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J Irani

Publications and source records attributed to J Irani.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Impact of genital prolapse on the upper urinary tract].

UNLABELLED: The authors reviewed five cases of genital prolapse affecting the upper urinary tract and causing renal failure. CLINICAL CASES: Five patients aged 55 to 75 years presented with genital prolapse, which was known by the patient in 3 cases for a period of 2 to 30 year, but left untreated. All cases had induced bilateral dilatation of the uretero-pyelocaliceal cavities with severe obstructive renal failure in 3 cases, moderate renal failure in 2 cases and associated with hypertension in 2 cases. Repair of prolapse, preceded by upper urinary tract diversion by ureteric and bladder catheters in 3 cases or pessary + bladder catheter because of the patient's age in 2 cases, cured or improved renal failure in 4 patients; only one patient had to be treated by dialysis because of the severity of the residual renal failure severity. DISCUSSION: The frequency (4%) of aetiopathogenic mechanisms (ureteric compression, progressive stretching of the ureter and posterior tilting of the trigone) are analysed. The delayed onset of sudden deterioration and the varying degrees of severity of renal failure demand emergency treatment of stage III prolapse with primary diversion of the upper urinary tract, currently by double J stents, until correction or improvement of renal function, after which surgical repair of the prolapse can be performed according to the usual surgical rules. Intravenous urography is still indicated in this situation. Palliative treatment is only indicated in elderly patients or patients with a high operative risk. The best treatment remains prevention by detection and treatment of prolapse before the development of this fortunately rare complication. CONCLUSION: This short clinical series emphasizes that undiagnosed prolapse can still be complicated by repercussions on the upper urinary tract with a risk of renal failure.

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PubMed1999

High-grade inflammation in prostate cancer as a prognostic factor for biochemical recurrence after radical prostatectomy. Pathologist Multi Center Study Group.

OBJECTIVES: To assess the prognostic value of prostatic stromal inflammation in surgically treated localized prostate carcinoma for biochemical recurrence-free survival. METHODS: Stromal prostatic inflammation grading was studied in 161 patients who underwent radical prostatectomy for prostate cancer without involvement of the lymph nodes and who did not receive preoperative or postoperative radiotherapy or hormonal therapy until recurrence occurred. Inflammation was graded as high-grade inflammation if confluence of inflammatory cell infiltrate and/or glandular epithelium disruption associated with interstitial inflammatory infiltrate were present and as low-grade inflammation otherwise. Each specimen was graded separately first in the stroma surrounding nonmalignant glands and second in the stroma surrounding malignant glands. Biochemical recurrence based on serum prostate-specific antigen (PSA) level was defined as two successive PSA measurements greater than 1 ng/mL. RESULTS: Malignant tissue was significantly less involved in high-grade inflammation than benign adjacent tissue (9.3% and 19.9%, respectively; P <0.01). In a univariate Kaplan-Meier analysis, the 5-year recurrence-free survival rate for patients with high-grade and low-grade classified prostates was 61.0% and 66.7% in benign tissue and 27.0% and 65.3% in malignant tissue, respectively, with a significant difference between grades only in malignant tissue (P <0.02). In a multivariate analysis controlling for Gleason grade, preoperative serum PSA, pathologic stage, and inflammation grade in malignant tissue, the latter factor remained significantly predictive of biochemical recurrence (P = 0.03). CONCLUSIONS: Patients with high-grade inflammation surrounding malignant glands in radical prostatectomy specimens had significantly more postoperative biochemical recurrence than patients with low-grade inflammation.

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PubMed1999

The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography-guided biopsy of the prostate: a prospective randomized placebo-controlled study.

OBJECTIVE: To evaluate the effect of the rectal administration of lidocaine gel on the tolerance of systematic sextant transrectal ultrasonography (TRUS)-guided prostatic biopsies. PATIENTS AND METHODS: From January to September 1997, patients undergoing initial biopsy mapping of the prostate (with six systematic TRUS-guided transrectal biopsies) were randomized using a pre-established randomization list into two groups. In group 1, 15 mL of 2% lidocaine gel (Astra, Södertälje, Sweden) was administered intrarectally 15 min before the biopsies. In group 2 (placebo), 15 mL of trans-sonic hydrophilic gel (Rivadis Laboratory, Thouars, France) was administered transrectally under the same conditions. Patients were randomized and the gel administered by a nurse; neither the patients nor the urologists were aware of which product was administered. At the end of the procedure, patients were asked to score the severity of discomfort of the biopsies, using a self-administered rating scale. RESULTS: In all, 109 patients were included, in either group 1 (56 patients) or group 2 (53 patients). Slight pain or no pain was experienced by the vast majority of patients in both groups. Moderate to severe pain was experienced in 12.5% of patients in group 1 and 11.3% of patients in group 2. There was no difference in patient tolerance between the groups (P=0.39). Only minor complications occurred and complication rates were not significantly different between the groups. CONCLUSION: The rectal administration of lidocaine has no impact on the tolerance to prostatic biopsy.

