Re: Subcutaneous urinary diversions for palliative treatment of pelvic malignancies.
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
J Irani
Publications and source records attributed to J Irani.
Radiographic prognostic criteria for extracorporeal shock-wave lithotripsy: a study of 485 patients.
OBJECTIVES: We studied 485 patients treated by extracorporeal shock-wave lithotripsy (ESWL) using an ultrasound electrohydraulic apparatus in an effort to define radiographic criteria for better patient selection for ESWL. METHODS: Results were assessed according to plain x-ray nephrotomography and ultrasound. The criteria for measuring success (stone free [SF]) excluded all residual fragments. After per-criteria analysis of the results, a multivariate analysis as well as an analysis of stone composition by infrared spectroscopy were performed. RESULTS: The SF rate was 57.5% (279 of 485). Calculi that were smooth, denser than bone, located in the lower calyx, and larger than 15 mm had less satisfactory results despite a greater number of impulses. A correlation was established between the radiographic appearance of the calculus, its composition, and ESWL results. Rough, less dense calcium oxalate dihydrate yielded satisfactory results (65%), whereas smooth, dense calcium oxalate monohydrate led to less conclusive results (41%). Multivariate analysis demonstrated the predominant influence of radiographic calculus profile on the results: rough, less dense calculi yielded a 79.4% SF rate, whereas smooth, dense calculi yielded a 33.6% SF rate. CONCLUSIONS: We propose that patients with dense, smooth calculi located in the lower calyx and larger than 15 mm be treated by other techniques, such as percutaneous nephrolithotomy. This would not only increase the ESWL effectiveness rate, but would also reduce the cost of treating kidney stones.
Adolescent↗
Serum-to-urinary prostate-specific antigen ratio: a potential means of distinguishing benign prostatic hyperplasia from prostate cancer.
OBJECTIVE: High concentrations of serum prostate-specific antigen (PSA) may be associated with the presence of benign prostatic hyperplasia or prostatitis. We investigated the serum-to-urinary PSA ratio in patients with or without prostate cancer to assess its efficacy in enhancing serum PSA specificity. METHODS: Patients presenting abnormal findings in digital rectal examination or documented prostate carcinoma were prospectively included in the study. A control group, with no evidence of prostate disease, hospitalized in the same time interval was included. Serum and urine PSA levels were measured in our laboratory with the Tandem R assay (Hybritech). Samples were drawn twice at 2-month intervals (M1 and M3). RESULTS: Sixty-eight patients were included in the study divided into 27 cases of benign prostatic hyperplasia, 20 of prostate carcinoma, 10 of prostatitis and 11 patients in the control group. Serum and urine PSA levels were not correlated (r < or = 0.1). There was no significant difference in any group from M1 to M3 as regards urinary PSA (p > or = 0.15). Intergroup comparison showed significantly (p < or = 0.004) high urinary PSA (mean level +/- SEM 28.3 +/- 3.4 micrograms/mmol creatinine) only in the benign prostatic hyperplasia group, mean levels in the prostate carcinoma, prostatitis and control groups being 3.7 +/- 1.1, 11 +/- 2.9 and 5.2 +/- 0.9 micrograms/mmol creatinine, respectively. Differences in urinary PSA levels between the confined prostate carcinoma and benign prostatic hyperplasia groups (p = 0.0008) were further increased when considering the serum-to-urinary PSA ratio (p = 0.0003). CONCLUSION: Our results suggest that the serum-to-urinary PSA ratio may be useful in distinguishing benign prostatic hyperplasia from prostate cancer.
Aged↗
[Genito-urinary injuries. Sequelae. Medico-legal aspects].
Traumatisms of the genito-urinary apparatus may be due to road or work accidents as well as mishaps occurring in surgery. Whatever be their cause, such after-effects may quite possibly not only perturb genital functioning, but also be detrimental to everyday life, if not survival itself. Such sequels are then open to legal redress, when making an estimate of the attendant damage, it behooves one to take into account the initial lesions, the gesture carried out in surgery, the evolution of such lesions as regards each particular organ and, last but not least, the way after-effects effectively impact upon the subject's everyday life. Such widespread considerations are integrally linked to equally widespread medical knowledge, to which one must necessarily add legal notions pertaining to juridical compensation for the type of corporeal injury which any surgeon, whatever be his degree of expertise, has got to know.
