Biomedical subjects
Publications and source records attributed to F Haab.
Post-prostatectomy incontinence is a devastating complication that is frustrating for the patient and the surgeon. Bladder dysfunction with or without sphincteric incompetence is the main cause for post-prostatectomy incontinence. Treatment based on the urodynamic evaluation is effective in restoring continence and improving the patient's quality of life.
OBJECTIVE: To report an unusual and life-threatening presentation of a nonseminomatous germ cell tumor of the testis. METHODS: A 35-year-old male presented with pulmonary embolism secondary to a neoplastic thrombus from a nonseminomatous germ cell tumor. Prompt management involved surgical thrombectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest, followed by orchiectomy and adjuvant chemotherapy. RESULTS: Three years later, the patient remains disease free according to physical examination, radiographic workup and serum markers. CONCLUSION: The excellent long-term outcome of this patient supports an aggressive multidisciplinary management of nonseminomatous germ cell tumors in young adults.
PURPOSE: This study was designed to determine whether lowering the initial reperfusion pressure can improve renal function after ischemia. MATERIALS AND DESIGN: Sixty minutes of warm renal ischemia was induced in 2 groups of 8 minipigs by clamping the left renal artery. Right kidneys were kept in situ as controls. In the standard reperfusion group, ischemic kidneys were immediately reperfused at systemic pressure. In the controlled reperfusion group, the renal artery reperfusion pressure was maintained at 60 mm. Hg for the initial 20 minutes of reperfusion by use of a regulating pump and then at systemic pressure for the next 100 minutes. RESULTS: On the basis of the postischemic anuria rate, glomerular filtration rate and renal histology, renal tolerance to ischemia was significantly improved in the controlled reperfusion group. CONCLUSION: These findings of improved renal function recovery after warm ischemia by controlled low reperfusion pressure may have clinical relevance to the reperfusion technique used after renal transplantation in humans.
PURPOSE: The recent literature on intrinsic sphincteric deficiency is reviewed. MATERIALS AND METHODS: We performed an extensive literature search related to the diagnosis, management and treatment of intrinsic sphincteric deficiency. RESULTS: Stress urinary incontinence results from insufficient urethral resistance and/or support during increases in intra-abdominal pressure. Since treatment of stress urinary incontinence is closely related to the mechanism of urinary leakage, recognition of intrinsic sphincteric deficiency is of the utmost importance in its evaluation. Furthermore, to date there is no consensus on the treatment of intrinsic sphincteric deficiency and various procedures may be considered. CONCLUSIONS: The pathophysiology of urinary incontinence in female patients is still controversial. Intrinsic sphincteric deficiency is best recognized by history and clinical examination in conjunction with documentation of severe stress urinary incontinence, a fixed urethra and a low Valsalva leak point pressure. The pubo-vaginal sling procedure still represents the most widely accepted treatment to correct intrinsic sphincteric deficiency.
Recent progress in the techniques used to assay prostate specific antigen (PSA) have made this diagnostic tool even more useful in the management of patients with cancer of the prostate. However, although "ultrasensitive" methods can now detect minute levels, there still is no widely accepted definition of the detection threshold making it difficult to compare results reported with the different techniques. Ultrasensitive assay is particularly interesting in patients who have had radical prostatectomy, offering complementary information to the pathology examination of the surgical specimen. Used as a tool for following disease course after surgery, ultrasensitive PSA is currently the most sensitive measure of disease recurrence. Ultrasensitive assay can also give an evaluation of the effect of post-surgery complementary radiotherapy. Inversely, it adds no further information compared with regular assay before surgery. Thus, ultrasensitive assay is not indicated for differential diagnosis or screening programmes but is a valuable tool for evaluating the effectiveness of curative surgery or exclusive curative radiotherapy.
