Biomedical subjects

D Prunet

Publications and source records attributed to D Prunet.

10 recordsLinked to original sources

PubMed2000

Intermittent androgen suppression in the treatment of metastatic prostate cancer.

BACKGROUND: To assess the feasibility of intermittent androgen suppression in patients with metastatic prostate cancer and to quantify the improvement in the quality of life. METHODS: Forty-three patients with M1 b prostate cancer were treated by intermittent hormonal deprivation using luteinizing hormone-releasing hormone (LHRH) analogue alone (n = 11), or associated with an antiandrogen (n = 32). The prospective nonrandomized study required an initial therapy period of 12 months with a stable biological response during 6 months (PSA, testosterone). Treatment was resumed when the serum PSA value recovered to 20 ng/ml, or when local failure or new bone metastasis occurred. The assessment of quality of life was carried out using the EORTC QLQ-C30. RESULTS: The mean follow-up time was 43.7 months. After the initial 12 months of androgen suppression, one patient with a minimal disease was off-therapy with a follow-up of 18 months. For the 42 other patients, the mean off-therapy period was 6.7 months. In the second therapy period (9-12 months), 7 patients were hormono-independent and died with a mean survival time of 27 months; 35 patients were responders. The mean off-therapy length in the second cycle was short (3.8 months). After this time, androgen suppression therapy was reintroduced permanently, but 10 patients were hormono-independent. No difference was observed in the EORTC QLQ-C30 between therapy and off-therapy periods, only a rapid decrease in adverse events due to the hormonal deprivation was reported in all cases during the off-therapy period. CONCLUSIONS: Intermittent androgen suppression in patients with M1 b prostate cancer could be associated with a significant period off-therapy in the first cycle (55.8%), and with a chance of second hormone response. But in the second cycle, the off-therapy period length was short and required a careful follow-up.

Aged↗

PubMed1999

[Skin graft urethroplasty].

OBJECTIVES: To evaluate the results of skin graft urethroplasty (SGU) in the management of urethral stricture. MATERIAL AND METHODS: Twenty eight patients, with a mean age of 54 years, treated by SGU were reviewed with a mean follow-up of 24.5 months (range: 1-66). The first-line material skin graft material was the foreskin or, in its absence, the penile skin or skin of the arm was used. RESULTS: This study demonstrated a satisfactory result (no clinical signs, maximum flow rate > or = 15 ml/s, no need for salvage surgery) in 67.9% of cases. Although the early complication rate was low, 8 stenoses were observed during subsequent follow-up; 3 of which required open surgical revision. The other relapses were treated by internal urethrotomy or hetero- or autodilatations. This study showed that urine sterility at the time of surgery was a decisive factor. CONCLUSION: The preferential indication for this type of urethroplasty remains a bulbar urethral stricture with sterile urine. However, the aetiology and length of the stricture are not discriminant factors.

Adolescent↗

PubMed1999

[Surgery of varicocele: results concerning sperm motility and morphology].

STUDY OBJECTIVE: This study evaluated the changes induced by surgical treatment of varicocele on the classical parameter of the sperm count as well as the parameters of Kruger's classification. MATERIAL AND METHODS: Comparative analysis of sperm concentration, mobility and head morphology was performed on the sperm counts obtained before and 6 months after surgery in 159 infertile patients with clinical left varicocele, suspected of being the only aetiological factor for infertility. RESULTS: Sperm mobility and the percentage of spermatozoa with normal head morphology were significantly increased after treatment. The percentage of spermatozoa with normal morphology was only slightly improved, due to the absence of improvement of flagellar and intermediate segment abnormalities. Fifty-nine term pregnancies were obtained after treatment, corresponding to 41.1% of treated patients. CONCLUSION: Treatment of varicocele in infertile patients can improve sperm count and morphology parameters, particularly abnormalities of the head according to Kruger's strict criteria. The number of pregnancies observed argues in favour of the treatment of varicocele, when it constitutes the only aetiological factor for infertility.

Adult↗

PubMed1999

[IgA deficiency and multiple Staphylococcus aureus perirenal abscesses. A case report].

The authors report the case of a patient with IgA deficiency who presented with a low-grade renal abscess. Due to the atypical nature of the clinical features and imaging, the diagnosis was not established prior to surgery. Despite radical surgery, the abscess recurred several weeks later. In the light of this case, the authors discuss the various possible diagnoses that must be considered in the presence of these types of images and the therapeutic approach during initial management. They discuss the various immune deficiencies to be investigated in a particular infectious context.

Abscess↗

PubMed1997

[Outcome of nephrogenic metaplasia of the bladder in kidney transplant recipients].

