Biomedical subjects
Publications and source records attributed to E Mazeman.
We present a case of a high-flow priapism related to a posttraumatic aneurysm in a ten-year-old boy treated by selective embolization. Patient history and thorough physical examination often lead to the diagnosis of high-flow priapism. Colour-coded duplex ultrasonography confirms the diagnosis, and treatment consists of angiographic embolization.
PURPOSE: The extraperitoneal approach is well suited to urological surgery. Transperitoneal laparoscopic para-aortic lymph node dissection has been reported with good results for early stage nonseminomatous germ cell tumor of the testis. We report our current experience with laparoscopic para-aortic lymph node dissection using a new extraperitoneal approach. MATERIALS AND METHODS: The technique consists of an internal iliac extraperitoneal approach and complete unilateral modified laparoscopic para-aortic lymph node dissection. We assessed 25 patients with clinical stage I (20) or IIA (5) testicular nonseminomatous germ cell tumor who underwent this technique, including left and right lymphadenectomy in 13 and 12, respectively. In addition, nerve sparing dissection was performed in the last 12 cases. RESULTS: An average of 9.8 (range 3 to 19) and 17. 7 (range 5 to 29) lymph nodes were dissected on the right and left sides, respectively. No intraoperative or postoperative complications developed that required laparotomy. Average operative time was 3 hours 50 minutes (range 3 to 5 hours). Average hospital stay was 1.2 days (range 1 to 3). Results were positive in 10 patients who were given platinum based chemotherapy. At close followup of 15 months no late adverse effects or recurrence was observed. CONCLUSIONS: Although a larger experience and longer followup are required, extraperitoneal laparoscopy is a safe, effective and well suited method of diagnostic para-aortic lymph node dissection for early stage testicular nonseminomatous germ cell tumor. The specific advantages of this approach are no blind trocar insertion or bowel contact and ability to perform nerve sparing dissection. Moreover, it is cost-effective since only 3 trocars are necessary and recovery is rapid.
The authors report the case of a patient presenting with bladder haemangiomas in the context of Klippel-Trenaunay syndrome treated by Neodymium:YAG laser. Klippel-Trenaunay syndrome consists of a combination of hypertrophy of a limb, cutaneous angiomas and varicose veins. Bladder haemangioma is a benign congenital vascular tumour associated with Klippel-Trenaunay syndrome in 3 to 6% of cases, especially affecting children and young adults. Its most frequent clinical manifestation is haematuria. The diagnosis is based on endoscopy. Endoscopic treatment by Neodymium:YAG (Nd:YAG) laser photocoagulation appears to be a satisfactory treatment option.
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The nucleus of mammalian spermatozoa is surrounded by a rigid layer, the perinuclear theca, which is divided into a subacrosomal layer and a postacrosomal calyx. Among the proteins characterized in the perinuclear theca, calicin is one of the main components of the calyx. Its sequence contains three kelch repeats and a BTB/POZ domain. We have studied the association of boar calicin with F-actin and the distribution of boar and human calicin during spermiogenesis compared with the distribution of actin. Calicin was purified from boar sperm heads under nondenaturating conditions. The molecule bound actin with high affinity (K(d) = approximately 5 nM), and a stoichiometry of approximately one calicin per 12 actin monomers was observed. Gel filtration studies showed that calicin forms homomultimers (tetramers and higher polymers). According to immunocytochemical results, calicin is present (together with actin) in the acrosomal region of round spermatids and is mainly localized in the postacrosomal region of late spermatids and spermatozoa. Taken together, the results suggest that the affinity of calicin to F-actin allows targeting of calicin at the subacrosomal space of round spermatids, and that its ability to form homomultimers contributes to the formation of a rigid calyx.
OBJECTIVE: Chromophobe renal cell carcinoma is a relatively uncommon variant of renal carcinoma described in 1985. The main differential diagnosis is renal oncocytoma. Hale's colloidal iron staining is a powerful adjunct to morphological interpretation but it is not specific and is sometimes difficult to interpret. We studied the immunohistochemical expression of cytokeratin 7 to determine its value in distinguishing chromophobe renal cell carcinoma from renal oncocytoma. METHODS: Immunostaining was performed on paraffin-embedded tumor tissue of 6 chromophobe renal cell carcinomas and 11 oncocytomas with an antibody to cytokeratin 7 (clone OV-TL 12/30, Dako, France) using a streptavidin-biotin method. RESULTS: All chromophobe renal cell carcinomas showed strong cytoplasmic staining with peripheral cell accentuation. In contrast, 8 of 11 oncocytomas were entirely negative and 3 showed only weak and focal staining in less than 5% of the tumor cells. CONCLUSION: Immunohistochemical staining for cytokeratin 7 may be useful for the differential diagnosis of renal oncocytomas and chromophobe renal cell carcinomas when Hale's colloidal iron staining is uncertain.
