PubMed Health⌕ Search

Biomedical subjects

F Saint

Publications and source records attributed to F Saint.

At least 37 records · Page 2Linked to original sources
PubMed2001

Retroperitoneal laparoscopic living-donor nephrectomy. Preliminary results.

PURPOSE: Living-donor nephrectomy is performed via a standard flank approach during open surgery in contrast to laparoscopy where kidneys are procured transperitoneally. Being more familiar with retroperitoneal laparoscopy for the surgery of the upper urinary tract, we investigated the feasibility of live donor nephrectomy by this approach. MATERIAL AND METHODS: We performed laparoscopic retroperitoneal left-sided nephrectomy in 3 living donors. The patients were placed in lumbotomy position. The retroperitoneal space was developed with blunt finger dissection, through a 2-cm mini-lumbotomy under the 12th rib in the posterior axillary line. 5 trocars were inserted. After primary access to the renal artery and vein, these were dissected to their junctions with the aorta and inferior vena cava, respectively, before freeing the kidney of its perinephric attachments. The kidney was delivered manually, through the slightly enlarged initial subcostal incision. RESULTS: The average duration of surgery was 83 min; warm ischemia time less than 5 min. Average blood loss was 120 cm(3). Donors did not present any postoperative morbidity and were discharged after an average of 2.3 days. Mean analgesic requirement was 5 mg morphine sulphate equivalent (0-15). Average convalescence was 13.3 days (10-18). All 3 kidneys harvested laparoscopically had immediate function with urine production after graft revascularization; serum creatinine levels returned to normal within 1 week. The first patient presented ureteral stenosis 2 months after surgery. He underwent ureteropyeloplasty using his native ureter. CONCLUSIONS: Laparoscopic living-related-donor nephrectomy become a new standard for organ harvesting. Our data suggest that retroperitoneal laparoscopic donor nephrectomy may represent a reasonable option in centers in which more extensive experience has been accumulated with retroperitoneal than with transperitoneal laparoscopy for the surgery of the upper urinary tract.

Female↗
PubMed2001

[Simultaneous chemotherapy/radiotherapy in locally advanced unresectable cancer of the bladder].

The development of new treatment techniques, including concomitant chemotherapy/radiotherapy, appears to achieve higher response rates in advanced bladder cancer. Previous studies have suggested that continuous infusion chemotherapy and concomitant irradiation act synergistically to induce significantly increased tumour cell destruction. With the combination of 5FU and radiotherapy, the local control rate of transitional cell bladder cancers was 70% with a 5-year survival rate of 36% to 62%. Concomitant cisplatin and irradiation improved the control of locally advanced bladder cancers, but failed to improve overall survival. The use of concomitant cisplatin has no effect on distant metastases. These treatment modalities require further evaluation because of the relationships between radiotherapy- and drug-induced apoptosis, delayed cell death, survival of clonogenic cells, clinical response and overall survival. The optimum concomitant chemotherapy/radiotherapy protocol has not yet been defined.

Antineoplastic Agents↗
PubMed2001

[Treatment of pheochromocytomas with retroperitoneal laparoscopy].

OBJECTIVES: Although laparoscopic adrenalectomy has become one of the techniques of choice for the treatment of adrenal tumours, this technique has not been widely used to treat phaeochromocytoma due to the risks of hypertension before control of the adrenal vein. The authors report their experience of retroperitoneal laparoscopic adrenalectomy for phaeochromocytoma. MATERIAL AND METHODS: From January 1995 to December 1999, 10 (5 right, 5 left) retroperitoneal laparoscopic adrenalectomies were performed for symptomatic phaeochromocytoma, in 4 men and 6 women, aged 40 to 67 years (mean: 51 years). In every case, the phaeochromocytoma had been diagnosed by elevated urinary catecholamines, abdominopelvic CT scan and positive MIBG scintigraphy. RESULTS: There were no conversions to open surgery. The mean operating time was 116 minutes (range: 100 to 140 minutes). Mean blood loss was 180 ml (range: 0 to 550 ml) and none of the patients were transfused. In one case, an injury to the adrenal vein was repaired intraoperatively. The mean length of hospital stay was 3.4 days (range: 1 to 12 days). The mean diameter of the lesion was 38 mm (range: 15 to 110 mm). Postoperative complications occurred in two cases (one haematoma and one incisional hernia repaired one year later). With a mean follow-up of 21.6 months (range: 6 to 46 months), all patients had normal urinary catecholamine levels and 9 had a normal blood pressure with no antihypertensive therapy. CONCLUSION: Retroperitoneal laparoscopic adrenalectomy can be performed for small phaeochromocytomas (less than 5 cm). Retroperitoneal laparoscopy is a direct approach which allows the surgeon to control the adrenal vein first in order to avoid hypertensive crises.

