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Biomedical subjects

J Toubol

Publications and source records attributed to J Toubol.

At least 19 recordsLinked to original sources
PubMed1992

[Perineal gangrene. Analysis of 24 cases].

Fournier's syndrome, characterised by anaerobic necrotising cellulitis of the soft tissues situated below the diaphragm, is a serous disease with an unpredictable course. From 1978 to 1991, we treated 24 men with a mean age of 57 years (27 to 90 years). Following the diagnosis of this disease, rigorous treatment was instituted immediately, consisting of a triple antibiotic combination, repeated surgical exposure, debridement and drainage with a frequent, almost systematic indication for faecal diversion (n = 16), hyperbaric oxygen therapy and classical intensive care measures. The mean interval between the first clinical signs and the diagnosis was 7.4 days. The lesions were limited to the perineum in 11 cases and extended to the abdomen, thighs and/or loins in 13 cases. The microorganisms responsible for the infection were identified in 19 cases and blood cultures were positive in 5 cases. This infection was of coloproctological origin in 12 cases, urogenital origin in 4 cases and postoperative in 2 cases, while no aetiology could be identified in 6 patients. There were 6 deaths and 18 cures without sequelae. 1. The prognosis of this disease is better in younger subjects (under the age of 60 years) with a localised clinical form, with no deterioration in the general status, sterile blood cultures and treated by a diversion colostomy. 2. A detailed aetiological work-up must be performed, looking for local or regional infection, cancer, haematological malignancy or arterial disease.

Adult↗
PubMed1991

[Exclusive piezo-electric lithotripsy (EDAP LT 01) in the treatment of calculi larger than 30 mm. Pyelic, partial or total staghorn].

Thirty patients with partial of total staghorn calculi or pyelic calculi greater than 30 mm were treated by extracorporal piezo-electric lithotripsy (PEL) exclusively with an EDAP LT 01 lithotripter equipped with an ultrasound localisation system. Nineteen patients had a pyelic calculus and the others a partial (n = 9) or total (n = 2) staghorn calculus. All patients first underwent extracorporal lithotripsy (ECL). None of the patients received IV sedation or anesthesia. When fragmentation of the calculus was observed after the first session, a double J stent was inserted before the second ELC session. Before the first session, urine samples were sterile in 18 of the 30 patients; 12 of the 30 patients presented major distention of the urinary tract. Results were analysed to identify factors affecting results of this type of treatment. Patients whose calculus had completely disappeared on plain films three months after the first session were considered to be cured clinically and radiologically (14/30 = 46%). Seven patients (23.3%) were clinically cured (absence of pain and sterile urine) but there were residual fragments (1 to 3 fragments less than or equal to 4 mm). No fragmentation was obtained after the first session in 9 patients (30.7%) (1 total staghorn, 8 pyelic calculi). The mean number of sessions was 5 (range 1-15). Only 10% of the patients (3/30) presented a complication: 2 steinstrasses and 1 acute pyelonephritis. 83% of the patients without urinary tract distention and 55% of the patients whose urines were initially sterile were cured.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

A randomized double-blind study evaluating Anandron associated with orchiectomy in stage D prostate cancer.

A randomized double-blind study with a 3-yr follow-up comparing the two arms "orchiectomy + Anandron (300 mg)" vs "orchiectomy + placebo" in 125 patients with stage D prostate cancer has confirmed the beneficial effects of the combined Anandron therapy on subjective parameters and on the best objective response (NPCP criteria), although these effects were not statistically significant, but failed to detect any improvement in time-to-disease progression or survival. Comparison with the results of other trials emphasizes the urgent need to establish suitable prognostic factors by further clinical research before evaluating the benefits of individual drugs.

Aged↗
PubMed1990

[Clinicopathologic and biological correlations (PSA-PAP) in pathology of the prostate. Apropos of 150 cases].