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OBJECTIVES: The risk of transmission of bovine spongiform encephalopathy cannot be excluded from the use of bovine-derived products. The present study was undertaken to evaluate the performance of a new fibrin glue free of bovine-derived components in vas anastomosis and to compare this product to conventional vas anastomosis with fibrin glue. METHODS: Bilateral delayed vas anastomosis was performed in 40 Sprague-Dawley rats. All animals underwent a fibrin glue-assisted vas anastomosis with three transmural sutures tied prior to fibrin glue application. The composition and preparation of fibrin glue was similar for all vas anastomoses except the fibrinolysis inhibitor component which was aprotinin (3,000 KUI/ml) in group 1 and tranexamic acid (10 mg/ml) in group 2. The animals (20 rats in both groups) were sacrificed 7 weeks postoperatively and evaluated for gross patency, presence of sperm granuloma and tensile strength measurements at the anastomosis site. RESULTS: No difference was found between the 2 groups for all parameters evaluated whether a bovine-derived or a synthetic fibrinolysis inhibitor component was used. CONCLUSION: This study showed that tranexamic acid, a fibrinolysis inhibitor, can be substituted for conventional fibrin glue thereby avoiding the risks of bovine products.
OBJECTIVES: To assess the benefit and diagnostic contribution of systematic scrotal ultrasound in the management of infertile men. MATERIAL AND METHODS: Between 1st January and 31st December 1997, the authors conducted a consecutive and prospective study of 609 infertile patients corresponding to 418 cases of oligoasthenoteratospermia and 191 cases of azoospermia. All patients were investigated by scrotal ultrasound. RESULTS: 133 patients (21.8%) did not present any clinical or ultrasound abnormality. 60 patients (9.9%) presented isolated clinical abnormalities and 125 patients (20.5%) presented a discordance between clinical findings and ultrasound results. 9 patients (1.5%) presented an ultrasound nodule, 6 of which were discovered incidentally. 22 patients (3.6%) in whom the clinical features were more difficult to interpret, presented unambiguous findings. CONCLUSION: Scrotal ultrasound makes a considerable contribution to more appropriate management of infertile men and diagnoses 1.5% of testicular tumours.
The therapeutic management of penile tumours is determined by the degree of local extension of the tumour, and the presence of lymph node involvement and visceral metastases. Many published studies have tried to define the best treatment options as a function of tumour grade and stage. However, in daily practice, the treatment of penile tumours still remains highly controversial. After reviewing the literature, the authors discuss the various treatment options available to urologists as a function of tumour stage and recall the management difficulties related to lymph node staging.
OBJECTIVES: Laparoscopic lumbo-aortic lymphadenectomy is proposed in order to decrease the morbidity of pretreatment lymph node dissections for early stage NSGCT of the testis. Two approaches are presented and compared retrospectively: the transperitoneal approach and the extraperitoneal approach. MATERIAL AND METHODS: From 1991 to 1999, 57 patients with clinical stage I (50) to IIA (7) NSGCT underwent pretreatment laparoscopic investigation of the para-aortic lymph nodes: 32 transumbilical transperitoneal dissections and 25 internal iliac extraperitoneal dissections were performed. RESULTS: Only the 19 patients with lymph node invasion received chemotherapy. All serious complications occurred in the transperitoneal group: 1 case of chylous ascites and 2 cases of transient neurological complications, 2 cases of permanent ejaculation failure and 2 extranodal recurrences among the 38 pN0 patients. CONCLUSIONS: Laparoscopy, especially extraperitoneal, appears to be a safe, effective and appropriate modality for pretreatment lumbo-aortic lymph node evaluation in early stage NSGCT of the testis.
Musculoskeletal disorders including arthralgia and myalgia are adverse effect common to all fluoroquinolones. We report a case of spontaneous rupture of the patellar ligament in a 37-year-old man participating in leisure sports which occurred one month after a three-week course of Ciprofloxacine(R). Several cases of tendon ruptures have been reported in the literature, including the patellar tendon. Unusual features in our case were the one-month delay before tendon rupture and the absence of inaugural signs. We reviewed the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discussed proper management. Care must be taken when prescribing fluoroquinolones for patients at risk. Close follow-up is most important.
Wilm's tumor is exceptional in adulthood. Its treatment is based on radical nephrectomy, adjuvant chemotherapy and radiotherapy. The prognosis is poorer compared with children because adults present more frequently with advanced stages and chemotherapy has a moderate efficacy. The various protocols of chemotherapy and the indications of radiotherapy are not defined with precision, mainly due to the rarity of the disease. The authors report a case of adult Wilm's tumor with a favorable evolution followed 4 years in spite of an unfavorable histology, lung metastases and a relapse after a first chemotherapy.