Adrenal Gland Neoplasms↗
PubMed2001

[Retroperitoneal laparoscopic surgery and carcinogenic risk].

OBJECTIVE: To retrospectively evaluate the development of metastasis at trocar sites, local recurrence and distance metastases associated with retroperitoneal laparoscopic surgery performed in the context of a malignant tumour. METHODS: From 1994 to 1999, 228 retroperitoneal laparoscopic surgical operations were performed in our centre. Fifty six operations (24.6%) were performed for malignant tumours and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumour and 7 nephro-ureterectomies for upper urinary tract tumours. The pathological stage and surgical margins were correlated with TNM 1997 stage. Postoperative data were obtained by physical and radiological examination performed one month and three months after the operation and then every six months. Metastases at the trocar site, local recurrences and distant metastases were investigated. The specific progression-free survival was calculated according to the Kaplan-Meier method. RESULTS: The mean follow-up was 24.9 +/- 13.85 months. All patients had tumour-free surgical margins. No trocar site metastasis was observed. For retroperitoneal laparoscopic radical nephrectomies: one patient developed a local recurrence with liver metastases 9 months after the operation (pT3G2) and died 19.7 months after the operation. One patient with a pT3G3M+ renal tumour at the time of diagnosis died 23.1 months after radical nephrectomy with no signs of local recurrence. For laparoscopic retroperitoneal nephro-ureterectomies: one patient with a pT3G3 lesion developed a local recurrence at 12.1 months and died 26.6 months after surgery. One patient with a pT1G2 tumour developed bone metastases at 9 months and died 29 months after the operation. The recurrence-free survival at 54 months was 91% for radical nephrectomies, 71% at 30 months for nephro-ureterectomies and 100% at 49 months for partial nephrectomies. CONCLUSION: Malignant tumours of the upper urinary tract can be managed by retroperitoneal laparoscopy. The short-term results suggest that this surgical technique is not associated with an increased risk of trocar site metastases or local recurrence and that recurrence-free survival rates comparable to those reported in series of conventional surgery.

Follow-Up Studies↗
PubMed2001

Experience with retroperitoneal laparoscopic adrenalectomy in 115 procedures.

PURPOSE: Laparoscopic adrenalectomy has become an effective option for removing small adrenal tumors. We evaluated the retroperitoneal approach with regard to operative complications, morbidity and hospital stay. MATERIALS AND METHODS: Between January 1995 and March 2000 we performed a total of 115 laparoscopic adrenalectomies via the retroperitoneal approach, including 70 on the left and 45 on the right side, in 64 women and 42 men 17 to 74 years old (mean age 49.3) with adrenal neoplasms. Average adrenal tumor size was 31 mm. (range 10 to 65). All procedures required 4 trocars and mean operative time was 118 minutes (range 45 to 240). RESULTS: There were no patient deaths. The conversion rate to open surgery was 0.8% and estimated blood loss was 77 ml. (range 0 to 550). At a mean followup of 23.4 months, morbidity was 15.5% with intraoperative vascular injury in 3 cases (3.4%) and postoperative complications in 12.1%, including wound infection, deep hematoma, parietal dehiscence and severe pneumopathy. Average hospital stay was 4 days and mean duration of analgesic requirement was 2 days (range 1 to 5). CONCLUSIONS: The retroperitoneal approach to laparoscopic adrenalectomy appears to be minimally invasive and safe for adrenal tumors not larger than 5 cm.

Adolescent↗
PubMed2001

[Retroperitoneal laparoscopic adrenalectomy: a safe and reproducible technique].