On the basis of 150 patients (16 controls with no disease of the prostate, 96 cases of benign prostatic hypertrophy (BPH) and 38 cases of carcinoma of the prostate (CP)), the authors intended to answer 3 questions: How can the borderline values of PSA in BPH be interpreted? Is there a correlation between the Gleason and PSA values in carcinomas? Should the simultaneous measurements of PSA and PAP be continued? All patients were examined with a rectal touch, transrectal echography (TRE) and PAS and PAP assays. All CP were examined with bone radionuclide scanning (BR). The correlation coefficient being 0.391 (p 0.001), the PSA value and prostatic weight can be regarded as linearly correlated in BPH (5 g BPH = 1 ng/ml PSA). This lower value of PSA is linked with the increase produced by TRE in the assessment of prostatic weight. On the other hand, the authors did no observe a correlation between the PSA and the Glisson grade in carcinomas with negative BR. Lastly, the sensitivity of PSA is noticeably higher than that of PAP (75% vs. 50%), and no false negative finding with PSA was corrected by PAP measurements.

Aged↗
PubMed1990

[Intraprostatic spiral for the treatment of benign prostatic hypertrophy. A new method of insertion with sonographic monitoring. Apropos of 35 patients].

The treatment of subvesical obstruction with a spiral endoprostatic prosthesis is now well-known since Fabian's initial work (1980). A new method of insertion of the spiral with a releasable catheter and under sonographic monitoring has been proposed recently. This article is a report of a series of 35 patients. These patients presented with an adenoma of the prostate and were fitted with a permanent urethral catheter due to an absolute contraindication for anesthesia. The spiral was inserted with US monitoring in 25 patients. In 5 patients, the spiral had to be inserted under classical endoscopic control. The average follow-up period is 7.2 months. In 25 patients (75%), the spiral remained in place; the maximum flow rate of urine after the insertion averages 12.8 ml/s and 76% of these patients report an improvement of their comfort during urination. The position of the spiral had to be changed in 8 cases. No infectious complication was noted. Hematuric complications are reported in 2 cases. The spiral endoprostatic prosthesis seems to be an elegant alternative to the permanent catheter in patients at high anesthetic risk.

Aged↗
PubMed1990

[Extracorporeal piezoelectric lithotripsy (EDAP LT 01) in the treatment of ureteral calculi. Apropos of a series of 143 cases].

The results for 143 cases of ureteral stones treated by EDAP LT01 were analyzed concerning stone location, ureteral manipulation and treatment position. The ureter was divided into six segments: ureteropelvic junction (UPJ), proximal ureter (PU1 and PU2), mid-ureter (MU), distal ureter (D1 and D2). The overall fracturization rate (FR) was 72%, as detailed below: UPJ (89%, 26/29), PU1 (86%, 13/15), PU2-MU (62%, 15/24), DU1 (59%, 25/42), DU2 (72%, 24/33). Anesthesia or iv sedation were never used for PEL. 24% of the patients underwent retrograde ureteral manipulation (in situ/push back = 108/35). For PU1, the FR was twice as high after retrograde manipulation (in situ/push back = 5/8). For PU2 and MU, the supine position was most common. For UPJ and PU1, it was often better to have the patient lie on his side. For DU1 and DU2, a prone position was necessary. For all stones in DU1, the bladder must be well filled; the FR was higher in DU2 than in DU1. DU2 stones appeared to adhere to the bladder wall or were intravesical (stone in the meatus). The stone-free rate for successfully manipulated ureteral calculi (3 month's follow-up) was 93% (27/29). The stone-free rate for in situ stones at 3 months was 94% (70/74). Extracorporeal piezoelectric lithotripsy combined with stone manipulation is highly efficient in the management of UPJ, PU1 and DU2 stones. The success rate of in situ PEL improves after the operator becomes skilled with the procedure. The advantages of the EDAP LT01 are the absence of pain, no need for anesthesia, and the mobility of the shock wave unit.

Adult↗
PubMed1990

[Cancer of the prostate. Computed tomography and magnetic resonance imaging in the assessment of extracapsular extension].

The stage of the tumor is commonly underestimated prior to radical prostatectomy for carcinoma. Can the growth of clinically localized carcinomas beyond their capsule be predicted with the modern medical imaging techniques (MRI and CT)? On the basis of 30 successive prostatectomies, we conclude that CT is ineffective. On the contrary, MRI seems to be an effective technique for this indication. However, no examination yet is better than clinical assessment.

Humans↗
PubMed1990

[Exclusive piezoelectric lithotripsy in the treatment of calculi larger than 30 mm (partial or complete coralliform, pyelic calculi)].

