[Mesenteric panniculitis and generalized cancer].
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Adrenal Gland Neoplasms↗
Biomedical subjects
J M Brisset
Publications and source records attributed to J M Brisset.
[Natural history of renal calcium lithiasis. Data obtained from a cohort of 667 patients].
Between January 1st, 1988 and May 31st, 1989, 667 patients (419 men, 248 women) with radioopaque, non cystinic and apparently idiopathic (lack of severe renal disease) renal stones were entered in a prospective study. The data obtained at entry enabled us to build up, retrospectively, a quantified presentation of the natural history of calcium nephrolithiasis. At the time the disease was discovered the patients' mean age was 40.4 years, and its presence had been known for 7.9 years on average in both sexes. The mean number of stones formed by the patients was 3.5. In 218 of the 277 patients who had only one stone the nephrolithiasis had been present for less than 3 years, as compared with at least 6 years in the 184/252 patients who had 3 stones or more; this suggests that in many of the patients studied the stones had rapidly become symptomatic. Women had a significantly (chi 2: P less than 10(-3)) more frequent history of urinary tract infection than men, and notably more frequent episodes of febrile infection (31.5 percent in women, 7.1 percent in men). A familial history of nephrolithiasis was found in 34.7 percent of women and 31 percent of men, but its presence had no influence on the number of stones formed or on the duration of the disease. On the other hand, the stones were discovered significantly earlier in men who has a familial history of nephrolithiasis (37.3 years) than in those who had no such history (42 years; P less than 10(-3)). These data will be used as baselines to a prospective evaluation of the course of nephrolithiasis in these patients.
Adult↗
Systematic prostatic biopsies in 100 men with no suspicion of cancer on digital rectal examination.
A total of 100 men with a mean age of 63 years underwent, in the following order, prostate specific antigen (PSA) assay (radioimmunometric assay, normal less than 2.5 ng./ml.), rectal examination, transrectal ultrasonography with a 7 MHz. probe, measurement of the prostatic volume, and 6 ultrasound-guided randomized biopsies and biopsies of any hypoechogenic zones. All men with a suspicious prostate on rectal examination (nodule, induration or firm zone) were excluded from the study. There were 14 prostatic cancers detected: 3 (8.5%) in men less than 60 years old, 4 (11%) in men between 60 and 70 years old and 7 (24%) in men more than 70 years old. No cancer was detected in men with a PSA level of less than 10 ng./ml., 5 (26%) were detected in 19 men with a PSA level of 10 to 19 ng./ml., 4 (40%) were detected in 10 men with a PSA of 20 to 29.9 ng./ml. and 5 (100%) were detected in 5 men with a PSA of 30 or more ng./ml. A total of 66 men (66%) had a PSA level of less than 10 ng./ml. There were 18 (18%) hypoechogenic zones detected: 2 (11%) were positive for cancer but, over-all, the hypoechogenic zones revealed cancer in only 2 of 100 cases (2%). In 12 of the 14 cancers detected (86%) with no clinical suspicion the PSA level was higher than the maximal PSA level related to the prostate weight. We conclude that systematic randomized prostatic biopsies are the best method of early diagnosis, detecting 41% of all prostatic cancers in men with a normal rectal examination when the PSA level is 10 ng./ml. or more. The real question is to determine whether this early diagnosis is useful for the patient, since presently, there is no certainty of the therapeutic benefit in terms of quantity and quality of life.
Aged↗
Focussed extracorporeal pyrotherapy: experimental results.
