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J Biserte

Publications and source records attributed to J Biserte.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Urinary lithotripsy in children. Multicenter study of the Pediatric Urology Study Group].

The authors present the results of a survey conducted among French paediatric urologists belonging to the Groupe d'Etudes en Urologie Pédiatrique (GEUP) (Paediatric Urology Study Group). This study, based on 122 cases observed in 13 centres, is not exhaustive, but is nevertheless statistically significant. The preoperative assessment confirms the usual findings of urinary stones in children: pyelonephritis, haematuria and abdominal pain, the usual presenting complaint, concomitant malformative uropathy (10% of cases) and a predominance of calcium stones. More than 200 stones were treated, larger than 10 millimeters in diameter in one-third of cases. Renal stones, mainly caliceal (more than 50%), included 11 staghorn calculi. This study also included 22 ureteric stones, mainly in the pelvic ureter, and 2 bladder stones. Lithotripsy was ultrasound-guided in 2/3 of cases and required general anaesthesia in about 3/4 of cases. Ureteric catheterization was required in 19 infants preoperatively, but in only 2 infants (stein strasse) postoperatively. One or two lithotripsy sessions were sufficient in most cases, but 4 sessions were necessary in 5 patients, to the same kidney in 1 case. The mean hospital stay was 2 to 3 days, but the procedure was performed on an outpatient basis in 15 cases. The immediate postoperative course was uneventful and asymptomatic. This survey revealed about 10% of complete failures, corresponding to solitary caliceal stones in 2/3 of cases; 29 partial failures were essentially due to lower caliceal stones and staghorn calculi; 84 successes (stone-free), mainly pelvic or simple caliceal stones. Scintigraphy did not reveal any immediate postoperative impairment of renal function. This study reported a success rate of about 70%, regardless of the type of apparatus used. Assessment of the results of ESWL requires sufficient follow-up both concerning the outcome of fragmented stones and evaluation of possible functional repercussions. This survey defines the main indications: although ESWL can be applied to most stones, some stones constitute poor indications (cystine stones, stenotic malformative uropathy) or dubious indications: small lower caliceal stones, densely calcified staghorn calculi in older children. This study confirmed the efficacy and low morbidity of ESWL in children. A prospective study needs to be conducted according to a rigorous protocol in order to refine the technique and indications while reducing the possible long-term risks.

Abdominal Pain↗
PubMed1999

[A case of metastatic nephroblastoma in an adult with favorable outcome under cisplatyl, etoposide].

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.

Adult↗
PubMed1997

[Surgical treatment of primary mega-ureter].

Primary megaureter is a congenital dilatation of the ureter secondary to obstruction of its terminal portion. It must be corrected surgically only when its obstructive nature can be demonstrated and/or in the presence of complications (especially when it is associated with vesicoureteric reflux). Surgical treatment must always include resection of the obstructive part and ureterovesical reimplantation with an anti-reflux device. Compliance with these 2 principles may require remodelling of the ureter depending on the size of the urethra and bladder. Many surgical procedures can be performed, but 3 procedures are proposed allowing the management of the great majority of situations: 1. Transtrigonal reimplantation according to Cohen without remodelling of the ureter, when the ureteric calibre is less than 1 cm. 2. Transtrigonal reimplantation according to Cohen with remodelling of the transmural portion of the ureter. 3. Suprahiatal reimplantation with extravesical remodelling of the ureter according to Hendren in the case of dolichomegaureter. The other ureteric remodelling or plication techniques are indicated more rarely.

Dilatation, Pathologic↗
PubMed1997

Study of the effects of thermotherapy in benign prostatic hypertrophy.