Thirty patients with partial or total staghorn stones or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had pelvic stones; the other 11 had partial (9) or total (2) staghorn stones. All patients first underwent an initial lithotripsy session. No anesthesia or IV sedation was required in any case. If stone fragmentation was achieved during this first session, a double-J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had sterile urine cultures; 12 of 30 presented major distension of the excretory tract. Results were analyzed to determine the factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stones had completely disappeared according to plain abdominal films (14 of 30, 46%). In seven patients (23.3%) fragmentation had occurred but residual fragments remained (1 to 3 fragments less than or equal to 4 mm). No fragmentation was obtained after the first session in nine patients (30.7%) (1 total staghorn stone, 8 pelvic stones). The mean number of treatment sessions was five (range, 1 to 15). Complications occurred in only 10% of patients (3 of 30): two steinstrassen and one acute pyelonephritis. Eighty-three percent of patients without major excretory tract distension and 55% of patients whose initial urine culture was sterile achieved a stone-free state. Therefore the best indications for PEL monotherapy for calculi larger than 30 mm are pelvic stones and partial staghorn stones and no major excretory tract dilatation in patients with sterile initial urine cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Can CT scanner and MRI predict capsular invasion of local cancer of the prostate? A study of 20 radical prostatectomies].

Spread beyond the capsule is a poor prognosis factor in clinically localized carcinomas of the prostate; preoperative diagnosis is difficult and clinical evaluation usually underestimates tumor spread. This prospective study was undertaken to confront results of the conventional workup (rectal examination, transrectal ultrasonography and PSA) and of CT scan and MRI findings with findings upon the pathologic study of operative specimens following radical prostatectomy. Results show that the conventional workup remains the diagnostic gold standard and that CT scan yields no additional information. Technically faultless MRI with sections in the three planes is a good means for analyzing the capsule of the prostate.

Humans↗
PubMed1990

[Extracorporeal piezoelectric lithotripsy in the treatment of calculi of the ureter. Apropos of a series of 143 cases].

The results obtained in 143 cases or ureteral stones treated by EDAP LT-01 were analysed concerning stone location, ureteral manipulation, and treatment position. The ureter was divided into six segments: ureteropelvic junction (UPJ), proximal ureter higher than the lower pole of the kidney (PU1), proximal ureter between the lower pole and the iliac crest (PU2), mid-ureter between the iliac crest and the lower end of the sacroiliac joint (MU), distal ureter between the lower end of the sacroiliac joint and the ischial spine (DU1), and the distal ureter below the ischial spine to the meatus (DU2). The overall fragmentation rate (FR) was 72%, as detailed below: (table; see text) Anesthesia or iv sedation was never used for EPL. 28% of the patients underwent retrograde ureteral manipulation (29/103). For PU1, the FR was twice as high after retrograde manipulation (push back/in situ = 5/8). For UPJ, the supine position was most common. For PU1 and PU2, it was often better to have the patient lie on his side. For DU1 and DU2, a prone position was necessary. For all stones in DU1, the bladder had to be well filled and the FR was higher in DU2 than in DU1. DU2 stones appeared to adhere to the bladder wall or were intravesical (stone in the meatus). The stone-free rate for successfully manipulated ureteral calculi (3 month follow-up) is 93% (27/29). The stone-free rate for in situ stones at 3 months is 94% (70/74). Extracorporeal piezoelectric lithotripsy combined with stone manipulation is highly efficient in the management of UPJ, PU1 and DU2 stones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Anatomoclinical and biologic correlations in prostatic pathology. Apropos of 150 case reports].

The authors analyzed 150 patient files (16 controls with no prostatic pathology, 96 patients with benign prostatic hypertrophy (BPH), 38 prostate cancer patients) in an attempt to answer three questions: how should borderline values of PSA be interpreted in patients with BPH; is there a correlation between the Gleason grade and PSA levels in prostate cancer? Should both PSA and PAP concentrations be assayed? All patients underwent digital rectal examination and transrectal ultrasonography (TU), and were assayed for PSA and PAP. All prostate cancer patients had a bone scintigraphy (Bs). In view of the correlation coefficient of 0.391 (p less than 0.001), it can be affirmed that PSA and weight are linearly correlated in BPH (5 g BPH = 1 ng/ml PSA). This lower value of PSA is due to the overevaluation of prostate weight by TU. In contrast, the authors did not find any correlation between the PSA level and the Gleason grade in prostate cancer patients with a negative bone scintiscan. Finally, the sensitivity of PSA was markedly better than that of PAP (75% vs 50%), and no PSA false negative error was corrected by the PAP value.

