Biomedical subjects

C Coulange

Publications and source records attributed to C Coulange.

At least 19 recordsLinked to original sources

PubMed1998

A French national epidemiologic survey on renal cell carcinoma. Oncology Committee of the Association Française d'Urologie.

BACKGROUND: In this multicenter study, the yearly national evaluation of tumors of the kidney was out by the Oncology Committee of the French Association of Urology. METHODS: During the period from April 1, 1992, to March 31, 1994, 1486 patients from 54 centers were included in this study. For each patient, an individual chart was created, in which age, gender, discovery circumstances of the tumor, radiologic and biologic workup, treatment, TNM classification, and histologic features of the tumor were recorded. RESULTS: The mean patient age was 62.1 years, and the male-to-female ratio was 2:1. Forty percent of the tumors were discovered accidentally. A radical nephrectomy was performed in 93% of the cases, and in 7% of the cases, conservative management was adopted. Medical treatment was chosen in 5% of the cases. The patient distribution according to classification was as follows: pT1 = 8%, pT2 = 53%, pT3a = 21%, and pT3b = 18%. Lymph node involvement was observed in 9% and visceral metastasis in 6% of the cases. The incidental tumors were intracapsular in 80% of the cases. From the histologic point of view, the majority of the tumors were clear cell adenocarcinoma (66%). The mean tumor maximum dimension was 6.4 +/- 3.5 cm; it was significantly greater in symptomatic patients and patients with poor prognostic indicators (involvement of the adrenal gland, inferior vena cava, and/or lymph nodes and visceral metastasis). Adrenal gland involvement or inferior vena cava involvement were each observed in 4% of the cases. Fourteen percent of the patients had multicentric tumor spread, which was influenced by neither the tumor size nor the cell type. The nuclear grade was established in 66% of the cases and was significantly correlated with involvement of the perirenal fat and the lymph nodes. CONCLUSIONS: This study allowed the authors to centralize one-fifth of all new cases of adenocarcinoma of the kidney in France in the course of a year. It enabled them to evaluate precisely the current epidemiologic profile of this disease among those patients.

Adult↗

PubMed1998

Posttransplantation acute tubular necrosis: risk factors and implications for graft survival.

Previous studies aimed at identifying the causes, risk factors, and outcome of kidney transplant recipients with delayed graft function (DGF) have yielded controversial results. We retrospectively analyzed the causes and risk factors for DGF in 263 cadaveric kidney transplantations from November 1988 to March 1997 in one center. Causes of DGF were assessed by postoperative graft evolution and graft biopsy. Univariate and multivariate analysis were used to investigate the risk factors for DGF induced by acute tubular necrosis (ATN). Seventy-six patients (29%) had DGF, which was caused by ATN in 70 patients (92.1%) and acute rejection (AR) in 6 patients (7.9%). Therefore, we focused on risk factors and consequences for ATN-induced DGF. In monofactorial analysis, ATN was significantly associated with greater weight and presence of an atheromatous disease in both donor and recipient. Other risk factors for ATN were older age of donor, recipient American Society of Anesthesiology (ASA) physical status category IV, cold ischemia time (CIT), and transplantation using the right kidney. The multivariate analysis showed that donor and recipient weight, donor age, transplantation using the right kidney, preservation in Eurocollins solution, ASA score, and CIT were associated with ATN. The incidence of rejection and renal function were not different at 3 months or 1 and 5 years. ATN is the main cause of DGF in kidney transplant recipients. ATN is caused by donor and recipient vascular background, grafting the right kidney, and CIT. ATN does not appear to have an adverse effect on long-term kidney function.

Adult↗

PubMed1998

[Malignant Leydig cell tumor of the testis secreting progesterone].

Malignant Leydig cell tumours of the testis occur in only 0.1-0.3% of patients with testicular tumours. Less than 50 cases of malignant Leydig cells tumours have been previously reported. A report of a new case is presented. This tumour was unusual because of high progesterone level. We analyzed malignant pathologic signs of Leydig cell tumours as immunohistochemical proliferation index. Management of this tumour, for which chemotherapy is not yet available, is discussed.

Aged↗

PubMed1997

[Epidemiology and diagnosis of bladder tumors].

Bladder cancer affects more often the male and accounts for about four per cent of death from cancer each year in France. Numerous factors may be responsible, first of which are smoking and certain carcinogens found in the workplace. Haematuria is well known as the main presenting symptom of bladder cancer but bladder tumors may present with and bladder symptom. Cystoscopy remains the key examination. Tumor resection brings details about the stage and the grade. In the case of an invasive tumor, staging procedures is necessary. This examination under estimates the stage in nearly 20% of cases. Superficial tumors are characterised by the risk of recurrence (40%).