UNLABELLED: Prostatic transurethral thermotherapy was evaluated clinically using the Prostcare microwave system of the Bruker Company, which uses a microwave radiometer to measure and control intraprostatic temperature. OBJECTIVES: The aim of our study was to evaluate the immediate histological lesions induced in the prostatic tissue depending on the temperatures delivered to the prostate; the histological changes when adenectomy is carried out after thermotherapy, and the endoscopic appearance of the prostatic fossa 48 h, and 1, 2, 3 and 6 months after thermotherapy. METHODS: Our study was divided into three stages: in the first stage, we conducted thermotherapy in 10 patients in whom suprapubic adenectomy was indicated. During thermotherapy, a multipoint fiber-optic receptor and two thermocouples were implanted into the prostage gland at a distance of 5-15 mm from the urethra. Adenectomy was carried out 10 min after thermotherapy; the second stage of our study concerned the changes seen over time. We heated adenomas using the same protocol and carried out adenectomy 24, 48, 72 h, and 1 week, 6 weeks and 3 months after thermotherapy, and lastly, we studied the endoscopic appearance after a single heating-session of 30 min by endoscopic controls at different times after thermotherapy (48 h, 1, 2, 3 and 6 months after thermotherapy). RESULTS: Macroscopic appearance: necrotic lesions measured 30 mm in length on average. Necrosis was roughly circumferential. Immediate histological aspect: in all cases, histological examination showed coagulation necrosis with periurethral thromboses. Histological changes: at 8 days, necrosis intensity was maximal and histological structures were difficult to identify. Endoscopic appearance: 3 months after thermotherapy, the typical endoscopic appearance was a large periurethral cavity. There was a sharp demarcation between untreated areas and cicatricial tissue. CONCLUSION: The efficacy of thermotherapy depends on the radiometric temperature, which should reach 47 degrees C (i.e. a temperature of 55-65 degrees C delivered to the prostate), and a rapid increase in temperature, i.e. in the power applied, which should reach the thermal radiometric level of 47 degrees C in 5 min. As soon as necrosis is obtained, the power is automatically reduced. Using this protocol, heating proves effective in 30 min.

Humans↗
PubMed1996

Urachal remnants: sonographic assessment.

OBJECTIVE: To evaluate the frequency of the visualization of urachal remnants (UR) with ultrasound and to determine their sonographic patterns. SUBJECTS AND METHODS: Two hundred and fifty consecutive patients were referred for abdominal and/or pelvic ultrasonography, 83 who had urinary tract symptoms. Patient age ranged from 1 month to 91 years (mean = 35 years). Patients were classified into four groups: (1) < 16 years (n = 47) (2) 16-35 years (n = 100), (3) 36-55 years (n = 49), (4) > or = 56 years (n = 54). Ultrasonography was performed using 3.75 MHz and 7.5 MHz transducers. Ultrasound criterion for diagnosis was a midline mass located between the rectus abdominus muscle and the upper part of the anterior bladder wall. RESULTS: UR were found in 90 cases (36%). UR demonstration was more frequent in groups 1 (61.7%) and 2 (49%) and 3 (20.4%) and 4 (3.7%). UR were nodular (87%) or tubular in structure (13%). Echogenicity was similar to or greater than adjacent muscle in 51% and less than in 49%. The length, width, and thickness mean and standard deviation values were 13.5 +/- 4.7 mm, 12.6 +/- 5 mm, and 5.2 +/- 1.5 mm, respectively. UR were observed in 50% of the asymptomatic patients of groups 1 and 2. CONCLUSION: Urachal remnants are commonly demonstrated with ultrasound, particularly in young patients. They should be considered to be a normal variant unless there is an increase in size or they are accompanied by clinical signs, without other possible causes for symptoms.

Adolescent↗
PubMed1996

[Spiral scanners: the key to imaging of kidney injuries].

Whatever the mechanism or extent of other lesions, ultrasonography is essential in evaluating damage to the kidney after abdominal trauma in order to identify renal devascularization, fracture or fragment separation, to recognize the different blood or urine components in perirenal collections, to search for associated or prior lesions, and to obtain a baseline measurement for future follow-up. Progression introduced with spiral scans now provides 3-D images for then entire organ at different times during contrast product diffusion. The corticovascular time is used to analyse the renal pedicle and cortical vascularization; the tubular time is ideal for analysing fractures and dislocations; the calicial or excretory time, together with urography films give information on extravasation of contrast product, the upper tract and the bladder. 3-D images allow reconstructions in all three plans for the different structures, faciliting interpretation. Spiral scan should be available in all emergency centers to guarantee quality management or renal trauma.

Humans↗
PubMed1996

[Moderately severe kidney injuries. Changes in therapeutic indications].

The choice of treatment for moderately severe blunt trauma to the kidney is a controversial issue. Modern imaging techniques, especially computed tomography and more recently 3-D imaging, have greatly improved analysis of the lesions. Ultrasonography and computed tomography allow for precise noninvasive follow-up, widening indications for non-surgical management. The question is raised as to whether retarding surgery may have a consequence on the development of late complications which were long the reason for routine surgical treatment in case of infection, urinary extravasation, large interfragment gaps, or devascularization.

Humans↗
PubMed1994

[A case of association of cyst of the urachus and Meckel's diverticulum].

