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Biomedical subjects

D Bon

Publications and source records attributed to D Bon.

At least 19 recordsLinked to original sources
PubMed2000

Polyethylene stent blockage: a porcine model.

BACKGROUND: Endoscopic insertion of biliary stents is a useful treatment for obstructive jaundice resulting from unresectable tumors of the pancreas and biliary tree. The main drawback is the recurrence of jaundice due to clogging. The aim of this study was to establish an experimental model of polyethylene stent clogging in large white pigs. METHODS: A straight polyethylene stent of 5F (group I), 7F (group II) or 10F size (group III) was inserted in the common bile duct. Animals were killed at 2 months, or earlier if physical signs suggesting stent clogging occurred. Chemicophysical analysis of stent deposition combined stereomicroscopy and identification of the contents by means of Fourrier transform infrared spectroscopy. Bacteriologic analyses included identification of aerobic and anaerobic bacteria and measurement of beta-glucuronidase, lecithinase and lipase activities. RESULTS: Physical signs suggesting stent obstruction or death occurred in 8 of 8 animals in group I, 11 of 12 in group II, and 2 of 8 in group III (p < 0.001). The proportion of mucoprotein in the stent contents tended to fall with increasing stent diameter (mean 82%, 58% and 47% for 5F, 7F and 10F, respectively), whereas wheat starch and calcium bilirubinate content increased with increasing stent diameter (9% and 4%, 18% and 10%, and 29% and 23% for 5F, 7 F, and 10F, respectively), although none of these differences were statistically significant. A variety of bacteria were cultured from the stent deposits, including anaerobic strains. Clostridium species were associated with the highest enzyme activities. CONCLUSIONS: In this model the major component of early stent deposits was mucoprotein, and numerous aerobic and anaerobic bacteria were isolated. Formation of calcium bilirubinate was a late phenomenon and poorly related to bacterial enzymatic activities.

Animals↗
PubMed1999

BTA stat and BTA TRAK: A comparative evaluation of urine testing for the diagnosis of transitional cell carcinoma of the bladder.

OBJECTIVE: We compared the BTA (bladder tumor antigen) stat test with the BTA TRAK assay in patients highly suspicious of bladder cancer. METHODS: The BTA stat and the BTA TRAK tests are two immunoassays that detect human complement factor H related protein in urine, employing the same antibody pair. The BTA stat is a qualitative test which can be performed in a consultation setting. The BTA TRAK is a quantitative test that is performed in the laboratory. Consecutive patients highly suspicious of bladder cancer were included in this prospective blinded trial to assess the clinical performances of the two methods. RESULTS: A total of 81 patients were tested using BTA stat and BTA TRAK before cystoscopy. A tumor was identified in 49 patients. BTA TRAK (38/49 true-positive cases) was more sensitive than BTA stat (32/49) in detecting bladder cancer (p < 0.05). When considering the subgroups of bladder cancer by stage and grade, the difference remained significant for low-grade and low-stage tumors. There was no significant difference between BTA TRAK and BTA stat as regards specificity (20/32 and 23/32 true-negative cases, respectively; p = 0.2). CONCLUSION: BTA TRAK with a cutoff of 14 U/ml had a significantly higher sensitivity than BTA stat in the detection of low-grade and low-stage bladder cancer.

Aged↗
PubMed1998

[Renal cancer and late pancreatic metastases. Apropos of 3 cases and review of the literature].

Renal cell carcinoma is a malignant epithelial tumour which can always give rise to metastases, usually situated in the lungs, bone and liver. In contrast, pancreatic metastases are exceptional and can occur late. The authors report three cases of metachronous pancreatic metastases, 1, 4 and 10 years after nephrectomy. The procedures performed consisted of Whipple procedure, tumour excision and total duodenopancreatectomy. Although rare when isolated to the pancreas, these metastases can justify even audacious pancreatic resection.

Adenocarcinoma, Clear Cell↗
PubMed1997

Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value.

PURPOSE: We attempted to identify morphological parameters of benign prostatic hyperplastic inflammation that correlate with pre-biopsy prostate specific antigen (PSA) concentrations. MATERIALS AND METHODS: Patients undergoing prostate biopsy at our department were prospectively studied between January 1995 and January 1996. preoperative blood and 24-hour urine samples were measured for PSA. Biopsy samples harboring exclusively benign prostatic tissue were graded on a 4-point scale for inflammation (0-no inflammatory cells, 1-scattered inflammatory cell infiltrate, 2-nonconfluent lymphoid nodules and 3-large inflammatory areas with confluence of infiltrate) and aggressiveness (0-no contact between inflammatory cells and glandular epithelium; 1-contact between inflammatory cell infiltrate and glandular epithelium; 2-clear but limited, that is less than 25% of the examined material, glandular epithelium disruption, and 3-glandular epithelium disruption on more than 25% of the examined material). RESULTS: A total of 66 patients with exclusively benign prostatic tissue on prostate biopsies was analyzed. Difference between inflammation graded groups was not significant when considering serum or urinary PSA. There was a significant correlation between aggressiveness grading and serum PSA (rho = 0.51, p < 0.0001), whereas aggressiveness grading and urinary PSA did not correlate (rho = -0.06, p = 0.6). CONCLUSIONS: Prostatic subclinical inflammation is not associated with high urinary PSA. Unless associated with glandular epithelial disruption, density of prostatic interstitial inflammatory cell infiltrate is not significantly correlated with serum PSA concentration. We believe that this issue should be considered when interpreting a prostate biopsy.

