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J M Ferrière

Publications and source records attributed to J M Ferrière.

At least 19 recordsLinked to original sources
PubMed2003

Subcutaneous interleukin-2, interferon alpha-2b and 5-fluorouracil in metastatic renal cell carcinoma as second-line treatment after failure of previous immunotherapy: a phase II trial.

The association of interleukin-2 (IL-2), interferon alpha-2a (IFNalpha), 5-fluorouracil (5-FU) has been reported to induce response in metastatic renal cell carcinoma (MRCC). This study evaluated IL-2, IFNalpha and 5FU as second-line treatment after failure under immunotherapy. A total of 35 patients received IL-2, at 9 x 10(6) IU m(-2), once or t.i.d, 5 days a week, every other week. Interferon alpha was administered at 6 MUI, TIW along with IL-2 every week. 5-Fluorouracil was given at 750 mg m(-2) day(-1) on days 1-5 every 4 weeks. One cycle lasted 8 weeks. All patients were evaluable for response and toxicity. There were two objective responses (5.7%) and 14 stable diseases (40%). Survival was 14 months. In all, 17 patients experienced grade 3 toxicity. The predictive factor for progression to second-line immunotherapy was the results of first-line immunotherapy, and performance status, delay from primary tumour to metastases and response or stabilisation to chemo-immunotherapy for survival. IL-2, IFNalpha and 5-FU induce low objective response but stabilisation in patients with MRCC having failed with immunotherapy, and may be considered only in selected patients on performance status, stabilisation or response after first-line immunotherapy and interval from their primary tumour to metastases.

Adult↗
PubMed2001

[Reiterated intravesical instillation of capsaicin in neurogenic detrusor hyperreflexia: a 5-years experience of 100 instillations].

INTRODUCTION: Capsaicin is a topic and specific C-fiber afferent neurotoxic. After spinal-cord injury, C-fiber afferent proliferate in the bladder mucosae and are involving in detrusor hyperreflexia AIM OF THE STUDY: To investigate middle-term efficacy and tolerance of intravesical instillation of capsaïcin in spinal-cord injured patients presenting severe urinary incontinence refractory to usual therapy due to detrusor hyperreflexia. METHODS: Thirty patients receveid a first intravesical instillation of 1mMol/L Capsaïcin solution in 30% alcohol. The efficacy (voiding diary, pads, quality of life, maximum cystometric capacity, maximum detrusor pressure, first and normal desire to void) and tolerance were evaluated before, 1 month and 3 months after each instillation, completed by anual cystoscopy. In patients who responded favorably to this instillation, repeated instillations were proposed when symptoms recurred. RESULTS: 25 patients (83.3%) were improved after the initial instillation (decrease of incontinence-frequency-urgency, best quality of life, rise on maximal cystometric capacity), since the 15(th) day and for 3.2 months. 76 reiterative instillations were performed in 22 patients (2 to 9 instillations per patient). 91.2% of them remained successfull, during an average period of 4.2 months. It does not appear loss of benefits after iterative instillations. Transient and moderate adverse effects followed 86% and 79% of the first and reiterated instillation (exacerbation of incontinence, supra-pubic pain). Two patients have presented a begnin and transient inflammatory cystitis after reiterated instillation. DISCUSSION-CONCLUSION: Intravesical instillation of capsaïcin are an effective treatment for incontinence and associated symptoms caused by neurogenic detrusor hyperactivity. Propositions to improve immediate tolerance are debated.

Administration, Intravesical↗
PubMed1999

[Intravesical instillations of capsaicin in urology: from pharmacological principles to therapeutic applications].

Capsaicin is a specific neurotoxin for type C nonmyelinated vesical afferent fibres involved in the transmission of nociceptive stimuli and reorganization of voiding reflexes in disease. The presence of afferents sensitive to vanilloid substances in the human bladder suggests the potential value of intravesical instillations of capsaicin in patients with symptoms of bladder hypersensitivity or bladder hyperactivity. Ten clinical trials document the efficacy and safety of vesical instillation of capsaicin in 200 patients with neurological or non-neurological lower urinary tract symptoms. The objective of this review is to analyse these various publications in order to define the indications and practical conditions of intravesical instillation of capsaicin. The value of intravesical capsaicin in neurogenic bladder hyperactivity has been clearly demonstrated. In non-neurological indications, the diversity of instillation protocols and the heterogeneity of the evaluation parameters complicate analysis of the results. Repeated low-dose capsaicin appears to be useful in bladder hyperactivity, but the value of capsaicin is uncertain in idiopathic detrusor instability. Transient adverse effects are almost systematically observed after intravesical capsaicin. The short-term and medium-term local histological safety appears to be satisfactory, but needs to be documented in the long-term.

