the first study to identify the influence of age difference between patient and partner on potency preservation following radical prostatectomy. Age difference was a significant predictive factor of maintaining postoperative potency independent of patient age. We suggest that partner age difference should be reported in radical prostatectomy outcomes series because it influences postoperative potency rates. It is a new prognostic factor that might help counseling patients preoperatively.

Adult↗
PubMed2006

Management of a malignant urinary fistula by ureteral embolization with coils.

We report the case of a 42-year-old man with a synovial sarcoma of the prostate, metastatic at presentation, who after aggressive chemotherapy followed by extensive surgery developed a complex pelvic fistula involving the lower ureter, bladder, and enteral structures. The patient was a poor candidate for surgery because of his short life expectancy and poor health status. Conservative management with bilateral nephrostomy tubes did not allow sufficient fistulous output for symptomatic relief. Using the percutaneous access already in place, we performed bilateral ureteral embolization with coils. Complete ureteral occlusion was obtained with a minimally invasive procedure and allowed total symptomatic relief.

Adult↗
PubMed2006

Gene expression profiling of ERBB receptors and ligands in human transitional cell carcinoma of the bladder.

PURPOSE: The ErbB driven growth pathway has been implicated in most human epithelial malignancies. Therefore, its blockade is a promising therapeutic strategy and several candidate drugs are currently undergoing clinical trials. Paradoxically little is known of the expression pattern or clinical significance of the 4 ErbB receptors and their 11 ligands in TCC of the bladder. MATERIALS AND METHODS: To obtain further insight into the molecular pathogenesis of TCC we used quantitative real-time reverse transcriptase-polymerase chain reaction assay to quantify mRNA expression of the 4 ERBB and their 11 known ligand genes, including recently described EPGN/epigen, in 73 tumor samples. RESULTS: The level of mRNA of 4 ligand genes (EGF, NRG1, NRG2 and NRG3) was extremely low, that is detectable but not quantifiable. Six genes were over expressed (ERBB2, TGFA, HB-EGF, AREG, EREG and EPGN), 3 were under expressed (ERBB1, ERBB4 and NRG4) and 2 were over or under expressed (ERBB3 and BTC). ERBB2 and AREG expression differed between early stage tumors (pTa grade 1) and normal samples. The most marked differences in expression were ERBB3, EREG and NRG4 between superficial and muscle invasive tumors (p = 0.0069, 0.00007 and 0.0000001, respectively), and TGFA and NRG4 between low and high grade superficial tumors, and between pT1 or greater and pTa tumors. CONCLUSIONS: This study shows the involvement of the ERBB family and ligand genes in TCC. Most receptor and ligand genes are deregulated at different stages of carcinogenesis, implying that they should be studied simultaneously. Quantitative real-time reverse transcriptase-polymerase chain reaction could be used to determine ErbB signaling pathway status in individuals with a view to tailored therapy.

Adult↗
PubMed2006

[Bilateral pyelonephritis and emphysematous cystitis: an exceptional association].

The authors report the case of a patient hospitalized for bilateral pyelonephritis and emphysematous cystitis requiring bilateral nephrostomy. This rare disease occurs in diabetic patients and is essentially due to Escherichia coli and Klebsiella pneumoniae. Treatment consists of antibiotics and renal drainage or nephrectomy. The prognosis is poor with a mortality rate greater than 50%.

Aged, 80 and over↗
PubMed2005

Evolution of health-related quality of life two to seven years after retropubic radical prostatectomy: evaluation by UCLA prostate cancer index.

To determine changes in health-related quality of life (HRQOL) in patients treated with retropubic radical prostatectomy (RP) between two and seven years after surgery. A questionnaire from the University of California Los Angeles Prostate Index was sent to 142 patients previously treated with retropubic RP as mono-therapy for clinically localized prostate cancer. Patients were divided into five groups according to time from surgery. Demographics, clinical and pathological characteristics of patients were compared between these groups. Correlation coefficients controlled for age at the time of questionnaire between HRQOL scores and time from RP were assessed. A total of 105 patients (74%) returned the questionnaire. The mean time from surgery was 48 months (range 25-84). Demographics, clinical and pathological characteristics of patients were not statistically different between time groups. Several recoding items were found to decrease significantly with the time from RP including physical functioning, role limitations due to physical health problem, vitality, and general health. In contrary, urinary, bowel and sexual scores were not significantly correlated to time from RP. Although sexual, urinary and bowel scores seem to remain stable from 2 to 7 years following RP, general health appears to significantly deteriorate with time after RP, independent of the patient's age at the time of the questionnaire.