France↗
Systematic removal of catheter 48 hours following transurethral resection and 24 hours following transurethral incision of prostate: a prospective randomized analysis of 213 patients.
The interval before removal of the catheter used in prostatic transurethral surgery depends to a great extent on the surgeon, with a frequently empirical orientation. We conducted a prospective, randomized and controlled study of 213 patients who underwent transurethral surgery for benign prostatic hyperplasia. The catheter was removed systematically 24 hours after transurethral incision and 48 hours after transurethral resection of the prostate (group 1-52 and 54 patients, respectively) or the catheterization interval was determined by each surgeon in accordance with the usual criteria (group 2-52 and 55 patients, respectively). No statistically significant differences were noted between these 2 groups in regard to complications. We conclude that systematic removal of the catheter at the aforementioned periods is cost-effective, safe and comfortable for the patient.
Aged↗
[Simplified vesico-urethral anastomosis after radical retropubic prostatectomy for cancer. A preliminary comparative study].
The authors have done a prospective non randomized study to compare two methods of radical retropubic prostatectomy, without bladder neck preservation (Group 1 = 30 patients) or with bladder neck preservation (Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure. A comparative urodynamical study was performed with each group. Selection for one or the other technique was made by the personal choice or every surgeon. Results were similar for pre operative clinical staging, Gleason score with both groups. There was no significant difference in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no difference between the 2 groups regarding operative time, blood loss, urethral catheterization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative transfused blood units in the Vest suture group (p < 0.001). There were no positive margin on the preserved bladder neck in group 2, even if there was finally an understaging or another apical positive margins. Complications were not significantly different in the two groups with 10 bladder neck strictures in the group 1 (33%) and only 2 in the group 2 (14.2%) (NS). Complete continence rate was 73.3% and 64.2% respectively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both were similar but there was a tendency to a higher urethral pressure in group 2. Comments pointed out that bladder neck preservation and simplified Vest traction suture did not give more post operative nor carcinological complications than classical technique with direct separate stitches sutures. Disease progression, continence and bladder neck stricture rates were compared to literature. The urodynamical results were the same as those observed by others studies.
Aged↗
[Experimental study of urinary calculi fragmentation with pulsed laser shockwave, based on their chemical composition].
OBJECTIVES: To attempt to classify the resistance of urinary calculi to shock waves according to the chemical composition of the calculi most frequently treated in clinical practice. METHOD: Seventy four urinary calculi obtained after surgery were submitted to shock waves produced by an experimental neodyme glass phosphate pulsed laser, at a frequency of 532 nanometres, delivering impulses of 4.8 Joules lasting 25 nanoseconds with a recurrence of 1 second. The calculi (25 homogeneous: 90% of one constituent, 49 heterogeneous: > 45% < 90% of one constituent) had to be fragmented down to 2 mm fragments. The total fragmentation energy (TFE) required was the parameter adopted to classify calculi and to compare the fragmentation of various chemical compositions studied by infrared spectrophotometry. The TFE of 25 homogeneous calculi were compared to a microhardness study performed on calculi with the same chemical composition. The fragmentation thresholds energy (TFE) was used to compare the fragmentation thresholds of each type of calculi. Statistical analysis by ascending multiple regression was performed to classify the various factors likely to influence fragmentation. RESULTS: Two groups were able to be significantly distinguished according to whether the TFE required to obtain 2 mm fragments was greater than 200 Joules (cystine, weddellite, brushite, uric acid) or less than 200 Joules (weddellite, carbapatite, struvite). Only cystine and whewellite significantly increased the fragmentation threshold. For the 125 homogeneous calculi, the correlation with microhardness demonstrated an inverse relationship between friability and increased microhardness. A crossover between microhardness and friability to shock waves was only observed for whewellite and cystine. For the 49 heterogeneous calculi, this study showed that when weddellite was the predominant component of a stone, the friability tended to increase. Struvite and whewellite significantly facilitated and decreased fragmentation of heterogenous calculi, respectively. CONCLUSIONS: This study allowed urinary calculi to be classified into three groups: friable (weddellite, carbapatite, struvite), intermediary (brushite, uric acid, whewellite) and resistant (cystine). Although this laser cannot be used clinically, the constants were similar to those of pulsed lasers available in clinical practice and the results of the study corresponded to those already observed empirically by other teams or observed experimentally on a single stone corresponding to each type of chemical composition. The clinical application of this study would be to prospectively compare the results with those observed in clinical lithotripsy.