Administration, Rectal↗
PubMed1999

Symptom characteristics and the development of tolerance with time in patients with indwelling double-pigtail ureteric stents.

OBJECTIVE: To determine the symptoms of and factors predicting the tolerance to double-pigtail ureteric stents, and the development of tolerance with time. PATIENTS AND METHODS: The study included 39 patients (median age 49.0 years, range 26-74; 24 men and 15 women) who were treated in our department for ureteric obstruction caused by benign conditions, excluding pregnancy and associated open surgery. All patients received a polyether-urethane double-pigtail ureteric stent (7 F, 28 cm long). Tolerance to the procedure was assessed using a questionnaire and a 10-cm linear visual analogue scale (VAS) at 24 h and again one week after placement, and on the day before stent removal. RESULTS: From the end of the first week to before removal of the stent, fewer patients reported dysuria, haematuria and having recourse to painkillers than during the first week. However, analysis of variance for repeated measures showed no significant difference between the VAS scores for first day, the first week and the day before removal, either overall or stratified by gender (P=0.15). A factorial analysis of variance analysing the VAS score for the first week as a function of gender, age and type of occupation (sedentary or mobile occupation) showed a significant effect only for gender (P=0.005) and gender-age interaction (P=0. 02): VAS scores were higher in men and particularly in younger men. CONCLUSION: Almost all patients with short-term placement of indwelling double-pigtail ureteric stents have untoward symptoms. Although some symptoms, e.g. dysuria and haematuria, significantly improve with time, the general tolerance remains unchanged. Tolerance in men, and particular in younger men, was significantly poorer.

Adaptation, Physiological↗
PubMed1999

BTA stat and BTA TRAK: A comparative evaluation of urine testing for the diagnosis of transitional cell carcinoma of the bladder.

OBJECTIVE: We compared the BTA (bladder tumor antigen) stat test with the BTA TRAK assay in patients highly suspicious of bladder cancer. METHODS: The BTA stat and the BTA TRAK tests are two immunoassays that detect human complement factor H related protein in urine, employing the same antibody pair. The BTA stat is a qualitative test which can be performed in a consultation setting. The BTA TRAK is a quantitative test that is performed in the laboratory. Consecutive patients highly suspicious of bladder cancer were included in this prospective blinded trial to assess the clinical performances of the two methods. RESULTS: A total of 81 patients were tested using BTA stat and BTA TRAK before cystoscopy. A tumor was identified in 49 patients. BTA TRAK (38/49 true-positive cases) was more sensitive than BTA stat (32/49) in detecting bladder cancer (p < 0.05). When considering the subgroups of bladder cancer by stage and grade, the difference remained significant for low-grade and low-stage tumors. There was no significant difference between BTA TRAK and BTA stat as regards specificity (20/32 and 23/32 true-negative cases, respectively; p = 0.2). CONCLUSION: BTA TRAK with a cutoff of 14 U/ml had a significantly higher sensitivity than BTA stat in the detection of low-grade and low-stage bladder cancer.

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PubMed1999

[Theoretical conditions for cancer screening. Example of prostate cancer].

Not all cancers are suitable for screening programmes. The disease must be frequent, serious and able to be diagnosed at a stage at which it is curable and an easily acceptable and very specific screening test must be available. The justification for prostate cancer screening is controversial and this screening cannot be recommended on the basis of current knowledge. In this study, the authors evaluated, in the light of the recent literature, to what degree prostate cancer satisfies the theoretical criteria for cancer screening.

Humans↗
PubMed1999

[Schwannoma and the urinary tract. Concerning a tumor of the obdurator nerve].

Peripheral nerve tumours, called schwannomas, because they are derived from cells of the Schwann sheath, are rare tumours that can involve any part of the body, but are essentially located on the limbs, which represent more than 50% of cases. Schwannomas of the trunk and especially pelvic schwannomas are even rarer. A tumour arising from the obturator nerve is exceptional, but its paravesical location can facilitate the diagnosis, as in this case. The complementary investigations most frequently performed are CT and MRI, although they are unable to define the exact nature of the tumour. Surgery must try to preserve continuity of the nerve, but that is not always possible and does not appear to have any major consequences in this site.

Humans↗
PubMed1998

[Can the prostatic capsule be preserved during cystectomy for bladder tumors: a study of urethral and prostatic involvement in the cystectomy specimens].