Acid Phosphatase↗
PubMed1989

[Endoscopic treatment of complicated ureteroceles in adults. Apropos of 2 cases].

Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed in adults because of a complication. Renal colic and dysuria were the clinical symptoms that led to discovery in the two patients reported here. These two women (aged 80 and 32 years) underwent transurethral meatotomy for complicated ureterocele. This procedure was sufficient for cure, with spontaneous evacuation of all stones in patient 2. There were no clinical or bacteriological (urine analyses) signs of reflux during the follow-up period (24 and 12 months). Endoscopic treatment of adult complicated ureterocele can thus be proposed as a first line procedure. Development of symptomatic secondary reflux is an indication for surgery.

Adult↗
PubMed1988

[Initial treatment of infiltrating tumors of the bladder. Combined transurethral resection and systemic chemotherapy].

From September 1983 to September 1986, 20 patients (mean age 65 years) with a muscle-infiltrating tumour of the bladder would normally have been treated by total cystectomy. Instead, they were staged by intravenous urography, pelvic and abdominal computerized tomography, physical examination under general anaesthesia and deep transurethral resection, then given neoadjuvant chemotherapy consisting of cisplatinum and 5-fluorouracil, six courses at intervals of 28 days. Results were evaluated after the 3rd and 6th courses by computerized tomography, intravenous pyelography and transurethral resection. Nine patients had a clinical complete response (6 pT2, 2 pT3, 1 pT4). The median follow-up in january, 1988 was 30 months (range 17-52 months). This protocol was objectively active and well tolerated, even by elderly subjects. Two problems remain concerning patients with complete response: the respective roles of chemotherapy and transurethral resection in the outcome, and the prevention of recurrence (5/9 complete response patients).

Adult↗
PubMed1988

Anandron (RU 23908) associated with orchiectomy in stage D prostate cancer. Preliminary results of a randomized, double-blind study.

A randomized, double-blind, multicenter trial was performed comparing the association of orchiectomy plus the nonsteroid antiandrogen Anandron (300 mg daily) to orchiectomy plus placebo in the treatment of patients with stage C or D prostate cancer. The results for 98 evaluable stage D patients with a median follow-up of 23.4 +/- 8.9 months are given. Although there was no statistically significant difference between the two treatments with regard to any parameter (subjective response, best objective response according to NPCP criteria, and progression-free interval and survival), the results were invariably in favor of the combined treatment, as already reported in other trials on Anandron.

Aged↗
PubMed1988

[Role of Chlamydia trachomatis in male urethritis. Analysis of 2,000 cases of male urethritis].

A study involving of 2,000 cases of urethritis revealed the presence of Chlamydia trachomatis in 44% of patients. Following a pathophysiological review, the strongly suggestive clinical picture of infection by this microorganism is emphasized. This study stresses two precise points by dealing with: firstly, the importance of the choice of technique for demonstration of the presence of the bacteria, and its reliability; secondly, the value of bacteriological evidence of the infection in order to treat not only the patient but also the partner(s) and to subsequently confirm the treatment as being effective.

Adult↗
PubMed1988

[Combination transurethral resection and systematic chemotherapy as primary treatment of infiltrating bladder tumors (pT2-pT4 NxM0)].

From Sept. 83 to Sept. 86, 20 patients (pts), mean age 65 yr, with a muscle-infiltrating bladder tumor would normally have been treated by total cystectomy. Pts were staged by intravenous urography, pelvic and abdominal CT, physical examination under general anesthesia, and deep TUR, then given neoadjuvant chemotherapy: cisplatinum and 5-FU. Courses were given every 28 days. Results were evaluated after the 3rd and 6th courses by CT, IVP and TUR. 9 pts had a histologically confirmed complete clinical response (pCR: 6 pT2, 2 pT3, 1 pT4). Median follow-up in Jan. 1988 was 30 mo. (17-52). This protocol was objectively active and well tolerated, even by elderly pts. Problems remain concerning pCR pts: (1) the respective roles of chemotherapy and TUR on the outcome; (2) prevention of recurrence (5/9 pCR).

Adult↗