OBJECTIVE: To study the clearance of serum prostate-specific antigen (PSA) after several types of prostatic tissue ablation. METHODS: Serum PSA levels were measured (YANG Proscheck ultrasensitive assay) just before surgery, immediately after specimen removal, then twice weekly for 5 weeks or until it was undetectable (< 0.05 ng/ml) in patients undergoing radical cystoprostatectomy for bladder cancer (n = 10), or radical prostatectomy for T1 T2 prostate cancer (n = 18) and daily for 6 days after open surgery for benign prostatic hypertrophy (BPH) (n = 10). RESULTS: Open enucleation for BPH: the immediately postoperative PSA level was 6 times its preoperative value. It decreased following a monoexponential curve with a very short half-life of 0.55 +/- 0.39 days, range (0.14-1.3), reaching a value lower than the preoperative level in all cases, except one by day 3. After radical cystoprostatectomy: the decrease of serum PSA is monoexponential with a half life of 1.92 +/- 1.2 days (0.57-4.24) reaching undetectable level (< 0.05 ng/ml) in all patients by day 21. After radical prostatectomy: 11/18 patients (61%) showed a one-component exponential decrease in PSA with a half-life of 2.5 +/- 1.33 days (range 0.97-4.6 days), and 7/18 showed a two-component exponential decrease with a first half-life of 0.94 +/- 0.8 days and a second of 7.62 +/- 6.35 days); 100% of the patients reached undetectable serum PSA by day 28 in the first group compared to 14.2% of the patients with a two component exponential decrease (P < 0.01). There was no difference between these groups as far as preoperative PSA levels and specimen pathology were concerned. CONCLUSION: Serum clearance of PSA after extirpative prostatic surgery is closely related to the type and indication of procedure used. Radical cystoprostatectomy is probably the best model in which to study the pharmacokinetics of PSA.
During the last 15 years 8 patients were diagnosed with renin secreting juxtaglomerular cell tumors among 30,000 hypertensive patients. Clinical characteristics included severe hypertension poorly medically controlled in young patients (mean age 22.3 years) and severe hypokalemia (mean 2.83 mmol./l.). Secondary hyperaldosteronism was present in all cases with a constant elevation of renin activity. Renal vein sampling was only positive in 64% of cases. Selective renal arteriography demonstrated an avascular area in 43% of the patients. Computerized tomography showed the tumor in all cases. Mean tumor size was 24 mm. (range 10 to 50). Conservative surgery was feasible in all patients. Perioperative ultrasonography was used for 3 intraparenchymal tumors. Hypertension and hypokalemia resolved within 1 week after surgery. At a mean followup of 98 months (range 24 to 204) no tumor recurrence was documented.
OBJECTIVES: To study prospectively the impact of adjuvant radiation therapy on the serum level of prostate-specific antigen (PSA), as measured by an ultrasensitive Yang Proscheck assay in patients with detectable serum PSA and a negative metastatic survey after radical prostatectomy for T1 or T2 prostate cancer. METHODS: Seventeen patients had a detectable serum PSA (2.40 +/- 2.1 ng/mL; range, 0.5 to 10) by the Yang polyclonal assay 2 to 71 months after radical prostatectomy for P2N0 (2 patients) or P3N0 (15 patients) prostate cancer. Metastatic workup (bone and computed tomography scan) was negative; 9 of 17 patients had a local recurrence documented by a positive biopsy of the vesicourethral anastomosis. All patients were treated by external radiotherapy, receiving 65 Gy on the prostate fossa over 5 weeks for an assumed low volume residual disease. Patients were followed up by determination of serum PSA every 3 months, using the Yang ultrasensitive assay for a mean duration of 14.4 months. RESULTS: In 17.6% of the patients (3 of 17) PSA became undetectable (less than 0.05 ng/mL) after radiotherapy. Radiotherapy had no impact on PSA in 35.3% (6 of 17). PSA decreased after radiation therapy within 6 months in 47.1% (8 of 17) and for up to 12 months in 2 patients, with a nadir of 0.28 ng/mL. All patients in this group experienced a secondary rise in PSA a mean of 10.6 months (range, 6 to 18 months) after radiotherapy. CONCLUSIONS: External radiotherapy has a limited impact on residual disease after radical prostatectomy, as assessed by its impact on PSA.