Meckel diverticulum and residual urachus have a common embryological origin: the yolk sac at the eight day of life. Their course is independent but the underlying mechanisms are identical. Meckel diverticulum occurs in 2 to 4% of the population. Clinical signs are often absent and complications occur in 4% of the cases (haemorrhage, occlusion, inflammation, and rarely tumoural formation). Residual urachus occurs as a cystic formation, a sinus or a fistulization and may degenerate into adenocarcinoma of severe prognosis. The reported association has not apparently been reported previously in the literature. Due to the risk of cancerization, it is suggested that residual urachus should be searched in cases of Meckel diverticulum.

Child, Preschool↗
PubMed1994

MR findings of ejaculatory duct cysts.

Ejaculatory duct cysts are a rare type of prostatic cysts. We report 3 cases of symptomatic ejaculatory duct cysts which have been explored by MR imaging. The MR findings were round or oval masses, medial or paramedial in the prostatic gland above the level of the verumontanum, extending into the prostatic base. They displayed a low signal intensity on T1-weighted images and high signal intensity on T2-weighted images (2 cases) or high signal intensity on both T1- and T2-weighted images (1 case). The diagnosis was confirmed by an ultrasonographically guided transperineal aspiration demonstrating spermatozoa in the cyst fluid.

Adult↗
PubMed1992

Extraperitoneal pelvioscopy in lymph node staging of bladder and prostatic cancer.

In view of the inadequate accuracy of radiological investigations, surgical lymphadenectomy is generally the last resort to assess lymph node involvement in bladder and prostatic cancers. Extraperitoneal pelvioscopy is a simple and effective method to avoid such invasive surgery, which is always slightly regrettable to perform purely for staging purposes. The investigation is performed with the patient under low spinal anesthesia via a short iliac incision using an instrument derived from the mediastinoscope. It allows biopsies from the external iliac, internal iliac, common iliac and obturator lymph node chains. We analyzed our results of pelvioscopy in 101 patients (36 prostatic and 65 bladder cancers). Extraperitoneal pelvioscopy, unilateral in 78 and bilateral in 23 cases, corrected the conclusions of the radiological assessment in 39% of the prostatic cancer cases and in 28% of the bladder cancer cases. The specificity and positive predictive value is 100%, sensitivity 84%, negative predictive value 93% and over-all reliability 95%. On the basis of the quality of the results and the low morbidity (5 cases of rapidly resolving lymphorrhea, 1 injury to the external iliac vein and 1 obturator nerve lesion), extraperitoneal pelvioscopy can be considered as a useful complement to the preoperative staging of bladder and prostatic cancer.

Endoscopes↗
PubMed1992

[Ureteral risk in celioscopic surgery].

In recent years, there has been a significant improvement in laparoscopic surgery which had led to more and more frequent use of this technic in various cases. As a consequence, the ureteral injury which have been a less common iatrogenic pathologic up to know is likely to be more and more frequent in the years to come. The authors present 2 cases of 28 and 36 years old patients. In both cases the laparoscopy was indicated for gynecologic pathology. The healing ureteral occurred in those cases during a revealing postoperative peritonitis. Treatment consisted in healing up the lesion by ureteral stent. Treatment and evolution of this injury are discussed.

Adult↗
PubMed1992

[Partial cystectomy: and alternative to radical cystectomy? Apropos of a series of 75 patients].

From a retrospective series of 75 patients, we try to determine the place of this treatment with respect to bladder urothelial cancer. Of our 75 patients the breakdown of tumours according to their stage is the following: PTA: 16 (21.3%) PT1: 12 (16%) PT2: 21 (28%) PT3 A: 15 (20%) PT3 B: 7 (9.3%) PT4: 4 (5.4%) 47 patients benefited from a complete check up of tumoural spread which is negative in any case. In 28 cases, an uretero-vesical reimplantation was necessary for carcinologic reasons. None of the patients benefited from chemotherapy and/or radiotherapy in pre or post-operative period. Mortality was 4% (3 cases) and morbidity 8% (6 cases)- Sixty two Patients were followed-up at 5 years. The results are expressed according to different carcinologic parameters. The overall rate of recurrence is 61.2% (38/62). The actuarial survival corrected at 5 years, all stages and grades included, is 53.2% (32/62). There was no recurrence in 18 patients (29%) and 29 patients preserved their bladder. The advantages of partial cystectomy are obvious: Its mortality and morbidity are weak. It also preserves the sexual function and mainly avoids resorting to urinary derivations. As a principle these indications apply to a small percentage of invasive tumours T2-T3 A located in the mobile part of the bladder that is unifocal and of small size (< 4 cms).

Actuarial Analysis↗