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J M Dubernard

Publications and source records attributed to J M Dubernard.

At least 19 recordsLinked to original sources
PubMed1997

Treatment of dual urinary and fecal incontinence by implantation of two AMS 800 artificial sphincters. Case report.

We report the case of a 61-year-old woman with urinary and anal incontinence due to neurologic disease. An AMS 800 artificial sphincter was implanted first round the bladder neck with recovery of satisfactory urinary continence. Four months later, another AMS 800 artificial sphincter was implanted round the anal sphincter. Two revisional procedures had to be performed: replacement of the pump for mechanical failure, and replacement of the low-pressure balloon by a high-pressure one. Finally the patient has been almost completely continent with only occasional leakage of feces or liquid stools (follow-up 24 months after activation). Defecography shows total rectal evacuation and anorectal manometry records an anal closing pressure of 70 cm H2O. Dual implantation of artificial sphincters is possible for incontinence of neurological origin, provided bladder and rectal compliance are normal.

Anal Canal↗
PubMed1997

Endopyelotomy with the Acucise cutting balloon device. Early clinical experience.

OBJECTIVES: To evaluate the efficacy of the Acucise balloon cutting device in the treatment of ureteropelvic junction (UPJ) stenosis. METHODS: Forty-four patients with primary (21) or secondary (23) UPJ stenosis underwent Acucise endopyelotomy between July 1992 and February 1995. RESULTS: The average operating time was 53 min and the average hospital stay was 6 +/- 4 days. The follow-up schedule included a symptom questionnaire, intravenous urography and diuretic renal scan. Of the 44 patients, 38 have been followed for a minimum of 3 months postoperatively (mean: 12 months, range: 3-39 months). Overall success was achieved in 29 (76%). The procedure was successful in 16 out of 19 cases (84%) with secondary strictures. When the technique was used for the treatment of primary UPJ strictures, the success rate was only 68% (13 out 19). The presence of a large periureteric urinoma was identified as the cause of failure in 2 cases of primary strictures. CONCLUSION: We recommend the use of the Acucise device as the first-line therapy for treatment of secondary UPJ stenosis (except in the presence of large enclosed stones). We do not approve the use of the Acucise device for treatment of primary UPJ strictures. In primary hydronephrosis, the negative role of periureteric extravasation probably explains the low success rate of 68% (as opposed to 85% for a large series of percutaneous endopyelotomies.

Adolescent↗
PubMed1997

[Contribution of computed tomography in the staging of upper urinary tract urothelial tumors. Importance of the tumor diameter measurement].

OBJECTIVES: To demonstrate a correlation between abdominal computed tomography (CT) data and the histological stage of upper urinary tract tumour (UUTT) in order to more accurately define therapeutic indications. MATERIALS AND METHODS: From 1984 to 1995, 51 patients were treated for UUTT and were assessed by preoperative abdominal CT. 41 of the 51 CT scans were considered to be interpretable and were reviewed retrospectively by a single radiologist. The CT stage and tumour diameter were compared to the pathological stage. RESULTS: CT staging had a reliability of 76%, by combining stages Ta-T2, which could not be distinguished. The sensitivity of CT to assess invasion of the renal parenchyma and ureteric or perirenal fat was 100% and 70%, respectively, with a specificity of 82% and 97%. The accuracy can be improved by decreasing the thickness of sections of the tumour. Tumour diameters (d) of pyelocaliceal tumours, measured by CT and pathology, were closely correlated (r2 = 0.83). All UUTTs less than 3 cm in diameter were found to be superficial on histology. CT correctly estimated the size of these small tumours in 14/15 cases. Overall, by setting the limit at 3 cm, CT was able to detect a superficial pyelocaliceal tumour with a specificity of 92% and a PPV of 93%; however, a CT size > or = 3 cm is not predictive of the histological stage of the lesion. CONCLUSIONS: CT is still imprecise for the staging of UUTT, as it cannot distinguish between Ta, T1 and T2 lesions, and is still not sufficiently reliable in the assessment of invasion of the periurothelial fat or of the renal parenchyma. CT measurement of the diameter of pyelocaliceal tumours can provide an argument in favour of the superficial nature of the lesion and therefore guide the therapeutic decision towards a conservative approach.

Adult↗
PubMed1996

Aerobic preservation of organs using a new perflubron/lecithin emulsion stabilized by molecular dowels.