Administration, Intravesical↗
PubMed1998

The effects of capsaicin on the neurogenic hyperreflexic detrusor. A double blind placebo controlled study in patients with spinal cord disease. Preliminary results.

PURPOSE: Several recent open studies have provided encouraging results as to the efficacy of intravesical installations of capsaicin for neurogenic hyperreflectivity. The present trial was performed to verify these results under controlled conditions. Intravesical installation of capsaicin represents a new therapeutic hope for the treatment of the neurogenic hyperrelfexic bladder. METHOD: This randomized, double-blind study compared the results of the intravesical installation of 30 mg capsaicin in 100 ml of 30% alcohol (experimental group) with those of installing 100 ml 30% alcohol alone (control group). On day 0 and day 30, urodynamic and biopsic examinations were performed in all subjects of each group. PATIENTS: All the subjects included in the study had a functionally disabling form of neurogenic hyperreflexic bladder resistant to the usual therapies. Cystoscopy and retrograde cystography were performed to exclude any patient who presented with a tumor-like lesion or had vesicoureteral reflux. RESULTS: Twelve paraplegic of tetraplegic subjects, seven women and five men whose average age was 46, were included. Eight had multiple sclerosis, and four had sustained a traumatic spinal cord injury. The patients were randomly separated into two groups of six. Initially, there was no clinical or urodynamic differences in these groups. Installation immediately triggered side effects and during the first 7 days (suprapubic burning sensation, sensory urgency, hot flushes, autonomic hyperreflexia, hematuria) in five of the six subjects in both groups. Bladder biopsy revealed no significant deterioration. On day 30, there was improvement in all of the experimental-group of patients with significant regression of leakage (P = 0.002) and of sensory urgency (P = 0.01). Only one control subject had amelioration. Urodynamic examination showed a rise in bladder capacity from 172.5 to 312.3 ml in the experimental group, significantly greater (P = 0.03) than the rise from 129 to 175.3 ml observed in the control group. CONCLUSION: This trial fully confirms the efficacy of intravesical installations of capsaicin, an efficacy obtained at the cost of nonnegligible side effects. An intermediate-term follow-up of this treatment will be necessary before considering more widespread use of this agent.

Adult↗
PubMed1998

Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease.

We studied the efficacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (-176 ml, P < 0.001), the bladder pressure on voiding (-19 cm water, P < 0.01), and the urethral pressure (-24 cm water, P < 0.001) were significantly decreased. The modality of voiding was improved in 10 patients (i.e. micturition by suprapubic tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic effect lasted 2 to 3 months on the average. The low doses used in this study probably explain in part why the treatment sometimes failed. Botulinum A toxin could become an alternative treatment for detrusorsphincter dyssynergia in certain patients, notably in those who are refractory to sphincterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.

Adult↗
PubMed1998

[Conservative treatment of infiltrating cancer of the bladder: neoadjuvant chemotherapy and radiotherapy].

PURPOSE: Retrospective evaluation of tolerance and efficacity of a combination of chemotherapy and radiotherapy in non metastatic invasive cancer of the bladder. MATERIALS AND METHODS: From 1984 to 1995, 36 patients presenting with invasive urothelial carcinoma of the bladder were treated conservatively with primary chemotherapy: cisplatin-methotrexate-vinblastine (24 patients), methotrexate-vinblastine-doxorubicin-cisplatin (11 patients) or carboplatin (one patient). Fourty-six Gy were then delivered by external radiation therapy to the pelvis, with a complement of 10 to 20 Gy to the bladder. Seventeen patients received a concomitant chemotherapy with cisplatin. RESULTS: The intolerance to chemotherapy was hematologic and digestive. One patient died from bone marrow depletion. External irradiation was well tolerated, except for one patient whose treatment was stopped at 48 Gy. Fifteen tumours (44%) were in complete remission (CR) after chemotherapy and 23 (64%) at the end of treatment. With a median follow up of 64.6 months, 13 out of 23 patients in CR had a relapse (ten local relapses, three metastatic); five salvage cystectomies were done. The median survival and 26 months and the probability of survival at 5 years was 43%. All but two patients surviving 5 years had a functional bladder. CONCLUSION: Neoadjuvant chemotherapy leads to CR in 44% of patients and CR is observed in 64% of the patients after radiation therapy. However, the survival rate at 5 years is insufficient, even if the rate of bladder conservation is high.