Reperfusion is a critical phase of organ preservation. The purpose of this study was to develop a solution specifically for postischemic kidney reperfusion. Unilateral left normothermic kidney ischemia was induced for 60 minutes in two groups of micropigs. In group 1 (control pigs, n = 6) the kidney was reperfused immediately with pure blood at systemic pressure by unclamping the renal artery. In group 2 (test animals, n = 6) the kidney was initially reperfused with an intracellular flush solution enriched with solution BT01 composed of cytoprotectors (natriuretic factor, PGI2), free radical chelating agents (allopurinol, mannitol), and substrates for the mitochondrial respiratory chain (aspartate, glutamate). This solution was mixed immediately before use with blood in a ration of 1:4 parts and injected into the left renal artery with a perfuser at a constant pressure of 60 mm Hg. After 20 minutes, the kidney was reperfused with systemic blood for 100 minutes. Glomerular filtration rate (GFR) was determined by measuring inulin clearance. Kidney blood flow was measured throughout the experiment. After 120 minutes of reperfusion, the kidneys were removed for histologic examination. In the control pigs (group 1) 50% of the animals were anuric. The ratio between GFR measured in the left kidney at the end of perfusion and at equilibrium in the remaining animals was 0.16 +/- 0.01. In test animals (group 2) all animals recovered diuresis. The ratio between GFR measured in the left kidney at the end of perfusion and equilibrium was 0.51 +/- 0.12 (p < 0.001, group 2 vs. group 1). In group 2 postperfusion kidney blood flow was higher than in group 1 (63.0 ml/min vs. 27.4 ml/min; p < 0.05) because of a decrease in renal vascular resistance. Light microscopic examination of kidneys form animals in group 1 revealed tubular necrosis that extended to the parenchyma, with exposure of tubular interstitium. In group 2 only degenerative lesions with edema of tubular cells and disappearance of brush borders were observed. Our findings indicate that flushing the kidneys with BT01 solution mixed with blood improves postischemic kidney function by reducing reperfusion damage.
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The authors report a case of cystitis due to Toxoplasma Gondii infection in a patient suffering from AIDS. Initial symptoms consisted of dysuria, extreme frequency and urgent micturition responsible for pseudo urinary incontinence. Urine culture was sterile. Pelvic computed tomography and pelvic MRI demonstrated thickening of the bladder wall and seminal vesicles. Cystoscopy confirmed the presence of an intravesical proliferation with a pseudoneoplastic appearance. The diagnosis of Toxoplasma cystitis was confirmed by the discovery of Toxoplasma cysts on histological examination of bladder biopsies. Toxoplasma cystitis is a rare cause of pseudoneoplastic bullous cystitis in HIV-seropositive patients.
Interstitial cystitis is a common disease with non objective diagnostic criteria. In 1989 the National Institute of Health (NIH) defined symptoms and cystocopic findings in order to select patients to include in research programs on pathophysiology of interstitial cystitis. While there is no lack of theories, the etiology of interstitial cystitis remains obscure. Today, the general opinion is that the etiology is multifactorial and that we may be dealing with a syndrome rather than with a specific disease.
