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Jacques Irani

Publications and source records attributed to Jacques Irani.

35 records · Page 2Linked to original sources
PubMed2004

[Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70: a multicentre retrospective study of 210 cases].

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70 is considered to be associated with a higher risk than extracorporeal shock-wave lithotripsy (ESWL). However this technique is sometimes necessary for very large or complex stones in patients with several comorbidities. STUDY OBJECTIVE: To evaluate the predictive factors of success and operative risks likely to influence the results of PCNL in a population of patients over the age of 70. MATERIAL AND METHOD: Retrospective study of 203 patients (110 males, 97 females) over the age of 70, in whom a total of 210 PCNL were performed over a 12-year period in ten referral centres for the treatment of stones. 68.5% of cases presented a comorbidity and the median ASA score was 2. The median stone dimensions were 24 x 15 mm. There were 67 solitary pelvic stones, 7 infrapelvic ureteric stones, 31 solitary inferior caliceal stones, 40 complex stones and 13 staghorn calculi. A standard one-stage operative technique was performed in 92% of cases; the nephrostomy tract was easily performed by the urologists themselves in 71.8% of cases. RESULTS: The overall stone-free (SF) rate was 70.8%. The patient's weight and height (p=0.03 and p=0.01), stone dimensions and their solitary nature were significant factors of success (p<0.00001 and p=0.01) with SF rates of 81.1% for pelvic stones and 90.3%for solitary inferior caliceal stones (p<0.003); the SF rate for complete staghorn calculi was only 30.8%. A history of stones (p=0.04) and diabetes (p=0.03) influenced the stone-free rate, but the other comorbidities, body mass index, and age did not influence the stone-free rate. There were two deaths (0.9% and haemostasis nephrectomy was performed in 2 ASA 3 subjects in renal failure. In the other patients, there was no difference between preoperative and postoperative serum creatinine and haemoglobin levels. The ease of nephrostomy, the rapidity of PCNL, the day of removal of the drainage nephrostomy, the mean hospital stay (median stay: 6 days), sterility of postoperative urine and at the 1-month visit were significantly correlated with the SF rate. CONCLUSIONS: PCNL in subjects over the age of 70 years is a safe and reliable technique that achieved a stone-free rate of 70.8% for all types of stones combined. The best results were obtained for solitary stones larger than 20 mm in the renal pelvis or inferior calyx. Apart from diabetes, which remains a risk factor, well controlled comorbidities do not increase the operative risk. PCNL did not affect haemodynamic parameters or renal function.

Age Factors↗
PubMed2004

[Urothelial tumors].

Explore the source record for details and available documents.

Carcinoma, Transitional Cell↗
PubMed2003

Prognostic significance of tumor volume after radical prostatectomy: a multivariate analysis of pathological prognostic factors.

OBJECTIVES: To analyze the association between Gleason score, stage and status of surgical margins with tumor volume in prostate cancer progression after radical prostatectomy. METHODS: 200 consecutive radical prostatectomy specimens were analyzed. Preoperative clinical stage, PSA, results of prostate biopsies as well as pathological results were noted. A biochemical recurrence was defined as a single, postoperative detectable PSA level (>0.2 ng/ml). Tumor volume was compared to postoperative staging, Gleason score, and surgical margin status to predict tumor progression. Univariate and multivariate analysis using stepwise logistic regression were used to identify parameters with additional prognostic value. RESULTS: Pathological results of the prostatectomy specimens showed 149 (74.5%) pT2a-b, 29 (14.5%) pT3a and 22 (11%) pT3b tumors. Tumor volume was 0.57 cc for pT2a, 1.2cc for pT2b, 1.7cc for pT3a and 2.9cc for pT3b, respectively (p<0.05). Taken together, mean volume for pT2 and pT3 were 1.06 and 2.2 cc, respectively (p<0.0001). Five-year progression-free actuarial survival was 69.7%. Using univariate analysis, tumor progression correlated with final Gleason score (p<0.0007), positive surgical margins (p=0.02), tumor volume (p=0.009) and stage (p<0.0001). In a multivariate analysis, tumor progression correlated only with the final Gleason score (p=0.04) and stage (p=0.0002). CONCLUSION: Gleason score and pathological stage are independent factors to predict prostate cancer progression after radical prostatectomy. When these parameters are known, tumor volume does not provide additional information.

Aged↗
PubMed2003

[Prevalence of osteoporotic fractures in patients treated by androgen blockade for prostate cancer].