Aged↗
PubMed1997

[The value of transrectal MRI in the staging of localized prostate cancer].

OBJECTIVE: To determine the diagnostic value of transrectal magnetic resonance imaging (MRI) in the local staging of prostatic cancer. METHOD: 75 patients suffering from clinically localized prostatic cancer were included consecutively from December 1992 to September 1996. An MRI examination (1.5 Tesla, Siemens) with a transrectal coil was performed before radical prostatectomy. The results of this examination in terms of capsular invasion, seminal vesicle lesion and apical invasion were correlated with the results of histological examination of the operative specimen and the findings of digital rectal examination, transrectal ultrasonography, serum PSA level and biopsy mapping. RESULTS: The best performance of transrectal MRI concerned elimination of seminal vesicle lesion with a specificity of 92%. The positive predictive value of transrectal MRI was 90% for the capsular invasion. The positive predictive value of transrectal MRI was 56% for the apex, the sensitivity was 40% and the specificity was 82%. When transrectal MRI did not reveal any extraprostatic involvement the risk of positive margins on radical prostatectomy was less than 6%. CONCLUSION: In this study, transrectal MRI appeared to be satisfactory to improve the staging of localized prostate cancer, especially in terms of seminal vesicle lesion and apical invasion, but, most importantly, appeared to be very useful to predict negative resection margins.

Aged↗
PubMed1995

[Conservative surgery in cancer of the kidney].

Partial nephrectomy is classically indicated in patients with renal cell cancer on a single kidney, although a certain amount of debate continues on surgical technique: simple enucleation or true partial nephrectomy. Incidence of multifocal tumours has been estimated at 6 to 19.6%. The crucial problem for the surgeon is to recognize satellite tumours pre- and peroperatively since it has been estimated that 4 to 10% of renal cell carcinomas contain a multifocal disease unrecognized during surgery. Is conservative nephrectomy acceptable for patients with a functional contralateral kidney? There are several arguments in favour of the technique: fortuitously discovered tumours are generally smaller and in a less advanced stage, morbidity after conservative surgery is low compared with total nephrectomy, nephron sparing improves long-term renal function and survival at 3 to 5 years is 95 to 100%. The fact that the risk of cancer on the contralateral kidney is small (1 to 2%) compared with the risk of local recurrence and the lack of sufficiently long follow-up in large series are negative arguments. Conservative nephrectomy must therefore be considered as the best solution when nephron sparing is essential. Total nephrectomy remains the reference treatment in other cases although the discussion remains open for cases with small (< 2.5 cm) tumours.

Carcinoma, Renal Cell↗
PubMed1990

[A critical study of the prognosis of renal adenocarcinoma and an attempted classification. Apropos of a series of 322 cases].

The prognosis of adult renal adenocarcinoma was evaluated by analyzing 322 cases treated by extensive nephrectomy (1979-1988). Five-year actuarial survival curves showed that prognosis was closely correlated with anatomic spread: no clear prognostic significance could be ascribed to venous invasion but involvement of retroperitoneal lymph nodes proved to be nearly as negative a prognostic factor as metastatic disease. The grade of malignancy also had a major impact on prognosis. Because the TNM classification, although accurate, is difficult to use and relies solely on descriptive data, a simple five-stage classification is proposed but remains to be validated. The classification system advocated by Robson groups stages with very different outcomes and consequently seems unhelpful.

Adenocarcinoma↗
PubMed1989

[Oncocytic tumors of the kidney. 11 cases (1978-1987)].

Analysis of this series of cases reveals the following points: complementary investigations (computed tomography, magnetic resonance imaging) sometimes suggest the diagnosis, the oncocytic nature is often a surprise pathological finding, it is difficult to determine whether the lesion is a pure oncocytoma and the exact grade cannot be determined on frozen section, the choice between radical surgery and conservative surgery is made even more difficult, the study of the course of the disease raises the question of whether the term of oncocytoma should not be reserved to low grade tumours.