OBJECTIVES: When abdominal imagery reveals bilateral adrenal tumours, diagnosis and treatment may have severe consequences leading to life-long hormone substitution. We report our series of 12 consecutive cases in order to evaluate the diagnostic procedures and propose an adapted therapeutic strategy. METHODS: Over a 5-year period we observed bilateral adrenal tumours in 12 patients (9 males and 3 females; mean age 49.2 years; range 22-67) among a population of 10,000 hypertensive subjects. Routine laboratory tests and hormonal levels were determined in all 12 patients. Abdominal computed tomography with opacification (n = 12) and magnetic resonance imagery (n = 5) was also performed. Other tests including echography and scintigraphy were performed as needed for diagnosis. All patients underwent laparotomy. RESULTS: Hormone levels were normal in 6 patients and led to the diagnosis of pheochromocytosis (n = 5) and primary hyperaldosteronism (n = 1) in the others. After laparotomy, the pathology diagnosis was bilateral pheochromocytosis (n = 5), bilateral metastasis (n = 2) and benign bilateral adenoma (n = 5). In 5 cases, hormone levels were insufficient for establishing diagnosis before laparotomy. In these cases the pathology diagnosis was benign tumour in 4 and malignant tumour in 1. Images of adrenal masses (metastases) led to the diagnosis of the primary cancer in one case. CONCLUSIONS: Search for pheochromocytosis and primary neoplasia, after eliminating adrenal myelolipoma and pseudotumours on the basis of the tomography images, should be the first exploration of fortuitously discovered bilateral adrenal masses. Exploratory puncture biopsy should be avoided and, for tumours greater than 30 mm, exploratory laparotomy is indicated. Tumours less than 30 mm should be followed echographically for six months to eliminate malignancy. Masses which increase in size should be explored surgically. Until larger series enable a standardized approach, malignancy should always be suspected in non-secreting bilateral tumours of the adrenal glands.
Aortomyoplasty consists of wrapping the latissimus dorsi muscle (LDM) around the ascending aorta and electrostimulating it during diastole. The ascending aorta will act as an ectopic neo-ventricle compressed during diastole, thus reproducing the effects of long-term diastolic counterpulsation. In 5 goats, the right LDM was transferred to the thoracic cavity after removal of the second rib. The ascending aorta was enlarged by a pericardial patch and wrapped with the LDM. Postoperative electrostimulation was delivered in a counterpulsating manner. Hemodynamic studies were performed at 12 and 24 months postoperatively. Percent increase in the subendocardial viability index (diastolic pressure-time index/systolic tension-time index) was calculated using unassisted and assisted cardiac cycles with the stimulator off versus the stimulator on at a 1:1 ratio in the basal state and after acute heart failure was induced by the administration of high doses of propranolol hydrochloride. Diastolic counterpulsation of the ascending aorta resulted in significant improvement in the subendocardial viability index long term, both in basal state conditions and after induced cardiac failure. During heart failure, aortomyoplasty increased the cardiac output and decreased systemic vascular resistance. Histopathologic studies up to 24 months showed preservation of the histologic structure of the aortic wall and no evidence of thromboembolism. Tight adhesions developed between the aortic wall (including the pericardial patch) and the LDM. The diameters of the enlarged aortas showed no significant differences compared with diameters immediately postoperatively. In conclusion, aortomyoplasty produces chronic diastolic augmentation with preservation of aortic structure. After induction of heart failure, aortomyoplasty offers efficient circulatory support.