Aged↗
PubMed2005

Outcome of patients with fortuitous prostate cancer after radical cystoprostatectomy for bladder cancer.

OBJECTIVES: To analyze the outcome of patients after fortuitous diagnosis of prostate cancer (PCa) on cystoprostatectomy (CPT) specimen. METHODS: The medical charts of 141 male patients who underwent radical CPT for urothelial cell carcinoma of the bladder between january 1995 and april 2000 were retrospectively reviewed. None of the patients had preoperative clinical or biological suspicion of PCa. RESULTS: Pathological examination of the CPT specimens showed PCa in 20 patients (14.2%). Of these, 6 had a microfocal PCa, 10 had a pT2a tumour, 2 had a pT2b tumour, and 2 had a pT3a tumour. The Gleason score was < or =5 in 5 cases, 6 in 13 cases, and 7 in 2 cases. Two patients were lost to follow-up. Ten patients died of bladder cancer after a median follow-up of 13 months. Eight patients remained free of disease after a median follow-up of 64.5 months. None of the 20 patients experienced PCa recurrence during follow-up. CONCLUSIONS: In our experience, the rate of unsuspected PCa on cystoprostatectomy specimens was 14.2%. The majority of these PCas were organ-confined, and there was no PCa recurrence during follow-up.

Aged↗
PubMed2005

Negative prostatic biopsies in patients with a high risk of prostate cancer. Is the combination of endorectal MRI and magnetic resonance spectroscopy imaging (MRSI) a useful tool? A preliminary study.

OBJECTIVE: Repeated biopsies in patients with a high risk of prostate cancer only allow a small proportion of new cancer diagnosis. The aim of this study was to evaluate the use of combined MRI and magnetic resonance spectroscopy imaging (MRSI) for these patients. METHODS: Between April 2003 and April 2004, 42 patients with negative multiple cores prostatic biopsies and serum PSA>4 ng/ml underwent a combined MRI/MRSI analysis. Suspicious zones on standard MRI included low intensity signals on T2 weighted images. A high choline+creatine-to-citrate ratio defined a MRSI suspicious zone. A 10 cores following peripheral biopsy scheme was done to which were added supplementary biopsies on the MRI/MRSI suspicious zones. RESULTS: The mean age was 62.3 years (51-74), the mean pre-biopsy serum PSA was 12 (3.87-35), the mean free/total PSA ratio was 11% (5-20). The mean number of previous prostate biopsy rounds was 2.04. 15 prostate cancers were diagnosed (35.7%). In 9 cases, abnormal MRI/MRSI findings and positive biopsy sites were located on the same prostatic zones. In 5 cases, MRSI alone located the positive biopsy zones. Sensitivity of combined MRI/MRSI in this study was 73.3%; specificity, positive predictive value, negative predictive value and accuracy were 96.3%, 91.6%, 86.6% and 88% respectively. CONCLUSIONS: This preliminary study shows that the combination of MRI and MRSI might be able to guide and therefore limit the number of iterative biopsies and cores for patients who are at high risk of having a prostate cancer. In some cases, MRSI alone allows identification of neoplasic prostatic zones. Other studies are needed to confirm these data.

Aged↗
PubMed2005

Pro PSA : a "pro cancer" form of PSA?

Pro PSA, the precursor of PSA, is an inactive 244-amino acid protein secreted by prostatic cells. Pro PSA, a distinct molecular form of free PSA in serum, includes native as well as several truncated forms. Clinical studies have recently provided evidence that pro PSA is associated with prostate cancer (PCa). The truncated (-2) pro PSA form accounts for only 6-19% of free PSA in the serum of patients without PCa, but it represents up to 25-95% of free PSA in that of PCa patients. In the PSA range of 2-10 ng/ml, it has been suggested that pro PSA may be useful to detect PCa, and to spare 10-20% of unnecessary prostate biopsies. However, only scant information about the role of pro PSA is available to date, and its real impact on PCa detection remains to be determined. Furthermore, it is questionnable whether pro PSA could be predictive of tumor recurrence of PCa after therapy. Prospective clinical studies with long term followup are needed to clarify this point.

Biomarkers, Tumor↗
PubMed2005

Intermittent androgen deprivation for biologic recurrence after radical prostatectomy: long-term experience.