A new device made of piezoelectric ceramic placed in a semispherical dish and focussed at 320 mm was developed in order to generate heat and cavitation responsible for coagulative necrosis of deep tissues. The target to be treated is located with a central ultrasound probe of 3.5 MHz. In vitro studies with polyurethane phantoms showed that the ultrasound melted a surface of 2 x 12 mm within 1 s. The temperature recorded at the focus was 270 degrees C. In tissue samples (prostate cancer and benign prostate hyperplasia), the temperature rose to 85 degrees C in vitro and a hyperechoic zone appeared at the focus during shots. In vivo 8-mm plastic spheres, introduced surgically into the bladder of pigs, were melted by repeat shots without burning of crossed tissues. These studies were performed in the kidney and the liver. Autopsy performed on day 0 showed congestion, autopsy performed between day 6 and day 11 showed necrosis, whereas at 3 months the focussed area was fibrosed. This technique, which we called 'focussed extracorporeal pyrotherapy', combines phenomena of cavitation and high heat at the focus. Prostate tumors, bladder tumors, kidney tumors and liver metastases are potential indications for pyrotherapy.
Animals↗
Seminal vesicle biopsies in the preoperative staging of prostatic cancer.
Twenty-five patients with localized prostate cancer underwent seminal vesicle biopsies before radical prostatectomy. A transrectal probe of 7 MHz, a 18-gauge needle and a biopsy gun were used. The preoperative biopsy established the absence of seminal vesicle invasion in 89% of cases. When the seminal vesicles are positive at biopsy, capsular penetration is observed in 100% of the cases and lymph node positivity in 50%. When seminal vesicles are negative at biopsy and the prostate-specific antigen level is less than 20 ng/ml (n less than 2.5), capsular penetration of greater than 1 cm is absent in 100% of cases and lymph nodes are positive in only 7% of cases. Biopsy of the seminal vesicle, as an outpatient procedure, improves the preoperative staging of prostate cancer before radical prostatectomy: negative biopsies are good predictors of the absence of lymph node invasion.
Antigens, Neoplasm↗
[Focused extracorporeal pyrotherapy. Initial experimental results].
The objective of this study was to develop an apparatus allowing the generation of a high temperature (exceeding 80 degrees C) in a precise focus (20 mm x 2 mm) by means of extracorporeal elastic waves. The treatment time at high temperatures is brief and administered in sequences of 4 to 7 seconds. In vitro studies on blocks of polyurethane demonstrated melting of the plastic at the focal point. Studies on plastic spheres introduced into the bladder of the pig demonstrated melting of the sphere without any alteration in the tissues in the wave path. Studies of cellular viability of bladder carcinoma cultures demonstrated a significant difference after 48 hours between the non-treated control group and the group of cells submitted to high temperatures. This technique, called Pyrotherapy, should be promising if the preliminary results are confirmed.
Animals↗
[Role of conventional surgery in the treatment of renal lithiasis].
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Endoscopy↗
Incidental detection of renal tumours by abdominal ultrasonography.
One hundred and twenty-six patients with renal cell carcinoma were treated by nephrectomy between 1985 and 1988. They were classified into three groups: group A: 47 patients in whom ultrasonography revealed the renal cancer in the absence of any suggestive clinical signs of tumour; group B: 63 patients who presented with clinical urological signs suggestive of the tumour; group C: 16 patients who presented with general signs leading to the diagnosis. In group A, 50% of the tumours measured between 5 and 10 cm, 51% were located at the lower pole of the kidney and 83% were stage T2. Sixty-six percent of cancers in this group were situated on the right side, indicating that left renal cancers are missed in 16% of cases. In group B, 60% of the tumours measured between 5 and 10 cm, 44% were located at the lower pole and 56% were stage T2. In group C, 60% of the tumours measured between 5 and 10 cm, 50% were located at the upper pole of the kidney and only 38% of the tumours were still stage T2. We can conclude that incidental detection reveals renal tumours at a relatively limited stage (83% of T2), with dimensions smaller than those of the other groups. It is therefore essential for radiologists, ultrasonographists and urologists to investigate the left lumbar fossa and the upper pole of both kidneys very carefully during abdominal or vesico-prostatic ultrasound examinations.
Abdomen↗
Use of antibiotics in the conjunction with extracorporeal lithotripsy.