OBJECTIVE: To compare retrospectively the efficacy of radical perineal and retropubic prostatectomy in patients with T1, T2 cancer of the prostate. PATIENTS AND METHODS: From January 1991 to January 1993, 71 patients with T1, T2 carcinoma of the prostate aged 52-74 years underwent radical retropubic prostatectomy (36) or radical perineal prostatectomy (35); this was preceded by endosurgical lymphadenectomy. The two groups were identical with regard to age (64 vs 66 years), clinical stage (T1a 17% vs 25%, T2 82% vs 74%), mean and median pre-operative prostate-specific antigen (PSA) (20 vs 26, 11 vs 15 using the YANG polyclonal assay n < 2.5 ng/ml). Radical retropubic prostatectomy and radical perineal prostatectomy were performed using standard procedures. Specimens were inked and analysed; operative time, volume of blood transfusions, duration of hospital stay, peri-operative complications, sexual function, urinary continence and quality of the specimens were assessed retrospectively. RESULTS: Both groups were identical as far as operation time, hospital stay, complications (one rectal injury in each group), specimen weight and pathology were concerned. The proportions of organ-confined (54% in radical perineal prostatectomy group vs 55% in radical retropubic prostatectomy group) and margin-positive cancers (37% in radical perineal prostatectomy group vs 39% in radical retropubic prostatectomy group) were identical. The volume of blood transfusion was significantly less in the radical perineal prostatectomy group: 54% required transfusion compared with 100% in the radical retropubic prostatectomy group), 7% of radical perineal prostatectomy patients received homologous transfusion vs 38% of the radical retropubic prostatectomy patients; 11 and 3% of the patients were potent 3-6 months after surgery. Two anastomotic strictures developed after radical retropubic prostatectomy and none after the radical perineal prostatectomy. Continence was achieved at 3 months in 71% of the radical perineal prostatectomy group and in 82% of the radical retropubic prostatectomy group; by 6 months 88% of the patients were dry in both groups. CONCLUSION: When nodal status has been assessed by lymph node dissection (open or endosurgical), radical perineal prostatectomy is a reasonable, minimally invasive alternative to radical retropubic prostatectomy provided that impotence and a slower return to full continence are accepted.
The development of ultrasonography has allowed the antenatal diagnosis of various forms of obstructive uropathy. The diagnosis of urinary tract dilatation is now possible by the 15th week of pregnancy. More recently, the study of foetal urine biochemistry has defined the prognostic factors of the course of postnatal renal function. The authors define and limit the current indications for the various antenatal interventions on the basis of the combination of antenatal ultrasonography and foetal urine biochemistry.
32 patients with bladder carcinoma in situ (CIS) were treated by intravesical instillations of BCG immun F Pasteur between 1988 and 1991. The CIS was isolated (13 cases, 40.6%) or associated with a pTa papillary tumour (10 cases, 31.2%), pT1 tumour (8 cases, 25.1%) or pT2 tumour (1 case, 3.1%). The protocol consisted of a series of weekly instillations of 150 mg of BCG for 6 weeks, repeated once in the case of persistent lesions on the first endoscopic follow-up examination. Patients were reviewed in the outpatients department every 3 months for 1 year, then every 6 months for 2 years in the absence of recurrence. Follow-up consisted of clinical examination, urine cytology and histology. The overall success rate, defined by complete resolution of the cytological and histological lesions for the total population was 81.25% (25/32) with a mean follow-up of 22.5 months. 18.75% (6/32) of cases were considered to be failures. Complications of treatment were observed in 59% of patients, but only required discontinuation of instillations in five patients (15.6%). In conclusion, intravesical BCG is the treatment of choice of bladder carcinoma in situ in the absence of detrusor invasion and contraindications to BCG.
Owing to its capacity of increasing glomerular filtration, potential beneficial effects of atrial natriuretic factor (ANF) were assessed during a post ischemic acute renal insufficiency in rats. Renal insufficiency was obtained by clamping the renal artery during 30 min., and by performing a reperfusion during 2 hours in uninephrectomized rats. Three groups were defined: a control group where animals were submitted to an operation procedure without renal artery clamping, a control group were animals received a physiological serum perfusion (1.5 ml/h) during the renal reperfusion time and an experimental group where animals were administrated a rat 1-28 ANF perfusion (5 microns/ml in NaCl 0.9%, 1.5 ml/hour) during the reperfusion time. Insulin clearance (1.0 + 0.05 ml/h vs 0.7 + 0.05 ml/h, p < 0.01), and diuresis (32.9 +/- 3.6 microliters/min. vs 7.5 +/- 0.23 microliters/min., p < 0.01) were significantly higher in rats which were administrated a NaCl 0.9% perfusion. Histologically, a significant decrease in kidney weight and in he percentage of diseases nephrons was observed after reperfusion in ANF treated rats. The results obtained demonstrate that ANF perfusion in case of post ischemic acute renal insufficiency in rats improves the recovery of renal function and reduces the renal histologic lesions.