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Biomedical subjects

D Beurton

Publications and source records attributed to D Beurton.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Cutaneous trans-jejunal ureterostomy: an original technique used in 29 patients].

The authors report an original technique of transintestinal cutaneous diversion using the jejunum A 10 to 15 cm segment of jejunum is raised from the second loop and is attached to the skin transperitoneally. The stoma lies below the ureterojejunal anastomosis and the two ureters, sutured according to Wallace's technique, are implanted end-to-end into the proximal and extraperitonealised end at the height of the sacral promontory. 29 patients have been treated by this technique for various indications: 21 bladder tumors, 5 neurogenic bladders, 1 bladder exstrophy, 1 cervical cancer, 1 prostatic cancer. 15 patients (52%) had previously received pelvic irradiation. The mean follow-up was 47 months (2-192 months) and the mortality was zero. 4 patients (13.8% developed early complications: 2 cases of urinary tract obstruction and 2 intestinal obstructions requiring 3 operations. 6 patients developed 7 minor late complications (24.1%): 2 cases of pyelonephritis, 4 cases of renal stones, only one of which required an operation, and 1 case of prolapsed stoma. None of the patients developed any alteration in renal function or dilatation of the upper urinary tract after the operation. The addition of sodium bicarbonate was found to be useless, as none of the patients developed any metabolic disorders. Transjejunal cutaneous ureterostomy achieves excellent drainage by means of a short graft with a stoma situated below the level of the ureteric implantation, as reflected by the absence of any long-term deterioration in renal function despite full lumen ureterojejunal implantation without an antireflux device. This technique is simple to perform and is indicated in all situations, particularly after pelvic irradiation. It is associated with low morbidity, no mortality and ensures an excellent long-term result.

Adolescent↗
PubMed1991

[Urological studies in urination disorders in children].

Enuresis nocturna in children must not be confused with incontinence associated with disorders of urination. Questioning and clinical examination are sufficient to distinguish between these two entities. The former is a psychogenic condition which does not require urological examination, whereas the latter is of urological or neurological origin and requires additional explorations to reach an aetiological diagnosis. These explorations (urography, cystography, cystomanometry, neurophysiological and/or neuroradiological studies) are determined according to the type of the presumed lesion and to the child's age.

Child↗
PubMed1991

[Prevention of vascular thromboses after renal transplantation using low molecular weight heparin].

Vascular thrombosis is one of the main causes of early transplant failure in pediatric patients. This paper reports the results of an open trial of the low molecular weight heparin (Enoxaparine) used to prevent renal graft thrombosis in pediatric recipients with risk factors including donor or recipient age under 5 years, multiple arteries supplying the transplant, and positive history for recurrent thrombosis. During 1989, 42 of 67 children given a renal transplant were prophylactically treated with Enoxaparin. Only one transplant was lost to thrombosis among treated patients (1.5%), versus 9 transplants among 73 (12%) children who received their kidney in 1988 without prophylactic Enoxaparin. Risk factors were comparable in both groups of recipients. Enoxaparine therapy was associated with an increased rate of bleeding (12/42) without severe consequences. In conclusion, Enoxaparin is effective in preventing renal graft thrombosis. Availability of this prophylactic therapy makes it possible to use transplants removed from the youngest donors considered as inadequate by some groups.

Age Factors↗
PubMed1991

[Do posterior urethral valves alter the results of renal transplantation in children?].