Humans↗
[Results of extracorporeal lithotripsy with ultrasonography-guided hydroelectric lithotriptor: study on 546 patients, prognosis factors].
OBJECTIVE: To investigate the existence of simple radiographic prognostic criteria, applicable on an outpatient basis, predictive of the result of extracorporeal lithotripsy (ECL). METHODS: This study was based on 546 patients treated by ECL using a hydroelectric apparatus. The results were evaluated on plain nephrotomographies and ultrasonography performed at the third month. Success was defined as the elimination of all residual fragments, regardless of their size, without fragments (WF). Analysis concerned 485 files after exclusion of patients lost to follow-up. Prognostic factors were evaluated criterion by criterion, and then by multiple ascending regression multivariate analysis. RESULTS: The fragment-free rate according to our criteria was 57.5%. Significantly poorer results were obtained for stones denser than bone (p < 0.001), smooth (p < 0.001, larger than 12 mm (p < 0.01), situated in the inferior calyx (p < 0.005), despite an increased (p < 0.005) number of ECL sessions and the number of shocks received. A correlation was established between the radiographic appearance of the stone, its predominant spectrophotometric nature (> or = 50%) and the results of ECL. Good results were obtained in 65% of spiculated, low-density Weddellite stones versus 41% of cases of dense, smooth Whewellite stones. Multivariate analysis of the predominant radiographic appearance of the stones showed that spiculated, low-density stones were completely eliminated in 79.4% of cases, and dense, smooth stones were completely eliminated in 33.6% of cases (p < 0.001). CONCLUSION: In this study, smooth, dense stones larger than 12 mm, situated in the inferior calyx appear to be particularly resistant to ECL. On the basis of this result, the authors propose a prospective clinical trial to compare the results of ECL and primary percutaneous nephrolithotomy in this type of stone with a high risk of failure.
Adolescent↗
[Multiple myeloma of the testis].
The testis is a rare site of multiple myeloma. The authors report such a case in a patient with a 7-year history of multiple myeloma. Transinguinal castration was performed. Six months after the operation, the patient did not have any other extramedullary sites, but the disease progressed rapidly with diffuse bone pain and end-stage renal failure. The diagnosis and management are discussed in the light of a review of the literature.
Humans↗
Prognostic value of histological grade and nuclear grade in renal adenocarcinoma.
We conducted a retrospective study of 237 cases of clinically localized renal adenocarcinoma treated at our department between November 1971 and December 1991 by radical nephrectomy. The parameters considered were tumor extension (pT stage), histological grading and nuclear grading. If the histological grade proved to be of little informational value in regard to survival, nuclear grade and pT stage had significant impact. On the other hand, nuclear grading considered in a given stage provided no significant influence. We conclude that nuclear grading cannot predict the outcome of patients at the same surgical stage.
Adenocarcinoma↗
[The treatment of stage I malignant non-seminoma tumors of the testis without systematic lumbo-aortic dissection. Results of a study begun 20 years ago. Apropos of 21 cases].
Over a 20-year period (1971-1991), the authors have treated 75 malignant testicular tumours, corresponding to 33 seminomas and 42 nonseminomatous tumours. The latter group included 23 stage I tumours according to Peckham's classification. The authors studied the therapeutic modalities of 21 of these patgients (2 non-protocol patients excluded) treated without lumboaortic lymph node dissection. Adjuvant therapy consisted of radiotherapy alone (2 cases), radiotherapy and chemotherapy (5 cases) and chemotherapy alone (14 cases). All patients are alive in complete remission (100%) with a follow-up of at least 24 months (range: 31-222 months, mean survival: 102.2 months). In line with what they already believed in 1971, the authors consider that systematic lumboaortic lymph node dissection is not essential in the treatment of stage I nonseminomatous testicular tumours, but propose systematic adjuvant therapy. Chemotherapy (PVB or, preferably, PEB) provides a guarantee of security and good acceptability.
Adult↗
[Vesico-urethral anastomosis after radical prostatectomy in cancer: Vest-Mayo's simplified technique].