Aged↗
PubMed1997

Patient tolerance of transrectal ultrasound-guided biopsy of the prostate.

OBJECTIVES: To determine the acceptability by patients of ultrasound-guided prostatic biopsy without anaesthesia. PATIENTS AND METHODS: From January 1995 to January 1996, 81 patients in our department undergoing transrectal ultrasound-guided prostate biopsy were asked to assess the tolerability of the procedure using an immediate post-operative questionnaire including a 10 cm linear visual analogue scale (VAS). RESULTS: The mean VAS score was 3 (standard error 0.24) and 16% of the patients had a VAS score of > or = 5. Responses to the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19% would not agree to undergo it again without some form of anaesthesia. CONCLUSIONS: Even when anaesthesia-free, transrectal ultrasound-guided prostatic biopsy was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of the current out-patient setting should be reassessed.

Aged↗
PubMed1997

[Orbital metastasis of a prostatic cancer. A therapeutic emergency].

In the light of a case of left orbital metastasis, constituting the presenting sign of prostatic cancer in a 60-year-old man, the authors emphasize the rarity of this site, despite the high frequency of bone metastases in this disease. They discuss the diagnostic methods and stress the need for urgent treatment to save ocular function.

Adenocarcinoma↗
PubMed1997

[Ureterosigmoidostomy after total cystectomy in cancer. Long-term results. Apropos of 60 cases].

OBJECTIVES: Restoration of continuity of the urinary tract after total cystectomy deserves discussion even if most authors currently opt for bladder replacement or transileal cutaneous diversion. Diversion into the colon, which was used for a long time, has possibly been unjustly abandoned. METHODS: From 1974 to 1995, sixty patients (116 renal units) underwent cystectomy for cancer, followed by systematic ureterosigmoidostomy when age and local conditions allowed. The mean age of the patients (52 men and 8 women) was 60 years. They were reviewed at least every six months and surveillance consisted of annual clinical and laboratory examinations and intravenous urography for 5 years. Evaluation of the functional results and quality of life was based on the information recorded in the patients' files and on the answers to a questionnaire for the 19 patients alive without recurrence. RESULTS: The median follow-up was 80 months. Thirty seven patients have died, 23 (38.38%) of them from bladder cancer. Forty patients (66.6% had an uneventful immediate postoperative course. The major late complications were septic reflux in the upper urinary tract stenosis of the ureteric reimplantation and febrile urinary tract infections, requiring either repeat reimplantation or another diversion. Nocturnal (82%) and diurnal (85%) continence was good and 17 of the 19 patients alive with no signs of recurrence are satisfied with their lifestyle. CONCLUSION: After total cystectomy for cancer, implantation of the two ureters into the colon remains a good method of urinary diversion due to its simplicity and good tolerance sometimes at the cost of a second operation. Recent technical modifications should restore the value of this operation.

Adult↗
PubMed1997

[Technique for protecting the liver graft less tolerant than the small bowel to heat-induced ischemia in experimental liver + small bowel transplantation in swine].

Multivisceral and orthotopic liver/small bowel transplantations have been performed to treat patients with intestinal failure associated with liver failure induced by parenteral nutrition. The aim of this experimental study was to determine the experimental liver-small bowel harvesting and transplantation technique that achieves the best compromise between liver and intestine ischemia times in pigs. Initial portal revascularization of the liver which reduces the hepatic warm ischemia time after cold ischemia preparation of the graft immersed in lactated ringer's solution at 4 degrees C, reduce the risk of primary non function of the graft.

Animals↗
PubMed1996

Radiographic prognostic criteria for extracorporeal shock-wave lithotripsy: a study of 485 patients.