INTRODUCTION: Endocrine therapy is the standard first-line treatment for metastatic prostate cancer. The use of this treatment modality for a number of years in a large population has demonstrated some of its iatrogenic complications, especially bone complications. Hypogonadism induced by chemical castration can be responsible for osteoporosis that may be complicated by fractures. OBJECTIVE: Evaluation of the prevalence of fractures in nonmetastatic sites. PATIENTS AND METHOD: Retrospective study of 49 patients treated for more than 5 years by endocrine therapy with determination of the fracture rate, mechanisms and fracture sites. RESULTS: Eight patients developed fractures after antiandrogen treatment. Three patients with a traumatic or metastatic fracture were excluded. Five patients (10.2%) were considered to present osteoporotic fractures on the basis of their site (vertebra and neck of femur) or their mechanism (minor trauma). The mean duration of treatment in these patients was 8.1 years. The prevalence of osteoporotic fractures in the general population is estimated to be 2.2 per 1,000 men between the ages of 65 and 80 years and 6.4 per 1,000 men after the age of 80 years. CONCLUSION: The prevalence of osteoporosis induced by endocrine therapy is increasing due to longer patient survival and early introduction of treatment. No prophylactic treatment is currently proposed when starting endocrine therapy.

Aged↗
PubMed2003

[Prostate cancer screening].

Prostate cancer has become the most frequent cancer and the second cause of cancer mortality in men. This public health problem is becoming increasingly important due to the increasing life expectancy. At the present time, prostate cancer will be discovered in one in every eight men during their lifetime. Prostate cancer represents 25% of all new cases of male cancers. Prostate cancer screening is designed to detect early stage, asymptomatic prostate cancer, as the patient's chances of cure are higher when the cancer is diagnosed at an early stage. The conclusions of the ANAES evaluation in 1998 did not recommend mass screening for prostate cancer. Several international prospective randomized studies based on serum PSA assay, sometimes associated with digital rectal examination, are currently underway. France is participating in the European ERSPC study (European Randomized Study of Screening for Cancer Prostate) and is organizing a national study on high-risk populations. While waiting for the final results of these studies, a recommendation needs to be proposed to inform general practitioners and specialists about optimal use of the currently available tests. Based on the conclusions of its oncology committee (composed of urologists, medical oncologists, radiotherapists, pathologists and radiologists), the Association Française d'Urologie proposes a recommendation concerning prostate cancer screening and defines its modalities, especially concerning the target population, screening tests and the information given to men before screening. The Association Française d'Urologie recommends prostate cancer screening by PSA assay (prostate specific antigen) and digital rectal examination annually between the ages of 50 and 75 years, and from the age of 45 years in men with a family or ethnic risk. If total PSA is above the normal value of the test or if digital rectal examination is abnormal, referral to a urologist is recommended. Information concerning the limits, benefits and risks of screening and the available treatment options must be given before performing these examinations.

Humans↗
PubMed2003

[Sensitivity of abdominal radiography without preparation compared with computed tomography in the assessment of residual fragments after percutaneous nephrolithotomy].

INTRODUCTION: Evaluation of possible residual fragments after percutaneous nephrolithotomy is an essential aspect of the management of stone disease. The results of this evaluation determine the therapeutic approach, follow-up and presumed duration of treatment. The imaging modalities most frequently used are non-enhanced spiral computed tomography and plain abdominal x-ray. The objective of this study was to evaluate the contribution of spiral CT to the immediate follow-up of percutaneous nephrolithotomy. MATERIAL AND METHODS: Over a period of two years, we prospectively included 50 patients in whom plain abdominal x-ray and spiral CT were performed on the first postoperative day after percutaneous nephrolithotomy. The diagnosis of residual fragments was based on these examinations by 2 independent radiologists. RESULTS: The sensitivity for the detection of residual fragments was 87% for plain abdominal x-ray compared 100% for computed tomography. 89% of the fragments not diagnosed by plain abdominal x-ray were less than 5 min. CONCLUSION: Plain abdominal x-ray was insufficient for the diagnosis of small residual fragments. Spiral CT is justified to confirm the absence of residual fragments in a patient after percutaneous nephrolithotomy despite the higher cost and irradiation compared to plain abdominal x-ray.

Adult↗
PubMed2003

[Partial infarction of the kidney caused by spontaneous idiopathic dissection of the renal artery].

Idiopathic spontaneous renal artery dissection (SRAD) is a rare disease and must be taken into account in the differential diagnosis of low back pain. It may be due to various aetiologies, secondary to degenerative or traumatic diseases, or it may be idiopathic. Intravenous urography is usually normal. Abdominal CT usually visualizes the renal infarction and selective arteriography confirms the diagnosis of renal artery dissection. Medical treatment and surveillance provide effective management of the disease. However, surgical management may be proposed either immediately or secondarily. SRAD usually has a favourable course, but, in the longer term, may be complicated by organic renal failure and renovascular hypertension.

