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Biomedical subjects

J M Dubernard

Publications and source records attributed to J M Dubernard.

At least 199 records · Page 11Linked to original sources
PubMed1987

[Endoscopic treatment of vesico-ureteral reflux].

Submucosal injection of Teflon for treatment of vesicoureteral reflux (the sting of O'Donnell) was used in 43 patients (66 ureters-21 bilateral cases). 14 patients were on dialysis and reflux was diagnosed at medical evaluation during pretransplantation work-up; correction of reflux was indicated as a preparation for renal transplantation. In another group of 24 patients with normal renal function reflux appeared as a simple congenital abnormality. 5 patients had reflux secondary to TUR or ureteral reimplantation. The procedure was performed under general or epidural anesthesia. Ultrasound examination of kidneys was performed 24 hours after the procedure, cystography and UIV was performed after 30, 100 days and one year. No ureteral obstruction were observed. In the first group of patients (on dialysis) correction of reflux was effective in 40% of cases. In the second group (congenital vesicoureteral reflux) correction was observed in 85% of cases (30/35 controlled cases). In the third group correction of reflux was observed in 83% of cases (5/6). Results in the first group of patients may be due to technical difficulties while injecting of Teflon in small, thickened sclerotic bladders. Though longterm results are still to be evaluated. The sting may be beneficial in patients on dialysis waiting for a renal transplant as it obviates the need for bilateral nephrectomy. In simple congenital reflux short and middle term results are excellent.

Adult↗
PubMed1987

[Revascularization of the renal artery in renovascular hypertension with progressive renal insufficiency].

Sixteen patients underwent surgical treatment for severe renovascular hypertension with rapidly progressive renal failure. These patients were assessed preoperatively with the measurement of serum creatinine and blood-urea levels (means 271 +/- 204 mumol/l and 15.6 +/- 10.3 mmol/l respectively), and renal clearances. 5 patients underwent aorto-renal bypass (bilateral in one case) and 11 patients were treated by autotransplantation of the kidney. Operative mortality was 6.2%. Early results were assessed at 1 and 6 months postoperatively. Renal function was normal in 8 patients, improved in 5 (p less than 0.05), unchanged in 1 and worse in 1 by aorto-renal bypass thrombosis. At long-term with a minimum follow-up of 12 months (mean 31 +/- 12 months), the initial improvement in renal function remained steady in 12 patients whilst 1 patient has gone on to hemodialysis. At middle and long-term, 81% of the patients were normotensive without medication or had improved blood pressure (p less than 0.001). These good results confirm the reversibility of renal ischemic lesions and support an aggressive attitude towards the use of revascularization in the surgical treatment of such patients with renovascular hypertension and renal failure.

Acute Kidney Injury↗
PubMed1986

Atracurium in patients with renal failure. Clinical trial of a new neuromuscular blocker.

Atracurium was given to 30 patients with terminal chronic renal insufficiency, in two regimens. Group I (20 patients) received a single dose of 0.6 mg kg-1 and group II (10 patients), received one or several injections of 0.2 mg kg-1. Tracheal intubation was performed with ease in all patients 3 min after the injection of atracurium. A supramaximal stimulus was applied to the ulnar nerve at wrist level, and thumb adduction force was recorded. Muscular blockade was 100% in 29/30 patients and 95% in one. Mean time between atracurium injection and reappearance of 25% of the initial muscular power (HT25) was 49 min. The recovery time index (IR25-75) was 12 min and did not increase after re-injection. No side-effects were observed and no significant differences in any of the measurements made were seen between the two groups.

Adult↗
PubMed1986

Ultrasound stone localisation for extracorporeal shock wave lithotripsy.

An extracorporeal shock wave lithotriptor using an ultrasound scan head pantograph location system has been designed. The shock wave ellipsoid reflector position is adjusted to the stone with a computer assisted positioning device. Seven dogs with stones implanted into the renal pelvis were treated and stone fragmentation occurred in all cases. Subsequently, 45 patients with stones were treated. The stones ranged in size from 5 to 29 mm (mean 16). Radio-opaque as well as poorly opaque or radiolucent stones were treated and fragmentation was achieved in 85% of cases. An additional endoscopic procedure was performed in four cases. No fragmentation occurred in four patients. Further shock wave treatment was necessary in two patients who presented with stones larger than 2 cm. Both radio-opaque and poorly opaque stones can be treated with this system. Ultrasound localisation and the ellipsoid positioning device avoid the need for expensive fluoroscopic equipment and a hydraulic patient positioning system.

Animals↗
PubMed1986

[Comparative diagnostic value of ultrasonics and rectal examination in prostatic cancer in a series of 213 patients].