INTRODUCTION: Laparoscopic adrenalectomy has become one of the reference techniques for resection of small tumours of the adrenal gland. The objective of this study was to evaluate the retroperitoneal approach in terms of its intraoperative complication rate, morbidity and length of hospital stay, comparing two centres using the same surgical technique. MATERIAL AND METHOD: Between January 1995 and March 2000, two different centres respectively performed 55 and 60 laparoscopic adrenalectomies (70 left, 45 right) using a retroperitoneal incision in 106 patients (64 women and 42 men) with a mean age of 49.3 years (range: 17 to 74 years). The mean size of the adrenal tumour was 31 mm (range: 10 to 61 mm). Five trocars were used in every case. RESULTS: No difference was observed between the two centres in terms of operating time (100 min vs 135 min), conversion rate (0% vs 1.7%), and blood loss (74 ml vs 80 ml). With a mean follow-up of 23.4 months, no difference was observed for morbidity rate (12.7% vs 16.7%), including intraoperative complications (1.8% vs 5%) with 3 vascular injuries, and postoperative complications (10.9% vs 11.7%) comprising wound abscesses, deep haematomas, a hernia at the trocar orifice and one case of severe pneumonia. The mean hospital stay was 3 days vs 5 days with a mean duration of analgesic consumption of 2 days (range: 1 to 5 days). CONCLUSION: Laparoscopic retroperitoneal adrenalectomy appears to be a reliable and reproducible approach for resection of adrenal gland tumours less than 6 cm in diameter.

Adolescent↗
PubMed2001

Early removal of the catheter after laparoscopic radical prostatectomy.

PURPOSE: We prospectively tested the safety of routine removal of the catheter as early as 2 to 4 days after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between March 1998 and March 2001, 228 patients underwent laparoscopic radical prostatectomy for clinically organ confined prostate cancer. The last 113 consecutive patients were included in a prospective study according to gravitational cystography performed 2 to 4 days postoperatively. If no leak was seen the catheter was removed. If a leak was apparent the catheter was left indwelling for another 6 days and cystography was repeated. RESULTS: Cystography 2 to 4 days postoperatively showed an anastomosis without a leak in 96 (84.9%) patients who subsequently had the catheters removed. There were 28 patients who had the catheter removed on postoperative day 2, 28 day 3 and 40 day 4. In 17 (15.1%) patients an anastomotic leak was observed, and the catheter was not removed at that time. Of the 96 patients in whom the catheter was removed early 10 (10.4%) had urinary retention that necessitated re-catheterization. This procedure was performed without the need for cystoscopy. After the catheter was removed all patients were able to void 24 hours later. Median followup was 7 months (range 1 to 15) and showed continence rates greater than 93%. No anastomotic stricture, pelvic abscess or urinoma developed in any patient. CONCLUSIONS: Patients who undergo laparoscopic radical prostatectomy can have the catheter safely removed 2 to 4 days postoperatively without a higher risk of incontinence, stricture or leak related problems.

Humans↗
PubMed2001

T helper 1/2 lymphocyte urinary cytokine profiles in responding and nonresponding patients after 1 and 2 courses of bacillus Calmette-Guerin for superficial bladder cancer.

PURPOSE: Interleukin (IL)-2 and interferon-gamma are released during T helper 1 lymphocyte responses and IL-10 is released during T helper 2 lymphocyte responses. We have previously reported that a T helper 1 lymphocyte urinary cytokine profile is associated with a favorable prognosis after bacillus Calmette-Guerin (BCG) treatment. We evaluated the T helper 1/2 lymphocyte cytokine profiles during courses 1 and 2 of 6 weekly BCG instillations. MATERIALS AND METHODS: Urinary interferon-gamma, IL-2 and IL-10 were measured by enzyme-linked immunosorbent assay after each of 6 weekly instillations of 150 mg. BCG, Pasteur strain, in 19 patients with superficial stages Ta and T1 bladder cancer, and carcinoma in situ. The 11 patients who did not respond to course 1 were re-treated according to the same schedule and reevaluated. RESULTS: During course 1 interferon-gamma was higher than during course 2 (p <0.001), which was associated with nonrecurrence (p <0.001). In contrast, IL-2 cytokine was higher after course 2 (p <0.01), which was associated with a BCG response (p = 0.01). Interferon-gamma and IL-10 correlated during courses 1 and 2 (p = 0.04 and 0.0004, respectively). We distinguished groups 1-immediate T helper 1 lymphocyte profile consisting of responders to course 1 with high interferon-gamma, IL-2 and IL-10, 2-delayed T helper 1 lymphocyte profile consisting of responders to course 2 with early high IL-2 and 3-consisting of nonresponders to the 2 courses with low interferon-gamma, IL-2 and IL-10. CONCLUSIONS: A T helper 1 lymphocyte urinary cytokine profile was associated with a clinical response to BCG. A repeat BCG course induces a favorable immune response in a subset of patients, suggesting that maintenance therapy may be beneficial.