Aged↗

PubMed1997

[Prostatic urothelial location of a tumor of the bladder].

Prostatic urothelial carcinoma concomitant with a bladder tumour is rare, but its incidence is increasing due to the precision of histological examination and the prevalence of bladder carcinoma in situ. Its prognosis depends on the depth of the prostatic lesion: carcinoma in situ, involvement of the ducts or even the stroma. In the case of high grade bladder tumour, multifocal tumour or bladder carcinoma in situ, a transurethral resection of the prostate is the best way of detecting this lesion. The therapeutic options depend on the depth of the prostatic invasion.

Carcinoma in Situ↗

PubMed1997

[Malignant histiocytofibroma of the bladder. A case report].

Malignant histiocytofibroma of the bladder is a rare (16 cases reported in the literature) and very aggressive sarcoma. It is sometimes associated with a haematological malignancy. The authors report a case of malignant histiocytofibroma of the bladder in a 72-year-old haemodialysed woman with a poor general status. She had a history of chemotherapy and radiotherapy for gastrointestinal lymphoma 6 years previously. Treatment consisted of palliative cystectomy for bladder pain and haematuria. A massive pelvic and abdominal wall recurrence occurred two months after cystectomy and the patient died. The authors review the 16 cases of malignant histiocytofibroma of the bladder reported in the literature. Histiocytofibroma is a tumour which requires aggressive treatment with a combination of radical surgery and systemic chemotherapy.

Aged↗

PubMed1997

[Infiltrating bladder tumor in a renal transplant patient: cystectomy with prostatic conservation and enterocystoplasty].

OBJECTIVE: The principles of treatment of de novo bladder tumours in renal transplant patients are comparable to those applied in non-transplant patients. In the case of an invasive tumour, techniques can be used to restore urinary tract continuity after cystectomy. A case of cystectomy with enterocystoplasty for invasive bladder tumour in a renal transplant patient is reported. MATERIAL AND METHODS: An invasive urothelial bladder tumour was discovered in a 62-year-old man, 3 months after a 2nd renal transplantation. Treatment consisted of cystectomy with prostatic preservation and nontubulized enterocystoplasty. RESULT: With a follow-up of 21 months after cystectomy, the patient is alive without recurrence. He is perfectly continent during the day, with normal sexual intercourse and no reflux or residual urine. Renal function is normal. CONCLUSION: Cystectomy with enterocystoplasty can be an effective treatment for invasive bladder tumour in renal transplant patients. This treatment ensures oncological control and acceptable comfort while preserving the transplant.

Carcinoma, Transitional Cell↗

PubMed1997

[Acucise endoureterotomy for distal ureteral stenosis in a renal transplant patient].

The treatment of ureteric strictures in renal transplantation used to be surgical, but has recently benefited from progress in endourology. The authors report the case of a renal transplant recipient who developed late stricture of the ureterovesical reimplantation of the transplant. After percutaneous nephrostomy, which restored good renal function, retrograde endoureterotomy was performed using an Acucise ureterotome balloon, followed by ureteric modelling on a 7F double J stent for 2 months. With a follow-up of 18 months, renal function was normal and ultrasonography showed residual hypotonia of the transplant cavities and no vesicorenal reflux was detected by retrograde voiding cystourethrography. Acucise retrograde endoureterotomy can constitute a simple endourological treatment for late ureteric strictures in renal transplantation.

Catheterization↗

PubMed1997

[Contralateral perirenal metastasis of renal adenocarcinoma].

The objective of this paper is to report an exceptional case of solitary contralateral perirenal metastasis from a renal cell carcinoma. Investigation of this 62-year old patient, presenting with isolated haematuria, revealed a tumour, 9 cm in diameter, in the upper pole of the right kidney, associated with contralateral metastasis in the left perirenal fat. A right radical nephrectomy and left lumpectomy including the fat around the tumour were performed via a bilateral subcostal incision. Pathological staging was pT3b N0 M1, Fuhrman grade III. With a follow-up of eight months, this patient was asymptomatic with a normal radiological assessment.

Adenocarcinoma↗

PubMed1997

[The AMS 800 sphincter in urinary incontinence after prostatic surgery. Apropos of 16 patients].