The authors conducted a retrospective study based on a series of 715 renal transplantations in children performed between January 1973 and December 1989 at the Hôpital Necker-Enfants Malades in order to determine whether the long-term result of renal transplantation was as good in children with posterior urethral valves (PUV) as in children with a normal lower urinary tract. Group 1 consisted of 50 renal transplantations performed in 41 children in whom the primary urological disease was PUV. The bladder was able to be used without modification in 36 cases and had to be enlarged in 5 cases. A permanent cutaneous urinary diversion was not required in any of these transplanted patients. Group 2 consisted of 665 renal transplantations performed in children without PUV. There was no significant difference between the two groups in terms of the distribution of cadaver kidney and living related donor transplantations. Immunosuppressive treatment consisted of various combinations of prednisone, azathioprine, ALS for the earlier patients in the series, OKT 3 and cyclosporin for the more recent patients. In group 1, we observed a urological complication rate of 20% and a vascular complication rate of 14%, while, in group 2, the urological complication rate was 16.9% and the vascular complication rate was 9.5%. The actuarial 5-year and 10-year graft survival rates were 63% and 49% in group 1 and 63% and 49% in group 2, respectively. The actuarial graft survival rates were therefore identical in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

[Urethral stricture in children. Long term results of surgical treatments].

Thirty-six urethral strictures were treated between 1977 and 1984. Three strictures were considered to be congenital, eleven were traumatic and twenty-two were iatrogenic. The authors performed twenty five internal urethrotomies, twelve resection-sutures of the urethra and eleven urethroplasties including eight patch grafts with a pedicle derived from scrotal or penile skin, a tubed pedicle scrotal skin flap, one Jurascek urethroplasty and one Leveuf urethroplasty. Internal urethrotomy only gave 50% of good results and is now reserved for short strictures less than one centimetre in length. Resection-suture is an excellent operation which should be reserved for strictures less than two centimetres in length: it gave 84% of good results. One of the various types of pedicle cutaneous urethroplasty is certainly the best operation for long strictures: it gave more than 90% of good results in the present series.

Adolescent↗
PubMed1990

[Chemotherapy in advanced transitional cell carcinoma of the urinary tract. Phase II trial of a combination of doxorubicin and cisplatin].

Between January 1, 1983 and December 31, 1984, 18 patients with advanced transitional cell carcinoma of the urothelium were treated in a Phase II trial with doxorubicin 45 mg/sqm plus cisplatin 90/mg/sqm/day every four weeks. 17 patients were evaluable for response. There were: 4 partial responses (24% of response objective effects, 95% confidence limits are 15% and 33%) and 13 failures. The median survival was 18.5 months for responders and 10 months for non responders.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[5-year treatment results of urethral stenosis using internal urethrotomy in adults].

The authors reviewed the records of 69 patients with a mean age of 51 years treated for single (81%) or multiple (19%) urethral strictures, in whom the first operation to be performed was endoscopic internal urethrotomy with a follow-up of at least 5 years. The mean follow-up was 71 months. The actuarial rate of good results was 27.2 +/- 11% at 5 years. The success rate of repeated internal urethrotomy was satisfactory, but was not evaluated with the same follow-up (62.5% after the first repeat urethrotomy with a mean follow-up of 13 months).

Adolescent↗
PubMed1990

[Stenosis of the urethra in children. Long-term results of surgical treatment].

Thirty-six urethral strictures were treated between 1977 and 1984. Three strictures were considered to be congenital, eleven were traumatic and twenty-two were iatrogenic. The authors performed twenty five internal urethrotomies, twelve resection-sutures of the urethra and eleven urethroplasties including eight patch grafts with a pedicle derived from scrotal or penile skin, a tubed pedicle scrotal skin flap, one Jurascek urethroplasty and one Leveuf urethroplasty. Internal urethrotomy only gave 50% good results and is now reserved for short strictures less than one centimetre. Of resection-suture is an excellent operation which should be reserved for strictures less than two centimetres: it gave 84% of good results. One of the various types of pedicle cutaneous urethroplasty is certainly the best operation to treat long strictures: it gave more than 90% of good results in the present series.

Adolescent↗
PubMed1989

[Adjuvant chemotherapy using adriamycin and cisplatin in infiltrating cancer of the bladder. Prospective study of 49 cases].