OBJECTIVES: To evaluate the frequency of urethral and prostatic lesions on cystectomy specimens for bladder tumour. MATERIAL AND METHODS: This retrospective histological study was based on 260 specimens: radical cystectomies performed in 7 operative sites. The prostate and urethra were analysed in 3 planes (upper, middle and lower thirds). The apex was studied separately. Urethral invasion was identified by continuity of the tumour or by the presence of vesical CIS. RESULTS: Urethral involvement is frequent (30.6% cases) essentially due to contiguous invasion (43/80). CIS is the second pathological association (44 urethral CIS/75 bladder CIS). Prostatic adenocarcinoma was present in 17.8% of cases with a Gleason score > 6 for 30% of lesions. CONCLUSION: The high frequency of urethral and prostatic involvement does not justify preservation of the prostate during cystectomy. A serial prospective study should define the precise criteria able to minimize the risk of conservative surgery.

Adenocarcinoma↗
PubMed1998

[Renal cancer and late pancreatic metastases. Apropos of 3 cases and review of the literature].

Renal cell carcinoma is a malignant epithelial tumour which can always give rise to metastases, usually situated in the lungs, bone and liver. In contrast, pancreatic metastases are exceptional and can occur late. The authors report three cases of metachronous pancreatic metastases, 1, 4 and 10 years after nephrectomy. The procedures performed consisted of Whipple procedure, tumour excision and total duodenopancreatectomy. Although rare when isolated to the pancreas, these metastases can justify even audacious pancreatic resection.

Adenocarcinoma, Clear Cell↗
PubMed1998

[New diagnostic tests for urothelial tumors of the bladder].

Urothelial bladder tumours require regular surveillance: cystoscopy combined with urine cytology remains the reference examination. Several tests designed to diagnose bladder tumours have been recently proposed in order to replace cytology and possibly reduce or even replace systematic cystoscopy. These tests are currently being evaluated and their indications have not yet been established. In this article, the authors review the results of recent studies concerning bladder tumour antigen (BTA), fibrin/fibrinogen degradation products (AuraTek FDP) and nuclear matrix protein (NMP-22). These tests are the subject of numerous research studies and have already been approved by the United States Food and Drug Administration. The majority of these studies appear to show that these tests have better diagnostic performances than cytology. However, in the absence of an experimental study validating the possibility of replacing cystoscopy in the surveillance of recurrent bladder tumours by one of these tests, they can only be used as an aid to diagnosis, at the present time.

Antigens, Neoplasm↗
PubMed1997

Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value.

PURPOSE: We attempted to identify morphological parameters of benign prostatic hyperplastic inflammation that correlate with pre-biopsy prostate specific antigen (PSA) concentrations. MATERIALS AND METHODS: Patients undergoing prostate biopsy at our department were prospectively studied between January 1995 and January 1996. preoperative blood and 24-hour urine samples were measured for PSA. Biopsy samples harboring exclusively benign prostatic tissue were graded on a 4-point scale for inflammation (0-no inflammatory cells, 1-scattered inflammatory cell infiltrate, 2-nonconfluent lymphoid nodules and 3-large inflammatory areas with confluence of infiltrate) and aggressiveness (0-no contact between inflammatory cells and glandular epithelium; 1-contact between inflammatory cell infiltrate and glandular epithelium; 2-clear but limited, that is less than 25% of the examined material, glandular epithelium disruption, and 3-glandular epithelium disruption on more than 25% of the examined material). RESULTS: A total of 66 patients with exclusively benign prostatic tissue on prostate biopsies was analyzed. Difference between inflammation graded groups was not significant when considering serum or urinary PSA. There was a significant correlation between aggressiveness grading and serum PSA (rho = 0.51, p < 0.0001), whereas aggressiveness grading and urinary PSA did not correlate (rho = -0.06, p = 0.6). CONCLUSIONS: Prostatic subclinical inflammation is not associated with high urinary PSA. Unless associated with glandular epithelial disruption, density of prostatic interstitial inflammatory cell infiltrate is not significantly correlated with serum PSA concentration. We believe that this issue should be considered when interpreting a prostate biopsy.

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PubMed1997

Serum-to-urinary prostate specific antigen ratio: its impact in distinguishing prostate cancer when serum prostate specific antigen level is 4 to 10 ng./ml.

PURPOSE: Benign prostatic hyperplasia (BPH) was shown to be associated with high concentrations of urinary prostate specific antigen (PSA). We investigated the serum-to-urinary PSA ratio in patients undergoing prostate biopsy to assess its efficacy in enhancing serum PSA specificity in the detection of prostate carcinoma. MATERIALS AND METHODS: From November 1995 through January 1996 consecutive patients undergoing prostate biopsy were prospectively included in the study. Serum and urine PSA levels were measured at our laboratory with the Tandem-R assay. Samples were drawn 24 hours before prostate biopsy and at a distance from prostatic manipulation or ejaculation. RESULTS: We studied 73 patients with BPH and 57 with prostate cancer. Differences between BPH and prostate cancer were statistically significant considering serum PSA or serum-to-urinary PSA ratios. In the 50 patients with a serum PSA of 4.0 to 10.0 ng./ml. (35 with BPH and 15 with prostate cancer) the differences between prostate cancer and BPH were still significant only when considering serum-to-urinary PSA ratio. Receiver operating characteristic curves showed that serum-to-urinary PSA ratio was a better predictor of prostate cancer than serum PSA. CONCLUSIONS: Our results suggest that the serum-to-urinary PSA ratio may be useful in distinguishing BPH from prostate cancer, particularly in the diagnostic gray zone of serum PSA between 4.0 and 10.0 ng./ml.