The value of endorectal sonography for the diagnosis of prostatic cancer was established after retrospective interpretation of sonographic data issued from 213 patients without prior knowledge of either clinical or pathological data. Endorectal sonography was performed with a mechanical sectorial high frequency (7.5 MHz) probe realized by the authors. A pathology report (73 biopsies, 52 TUR, 7 suprapubic adenomectomy specimens) was available for 132 patients: 25 pathological examinations were interpreted as normal, 41 adenomas, 24 prostatitis or fibrosis and 42 cancers (5 clinical stage T0, 22 T1, 2 T2 and 13 T3). Specificity for the diagnosis of cancer was respectively 65% or 79% according to the normality reference considered, i.e. either the group of patients having a normal pathological control (90 patients) or the same group plus another group of patients with a normal rectal examination (171 patients). Sensitivity for the diagnosis of cancer was only 48%: 53% of cancers were falsely interpreted as prostatitis or adenomas and 9% as normal (2 T0 and 2 T1). The large proportion of local stages without capsular involvement (29/42) is partly responsible for this lack of sensitivity. Sonography can reveal the presence of abnormalities in the echostructure of the gland but does not allow tissue characterization. Rectal examination and sonography are complementary techniques. In the same study, rectal examination had a 48% specificity and a 92% sensitivity.

Humans↗
PubMed1986

[Extracorporeal lithotripsy by shock waves. Initial results (322 cases)].

Results of 322 patients treated with extracorporeal shock wave desintegration are reported (277 patients treated with the Dornier lithotripter, 45 patients treated with Solonithe using ultrasonic stone location). Lesions treated included 168 caliceal, 111 pyelic, 23 ureteral and 21 coralliform calculi. 45 patients presented multiple and 28 bilateral renal lithiasis. Stones were mainly between 10 and 20 mm in diameter (157 patients) but were less than 10 mm in size in 110 cases and more than 20 mm in 55. For poorly opaque stone, lithotripsy was performed after ultrasound localization with the Sonolithe apparatus. The Dornier machine was used to treat 277 patients during 308 sessions, equivalent to an 11% repeat rate. Fragmentation was excellent in 84% of cases after a single session, and 5% of stones could not be fragmented and required complementary therapy. Out of 200 patients reviewed after 3 months, only 8% had residual fragments (92% success rate), 5% having to undergo auxillary endoscopic manoeuvres: stenting ureteral catheter (4 cases); percutaneous nepholithotomy (3 cases); ureteroscopy (7 cases). Septic complications (6 patients) responded well to antibiotic treatment. Renal colic or pain was recorded in 25% of cases. One kidney was non-functional at 3 months due to distal ureteral obstruction without subsequent dilatation of the collecting system. Out of 45 patients treated with the Sonolithe, 3 (6.6%) were failures of fragmentation and 85% had satisfactory results. After a minimum follow up of 3 months, 20/22 patients were free of residual calculi, and there were no complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Study of the DNA content of 72 cases of bladder tumors using flow cytometry. Relation with anatomoclinical data].

The DNA content of 72 bladder tumors and 20 healthy bladders was studied with flow cytometry. Reproducibility of DNA measurement was systematically verified with the use of 3 controls: calf thymocytes, mouse hepatocytes and a mixture of human lymphocytes with trout red blood cells. For each tumor or normal bladder, a first sample containing urothelial cells only and a second sample with the addition of trout red blood cells were systematically examined. In the first group of patients with healthy bladders the percentage of urothelial cells with a DNA content greater than G0 G1 (2N) was on average 7.9% +/- 2.8%. Among the second group of 72 tumors, 2 DNA profiles were remarkable: in a first group (39/72; 55%) DNA profile was unimodal (single diploid peak); in a second group (33/72; 45%) DNA profile was bimodal (association of a diploid peak with an aneuploid one). Comparison of flow data with pathology data (WHO classification) clearly demonstrated that the presence of an aneuploid peak, characterizes grade elevation and infiltration. Hence, 1/16 (6%) of grade I; 7/75 (28%) of grade II; 25/31 (81%) of grade III tumors show an aneuploid peak, as well as 11/44 (25%) of Ta; 9/14 (64%) of T1; 5/6 (83%) of T2, and 8/8 (100%) of T3 tumors. Demonstration of an aneuploid peak with flow cytometry particularly in the group of patients having non infiltrating Ta tumors (11/44 in our series) could further either lead to a closer follow-up of this high risk group of patients or to the early recommendation of a non conservative treatment.

DNA, Neoplasm↗
PubMed1985

Metabolic control of type I (insulin dependent) diabetes after pancreas transplantation.