OBJECTIVES: We studied 485 patients treated by extracorporeal shock-wave lithotripsy (ESWL) using an ultrasound electrohydraulic apparatus in an effort to define radiographic criteria for better patient selection for ESWL. METHODS: Results were assessed according to plain x-ray nephrotomography and ultrasound. The criteria for measuring success (stone free [SF]) excluded all residual fragments. After per-criteria analysis of the results, a multivariate analysis as well as an analysis of stone composition by infrared spectroscopy were performed. RESULTS: The SF rate was 57.5% (279 of 485). Calculi that were smooth, denser than bone, located in the lower calyx, and larger than 15 mm had less satisfactory results despite a greater number of impulses. A correlation was established between the radiographic appearance of the calculus, its composition, and ESWL results. Rough, less dense calcium oxalate dihydrate yielded satisfactory results (65%), whereas smooth, dense calcium oxalate monohydrate led to less conclusive results (41%). Multivariate analysis demonstrated the predominant influence of radiographic calculus profile on the results: rough, less dense calculi yielded a 79.4% SF rate, whereas smooth, dense calculi yielded a 33.6% SF rate. CONCLUSIONS: We propose that patients with dense, smooth calculi located in the lower calyx and larger than 15 mm be treated by other techniques, such as percutaneous nephrolithotomy. This would not only increase the ESWL effectiveness rate, but would also reduce the cost of treating kidney stones.

Adolescent↗
PubMed1996

Patient acceptability of transurethral incision of the prostate under local anaesthesia.

OBJECTIVE: To determine the acceptance by patients of transurethral incision of the prostate (TUIP) under local anaesthesia. PATIENTS AND METHODS: The study comprised 30 consecutive patients who elected to undergo local anaesthesia for TUIP and were treated between December 1994 and September 1995. Twenty-two were considered a high risk for general anaesthesia and eight patients chose local anaesthesia for personal reasons. Patients were premedicated (opioid and benzodiazepine) and 1% lidocaine was infiltrated transurethrally using an endoscopic needle. The level of acceptance was determined using an immediate post-operative questionnaire which included a linear visual analogue scale (VAS) to rate pain. RESULTS: No patient required conversion to another type of anaesthesia and there were no complications related to the local anaesthesia. The mean (SE) VAS score was 3.2 (1.7) and the questionnaire results showed that 83% of the patients did not consider that general anaesthesia was necessary for the operation and that 90% would agree to undergo the procedure again under local anaesthesia. CONCLUSION: TUIP under local anaesthesia was well tolerated in motivated patients. We recommend it as the operation of choice for the relief of obstruction in high-risk patients with a small benign prostatic hyperplasia.

Aged↗
PubMed1995

Systematic removal of catheter 48 hours following transurethral resection and 24 hours following transurethral incision of prostate: a prospective randomized analysis of 213 patients.

The interval before removal of the catheter used in prostatic transurethral surgery depends to a great extent on the surgeon, with a frequently empirical orientation. We conducted a prospective, randomized and controlled study of 213 patients who underwent transurethral surgery for benign prostatic hyperplasia. The catheter was removed systematically 24 hours after transurethral incision and 48 hours after transurethral resection of the prostate (group 1-52 and 54 patients, respectively) or the catheterization interval was determined by each surgeon in accordance with the usual criteria (group 2-52 and 55 patients, respectively). No statistically significant differences were noted between these 2 groups in regard to complications. We conclude that systematic removal of the catheter at the aforementioned periods is cost-effective, safe and comfortable for the patient.

Aged↗
PubMed1995

[Results of extracorporeal lithotripsy with ultrasonography-guided hydroelectric lithotriptor: study on 546 patients, prognosis factors].

OBJECTIVE: To investigate the existence of simple radiographic prognostic criteria, applicable on an outpatient basis, predictive of the result of extracorporeal lithotripsy (ECL). METHODS: This study was based on 546 patients treated by ECL using a hydroelectric apparatus. The results were evaluated on plain nephrotomographies and ultrasonography performed at the third month. Success was defined as the elimination of all residual fragments, regardless of their size, without fragments (WF). Analysis concerned 485 files after exclusion of patients lost to follow-up. Prognostic factors were evaluated criterion by criterion, and then by multiple ascending regression multivariate analysis. RESULTS: The fragment-free rate according to our criteria was 57.5%. Significantly poorer results were obtained for stones denser than bone (p < 0.001), smooth (p < 0.001, larger than 12 mm (p < 0.01), situated in the inferior calyx (p < 0.005), despite an increased (p < 0.005) number of ECL sessions and the number of shocks received. A correlation was established between the radiographic appearance of the stone, its predominant spectrophotometric nature (> or = 50%) and the results of ECL. Good results were obtained in 65% of spiculated, low-density Weddellite stones versus 41% of cases of dense, smooth Whewellite stones. Multivariate analysis of the predominant radiographic appearance of the stones showed that spiculated, low-density stones were completely eliminated in 79.4% of cases, and dense, smooth stones were completely eliminated in 33.6% of cases (p < 0.001). CONCLUSION: In this study, smooth, dense stones larger than 12 mm, situated in the inferior calyx appear to be particularly resistant to ECL. On the basis of this result, the authors propose a prospective clinical trial to compare the results of ECL and primary percutaneous nephrolithotomy in this type of stone with a high risk of failure.