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PubMed1997

Patient tolerance of transrectal ultrasound-guided biopsy of the prostate.

OBJECTIVES: To determine the acceptability by patients of ultrasound-guided prostatic biopsy without anaesthesia. PATIENTS AND METHODS: From January 1995 to January 1996, 81 patients in our department undergoing transrectal ultrasound-guided prostate biopsy were asked to assess the tolerability of the procedure using an immediate post-operative questionnaire including a 10 cm linear visual analogue scale (VAS). RESULTS: The mean VAS score was 3 (standard error 0.24) and 16% of the patients had a VAS score of > or = 5. Responses to the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19% would not agree to undergo it again without some form of anaesthesia. CONCLUSIONS: Even when anaesthesia-free, transrectal ultrasound-guided prostatic biopsy was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of the current out-patient setting should be reassessed.

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PubMed1997

Breast conservation and prolonged chemotherapy for locally advanced breast cancer: the University of Michigan experience.

PURPOSE: To determine whether breast conservation and prolonged neoadjuvant chemotherapy have efficacy in locally advanced breast cancer (LABC), as measured by survival and rate of breast conservation. MATERIALS AND METHODS: Eighty-nine patients with stage III disease were enrolled at the University of Michigan (UM) onto a prospective nonrandomized trial. Patients received nine 21-day cycles of neoadjuvant chemohormonal therapy that consisted of doxorubicin 30 mg/m2 and cyclophosphamide 750 mg/m2 intravenously on day 1, conjugated estrogens 0.625 mg orally twice daily on days 6 to 8, methotrexate 40 mg/m2 and fluorouracil 500 mg/m2 intravenously on day 8, and tamoxifen 10 mg orally twice daily on days 9 to 14. Patients with a negative biopsy received radiation only, while those with residual disease underwent mastectomy and postoperative radiotherapy. Eight more cycles of chemohormonal therapy were administered after local-regional therapy. RESULTS: The clinical response rate to neoadjuvant therapy was 97%, 28% of patients had a complete pathologic response evaluated at biopsy. Five-year overall and disease-free survival probabilities were 54% and 44%, respectively. The median disease-free survival time was 2.4 years. The 5-year actuarial rates of local-regional control with local failure as only first failure were 82% and 78% following radiotherapy, and mastectomy and radiotherapy, respectively (P = .99). CONCLUSION: Prolonged neoadjuvant chemohormonal therapy and biopsy-driven local therapy have efficacy in LABC, with 28% of patients being candidates for breast conservation and a 5-year overall survival rate of 54%.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Serum and urine prostate-specific antigen ratio: its value in the distinction between prostate cancer and adenoma when serum prostate-specific antigen level is between 4 and 10 ng/ml].

BACKGROUND: In an earlier study, we demonstrated that benign prostatic hyperplasia (BPH) was associated with significantly higher urine levels of prostate-specific antigen (PSA) than in prostate cancer (PC). These early results led to the present study: we assessed, in patients undergoing a prostate biopsy, the clinical value of the PSA serum/urine ratio (PSA S/U) in patients for the differential diagnosis of PC, particularly when the pre-biopsy serum level of PSA lies between 4.0 and 10.0 ng/ml. METHODS: All patients without an indwelling drain who underwent transrectal echoguided biopsy were prospectively included in this study from November 1994 to December 1995. All serum and urine PSA measurements were done by the same laboratory using a Tandem R kit (Hybritech). Blood and urine samples were obtained during the 24 hour period prior to surgery during which all urethral or rectal manipulation was avoided. RESULTS: We studied 130 patients with BPH (n = 73) or PC (n = 57). The PSA serum levels and the PSA S/U were significantly different between the BPH and the PC groups. In the subgroup of 50 patients with a serum PSA level in the 4-10 ng/ml range, the difference between the BPH and PC patients was not significantly different except for the PSA S/U ratio. Receiver operating characteristic (ROC) curves showed that the diagnostic power of PSA S/U was greater than serum PSA. CONCLUSION: These results suggest that the PSA S/U ratio could be useful to distinguish between BPH and PC, particularly when diagnosis is uncertain in patients whose serum PSA is in the 4.0-10.0 ng/ml range.

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