The first 400 patients treated on an inpatient basis at our center underwent bacteriological follow-up after extracorporeal lithotripsy (ECL) for ureteric or renal stones. 278 patients did not have any urinary tract infection on the urine culture before ECL. They did not receive any antibiotic prophylaxis and 4.8% of the patients developed infectious problems, with significant bacteriuria in only 1.5% of the cases. 89 patients had urinary tract infection on the preoperative cultures. 21.3% developed either fever or significant bacteriuria and this virtually always occurred in patients who were treated for less than 4 days before ECL, with septicemia in 4.5% of the cases. 33 patients with sterile urine received flush antibiotic prophylaxis and none of them developed postoperative infection. Two of these patients had infection at the time of the flush: one of them, who, by error, did not receive antibiotic treatment prior to ECL, developed bacteremia after the procedure. The rational use of antibiotics in conjunction with ECL should ensure effective prevention of urinary tract infections without requiring the excessive use of antibiotics.
Anti-Bacterial Agents↗
[Functional renal failure caused by vascular diversion. The role of a hypervascular renal tumor].
Tumorectomy was performed in a patient with hypervascular renal carcinoma on a solitary kidney. Prior to surgery, this patient had mild renal impairement (plasma creatinine 195 mumol/l, creatinine clearance 48 ml/min), but it was noted that 45 days after surgery his renal function had improved (plasma creatinine 142 mumol/l, creatinine clearance 63 ml/min). The hypothesis of a prerenal model of renal impairment is put forward, the probable physiopathological mechanism being a diversion of blood flow from the healthy kidney to the hypervascularized tumoral kidney.
Adenocarcinoma↗
Relationship between the frequency of piezoelectric shock waves and the quality of renal stone fragmentation. In vitro study and clinical implications.
Nine renal stones were separated into 5 fragments of similar weight and size. One fragment was analyzed chemically and the other 4 fragments were submitted to treatment by piezoelectric shock waves according to the following modalities: 3,000 shock waves at firing frequencies of 1.25, 2.5, 5 and 10 shock waves/s. In the case of hard stones, better quality fragmentation was obtained with low frequencies than with high frequencies. With friable stones, using only 800 shock waves, the result was the same regardless of the frequency used. Treatment of hard stones by shock waves for 20 min at various frequencies revealed that a slightly better result was obtained with a frequency of 5 shock waves/s, although the result was not significantly better. In conclusion, slow frequencies of 1.25 or 2.5 shock waves/s allow better fragmentation of hard stones at the cost of a longer mean treatment than at high frequencies. High frequencies do not give significantly better results than low frequencies when the same firing time is used. In the clinical situation, it is therefore preferable to use low frequencies which allow treatment without anesthesia or analgesia and without admission to hospital.
Humans↗
Comparison of the efficacy of digital rectal examination and transrectal ultrasonography in the diagnosis of prostatic cancer.
167 patients with a mean age of 64 years underwent digital rectal examination (DRE), transrectal ultrasonography with a 7-MHz transverse and/or longitudinal transducer, followed by prostatic biopsy under ultrasound guidance. 231 biopsies were performed. 74 peripheral hypoechogenic zones were demonstrated. The sensitivity of DRE was 82% and the specificity 91%. The sensitivity and the specificity of ultrasound were respectively 69 and 83%. On 123 patients with normal DRE, 19 hypoechoic zones were detected and 2 patients had a positive biopsy (11%). On 104 patients without hypoechoic zone, 5 biopsies were positive (5%). The use of transrectal ultrasound scanning is able to multiply the number of impalpable cancer by 2, but in only 3 lobes, a hypoechogenic zone associated with a normal rectal examination was confirmed to be a cancer on biopsy. These cases represent 5.5 of the 56 positive biopsies, 4% of the hypoechogenic zones and 1.6% of the investigated patients with normal rectal examination. No impalpable cancer of 5 mm or less was detected by high resolution ultrasonography. DRE is still the most reliable examination for the diagnosis of prostatic cancer. Ultrasonography is a useful complement, particularly by allowing collection of tissue interpretable by the histologist in 100% of cases.