OBJECTIVE: To present the results of a series of artificial sphincters implanted for urinary incontinence after prostatic surgery. PATIENTS AND METHODS: From 1987 to 1996, artificial sphincters were implanted for urinary incontinence after prostatic surgery, consisting of one transvesical prostatectomy, 11 prostatic resections and 4 radical prostatectomies. All these patients were evaluate by urine culture, cystourethrography and urethrocystoscopy. Eleven patients underwent urodynamic assessment. The AMS 800 artificial sphincter was used. RESULTS: The mean interval between onset of incontinence and implantation was 18 months. The mean follow-up after implantation of the sphincter was 6 years. An operative wound of the bulbar urethra did not prevent implantation of the sphincter, but required repair and prolonged catheterization (12 days). The mean duration of catheterization was 6 days. The overall functional result was 81% (13 case), and 75% of sphincters were functional at 5 years. Five revisions were necessary to maintain functioning of the sphincter in 2 cases of rupture and 1 displacement of the balloon, 1 case of urethral atrophy and 1 rupture of the pump. Three explanations, 2 total and 1 partial, were performed. Two reimplantations were performed after 12 months and 26 months respectively. CONCLUSION: The AMS 800 artificial sphincter currently represents an effective treatment for urinary incontinence due to sphincter insufficiency after prostatic surgery. However, an old artificial sphincter may require revision to restore function.

Aged↗

PubMed1996

Transplantation of a horseshoe kidney into 2 recipients.

We report the case of a transplantation of a horseshoe kidney to 2 recipients after isthmic section of the kidney. A review of the literature since 1975 mentions only 14 cases of transplantation of a horseshoe kidney. In the absence of a significant urological clinical history of the donor, the presence of a horseshoe kidney, in the case of multiorgan harvesting, does not represent a contraindication for transplantation.

Adult↗

PubMed1996

[Urachal adenocarcinoma associated with urothelial tumor of the bladder. Report of a case].

The authors report a rare association of adenocarcinoma of the urachus and urothelial bladder carcinoma. Treatment consisted of cystoprostatectomy with removal of the urachus and cutaneous ureterostomy. A review of the literature indicates that adjuvant treatment has yet to be defined. This is a chance association whose prognosis depends on the invasive nature of the urothelial tumour.

Adenocarcinoma↗

PubMed1996

Impact of recombinant human granulocyte colony stimulating factor on dose intensity and toxicity of three cycles of methotrexate, vinblastine, doxorubicin and cisplatin in patients with previously untreated urothelial bladder carcinoma.

This single arm, open labeled, non randomized study was aimed to evaluate the toxicity of 3 cycles of MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) with rhG-CSF (5 micrograms/kg/day from day 3 to day 14), on 14 patients with previously untreated infiltrating bladder carcinoma, 42 cycles were administered. Chemotherapy toxicity was very low, with 7% of neutropenia grade 3 or 4.4% of thrombocytopenia grade 2, no mucositis above grade 2 and no nadir sepsis. Bone pain related to rhG-CSF occurred in 14% of cycles. 88% of the cycles were given at full dose without any delay and mean relative dose intensity was 96.4% (RDI was 100% for 9 patients). One patient achieved a complete pathological response (cystectomy: 1) and 6 clinical responses with negative transurethral resection. Addition of rhG-CSF to MVAC chemotherapy allows a high dose intensity of MVAC with very low toxicity over 3 cycles. This association should be compared to standard MVAC or intensified regimens to evaluate efficacy, toxicity, and cost effectiveness.

Adult↗

PubMed1996

[Prostate specific antigen].

Prostate specific antigen is the "gold standard" prostate tissue marker. Based on a reviews of the literature, we present the metabolism, method and lassay clinical use for diagnosis, staging and prostate cancer as well as for monitoring response to treatment. The authors also discuss some situations able to increase the level of this marker.

Adult↗

PubMed1996

[Surgical treatment of iatrogenic stenoses of the ureter. Apropos of 17 cases].

OBJECTIVE: Assess the surgical treatment of iatrogenic stenosis of the ureter. METHODS: Seventeen cases of iatrogenic stenosis of the ureter operated between 1991 and 1995 were reviewed. There were 10 women and 7 men, mean age 52 years with pelvic (n = 12), iliac (n = 4) and lumbar (n = 1) stenosis. Ten persons had ureterovesicular reimplantation, including 6 with psoic bladder, 2 with homolateral ureteroureterostomy and 5 with ureteroileoplasty. Mean follow-up was 24 months. RESULTS: Treatment was successful in 14 patients. There were 3 failures, 2 recurrences with reflux which were treated by reoperation with success. CONCLUSION: Our results were in agreement with those reported in the literature. Classical surgery gives sur results in case of endourologic treatment of iatrogenic stenosis of the ureter.

Adult↗

PubMed1996

[Prognostic factors of renal adenocarcinoma: study of a series of 233 patients].