Between January 1981 and March 1988, we prospectively treated 49 patients with infiltrating bladder cancer (Stages B2, C and D1 of the classification of Marshall or pT3-T4, No/N+ of the UICC classification) by adjuvant combination chemotherapy with Adriamycin and Cisplatin. Chemotherapy started 4 to 8 weeks after radical surgery with total prostatocystectomy in males or anterior pelvectomy in females associated in all cases with bilateral ilio-obturator pelvic lymph node dissection. With a mean follow up of 34 months (3 to 85 months) 32 patients are still alive and disease free (17/23 stage B2, 8/15 stage C, and 7/11 stage D1). The crude disease free survival is 76%, 49% and 25% for stages B2, C and D1 respectively. These results seem better than those reported with radical surgery alone and encourage the adoption of adjuvant chemotherapy to improve survival in patients with infiltrating bladder cancer.

Adult↗
PubMed1989

[Anomaly of the pyelo-ureteral junction and antenatal ultrasonic diagnosis].

Over a period of five years, 40 cases of anomaly of the pyelo-ureteral junction were diagnosed ante-natally which subsequently required surgical intervention during the first year of life. The indication for the therapy was based on the degree of obstruction (IVU, DTPA scanning, Whitaker test), the thickness of the renal parenchyma (IVU, ultrasound) and, to a lesser extent, on calyceal dilatation. After a period of follow up ranging from 3 to 48 months (mean 16.8 months), good results were noted in 37 cases, there were two permeable junctions with poorly functioning kidneys and one obstruction which was successfully reoperated. These results suggest that intervention is preferable to surveillance at varying intervals for an undetermined period, where the risk of a sudden exacerbation is always possible.

Diagnostic Imaging↗
PubMed1988

[Surgical correction of intermittent vesico-ureteral reflux without radiologically detectable reflux].

On the basis of a series of 62 children with no radiological evidence of reflux but with an abnormality of a ureterovesical implantation similar to that seen in children with radiologically detected reflux, the authors attempt to show that under certain precise conditions (presence of cortico-papillary renal lesions, recurrent episodes of acute pyelonephritis, even in the absence of renal lesions), the absence of radiologically detectable reflux is not sufficient to confirm the primary nature of pyelonephritis. The sub-mucosal course of the ureters was found to be short in all of these children, and anti-reflux surgery was carried out on one or both sides according to whether the abnormality of uretero-vesical implantation was uni or bilateral. In this small selected group, clinical and bacteriological results were similar to those obtained by anti-reflux surgery in children with radiologically detected vesico-renal reflux.

Child↗
PubMed1987

Hypertension following renal transplantation in children.

The files of 334 consecutive cadaver kidney (CK) and of 27 living related (LR) transplantations (T) in children and adolescents performed from 1973 to 1984 have been reviewed. Following cadaver transplantation, 52 patients (15%) never had hypertension (HT), 41 patients (12%) had only initial HT up to 6 months after transplantation and 18 other patients (5%) exhibited transient HT episodes while on high-dose steroid therapy. Finally, 209 patients (62%) had HT for periods longer than 6 months and 16 patients (5%) until death or graft failure within the first 3 months. Chronic graft rejection was the major cause of HT, but other factors either isolated or in association were also present. Renal artery stenosis (RAS) was diagnosed in 43 cases (13%) 2-17 months post-transplantation; 10 of these were operated upon (5 successfully) and 9 underwent transluminal angioplasty with a single success. Nine cases of RAS resolved spontaneously. HT was attributed to the host kidney in 10 cases (3%) and to recurrence of primary renal disease in 9 (3%). HT observed after CKT was sometimes severe and difficult to control. Acute complications from HT were recorded in 35 cases, with 6 deaths and 2 severe neurological sequelae. Among 25 LRT, 11 cases (40%) had no HT 13 (48%) had HT for longer than 6 months. In this group, no case of RAS was observed and only one complication (without sequelae) was noted. In conclusion, HT is a frequent and sometimes severe complication post-transplantation in children and adolescents.

Child, Preschool↗