The purpose of the study reported here was to explore a new strategy for the aerobic preservation of transplants using stable concentrated fluorocarbon emulsions as an oxygen delivery system. Fluorocarbons (FCs) are synthetic molecules, chemically and biologically inert, with a high oxygen-dissolving capacity. As they do not mix with water, it is necessary to emulsify them for intra-vascular use. Perfluorooctyl bromide (or perflubron) can be emulsifled with egg-yolk phospholipid (EYP), a nontoxic emulsifiant. The recent adjunction of amphiphilic fluorocarbon-hydrocarbon diblock molecules allows the obtaining of stable emulsions. By contrast with hemoglobin, fluorocarbons release oxygen following Henry's linear law rather than Barcroft's sigmoid curve. Release of oxygen by the FCs is only slightly influenced by temperature, which is an advantage for the preservation of organs. We tested a new 90% w/v fluorocarbon stem emulsion (perflubron/EYL/F6H10) diluted to 36% w/v with a hydroelectrolytic solution containing albumin, on four multiple organ blocks (MOBs; heart-lungs, liver, pancreas, kidneys, small intestine) of rats (EMOBs). Five control MOBs were perfused with a 50% v/v mixture of rat-blood and Krebs solution (KBMOBs). The lungs were ventilated with a FiO2 = 100%. In all cases the survival of the MOBs was greater than 210 min, with stable hemodynamics and preserved hydroelectrolytic and acid-base balances. The levels of lactate, amylase, and CK of the EMOBs were inferior (P < 0.05) to those of the KBMOBs between the first and the second hour. The diuresis of the EMOBs was higher (P < 0.05) than that of the KBMOBs (5.65 +/- 1.76 vs 1.21 +/- 0.28 mg/min). The production of bile, and the AST and ALT levels, were not significantly different. The PaO2 of the EMOBs was higher (P < 0.01) than for the KBMOBs. In normothermy, the maintenance of an aerobic metabolism using the FC emulsion caused less damage to the organs. Aerobic preservation of organs using FC emulsions therefore appears to be an attractive alternative to the presently used cold ischemia.

Animals↗
PubMed1996

Ureteropelvic invagination procedure for endopyelotomy (Gelet technique): review of 51 consecutive cases.

Between 1990 and 1995, we performed 51 endopyelotomies on 38 cases of primary and 13 of secondary obstruction of the ureteropelvic junction (UPJ) using the ureteropelvic invagination technique. Of the 51 patients in the series, 49 have been followed for a minimum of 3 months postoperatively (mean follow-up 16 months). Overall, success was achieved in 38 (77.5%). Endoscopic endopyelotomy was successful in 11 of 13 cases (84.5%) with secondary strictures. When the technique was used for the treatment of primary UPJ stricture, the success rate was only 75% (27 of 36). The presence of a crossing vessel was identified as the cause of failure in five cases of primary strictures; hence, we advocate the use of angiography to identify crossing vessels preoperatively. We recommend the use of the ureteropelvic invagination technique as the first-line therapy for primary hydronephrosis in adults in the absence of a crossing vessel.

Adolescent↗
PubMed1996

Treatment of prostate cancer with transrectal focused ultrasound: early clinical experience.

OBJECTIVES: To evaluate the efficacy of transrectal focused ultrasound on localized prostatic cancer. METHODS: Fourteen patients (mean age 72.5 years) with clinical stage T1 (3) and T2 (11) prostatic cancers, who were not suitable candidates for surgery were treated. The mean PSA pretreatment level was 12 +/- 10 ng/ml (Hybritech). The device used (Ablatherm, Technomed M.S.) combines a 2.25-MHz therapy transducer and a 7.5-MHz transrectal biplane ultrasound scanner probe (linked to a software enabling the operator to determine precisely the zone of the prostate to be treated. The prostate was treated in one (3 patients), two (7 patients) or three sessions (4 patients) under spinal (25 sessions) or general anesthesia (4 sessions). RESULTS: Complications occurred in 9 of the 14 patients (64%): early complications occurred in 6 (rectal burns 3, urinary retention 2, transient incontinence 1) and late complications in 5 (incontinence 2, bladder neck stenosis 3). The median PSA NADIR value (1.79 +/- 2.35 ng/ml) was achieved at 6 months and the final PSA value was 2.94 +/- 3.27 ng/ml (mean follow-up 380 days). Control biopsies demonstrated coagulative necrotic lesions of the treated prostate zones with secondary development into fibrosis. No residual cancer was observed in 7 patients after several random sextant biopsies. Residual cancer was found in 7 patients: 4 required complementary treatment (orchidectomy 2, external beam radiation therapy 2). Adjuvant therapy was deferred in 3 patients with stable PSA values under 2 ng/ml. CONCLUSIONS: A satisfactory local control with negative control biopsies was achieved in 50% of the cases in this pilot study. However, this therapy is an investigational procedure: long-term follow-up will be necessary to confirm these early results.