OBJECTIVES: To analyze the oncologic results of intermittent androgen deprivation (IAD) for biochemical recurrence after radical prostatectomy (RP). METHODS: A total of 57 patients with biochemical recurrence after RP have been treated with IAD at our institution. The 57 patients were divided into two groups: group 1 comprised 29 patients who received salvage radiotherapy after RP; group 2 comprised 28 patients who did not receive salvage radiotherapy. Hormonal therapy during the first treatment phase consisted of an antiandrogen alone. This treatment was maintained for 3 months after the prostate-specific antigen (PSA) level had become undetectable and was then discontinued. Hormonal therapy was resumed when the PSA level exceeded 4 ng/mL; treatment was discontinued when the PSA level dropped to less than 1 ng/mL. RESULTS: The patients in group 1 had less favorable characteristics than those in group 2 in terms of pathologic stage and Gleason score. Overall, the median follow-up after starting hormonal therapy was 92 months (range 36 to 176). The percentage of each cycle that was spent "off" treatment decreased from 60% to 50%. During follow-up, 38.6% of patients required a luteinizing hormone-releasing hormone analog for nonresponse to the antiandrogen alone, and 15.8% experienced metastatic progression. The cancer-specific mortality rate was 12.3%; all patients who died of prostate cancer were from group 1. The median interval between initiation of hormonal therapy and cancer-related death was 86 months. CONCLUSIONS: In our experience, IAD for biochemical recurrence after RP provided satisfactory long-term oncologic results. Our data suggest that IAD can be initiated with an antiandrogen alone.

Aged↗
PubMed2005

Serum levels of vascular endothelial growth factor in patients undergoing prostate biopsy for suspicion of prostate cancer.

OBJECTIVES: To analyze the correlation between serum levels of vascular endothelial growth factor (VEGF) and biopsy findings in patients with a suspicion of prostate cancer. METHODS: Serum levels of VEGF were measured on frozen, archival serum obtained before prostate biopsy in 47 patients with clinical and/or biologic suspicion of prostate cancer. VEGF-A levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The prostate biopsies showed cancer in 27 patients (group 1) and benign tissue in the remaining 20 patients (group 2). No statistically significant difference was found between the two groups in age, digital rectal examination findings, total prostate-specific antigen (PSA) levels, free PSA levels, and complexed PSA levels. The mean prostate volume was significantly lower in group 1 (45.5 g versus 53.9 g; P = 0.04), and the mean percentage of free PSA (free PSA/total PSA) was significantly lower in group 1 (11.3% versus 19%; P = 0.0003). Serum VEGF-A levels were not significantly different between the two groups. The mean VEGF level was 90.6 pg/mL in group 1 and 107.9 pg/mL in group 2 (P = 0.55). Multivariate analysis showed that VEGF-A levels were not predictive of prostate cancer. CONCLUSIONS: Our findings suggest that serum VEGF-A is not helpful to predict prostate cancer in patients with clinical and/or biologic suspicion of prostate cancer.

Aged↗
PubMed2005

Combination of gemcitabine and oxaliplatin in urothelial cancer patients with severe renal or cardiac comorbidities.

Clinical trials in urothelial cancer exclude a large population of patients. An observational study evaluated the behavior of frail patients not eligible for cisplatin- or carboplatin-based regimens. Urothelial cancer patients requiring chemotherapy with either chronic renal failure (creatinine clearance <60 ml/min), and/or performance status (PS) > or =2 and/or cardiac dysfunction were prospectively observed. The treatment associated gemcitabine 1200 mg/m and oxaliplatin 85 mg/m, bimonthly (GO). Over 2 years, 31 of 45 (69%) patients with urothelial cancer requiring chemotherapy were not eligible for cisplatin- or carboplatin-based chemotherapy. Sixteen (52%) had a PS > or =2, 23 (74%) had creatinine clearance <60 ml/min, and 20 (65%) had an underlying cardiopathy. A total of 178 cycles of GO were administered (median 6 per patient, range 2-12). No aggravation of renal or cardiac status was noted. Acute grade 3 and 4 neutropenia and thrombocytopenia were observed in 16 and 13% of patients, respectively, with one febrile neutropenia. The median progression-free and overall survival values were 4.2 and 9.5 months, respectively. The majority of urothelial cancer patients have severe renal or cardiac comorbidities, and we conclude that in this subset of patients the combination of gemcitabine and oxaliplatin is well tolerated, and its clinical activity warrants further evaluation.

Aged↗
PubMed2005

Management of prostate cancer in China: a multicenter report of 6 institutions.