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OBJECTIVE: To evaluate the incidence of renal and seminal vesicle (SV) abnormalities, and the presence or absence of CFTR gene mutations, in a cohort of patients referred for congenital bilateral absence of the vas deferens (CBAVD). PATIENTS AND METHOD: Forty-one patients with CBAVD, confirmed by surgical exploration, were evaluated by ultrasonography for renal and SV anomalies. Semen variables (pH, fructose level and ejaculate volume), sweat chloride levels and mutations of the 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 exons of the CFTR gene were determined. RESULT: In eight patients with renal anomalies there were no detectable mutations of CFTR, compared with 23 in the 33 patients with no renal anomalies (P < 0.02). SV anomalies were not related to the presence or absence of mutations (11 of 23 vs 11 of 18), or in compound heterozygote patients carrying two mutations (eight of 13 vs three of 10). Semen variables (pH < 7.2, fructose < 1 g/L and ejaculate volume < 2 mL) did not differentiate patients with or without anomalies of the kidney, SV or with mutations, except in patients with a pH < 7.2 for which renal anomalies were less frequent (two of 25 vs six of 16, P < 0.05) and mutations more frequent (19 of 25 vs five of 12, P < 0.01). CONCLUSION: Renal anomalies associated with CBAVD should be considered as supporting maldevelopment as a cause, but analysis of CFTR mutations in these cases should not be omitted. Unlike anomalies of the SV, a low ejaculate volume or low fructose level, a semen pH of < 7.2 is the only nonspecific variable in patients with CFTR mutations.
OBJECTIVES: The actual number of transmural sutures needed to ensure a successful fibrin-glued vasovasostomy is a key study parameter of the few experimental works already published. The present work was done to evaluate fibrin-glued vasovasostomy in rats in combination with only 2 transmural sutures. We compared the results to our previous study in which we demonstrated the efficiency of a combination of the use of fibrin glue with 3 sutures in comparison with a conventional microsurgical technique. MATERIALS AND METHODS: Twenty Sprague-Dawley rats underwent bilateral vasectomy followed 2 weeks later by bilateral vasovasostomy using fibrin glue combined with 2 transmural sutures. Each animal was sacrificed 7 weeks postoperatively after a 3-week mating period with a Sprague-Dawley female rat, the vasal specimens were evaluated for sperm granuloma formation. Mean operative time and fertility rates were recorded. RESULTS: The combination of fibrin glue with 2 transmural sutures gave evidence of less successful performances than the combination with 3 transmural sutures and the conventional microsurgical technique for all parameters evaluated but the mean operative time. CONCLUSION: Our study underlines the need for a third transmural suture placed 120 degrees apart from the others when performing a fibrin glue delayed vasovasostomy. This allows a better vas lumen opening at the anastomotic site and therefore a more efficient vasal anastomosis in a delayed protocol.
OBJECTIVES: To evaluate the frequency of urogenital ultrasound and spermatic abnormalities in patients with bilateral vas deferens agenesis according to the presence or absence of CFTR gene mutation. METHODS: In 41 patients with bilateral vas deferens agenesis confirmed by surgical exploration between 1988 and 1997, renal and seminal vesicle anomalies were investigated by ultrasonography. Spermatic parameters (pH, fructose and ejaculate volume) were also studied, together with sweat chloride assay and PCR of mutations on exons 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 of the CFTR gene. RESULTS: None of the 8 patients with a renal anomaly presented a CFTR gene mutation, versus 23 out of 33 patients without a renal anomaly (p < 0.02). Seminal vesical anomalies were not more frequent in patients with or without mutations (11/20 versus 13/19, p = NS), except for composite heterozygous patients (with 2 mutations: 8/13 versus 4/11, p = NS). Spermatic parameters (pH < 7.2, fructose < 1 g/l and volume < 2 ml) could not distinguish between patients with or without renal or seminal vesical anomalies or mutation, except for patients with pH < 7.2, who presented fewer renal anomalies (2/25 versus 6/16, p < 0.05) and a higher incidence of gene mutation (19/25 versus 5/12, p < 0.01). CONCLUSION: Renal agenesis is considered to be pathognomonic of a developmental anomaly. Unlike a seminal vesical anomaly, a semen volume < 2 ml or fructose < 1 g/l, pH less than 7.2 is a nonspecific parameter, but more frequently present in patients with CFTR mutation.
OBJECTIVE: To evaluate 3 in vitro methods detection (immunocytochemistry, flow cytometry and RT-PCR PSA) of circulating prostate cancer cells from a model of uncap dilution in immortalised lymphocytes. METHODS: In vitro comparison of 3 techniques (immunocytochemistry, flow cytometry, RT-PCR PSA) was performed from a range of dilutions of LbCap cells in immortalised human lymphocytes (concentration range: 1 LnCap cell per 100 lymphocytes to 1 LnCap cell per 100 million lymphocytes). Cells were detected by anti-PSA (prostate specific antigen) and PAP (prostatic acid phosphatase) antibody by immunochemistry, by fluorescent linked antipancytokeratin antibody by flow cytometry and RT-PCR PSA. RESULTS: The limit of detection was 1 LnCap cell per 200,000 lymphocytes (1/2.10(5)) for immunochemistry, 1 LnCap cell per 1,000 lymphocytes (1/1.10(3)) for flow cytometry and 1 LnCap cell per 10 million lymphocytes (1/10(7)) for RT-PCR PSA. CONCLUSION: RT-PCR, due to its most perceptible limit of detection, appears to be the method of choice for the detection of prostatic epithelial cells. Immunocytochemistry has the advantage of providing a quantitative approach. Flow cytometry is limited by the limit of detection of the apparatus used. The prognostic significance of detection of circulating prostate cancer cells remains to be clarified, but the detection of these cells and their correlation with the primary tumour will provide a better understanding of metastatic phenomena.