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Biomedical subjects

D Grasset

Publications and source records attributed to D Grasset.

At least 19 recordsLinked to original sources
PubMed1992

[Cancer of the testis after Hodgkin's disease. Apropos of 2 cases].

We report about two cases of cancer of the testis occurring 2 and 7 years after Hodgkin's disease treated with combined chemotherapy and radiation therapy. From an etiopathogenic point of view, this association may, of course, be accidental, but it may also have an iatrogenic origin or be caused by contiguous carcinogenesis, or even by an immune deficiency. In addition to orchidectomy, the therapeutic history of these patients requires an adaptation of the treatment of their tumors of the testes.

Adult↗
PubMed1992

[Piezoelectric extracorporeal lithotripsy in children: first results and reflections after 18 sessions].

From 1988 to 1990, we treated 13 children between the ages of 2 and 15 years with stones of the upper urinary tract. These stones were treated by means of 18 sessions of piezoelectric extracorporeal lithotripsy: 14 under general anaesthesia and 4 without even any analgesia. We obtained an 84.5% success rate with no particular adverse effects. These results are similar to those reported for hydroelectric or electromagnetic shock wave lithotripsy, which are associated with a higher morbidity. The efficacy of extracorporeal lithotripsy in paediatrics is remarkable, but clinical studies in adults as well as animal experimentations have demonstrated severe renal contusion and do not formally exclude the possibility of delayed complications. At the present time, this technique should therefore be used very cautiously and must be accompanied by systematic prevention of recurrent stones.

Adolescent↗
PubMed1992

[Endo-urologic treatment of ureteral fistulas occurring after pelvic surgery for carcinoma: report of 5 cases].

The authors report 5 cases of ureteric fistula after radical pelvic cancer surgery. Three patients had a recurrent tumour and 3 had received radiotherapy. Endourological methods achieved 4 immediately satisfactory results, but only one complete long-term success. Isolated percutaneous drainage of the pyelocaliceal cavities effectively dried up the urine leak, but carried a high risk of secondary stenosis of the excretory tract in the absence of concomitant intubation of the fistula zone. However, endourological treatment, combined with urinary diversion and catheterisation of the pathological ureter, represented a reliable alternative to conventional surgery.

Abdominal Neoplasms↗
PubMed1992

[Leiomyosarcoma of the inferior vena cava].

The authors report a case of leiomyosarcoma of the infrarenal inferior vena cava presenting as an abdominal mass. CT and MR imaging and immunotyping led to the diagnosis of retroperitoneal leiomyosarcoma whose origin in the inferior vena cava was only confirmed by histological examination of the resection specimen. Surgical resection was followed by radiotherapy (4,500 rads) with a favourable course after 12 months. The progress in medical imaging and histology has considerably simplified the diagnosis of these rare retroperitoneal tumours. In the absence of any truly effective adjuvant therapy, treatment essentially consists of surgery and the clinical course is characterised by a high incidence of local recurrences.

Humans↗
PubMed1992

[Abdominal contusions in children. Diagnosis and treatment of renal lesions. Apropos of 26 cases].

During the past ten years, we have treated 26 children with closed renal injuries. Hematuria appeared in 19 cases, but was not detected in 7 other cases, 6 of which corresponded to severe, especially pedicular, lesions. The diagnostic means for the lesion included IVP in 24 cases, ultrasonography in 23, angiography in 8 and computed tomography in 7. The treatment was medical for 18 children and surgical for 8. Observation revealed 4 cases of renal atrophy, including 1 of general atrophy without residual arterial hypertension. On the basis of this series and of a review of the literature, we study the evolution of the diagnosis and treatment of this condition with the development of new medical imaging techniques, especially of CT.

Adolescent↗
PubMed1992

[Abdominal injuries in children. Diagnosis and treatment of renal lesions. Apropos of 26 cases].