The authors describe the technique of anastomosis without vesicourethral suture after radical prostatectomy for cancer. The operative details are described with a brief analysis of the principal complications observed in the first 14 patients operated with preservation of the bladder neck. These results are compared with the in the literature concerning this old technique recently revised by the Mayo Clinic surgical team in 1988.
Anastomosis, Surgical↗
[Cerebral metastases of testicular neoplasms. Apropos of 2 cases and review of the literature].
The authors report two cases of brain metastasis of a testicular cancer in two young men. In the first case the histology was an embryonal carcinoma, in the second the association of a seminoma and a teratocarcinoma. The first patient was submitted to chemotherapy, neurosurgery and radiotherapy. The second one to chemotherapy alone. The survival time was respectively of 16 and 58 months. It looked interesting to review the different treatments and their indications in this extremely severe pathology to define the interest of surgery and radiotherapy, and the different prognostic factors. In the literature, among the various treatment, the role of chemotherapy is widely emphasized. The prognosis remains desperately bad when several brain metastasis exist, or if a brain metastasis develops during chemotherapy.
Adult↗
[A technical device for the percutaneous extraction in monobloc of various renal calculi larger than 10 mm].
The authors present a technical device consisting of a modification of the operating channel for stone extraction by percutaneous nephrostomy. For selected stones, widening of the lips of the operating channel allows the stone to be rapidly and entirely removed without the need for ultrasound or hydroelectric fragmentation, which is always associated with a risk of leaving residual fragments. The aim of this technical device is to ensure complete absence of residual fragments with a minimum of risks for the renal parenchyma.
Calcium Oxalate↗
[Percutaneous nephrolithotomy after failure of extracorporeal shockwave lithotripsy. Indications, results, perspectives].
Eighty-one of the 579 extracorporeal lithotripsies (ECL) performed between 1987 and 1992 with an ultrasound-guided hydroelectric lithotriptor required the use of another treatment modality. 53 percutaneous nephrolithotomies (PCNL) were performed in these 81 patients after failure of ECL (21 for non-fragmentation, 32 for residual fragments). The authors analyse the factors responsible for failure in order to select the more appropriate type of treatment for different types of stones. The site of the stones, their size, their radiographic appearance, their chemical composition, the number of ECL sessions and the number of days spent in hospital were compared between the PCNL and ECL groups. Smooth, homogeneous stones denser than bone and larger than 15 mm in diameter were significantly more resistant to ECL, despite an increased number of shock waves. PCNL was successful in 92% of cases of non-fragmented stones (with no residual fragments). The success rate for multiple residual fragments was 64%. In view of the risk of complications associated with residual fragments, regardless of their size, the potential risks of ECL and cost imperatives, the authors recommend that these stones, considered to be resistant, should be treated immediately by PCNL, as the results of PCNL after ECL are less satisfactory.
Adult↗
[Ectopic ureteral orifice into the seminal duct with homolateral renal agenesis: contribution of ultrasonography].
Based on an incidental case of ectopic ureteric orifice in the seminal tract associated with homolateral renal agenesis, the authors demonstrate the value of ultrasonography, particular transrectal, both for diagnosis and follow-up. Digital rectal examination is the key to the diagnosis, combined with ultrasonography and urography. The indications for surgery depend on the clinical symptoms and signs.
Abnormalities, Multiple↗
[Idiopathic vaginal hydrocele. Treatment using a sclerosing injection of minocycline].
The authors report a series of 31 hydroceles (26 patients) treated by drainage followed by sclerosing injection of minocycline hydrochloride. The pain usually experienced with this injection required the use of general anaesthesia in 38.70% of cases and local-regional anaesthesia in 41.94% of cases. The patients were able to return to work on the day after the procedure, but after 6 months, only 51.61% of them were free of recurrence of the effusion. Patients must therefore be warned about the inconstant results of this technique.
Administration, Intravaginal↗
[Silica urinary calculi. Report of a case].
The authors report a case of anuria due to bilateral ureteric obstruction by silica stones in a patient taking magnesium trisilicate for many years. A review of the literature concerning silica stones is presented. The diagnosis should be suggested by the clinical history and confirmed by stone analysis. The treatment of silica stones is not specific, but must be associated with withdrawal of the drug responsible.
Humans↗