Adjuvants, Immunologic↗
PubMed2001

[Diagnostic methods for obstruction of the upper urinary tract: which tests are available in 2001].

The presence of upper urinary tract obstruction, its site and its nature can be determined and the most appropriate treatment can be defined in the majority of clinical cases. However, in some circumstances, non-invasive or minimally invasive methods, such as ultrasonography, intravenous urography, urography with diuretic test, conventional and diuretic nephrography and MR urography, are unable to confirm the presence of obstruction, requiring assessment of the upper urinary tract by antegrade pyelomanometry. This investigation measures the pressure in the upper urinary tract perfused at a constant rate by a percutaneous catheter and allows evaluation of the obstruction. The authors discuss the place of the various upper urinary tract investigations to confirm the definitive diagnosis of upper urinary tract obstruction.

Humans↗
PubMed2001

[Tolerance and efficiency of intravesical instillation of Calmette-Guérin in the prophylactic treatment of superficial bladder tumors, using a maintenance treatment].

UNLABELLED: Maintenance treatment with complementary BCG instillations in the prevention of superficial bladder tumour could improve the results of this immunotherapy. This maintenance treatment is limited by accentuation of the adverse effects related to BCG. OBJECTIVES: To evaluate the impact of maintenance treatment on tumour recurrence and progression, and to evaluate the influence of adverse effects on maintenance treatment and the recurrence rate. MATERIAL AND METHODS: 72 patients were treated with six weekly instillations of 81 mg of BCG (Immucyst) followed by three complementary instillations 3, 6, 12, 18, 24, 30 and 36 months later. Adverse effects (AE) were classified into four classes, according to their type, severity and duration, and were recorded prospectively for 518 instillations. An adverse effect score was determined for each patient. RESULTS: 84.9% of patients did not present any recurrence, 12.5% developed recurrence and 2.6% progressed. The instillation regimen was completed by 19% of patients, the dose had to be decreased for 57% of patients and treatment had to be discontinued for 39% of patients. An initial adverse effect score (AESi) greater than 1.5 was associated with an increased risk of discontinuation of treatment or reduction of the dosage during maintenance treatment (p = 0.01). CONCLUSIONS: Maintenance treatment was associated with a very low recurrence and progression rate. We have established and validated an adverse effect severity scale and the consequences of these adverse effects on maintenance treatment. This scale could be used to prospectively define the most appropriate maintenance instillation regimen, by preventively decreasing the doses or deferring instillation.

Adjuvants, Immunologic↗
PubMed2001

[Urinary leukocytes as a new prognostic marker of therapeutic response and of adverse effects associated with the maintenance treatment with endovesical BCG, for the prophylaxis of superficial bladder tumors].

UNLABELLED: The use of Bacillus Calmette-Guérin (BCG) vaccine as immunotherapy for superficial bladder cancer constitutes a major progress, although it remains limited by the development of adverse effects and problems related to safety. No individual tool is currently available in clinical practice to predict the efficacy or adverse effects of BCG therapy. These problems are accentuated in the case of maintenance therapy according to the protocol of D.L. Lamm. OBJECTIVES: To define whether the urinary leukocyte count observed after intravesical BCG instillation could be associated with adverse effects and efficacy of treatment. MATERIAL AND METHODS: A cohort of 72 consecutive patients (518 instillations) was studied prospectively. We defined four classes of adverse effects associated with BCG, according to their type, severity and duration. In combination with this classification, we performed systematic optical urinary leukocyte count on the third day after each instillation (KOVA-Slide 10). RESULTS: A high urinary leukocyte count (cut-off value: 165,000/ml) was correlated with absence of recurrence (p = 0.009). The adverse effect classification also demonstrated that urinary leukocyte count was related to the severity and duration of adverse effects (p < 0.0001). Median values observed for class I, II and III adverse effects were 40,000 leukocytes/ml, 150,000 leukocytes/ml and 350,000 leukocytes/ml, respectively. No class IV adverse effects were observed. The risk of developing class III adverse effects was increased when the urinary leukocyte count was greater than 86,000 leukocytes per ml. CONCLUSION: These results suggest a probable relationship between efficacy and safety of BCG, during maintenance therapy. Randomized prospective studies are necessary to evaluate urinary leukocyte count as a tool for adaptation and optimization of BCG therapy.

