Biomedical subjects

D Pelle-Francoz

Publications and source records attributed to D Pelle-Francoz.

9 recordsLinked to original sources

PubMed1988

[Percutaneous placement of ureteral prostheses. 150 cases].

Percutaneous placement of ureteral stents was attempted on 150 occasions with an 85 p. 100 success rate. Whether released or not, this type of prosthesis ensures that the urine is drained internally from kidney to bladder. Stenting is effective as palliative treatment of malignant stenosis or curative treatment of benign stenosis, as it maintains the ureteral lumen diameter after balloon catheter dilatation. It also dries up post-operative urinary fistulae and it controls and promotes their healing. Because of the satisfactory results obtained, the percutaneous technique is increasingly preferred to surgery performed under difficult conditions.

Adolescent↗

PubMed1987

Fistulas of the upper urinary tract: percutaneous management.

We treated 40 patients with urinary fistulas by interventional radiology. The antegrade percutaneous route, catheterization of the ureter and bypassing of the fistula enabled ureteral stenting in 36 patients (90 per cent). Criteria for successful treatment were healing of the fistula, normal renal function (evaluated by excretory urography and radionuclide studies) and absence of secondary stenosis at 6 months. Of the patients 28 (70 per cent) were treated successfully. The number of nephrectomies after failure of percutaneous techniques (5 of 40, or 12.5 per cent) seems lower than in the case of surgery. The results were excellent for fistulas occurring after endourology (all 9 successful) or after ureterointestinal anastomoses (7 of 8). On the other hand, the results appear disappointing in patients with fistulas in transplanted kidneys (3 of 4 failures).

Adolescent↗

PubMed1987

[Local treatment of obstructive uric acid calculi].

Dissolution of uric acid calculi could be obtained by oral or parenteral urinary alcalinization, but this method cannot apply to the case of obstructive calculi. Nineteen obstructive calculi in 18 patients were treated by in situ alcalinization through a percutaneous nephrostomy catheter (PCN). Eight patients were initially anuric, 7 of whom from an obstructed solitary kidney and 1 from a bilateral obstructive lithiasis. Fifteen calculi were located in the ureter, 3 in the uretero-pelvic junction and 1 in the pelvis. After 48 h of urinary diversion through PCN, an isotonic sodium bicarbonate solution (14 g %) was continuously infused at an average flow rate of 2.8 l/24 h, through either an unique PCN, or a 2 PCN-irrigation circuit in the 7 cases with permanently obstructive calculus. Fifteen calculi (80%) were completely dissolved after 3 to 13 days of alcalinization (average 5.8 days). One large calculus was reduced by 3/4 and further removed by percutaneous lithotripsy. Three patients underwent ureterotomy after 9 to 11 days of uneffective treatment. Local alcalinization is an effective and non invasive treatment for obstructive uric acid calculi, and is logically associated with the necessary urinary diversion.

Aged↗

PubMed1986

Nondilated obstructive acute renal failure: diagnostic procedures and therapeutic management.

We examined 80 patients with acute obstructive anuria by ultrasound (US). Four of the 80 patients did not have dilatation of the urinary tract. In all four cases, antegrade pyelography guided by real-time US demonstrated urinary tract obstruction after the four patients had experienced 4, 5, 8, and 34 days of anuria, respectively. Diuresis occurred as a result of percutaneous nephrostomy in all four cases. Three of the patients were successfully treated by percutaneous techniques alone. Our findings demonstrate that even a complete and long-term obstruction of the urinary tract does not necessarily induce dilatation in the upper part of the tract. In such cases, only the direct opacification of the urinary tract can help confirm that the obstruction is present. Even in the absence of dilatation, antegrade pyelography guided by real-time US is a possible diagnostic method and can be the first step in the performance of percutaneous nephrostomy.

Acute Kidney Injury↗

PubMed1986

[Dissolution of obstructive uric acid calculi by percutaneous nephrostomy and in situ alkalinization].