OBJECTIVES: To evaluate the risk of recurrence and malignant degeneration of vesical nephrogenic metaplasia in renal transplant recipients. MATERIAL AND METHODS: Fourteen patients with known nephrogenic metaplasia were systematically followed. Vesical biopsies were performed with a resector, stained with eosin haemalun saffron, analysed and compared to initial results. Labelling by anti-EBV and anti-CMV monoclonal antibodies was performed in 5 cases of intense inflammatory reactions. RESULTS: All patients were males, with a median age of 39 years. Nephrogenic metaplasia had been diagnosed 7 to 80 months after renal transplantation (median = 37.8). Twelve patients were reviewed 5 to 116 months after the initial diagnosis (median = 52). Relapse was observed in 83% of cases, but without any malignant degeneration. CONCLUSION: Nephrogenic metaplasia is therefore a benign recurrent disease. The importance of the initial blood supply and fibrosis in the case of recurrence suggest a disorder of the blood supply, probably traumatic in origin. Only symptomatic patients are currently followed.

Adolescent↗

PubMed1996

[Wermer syndrome associated with a bilateral renal tumor].

Wermer's syndrome is a polyendocrinopathy characterized by neoplasia of the parathyroidis, pancreas and the pituitary. We report a case, unique in our knowledge, of an unusual association of a bilateral renal tumors and Wermer's syndrome. The originality of this case is: Bilateral renal blow. Therapeutic difficulties. This manifestation may represent a new manifestation of this pleiotropic syndrome.

Adenocarcinoma↗

PubMed1996

[Penile injuries].

Penile trauma is uncommon, but can be serious due to its urinary and sexual complications. After reviewing the literature, the authors examined three types of trauma of particular interest because of the specificity of the lesions induced and their treatment. The circumstances of onset, the various lesions observed, the complementary investigations required, and the therapeutic modalities are studied for each type of trauma. Fractures of the corpora cavernosa are diagnosed clinically. When in doubt, cavernography is the examination of choice. Treatment must be surgical by suture of the defect of the albuginea. Strangulations can lead to ulceration of the skin and urethral fistula. The causes of strangulation are varied, including the very unusual case of strangulation by a hair in a young circumcised boy. Automutilations of the penis are rare, but, after psychiatric assessment, microsurgical reimplantation can be performed with good functional and aesthetic results.

Amputation, Traumatic↗

PubMed1995

[Urethroplasty in 2 stages using skin grafts].

OBJECTIVE: To present the technique and results of 2-stage mesh-graft urethroplasty, as described by Schreiter in 1984. METHODS: 11 patients with a stricture of the anterior urethra were treated according to this urethroplasty (pedicle skin flap). The site of the stricture was penile in 4 cases and perineoscrotal in 7 cases, and the mean length was 7.7 cm (range: 3 to 12.5). RESULTS: 10 patients were treated in 2 stages, while the remaining patient has a persistent perineal urethrostomy. With a mean follow-up of 3.5 years (range: 14 to 77 months), 9 patients obtained a satisfactory result with no radiographic recurrence, but with persistent nocturia (x 2/night), a mean peak flow rate of 12.8 ml/s, and a mean residual urine of 55 ml present in 8 our of 9 cases. One complete failure was observed, following complete recurrence of the stricture due to the limited dimensions of the skin flap at the 2nd stage. CONCLUSION: This technique constitutes a useful salvage solution after failure of a one-stage urethroplasty. It can be used to treat extensive strictures of the anterior urethra by reconstituting a good quality urethral lumen with well vascularized tissue. It also has the advantage of avoiding the presence of hair follicles and allows the two stages to be performed at a brief interval.

Aged↗

PubMed1992

[Muir-Torre syndrome. Apropos of a case associated with a familial form of cancer].

We report the case of 41 year-old male patient, in whom multiple and recurrent infrequent cutaneous lesions (sebaceous adenomas) led to suspect the diagnosis of Muir-Torre syndrome. This diagnosis was confirmed when 2 colo-rectal adenocarcinomas were discovered and curatively excised (trans-anal excision, followed by total colectomy). The Muir-Torre syndrome was part of a familial cancer syndrome in this case, as the patient's mother and brother died from colonic cancer before the age of 45. The case-report underlines the diagnostic role of cutaneous lesions in this syndrome, allowing early detection of internal malignancy.

Adenocarcinoma↗

PubMed1991

[Inflammatory pseudo-tumors of the liver. Apropos of 2 cases].

Inflammatory pseudotumors of the liver (IPTL) are a reaction pathology of most often mysterious etiology. This is an ill-known clinicopathological entity, of which 13 cases only have been reported. The authors report about 2 cases for which an infectious or parasitic etiology can be suggested. They sum up the characteristics of these pseudotumors, which are most often single, solid, preferentially developing in the right liver. The clinical signs of these lesions are pain and fever, associated to jaundice in case of pedicular extension. From a morphological and macroscopic point of view, IPTLs have the features of a primary or secondary malignant tumor. Cytological puncture usually fails. The diagnosis can be based only on an extensive surgical biopsy or the study of the specimen of liver exeresis. Finally, IPTLs are characterized by a spontaneously regressive evolution. This notion justifies a prudent, even conservative surgical attitude.

Diagnosis, Differential↗