Adolescent↗
PubMed1994

[The treatment of stage I malignant non-seminoma tumors of the testis without systematic lumbo-aortic dissection. Results of a study begun 20 years ago. Apropos of 21 cases].

Over a 20-year period (1971-1991), the authors have treated 75 malignant testicular tumours, corresponding to 33 seminomas and 42 nonseminomatous tumours. The latter group included 23 stage I tumours according to Peckham's classification. The authors studied the therapeutic modalities of 21 of these patgients (2 non-protocol patients excluded) treated without lumboaortic lymph node dissection. Adjuvant therapy consisted of radiotherapy alone (2 cases), radiotherapy and chemotherapy (5 cases) and chemotherapy alone (14 cases). All patients are alive in complete remission (100%) with a follow-up of at least 24 months (range: 31-222 months, mean survival: 102.2 months). In line with what they already believed in 1971, the authors consider that systematic lumboaortic lymph node dissection is not essential in the treatment of stage I nonseminomatous testicular tumours, but propose systematic adjuvant therapy. Chemotherapy (PVB or, preferably, PEB) provides a guarantee of security and good acceptability.

Adult↗
PubMed1994

[A technical device for the percutaneous extraction in monobloc of various renal calculi larger than 10 mm].

The authors present a technical device consisting of a modification of the operating channel for stone extraction by percutaneous nephrostomy. For selected stones, widening of the lips of the operating channel allows the stone to be rapidly and entirely removed without the need for ultrasound or hydroelectric fragmentation, which is always associated with a risk of leaving residual fragments. The aim of this technical device is to ensure complete absence of residual fragments with a minimum of risks for the renal parenchyma.

Calcium Oxalate↗
PubMed1993

[Prostatic cancer between 50 and 60. A more than 20-year-long retrospective study. Apropos of 65 case reports].

Sixty five 50 to 60 year old patients have been treated for prostatic cancer over a 21 year period. Twenty four had a local prostatic cancer (A1, A2, B1, B2) and 41 (63.2%) a locally advanced or metastatic (D1, D2 disease at diagnosis. The mean age was 56 years old. As being as retrospective study, miscellaneous treatments were done. The 5 and 10 years survival, analysed with the Kaplan-Meier method, was 61% and 31% respectively. According to the stage of cancer, the 10 year survival was 72% and 5% for (A-B) and (C-D) respectively. For well differentiated tumors, 5 years survival was 67% instead of 36% for undifferentiated ones. The 10 year survival was 36% for well differentiated tumors with 6 on 8 patients who survived with a mean of 11.6 ears. The authors discussed the benefit of an early diagnosis of prostatic in the 50-60 year old men group which is 4% of the total prostatic cancer diagnosed within the same period. They analysed the influence of PSA and transrectal sonography interest at this age.

Bone Neoplasms↗
PubMed1993

[Percutaneous nephrolithotomy after failure of extracorporeal shockwave lithotripsy. Indications, results, perspectives].

Eighty-one of the 579 extracorporeal lithotripsies (ECL) performed between 1987 and 1992 with an ultrasound-guided hydroelectric lithotriptor required the use of another treatment modality. 53 percutaneous nephrolithotomies (PCNL) were performed in these 81 patients after failure of ECL (21 for non-fragmentation, 32 for residual fragments). The authors analyse the factors responsible for failure in order to select the more appropriate type of treatment for different types of stones. The site of the stones, their size, their radiographic appearance, their chemical composition, the number of ECL sessions and the number of days spent in hospital were compared between the PCNL and ECL groups. Smooth, homogeneous stones denser than bone and larger than 15 mm in diameter were significantly more resistant to ECL, despite an increased number of shock waves. PCNL was successful in 92% of cases of non-fragmented stones (with no residual fragments). The success rate for multiple residual fragments was 64%. In view of the risk of complications associated with residual fragments, regardless of their size, the potential risks of ECL and cost imperatives, the authors recommend that these stones, considered to be resistant, should be treated immediately by PCNL, as the results of PCNL after ECL are less satisfactory.

Adult↗
PubMed1993

[Ectopic ureteral orifice into the seminal duct with homolateral renal agenesis: contribution of ultrasonography].

Based on an incidental case of ectopic ureteric orifice in the seminal tract associated with homolateral renal agenesis, the authors demonstrate the value of ultrasonography, particular transrectal, both for diagnosis and follow-up. Digital rectal examination is the key to the diagnosis, combined with ultrasonography and urography. The indications for surgery depend on the clinical symptoms and signs.

Abnormalities, Multiple↗