Following the introduction of one or two percutaneous nephrostomy drains, 16 obstructive uric acid calculi were treated by perfusion of excretory cavities with 14% sodium bicarbonate solution. Twelve calculi had dissolved within an average of 5 days, 1 required percutaneous lithotripsy because of incomplete dissolution and 3 were unaltered. Success of this treatment appears to be dependent on the total radiotransparency of calculi, a feature difficult to demonstrate. There were no reports of major complications. The only weakly invasive nature of alkalinization in situ makes it a method of choice to be reserved for obstructive calculi, and a therapeutic strategy is proposed.

Aged↗

PubMed1986

[Ultrasonic diagnosis in scrotal pathology. Apropos of 137 tests].

Ultrasound imaging of scrotum in 137 patients detected 31 inflammatory lesions of epididymis or testis, 8 tumors, 23 cystic lesions, 21 hydroceles and 19 other affections. Medical or surgical treatment was instituted in 63% of patients, the other 37% failing to attend. Therapy was effective in 90.5% of cases (100% of fluid lesions, 80.6% of inflammatory lesions and 87.5% of tumors). Ultrasound imaging appears to be an excellent complement to clinical examination, when findings are insufficient or when examination is difficult because of severe pain, allowing identification of the fluid or solid nature of a lesion. It is also of specific value for diagnosis of subclinical tumors, surveillance of patients at risk and detailed investigation of inflammatory lesions.

Follow-Up Studies↗

PubMed1986

[Colonic perforations during interventional urinary radiology].

Three patients had colonic perforation as a result of percutaneous nephrostomy and lithotripsy. These patients did not respond to conservative measures and required surgery (colostomy, hemicolectomy, drainage). This report reviews the anatomic and technical aspects of percutaneous access to the kidney. Fluoroscopy and ultrasonography do not allow simple and accurate information of the position of the colon, and CT is the method of choice. Some factors seem of high risk : thin and young patient, female, dilated pelvo-calyceal system, associated colonic obstruction.

Adult↗

PubMed1985

[Obstructive anuria with non-dilated cavities].

Four patients with no evidence of acute functional or organic renal failure suddenly developed anuria. Repeated ultrasonographic exploration failed to show any dilatation of the urinary tract. After 4, 5, 7 and 34 days of anuria respectively, an obstacle was detected, located and identified by ultrasonically guided antegrade pyelography, which led to immediate urine derivation by percutaneous nephrostomy. Three of these patients were cured by percutaneous techniques alone. These 4 cases represent a small but not negligible part of a series of 74 patients with obstructive anuria, 70 of whom had dilated renal cavities. They throw doubt not on the reliability of ultrasonography, but on the idea that all obstacles are associated with dilatation upstream. They also confirm that opacification of the urinary tract is the only way of making sure that an obstacle is present. Antegrade pyelography gives excellent contrast images and can be used as first stage of a percutaneous nephrostomy. The other diagnostic methods are fraught with a high proportion of inadequacy or failure.

Acute Kidney Injury↗

PubMed1984

[Nephrostomy and percutaneous internal bypass. Technic and results. Apropos of 130 cases].

130 percutaneous nephrostomies have been performed on 106 patients, 6 of whom had transplanted kidneys. On 4 of these patients percutaneous drainage of a perinephric abscess was performed at the same time. Over 50% of the patients were in obstructive anuria. No failure was noted in placement of the nephrostomy tubes. Only one major complication occurred, a resolvent septic shock. Minor complications i.e. pelvocalyceal blood clotting, catheter dislodgement, retroperitoneal urine extravasation, are rare. There is no contra-indication to this procedure. 30 indwelling ureteral catheters and 10 double pigtail stent catheters were also inserted by this antegrade technic. The main indications for these procedures are 1) acute or chronic supravesical obstructions, especially infected cases. The therapeutic decision is often difficult in stenosis of neoplastic origin 2) ureteral fistulas which are always dried by a nephrostomy and which can be definitely cured by indwelling catheters, 3) certain types of calculi, which can be either treated by irrigation in situ with stone-dissolving solutions, or removed percutaneously by extraction or ultrasonic lithotripsy.

Adolescent↗