During the past ten years, we have treated 26 children with closed renal injuries. Hematuria appeared in 19 cases, but was not detected in 7 other cases, 6 of which corresponded to severe, especially pedicular, lesions. The diagnostic means for the lesion included IVP in 24 cases, ultrasonography in 23, angiography in 8 and computed tomography in 7. The treatment was medical for 18 children and surgical for 8. Observation revealed 4 cases of renal atrophy, including 1 of general atrophy without residual arterial hypertension. On the basis of this series and of a review of the literature, we study the evolution of the diagnosis and treatment of this condition with the development of new medical imaging techniques, especially of CT.

Abdominal Injuries↗
PubMed1991

[Prognostic factors of success in renal transplantation].

From January 1984 to January 1989, 139 kidneys were retrieved from 74 brain dead donors in our institution. The transplantation was performed either locally (79), or in an other French institution (40). The five year actuarial survival rate, for the 139 kidneys retrieved in Montpellier, was 65 percent. Many factors about the donor, the retrieval and the recipient, which may affect the graft survival, were entered in a Cox multivariate analysis. The minimal follow up duration was 18 months. The risk factors studied included: donor parameters (age, sex, cause of death, haemodynamic parameters and renal function); retrieval parameters (kidney alone or multiorgan harvesting, discoloration and renal perfusion quality); organ characteristics (multiple arteries and cold ischemia time); recipients parameters (age, sex, prior transplantation, local transplantation or not, and HLA matching). A first multivariate analysis included only pretransplant risk factors. The risk factors for graft loss, as identified by the Cox model, were in the order: donor's age (P = 0.03), arterial pressure (P = 0.01), prior transplantation of the recipient (P = 0.01) and kidney discoloration quality during the retrieval (P = 0.008). Early post transplant parameters were included within this Cox model (poor early renal function, need for dialysis, serum creatinine level at one week). The need for dialysis therefore was identified as the main predictive value (P = 0.002). The 4 other risk factors, selectioned in the first model, always remained significant.

Actuarial Analysis↗
PubMed1991

[Urination control during sleep].

The authors present their approach to the sleep factor in children with enuresis, based on a still on-going exploration of manometric changes in bladder activity. Twenty patients have already been examined by cystomanometry in day time and polygraphic sleep recording at night, combined with continuous measurement of bladder pressure. This method derives from the studies of Gastaut and Broughton, in 1963, but takes into account the concept of bladder immaturity. The patients studied fell into two homogeneous groups, depending on whether enuresis was obviously due to bladder immaturity (Group I) or was strictly isolated (Group II). No disorder of sleep organization has been found in none of these two groups, but both had apparently nonspecific irritant factors. The enuresis episode is described. It tends to occur frequently at the beginning of the night, is prepared by an increase in bladder pressure which is always very pronounced in Group I subjects, and is associated with insufficient awakening reaction due to an apparently exceedingly high awakening threshold. The physiopathological and therapeutic implications of these findings are discussed.

Adolescent↗
PubMed1990

[Extracorporeal lithotripsy in gallbladder calculi. Results of a single-center experience of 31 patients].

The authors studied thirty one cases (18 women, 13 men) of extracorporeal shock-waves lithotripsy on symptomatic gallbladder stones realized with piezoelectric generators. There were one to six stones per patient with individual stone size from 8 to 40 mm; among them 16% were calcified. Any anesthesia was necessary. Shock-wave frequency was 1.25 and 2.5 Hz. The average number of shock waves administered was 4,600 per treatment. Fragmentation occurred in 67% after first treatment and in 74% after second treatment. Gallstones disappeared in 9.5% and 19.5% of patients after 6 weeks and 4 months respectively. There was no modification after four treatments in 22.5% of patients. Minor side effects were noted: back pain (29%) probably because of uncomfortable position during treatment; increased thickness of gallbladder wall (26%); biliary pain (22%). Two episodes of biliary tract obstruction by stone fragments (one mild pancreatitis, one jaundice with liver enzymes elevation) disappeared spontaneously. These results were comparable with those of other groups using the same shock waves lithotripter.

Adult↗
PubMed1989

Pharmacodynamic and pharmacokinetic study of propranolol in patients with cirrhosis and portal hypertension.