Aged↗
PubMed1996

Surgical management of complex renal cysts: a series of 32 cases.

PURPOSE: The differentiation between benign cysts of the kidney and those that require surgical exploration remains difficult. The accuracy of radiological techniques (ultrasound, computerized tomography [CT], angiography, magnetic resonance imaging, cyst puncture and intraoperative pathological examination) is analyzed. MATERIALS AND METHODS: Surgical exploration was performed in 30 patients with 32 asymptomatic renal cysts, and the pathological specimens were compared retrospectively to the radiological findings. The classification of Bosnaik was used to categorize the ultrasound and CT findings. RESULTS: Of our complex renal cysts 41% proved to be malignant. Our results suggest that the radiological techniques are not well suited for characterization of these cysts. None of the Bosnaik types was sufficiently predictive of the lesion. Only a Bosnaik score of 4 (the sum of ultrasound and CT Bosnaik types) was not associated with renal cell carcinoma. According to the radiological findings, 1 patient was under treated (recurrent renal cell carcinoma) and 4 were over treated (radical nephrectomy for benign lesions). CONCLUSIONS: A practical therapeutic strategy is described in which radical nephrectomy is performed when malignant lesions are detected either by preoperative or intraoperative techniques. Conservative surgery is indicated for benign cysts according to the clinical status and risks of nephron sparing surgery.

Adult↗
PubMed1996

[Role of celioscopy in the treatment of lymphocele after transplantation].

Lymphoceles can be observed after renal transplantation. Sometimes lymphoceles can cause symptoms (renal insufficiency, pain). In these cases they require surgical treatment. From january 92 to december 1993 seven patients with complicated lymphoceles were treated. Simple drainage with injections of polyvidone iodine was used in 4 cases without effect. Surgical drainage was performed in 5 cases with complete disappearance of the pouch (on open surgical procedure, four celioscopic procedures). Celioscopic marsupialization of lymphoceles after transplantation is a method of choice and is preferred to open surgery for lymphoceles which develop internally.

Adult↗
PubMed1996

[Quality of life and skin urinary diversions. Results of a questionnaire completed by 73 patients].

UNLABELLED: The objective of this study was to evaluate the quality of life of patients with a cutaneous urinary diversion. MATERIAL AND METHODS: A 25-item self-administered questionnaire was sent to 73 patients with a cutaneous urinary diversion, either non-continent (NCD), such as a transileal cutaneous ureterostomy, or continent (CD), such as a Mainz or Kock reservoir. RESULTS: 66 patients answered the questionnaire: 34 NCD and 32 CD. The mean follow-up was 69.2 years for NCD and 58 years for CD. No significant difference was demonstrated between the two samples in terms of the interference of their diversion with their everyday life. Most patients declared that their sex life was now "severely disturbed". However, 3 patients regained a sexual activity after their diversion. Patients with an ideal conduit presented a higher incidence of stoma problems. Overall, 90% of patients with an NCD and 97% of those with a CD were satisfied or very satisfied with their diversion. CONCLUSION: Regardless of the type of diversion, patients were satisfied with their operation. When a cutaneous diversion is necessary, the choice of a continent or non-continent diversion cannot be solely based on the argument of "continence". The best possible choice, as a function of surgical limitations and the patient's desires, can only be determined on the basis of a dialogue between the surgeon and the patient.

Dermatologic Surgical Procedures↗
PubMed1996

[Treatment of lymphocele after kidney transplantation].

Lymphocele is a possible postoperative complication of renal transplantation and its treatment is still controversial. Over a 3-year period (January 1992 to December 1993), 7 patients with a complicated lymphocele were treated by various modalities. Puncture-drainage was used in 7 cases, Povidone sclerotherapy was performed in 4 cases and internal drainage was performed by surgical marsupialization in one case and by laparoscopy in 4 cases. The results of external drainage and sclerotherapy were disappointing, with 1 good result out of 7 and 1 moderate result out of 4, respectively. On the other hand, internal drainage was effective in every case, whether it was performed by surgical or laparoscopic marsupialization. The latter technique avoids the disadvantages of open surgery in high-risk patients. Laparoscopy appears to be the treatment of choice for post-renal transplantation lymphoceles, as it is simple, rapid and effective.

Adult↗