A study was conducted of the circadian hormonal and metabolic patterns of 10 type I (insulin dependent) uraemic diabetic patients after pancreas and renal transplantation. A single 24 hour profile was obtained in each patient following as closely as possible his or her normal daily routine two to 15 months after transplantation. None of the patients were using insulin at the time of the study. Compared with a group of six normal subjects the transplant recipients had mildly raised blood glucose concentrations, hyperinsulinaemia between meals and at night, delayed postprandial insulin peaks, mild hyperketonaemia, and normal blood lactate and plasma glucagon concentrations. The findings showed that successful pancreas transplantation results in disappearance of the need for insulin and return to normal or near normal of the metabolic abnormalities of diabetes. The minor differences observed in comparison with normal hormonal and metabolic homoeostasis were probably due to intrinsic (reduced islet mass, denervation, peripheral hormone delivery) and environmental (immunosuppression, relatively impaired renal function) factors.

3-Hydroxybutyric Acid↗
PubMed1985

Clinically occult bladder cancer diagnosis. Trial using ultraviolet cystoscopy.

Ultraviolet cystoscopy was used to demonstrate flat cancerous and precancerous bladder lesions by two techniques based on different principles: the loss of epithelium blood group antigenic expression using immunofluorescence reaction, and submucosa neoangiogenesis after fluorescein intravenous injection. The results obtained with these two techniques were disappointing, but do not preclude the use of ultraviolet cystoscopy in this type of study.

ABO Blood-Group System↗
PubMed1985

Extracorporeal replacement of the renal artery: techniques, indications and long-term results.

Extracorporeal repair of the renal artery was done in 24 patients for complex lesions extending to branches of the renal artery (9 dysplasias, 5 atheromas and 10 aneurysms). The renal artery and its branches were replaced by a hypogastric branched autograft in 20 patients and a saphenous vein graft in 4. Indications for an extracorporeal operation were hypertension, preservation of renal function against progressive deterioration and extension of the lesion to more than 2 branches of the renal artery. Of 76 peripheral anastomoses 68 were patent postoperatively. Two secondary nephrectomies were performed. Mean followup was 54 months. Hypertension was cured in 19 patients and improved in 2, while 2 failed treatment and 1 died. An extracorporeal operation may represent the best alternative for treatment of renal arterial lesions involving more than 2 branches.

Adult↗
PubMed1985

Aneurysms of the renal artery: surgical management with special reference to extracorporeal surgery and autotransplantation.

27 patients underwent surgical arterial reconstruction for renal artery aneurysms. Hypertension was present in 21 cases. The indication for surgery was the prevention of hemorrhagic rupture in association with hypertension. Extracorporeal surgery was performed 13 times for complex aneurysms involving several branches of the renal artery. Simple autotransplantation was performed 3 times for aneurysms located on the main renal artery. In situ surgery was performed on 11 patients (5 aneurysmectomy-arteriorrhaphies and 7 bypass operations). Results on high blood pressure showed that 10 of the 14 hypertensive patients operated by extracorporeal surgery and/or autotransplantation were cured. 1 delayed nephrectomy was performed in this group and 1 death was observed. 39 of the 46 peripheral anastomoses were patent postoperatively. All patients treated with aneurysmectomy-arteriorrhaphy were cured. In patients treated with bypass operations, 3 thromboses of the bypass and 2 failures on hypertension were observed. Aneurysmectomy and simple arterioplasty are preferred for simple renal artery aneurysms. For complex lesions involving several branches and of an intrarenal location, extracorporeal surgery and autotransplantation represent an effective treatment on hypertension and preservation of kidney function.

Adolescent↗
PubMed1985

[Ultrasonic high frequency probes in urology].

The authors report on their experience with Ultrasonic high frequency ultrasonography probes. The endorectal and the endourethral probes were designed and developed by the authors. High resolution imaging, easy handling of the probes with a range of several scanners are the major qualities of this material.

Humans↗
PubMed1985

Renal autotransplantation versus bypass techniques for renovascular hypertension.

From 1972 to 1983, 78 patients underwent surgical treatment for renovascular hypertension caused by a lesion limited to the trunk of the renal artery. Forty-five of these patients underwent aortorenal bypass (24 saphenous grafts and 21 arterial hypogastric grafts); 36 patients (80%) had either a relief of the hypertension or were improved. Graft closure occurred in five cases. Thirty-three patients were treated by autotransplantation of the kidney. After resection of the lesion, the renal artery was anastomosed end-to-end to the hypogastric artery or end-to-side to the common iliac artery and the renal vein and side-to-side to the iliac vein or the origin of the vena cava. In this group all patients but one (97%) had relief of the hypertension or were improved. No thrombosis was observed. Late angiography was performed 5 years after surgery in 19 patients (nine autotransplantations and 10 bypass operations): patients who underwent autotransplantation had no alteration of the renal vessels whereas four patients who underwent bypass operations had dilatation of the saphenous vein bypass. Renal autotransplantation was superior to the bypass technique in the surgical treatment of renovascular hypertension caused by lesions of the trunk of the renal artery and may represent a better alternative in the surgical treatment of this condition.

Adolescent↗