Adjuvants, Immunologic↗
PubMed2001

[Tendinopathy associated with fluoroquinolones: individuals at risk, incriminated physiopathologic mechanisms, therapeutic management].

The use of fluoroquinolones in urology has grown considerably over recent years. Unfortunately, although these molecules are not associated with severe life-threatening complications, they have nevertheless been associated with tendon lesions responsible for functional disability. The frequency of these complications is probably underestimated. There is a variable lag-time (3 to 5 days) between introduction of the antibacterial and onset of pain. The symptom most frequently reported is pain over the tendon affected and the tendons most frequently affected are those submitted to high constraints. Bilateral lesions are present in 66% of cases. Although Pefloxacin is associated with the highest frequency of tendon complications (2.7% versus 0.2-0.3% for other fluoroquinolones), the duration of treatment appears to be important in every case, with a peak frequency after a fortnight of treatment. Although these complications were considered for a long time to be associated with patients presenting certain risk factors (age, steroid therapy, renal failure), they can also occur suddenly, in young adult sportsmen or non-sportsmen, with no known tendon disease. Several hypotheses have been proposed to explain the development of these cases of tendinopathy: immuno-allergic mechanisms, direct toxicity of the molecule on collagen fibres, cell-mediated oxidative aggression, or tendon necrosis due to vascular mechanisms. The outcome remains favourable in 75% of cases of tendinitis and in 49% of cases for tendon rupture. Contraindications must therefore be identified and the duration of treatment must be adapted, as the functional handicap can be long and particularly severe.

Anti-Infective Agents↗
PubMed2000

Laparoscopic radical prostatectomy: preliminary results.

OBJECTIVES: To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures. METHODS: Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first 10 patients, we performed the vesicourethral reconstruction with interrupted sutures; in the remaining 33 patients, we performed it with two hemicircumferential running sutures. The specimen was removed through the umbilical port site. RESULTS: Once the developmental phase with the first 10 patients was concluded, the median operating time was 4.3 hours without pelvic lymphadenectomy, and the median postoperative bladder catheterization was 4 days. Two (4.7%) of 43 patients underwent transfusion. Twelve patients (27.9%) had positive surgical margins; all patients had a postoperative prostate-specific antigen level of less than 0.1 ng/mL at 1 month. Rectal injury occurred in 1 patient, requiring colostomy, and 4 patients had urethrovesical anastomotic leakages requiring surgical repair. One month postoperatively, 36 patients (84%) were fully continent (no leakage). Six patients had had erections, and four stated they had had sexual intercourse. CONCLUSIONS: Laparoscopic radical prostatectomy has evolved to a fully standardized and reproducible procedure. The short-term oncologic and functional efficacy rates are equivalent to those for open surgery. The operating time is reasonable once the learning curve is over, and postoperative morbidity is diminished. Because of the improved visual accuracy, permitting more precise dissection, this technique has the potential to become an important advancement in urologic surgery.

Aged↗
PubMed2000

Extraperitoneal laparoscopic repair of ureteropelvic junction obstruction: initial experience in 15 cases.

OBJECTIVES: To assess the feasibility and results of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. METHODS: From September 1996 to January 1999, 15 patients underwent extraperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction. Aberrant vessels were noted in 4 patients. Dismembered pyeloplasty was performed in 7 patients and nondismembered Fenger plasty in 7 patients. Pyeloplasty was not possible in 1 patient. RESULTS: Fourteen of the 15 procedures were successfully completed. The procedure was not possible in 1 patient who had already undergone endopyelotomy repair. The mean operating time was 178 minutes (range 100 to 250), and the mean postoperative hospital stay was 4.8 days (range 1 to 14). Postoperative complications occurred in 3 patients (two hematomas and one urinoma). Radiographic assessment by intravenous urography 3 months after the procedure showed good results. CONCLUSIONS: Retroperitoneoscopy, by providing easy and rapid access to the retroperitoneal space, seems to be a valuable alternative treatment for ureteropelvic junction obstruction.

Adolescent↗
PubMed2000

Utility of cytokeratin 7 for distinguishing chromophobe renal cell carcinoma from renal oncocytoma.

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.

Adenocarcinoma↗