Biopsy↗
Comparison of the efficacy of digital rectal examination and transrectal ultrasonography in the diagnosis of prostatic cancer.
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Aged↗
[Ureteral flushing].
Flushing back stones of the lumbar or iliac ureter towards the renal cavities by means of a catheter is now part of everyday practice. The ureteric flush-back technique is often easily performed when the appropriate equipment is used wisely. We used a 23 Ch cystoscope with a 5 degrees lens to work in the axis of the ureter and a 7 Ch catheter with a single orifice is advanced as far as the stone. In 30% of cases, the stone immediately ascends as far as the renal cavities due to ureteric distension. In the case of failure, rapid injections of physiological saline with a syringe are successful in 40% of cases. In 10% of cases, success depends on progressive hydraulic distension of the ureter above the stone following injection of physiological saline.
Cystoscopy↗
Parenchymal-sparing surgery for small renal cell cancer: are there any reasonable arguments?
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Adult↗
Piezoelectric extracorporeal lithotripsy by ultrashort waves with the EDAP LT 01 device.
A total of 433 extracorporeal lithotripsy procedures was performed for renal, ureteral and bladder stones by means of a system of ultrasonographic detection and piezoelectric destruction in 386 patients. The stones were detected easily in 87 per cent of the patients, difficult to detect in 10 per cent and impossible to detect in 3 per cent. Mean duration of treatment was 35 minutes. Mean number of piezoelectric waves was 2,700 at 1.25 per second. With a frequency of 1.25 to 5 per second, extracorporeal lithotripsy was performed without any local, regional or general anesthesia, and without premedication in 210 patients. Of the 217 patients with a renal stone reviewed at 3 months 161 (74 per cent) had successful results and 56 (26 per cent) failed therapy. Thirty patients (14 per cent) underwent 2 or 3 sessions. The morbidity was low: 2 per cent of the patients suffered ureteral obstruction, 1.5 per cent had subcapsular hematoma and 4 per cent had fever. No significant modifications of laboratory tests were necessary and no patient suffered renal failure. Of the stones 31 in the lumbar ureter, 15 in the pelvic ureter and 8 in the bladder were treated, with success rates of 87, 46 and 50 per cent, respectively. A total of 103 patients was treated on an outpatient basis. This outpatient treatment, together with the low cost and minimal maintenance of the apparatus, and the absence of anesthesia constitute a new progress in the treatment of renal stones.
Equipment Design↗
Outpatient extracorporeal lithotripsy of kidney stones: 1,200 treatments.
1,200 extracorporeal lithotripsies have been performed in 816 patients. 58% of the stones had a diameter of 3-10 mm, 41% measured between 11 and 20 mm and 1% were larger than 20 mm. The patients were all treated on an outpatient basis without either anesthesia or analgesia. The mean time spent at the lithotripsy center was 2 h: the mean treatment time was 46 min, i.e. 3,450 shocks at a frequency of 1.25/s. 530 patients were reviewed after 3 months. Overall, 64% of them were stone free. These results varied between 73% for stones less than 10 mm in diameter and 43% for stones larger than 20 mm in diameter. 69% of the patients presenting with a single stone were stone free at 3 months. The best results were obtained in upper caliceal stones (78%) and the least satisfactory results were obtained in the lower caliceal stones (68%). The complication rate was low: renal colic in 18% of cases, fever in 2% of cases. Altogether, 13 disobstructions were required, namely 12 endoscopic and 1 surgical. 33% of patients were retreated without admission to hospital. Outpatient extracorporeal piezoelectric lithotripsy is indicated for renal pelvic or caliceal stones less than 20 mm in diameter situated in a nonobstructed renal cavity, in a noninfected patient without any particular risk factors. 85% of patients are currently treated at the lithotripsy center on an outpatient basis.
Adult↗
Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: a randomized study.
Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).
Humans↗