Adult↗
PubMed2003

[Management of bladder cancer associated with prostate cancer].

The treatment decision in patients with simultaneous development of bladder cancer and prostate cancer is based on the prognostic factors of the two tumours, the life expectancy, and the complications of treatment influencing patient follow-up. This review of the literature tends to confirm a higher incidence of prostate cancer in patients with bladder cancer. The diagnostic and treatment options are proposed for each situation, but evidence-based recommendations cannot be proposed on the basis of the published data.

Humans↗
PubMed2003

[Neuroendocrine cancer of the prostate. A series of 6 cases].

INTRODUCTION: Neuroendocrine cancer of the prostate (NECP) is a rare entity. Screening for this tumour, although not systematic, may have therapeutic implications. The authors retrospectively evaluated 6 cases of NECP observed in the department between September 1998 and May 2002. MATERIAL AND METHODS: The diagnosis was based on immunohistochemical analysis of biopsy fragments with the presence of marked neuroendocrine differentiation (minimum 50%). Positive staining for anti-Neuron-Specific Enolase (NSE) and anti-Chromogranin A antibodies was observed in 5 and 6 cases, respectively, while anti-PSA antibody labelling was always negative. RESULTS: NECP represented 2.1% of all prostate cancers diagnosed in the department over the same period. Digital rectal examination was abnormal in every case with a median PSA of 9.75 ng/ml (range: 0.25-19.6). Three patients presented metastatic disease at the time of the diagnosis. Four of the 6 patients were urgently admitted to hospital because of acute clinical features. Paroxysmal abdominal pain occurred during the course of the disease in every case with a median of 52 days (range: 22-198) and was initially present in 2 cases. Chemotherapy was performed in 3 cases and palliative therapy was administered in the other cases. A survival difference was observed for patients treated by chemotherapy (13 months versus 4.7). The median survival was 9 months and 14 days. Death occurred in a context of rapid alteration of the general state and renal function. CONCLUSION: NECP has a poor prognosis. Clinical and complementary features guide the diagnosis, which can be confirmed by immunohistochemical analysis, allowing early management based on chemotherapy.

Aged↗
PubMed2002

Infective endocarditis after transrectal prostatic biopsy.

We report the first case of infective endocarditis secondary to transrectal prostatic biopsy, occurring 2 weeks later in a patient with no obvious risk factors. Enterococcus faecalis was isolated in blood and urine cultures. This case suggests that infective endocarditis can be associated with transrectal procedures.

Aged↗
PubMed2002

[Consequences of intravesical obstruction on detrusor muscle energy metabolism].

Alteration of the emptying function of the bladder observed during the natural history of benign prostatic hyperplasia may be related to a biochemical disorder, more specifically a disorder of energy metabolism. Under conditions of obstruction, the bladder is no longer able to contract effectively as it is unable to produce a sufficient quantity of energy. This energy dysfunction is induced by anaerobic diversion of glucose metabolism. The key element of this disturbance is the mitochondrion. Morphological studies have demonstrated degeneration of this organelle controlling energy metabolism. This intracellular alteration is also reflected by functional changes. Disturbances of the various mitochondrial energy producing cycles appear to be responsible for detrusor dysfunction. Further investigations are necessary, especially clinical studies to corroborate these experimental findings. A better knowledge of the pathophysiology of vesical functional consequences of BPH would allow the use of new therapeutic categories of drugs.

Energy Metabolism↗
PubMed2002

[Renal adenocarcinoma in a two and a half year old child: Diagnosis, therapeutic management and 10-year followup].

Renal cell carcinoma is a rare tumour in children and is difficult to diagnose, often leading to inappropriate primary treatment with chemotherapy in Europe. The incidence of renal cell carcinoma is much lower than that of Wilms tumour. These two types can be associated, in which case Wilms tumour is the predominant tumour. However, pure renal cell carcinoma remains an exceptional tumour in children and appears to present an identical natural history and follow-up as in adults. The authors report the case of a two and a half year old child treated by surgery alone with a follow-up of 10 years without recurrence.

Adenocarcinoma↗
PubMed2002

[Hyperbaric oxygen therapy and radiation-induced hemorrhagic cystitis].

Radiotherapy alone or in combination with other modalities is used in the treatment of a large number of pelvic tumours of urological or gynaecological origin. Despite constant progress in this field, medium-term and long-term complications remain frequent and often require difficult long-term management. Radiation cystitis is one of the most frequent complications and directly concerns urologists. Among the various treatment options for haemorrhagic cystitis, hyperbaric oxygen therapy appears to give good short-term and medium-term results. It is currently reserved for cases refractory to the standard treatments for radiation cystitis.

Cystitis↗