OBJECTIVE: To identify certain prognostic factors of renal cell carcinoma in a retrospective series of 233 patients. PATIENTS AND METHODS: 233 patients (162 males and 71 females with a mean age of 60 years) were operated for renal cell carcinoma between January 1980 and December 1991. sith a mean follow-up of 41.7 months. Statistical analysis was performed according to the Kaplan-Meier method for survival curves, according to the Mantel-Cox model for univariate or multivariate analysis and according to Student's t test and Chi-square test for comparison of quantitative and qualitative variables. RESULTS: The operative and global mortality was 2.2% and 28%, respectively. The following prognostic factors were identified: visceral metastases (p = 0.0001), lymph node invasion (p = 0.001), symptomatic nature of the tumour (p = 0.0004), local pathological stage (p = 0.0001) and nuclear grade (p = 0.0001). Multivariate analysis showed that the first 3 factors were the most pejorative (relative risk (RR) = 6.7, 4.6, and 1.7, respectively). Venous invation, multifocal tumours, and cell type were not studied in our series. CONCLUSION: This study confirmed that metastases, lymph node invasion and symptomatic tumours were the most pejorative prognostic factors.

Adenocarcinoma↗

PubMed1995

Prognostic value of nuclear grade of renal cell carcinoma.

BACKGROUND: The authors assessed the interest and the value of Fuhrman's nuclear grade as a possible prognostic factor for renal cell carcinoma (RCC). METHODS: An 11-year retrospective study of 190 patients with RCC treated by radical nephrectomy was performed. The distribution by grade was: Grade I, 54 patients; Grade II, 58; Grade III, 58; and Grade IV, 20. The distribution of the patients by tumor stage according to the TNM15 classification was: pT1, 56 patients; pT2, 41; pT3a, 55; pT3b, 25; pT3c + pT3d + pT4b, 5; and pT4a, 8. Significant correlations with other prognostic parameters were noted. Survival curves by grade were evaluated by the Kaplan-Meier method. RESULTS: Nuclear grade was correlated with tumor stage (P = 0.0001), synchronous metastases (P = 0.003), lymph node involvement (P = 0.0001), renal vein involvement (P = 0.0001), tumor size (P = 0.0001), and perirenal fat involvement (P = 0.001). No correlation was found between nuclear grade and tumor multicentricity (P = 0.14) and cell type (P = 0.2). Nuclear grade was an effective parameter in predicting development of distant metastases after nephrectomy. Among the 54 patients who presented with Grade I tumors, only one tumor did metastasize during the 5-year follow-up, whereas 17% of the Grade III and 30% of the Grade IV tumors metastasized. The 5-year actuarial survival rates of the patients with Grade I, II, III, and IV tumors was 76%, 72%, 51%, and 35%, respectively. The comparison of the survival curves by grade showed a statistically significant difference between the curves when Grade I and II tumors were compared with Grade III and IV tumors (P = 0.001). CONCLUSION: In this study, nuclear grade was found to have prognostic significance and seems to be an important criterion when considering the outcome of patients with RCC.

Adult↗

PubMed1995

Prognostic significance of incidental renal cell carcinoma.

From 1980 to 1991, 236 patients with renal cell carcinoma were treated in our department. We studied the characteristics and the prognostic significance of 74 patients with incidental renal cancer in comparison with those with symptomatic tumors. The mean age of the patients was 59.8 years and the sex ratio 2 males/1 female. The incidence of incidental tumors increased from 14% in 1980 to 48% in 1991. Incidental tumors were discovered mainly during examination for cardiovascular diseases (26%), hepatobiliary diseases (22%) and general health examination (23%). Local tumoral stage and histologic grade were significantly lower for the incidental tumors than for symptomatic ones (p = 0.002 and p = 0.001). In the same way, the rates of the patients with metastases or nodal involvement were lower for those with incidental tumors than for those with symptomatic tumors (p = 0.008 and p = 0.001). The mean tumoral size was 5.7 +/- 3 cm for incidental tumors and 7.6 +/- 3.5 cm for symptomatic tumors (p = 0.0001). The survival was significantly different according to the circumstances of detection of the tumors (p < 0.001); the 5- and 10-year actuarial survival rates was 85% for the patients with incidental tumors and respectively 61 and 44% for the patients with symptomatic tumors. The multivariate analysis by Cox proportional hazard model showed three important and independent prognostic factors: the presence of metastases (relative risk (RR): 6.7), nodal involvement (RR: 4.6) and symptomatic tumors (RR: 1.7). The patients with incidental tumors had a better prognosis than those with symptomatic tumors because of lower tumoral size and local stage. The early diagnosis of renal cell carcinoma improved the prognosis of the patients.

Adolescent↗