Adenoma↗
PubMed1989

[Renal autotransplantation. An exceptional solution for salvage of the kidney following failure of surgery of bilateral megaureter].

The authors report the case of a patient with primary bilateral mega-ureter presenting with recurrent pyelonephritis due to reflux occurring after 3 successive reimplantations. Transposition of the right kidney into the homolateral iliac fossa allowed correct anti-reflux with a good clinical, radiological and bacteriological result with a follow-up of 3 years. Renal auto-transplantation represents a last resort solution in certain extreme situations when other simpler procedures are impossible and when preservation of the kidney is essential (solitary kidney or bilateral lesions).

Abnormalities, Multiple↗
PubMed1988

[Vesical replacement by ileo-caecal graft detubulized after total prostato-cystectomy].

Following total prostato-cystectomy, the nearest substitute to a physiological reservoir is a constructed ileo-caecal pouch. The non-mesenteric sides of the caecum and ileum are incised on a length of 15 cm for each apex of the caecum which is anastomosed with the urethra, respecting the striated sphincter. The ureters are implanted into the caecal portion of the pouch. Owing to the length of the ileo-caecal mesenterium, this technique can be used in every case of prostato-cystectomy. Twelve cases followed up for 6 to 18 months are reported.

Cecum↗
PubMed1988

[Diagnostic and therapeutic strategy in injuries of the kidney. Apropos of a series of 248 cases].

The analysis of a series of 248 cases led to the following conclusions: intravenous pyelography, together with nephrotomography and ultrasonography represent, the pillars of emergency assessment; computed tomography, performed systematically since 1985, is the most appropriate examination for the precise assessment of the lesions in a functioning kidney; arteriography is still essential in cases of urographically silent kidneys. The choice of therapeutic approach essentially depends on the type of the lesion: severe parenchymal lesions (type III) (58 cases) and certain cases of type II trauma (25 cases) underwent a deferred emergency operation which was as conservative as possible; pedicle lesions (type IV) and serious haemorrhagic lesions required emergency surgery (11 cases); type I or type II lesions with moderate hematomas were usually treated by simple observation (145 cases); cases of trauma seen at the stage of sequelae (8 cases) sometimes required a surgical solution (arteriovenous fistula, segmental ischaemia of the parenchyma with hypertension, encysted urinoma).

Adolescent↗
PubMed1988

[Cisplatin-based chemotherapy in the treatment of advanced-stage tumors of the bladder].

Since October 1984, 39 patients have been treated with cisplatin based chemotherapy for advanced bladder tumour of for pelvic recurrence or metastasis after total cystectomy. Cisplatin-methotrexate protocol (23 cases): 2 cases died during the first two cycles and 21 were evaluated after three cycles: only 39% of objective responses (2 CR-5 PR-2 MR) were observed with a mean survival not exceeding 12.6 months (7 deaths, 2 patients alive at the present time). All of the non-responders died within 4 to 16 months following the start of treatment (mean survival: 8.7 months). These particularly disappointing results led to the suspension of this protocol. Cisplatin-methotrexate-vinblastine protocol: 16 cases since September 1986. Eleven patients have been evaluated after three cycles: 3 CR-3 PR-5 PROG. The C.M.V. protocol appears to have a superior efficacy, principally on bladder, lymph node or lung lesions, at the cost of a higher but acceptable toxicity. Hepatic and central nervous system metastases were observed secondarily in this case.

Adult↗
PubMed1988

[Use of the laser in urology].

The usage of laser therapy in urology is based upon thermal effects that lead to tissue destruction by coagulation necrosis and volatilization. The endoscopic treatment of bladder tumors has been its most important utilization. The authors report their experience with 681 bladder tumors in 198 patients and present the technical details of laser therapy, the indications and the results. The recurrence rate at the previously treated tumor area was found to be rather improved: 0.75/100 months/patient for stage pTa and 0.92/100 months/patient for stage pT1. Other utilizations for laser therapy exist: upper tract urothelial tumors mainly in selected cases as solitary kidney; urethral localizations of urothelial tumors and condylomata acuminata; urethral stenosis, as a complement of optical urethrotomy; hemorrhagic cystitis after radiotherapy and some forms of chemotherapy. The pulsed dye laser may become an important advance in endoscopic treatment of ureteral calculi.

Cystitis↗