PURPOSE: In China the incidence of prostate cancer (PCa) is low and sparse data are available regarding its management. We analyzed the management of PCa at 6 Chinese urological institutions. MATERIALS AND METHODS: A retrospective analysis was performed of 431 consecutive patients treated for PCa at 6 Chinese institutions, including 5 in the divisions of Shanghai and 1 in the province of Chongqing, between January 2000 and December 2004. Tumor characteristics, therapeutic options and patient outcomes were recorded. RESULTS: At diagnosis median patient age was 72 years and median prostate specific antigen was 46.1 ng/ml. Most PCa cases were revealed by urinary symptoms (75.9%) or bone pain (12.8%). PCa was palpable on digital rectal examination in 74% of cases. At least 44 patients (10.2%) had metastases to lymph nodes at diagnosis and 112 (26%) had bone metastases. A total of 236 patients underwent bilateral orchiectomy and 100 received medical hormone therapy, which in 75% consisted of antiandrogen alone. At a median followup of 16.8 months 60% of these patients experienced biological recurrence. Radical prostatectomy was performed in 24 patients as monotherapy or in combination with bilateral orchiectomy. No patient with clinically localized PCa experienced biological recurrence after radical prostatectomy. CONCLUSIONS: The management of PCa in China differs from that in Western countries. To date surgical castration represents standard treatment. Screening detection of PCa could help detect earlier stage tumors and improve the outcome in patients.

Age Distribution↗
PubMed2005

[Results of open radical nephrectomy in a series of 230 patients].

OBJECTIVE: To analyse the oncological results of open radical nephrectomy for renal cancer PATIENTS AND METHODS: Between December 1989 and June 2003, open radical nephrectomy for renal cancer was performed by the same operator in 230 patients. Cancers treated by partial nephrectomy were excluded from this study. The operation was performed via a lumbar incision in 95.7% of cases. Surveillance consisted of clinical examination and thoracic and abdominopelvic computed tomography twice a year for the first two years, then annually for 3 years, and then at 7 years and at 10 years in the absence of recurrence. RESULTS: With a median follow-up of 63.1 months, the 5-year and 10-year recurrence-free survival rates were 88.4% and 67.2%, respectively. Tumour size, tumour stage (TNM 1997), Fuhrman's nuclear grade, histological type of cancer, and the presence of suggestive signs were correlated with the recurrence-free survival rate. The 10-year recurrence-free survival rate was zero in patients with visceral or lymph node metastases at the time of diagnosis. The patient's age at the time of diagnosis and the presence of a paraneoplastic syndrome did not influence recurrence free survival in this series. CONCLUSIONS: This study confirms the data of the literature: tumour size, tumour stage, nuclear grade, histological type, and suggestive signs are prognostic factors of renal cancer. Radical nephrectomy ensures a global 5-year recurrence-free survival rate higher than 85%.

Adult↗
PubMed2005

[Results of the AMS 800 artificial urinary sphincter in men, based on a series of 47 patients].

INTRODUCTION: Male urinary incontinence due to sphincter incompetence is usually secondary to prostate surgery. After failure of other treatments, severe sphincter incompetence requires placement of an artificial urinary sphincter The authors present the results of the AMS 800 artificial urinary sphincter based on a series of 47 consecutively operated patients. PATIENTS AND METHODS: From 1990 to 2003, 47 AMS 800 were inserted by the same operator and according to the same technique. The aetiologies of urinary incontinence were: radical prostatectomy (45% of cases), transurethral resection of the prostate (36%), open prostatectomy (10.5%), and others (8.5%). RESULTS: The mean age of the patients was 65 years. The mean follow-up was 36 months. The mean time to insertion was 3 years and 10 months (range: 5 months-15 years). 23.4% of patients presented one or several complications (mechanical failure: 19%; infection; 10.6%; erosion: 4%; bladder stones: 2%), 21% of patients required one or several surgical revisions after a mean interval of 25.5 months (range: 2-80 months). The actuarial 5-year revision rate was 25.5%. With a mean follow-up of 36 months, 98% of patients had a functioning artificial urinary sphincter and 83% still had their original artificial urinary sphincter Social continence and patient satisfaction rates were 87% and 95.7%, respectively. CONCLUSION: These results are comparable to those of similar published series. The AMS 800 is associated with high continence and patient satisfaction rates and currently remains the reference treatment for refractory sphincter incompetence in men.

Adult↗