1. The aim of this study was to investigate the pharmacokinetics and the beta-adrenoceptor blocking activity according to time of conventional (C) and long acting (LA) propranolol in cirrhotic patients. Twenty-four patients with alcoholic cirrhosis and oesophageal varices were randomly assigned to receive either 160 mg C propranolol, 160 mg LA propranolol or placebo acutely and then following repeated administration (acute and chronic phases). Thereafter propranolol concentrations and beta-adrenoceptor blockade (resting and exercise heart rates) were measured at different intervals. 2. The Cmax was significantly higher with C propranolol in both phases. The time of Cmax was significantly later with LA propranolol in both phases. The AUCs were significantly higher after chronic administration with both formulations of propranolol. 3. The exercise peaks of beta-adrenoceptor blockade were similar between the two formulations and between the two phases of administration of propranolol. The duration of effective beta-adrenoceptor blockade was significantly longer in the chronic phase and seemed to be longer with LA than with C propranolol although this was not significant (72 +/- 31 vs 48 +/- 18 h, respectively). 4. There was a significant correlation between the log propranolol concentration and exercise heart rate but not with resting heart rate. No correlation could be demonstrated between pharmacological data and the Child Pugh score. 5. We conclude that in cirrhotic patients exercise testing was a reliable method in the assessment of beta-adrenoceptor blockade. Pharmacology of propranolol was found to be different according to the formulation or to the phase of administration.

Adrenergic beta-Antagonists↗
PubMed1989

[Early surgery of obstructive uropathies discovered antenatally. First results apropos of 56 cases].

Between September 1984 and April 1988, 56 children underwent surgery for an obstructive uropathy discovered on antenatal ultrasound examination. These included 31 cases of stenosis of the pyelo-ureteral junction (PUJ), 9 cases of vesicorenal reflux, 6 mega-ureters (MU), 6 ureteroceles, 3 posterior urethral valves and 1 ectopic ureteral orifice. Major reflux (type III and IV) was included within the obstructive uropathy classification in that it opposes the normal pressure gradient which ensures progression of urine towards the bladder. The nature of the obstruction, morphological study of the kidneys and the renal function itself were very precisely studied and monitored (IVU, ultrasound, isotope tests, DTPA with frusemide and DMSA). In 46 children reconstructive and conservative surgery was possible. Analysis of the various groups of uropathy showed that: 1. Stenosis of the JPU had a very favorable or sometimes spectacular outcome both functionally and morphologically. 2. Cases of reflux showed excellent results, except in the presence of preexisting major renal dysplasia. 3. Mega-ureters had a less good prognosis. Renal growth depended above all on the degree of renal dysplasia which was often associated. 4. This was also true for sever forms of posterior urethral valves. A discussion follows which tries to reply to the following questions: 1. Why does early surgery for stenosis of the JPU give better results? 2. On the other hand, why is the same benefit not obtained in the other obstructive uropathies?

Female↗
PubMed1989

[Acute epididymitis and antibiotherapy. Measurement of the epididymal diffusion of pefloxacin].

Acute epididymitis is a common infection in the young sexually active adult. Etiologically, the organisms most frequently found are Chlamydia trachomatis, Neisseria gonorrhea and gram negative bacilli. Pefloxacin is a novel quinolone whose antibacterial spectrum and bactericidal activity allow it to be considered for use in the treatment of orchitis and epididymitis Prior to clinical study the authors investigated the degree of epididymal diffusion of Pefloxacin. Ten subjects underwent extraction of an epididymal sample by direct access to the epididymis through a transverse scrotal incision under peridural anesthesia. Three days before surgery, Pefloxacin was administrated at the rate of 400 mg every 12 hours by the oral route. On the day of the operation, the subject receive a 400 mg infusion over one hour, 2 hours before epididymal biopsy. Blood specimens were also extracted. Pefloxacin assays were performed by HPLC following a method derived from that of Montay. The trough concentration of Pefloxacin inhibiting 90% of sensitive strains (MIC 90) is less than or equal to 2 micro-g/ml. The majority of sensitive organisms have minimum bactericidal concentrations equal to twice the MIC 90. The epididymal concentrations that the authors measured are situated at values of 8.15 to 21.80 miro-g/g tissue (mean 13.44). These data allow the use of Pefloxacin to be considered an option in the treatment of epididymitis.

Acute Disease↗