Biomedical subjects

Jean-Jacques Patard

Publications and source records attributed to Jean-Jacques Patard.

48 records · Page 3Linked to original sources

PubMed2003

Mumps virus decreases testosterone production and gamma interferon-induced protein 10 secretion by human leydig cells.

Mumps virus is responsible for sterility. Here, we show that the mumps virus infects Leydig cells in vitro and totally inhibits testosterone secretion and that ribavirin in mumps virus-infected Leydig cell cultures completely restores testosterone production. Moreover, we show that gamma interferon-induced protein 10 (IP-10) is highly expressed by mumps virus-infected Leydig cells and that ribavirin does not block IP-10 production.

Animals↗

PubMed2003

[Correlation between the mode of presentation of renal tumors and patient survival].

OBJECTIVES: To establish a symptom score and to test its prognostic value in comparison with the usual histological prognostic criteria. MATERIAL AND METHODS: 388 renal tumours were classified into three symptomatic grades according to the circumstances of discovery: S1: incidental discovery, S2; patient presenting with haematuria or low back pain, S3: patient presenting with alteration of general state or symptomatic metastasis. The following prognostic criteria were studied: age, gender, tumour volume, symptom score, ECOG (0 vs 1 or more), stage (TNM 1997), Fuhrman grade, venous and adrenal invasion. Survival rates were compared by the Kaplan-Meier method (Log rank test). Multivariate analysis was performed according to the Cox model. RESULTS: Tumours were classified as T1, T2, T3, T4 in 140 (36.1%), 73 (18.80%), 162 (41.8%) and 13 (3.4%) cases, respectively. 31 tumours were graded as G1 (8%), 167 as G2 (43%), 152 as G3 (39.2%) and 38 as G4 (9.8%), 143 tumours were classified as S1 (36.9%), 159 as S2 (41%) and 86 as S3 (22.10%). 45 patients were N+ (11.6%) and 54 were M+ (13.9%), The mean follow-up was 73 months. The significant parameters on univariate analysis were: ECOG, symptom score, TNM stage, grade, venous and adrenal invasion and tumour volume (p < 0.001), while symptom score, TNM stage and Fuhrman grade were significant on multivariate analysis (p < 0.001). CONCLUSION: The symptom score is an independent prognostic factor in the same way as tumour stage and grade. This score could be used in a mathematical algorithm predictive of survival of patients with renal cancer.

Carcinoma, Renal Cell↗

PubMed2003

[PSA: the difficult position of general practitioners between patients and urologists].

OBJECTIVE: To determine the reasons for ordering PSA assay and delayed referral to an urologist following detection of elevated PSA in general practice. MATERIAL AND METHOD: Retrospective study of 200 patients referred to the department by general practitioners for elevated PSA from September 2000 to April 2001. RESULTS: The median age was 67 years (range: 52 to 87). The median PSA was 7.9 ng/ml (range: 4.1 to 897). Patients were referred after 1 to 5 PSA assays (mean: 1.6) with a median interval after discovery of elevated PSA of 1.7 months. The referral time was greater than 6 months for 52 patients (26%) and 31 patients (15.6%) were referred after more than two PSA assays were found to be elevated. PSA assay was ordered in the absence of symptoms or abnormal digital rectal examination in 43% of patients over the age of 70 years. CONCLUSION: Prostate cancer screening is regularly performed in general practice. The information given to general practitioners, faced with a well informed population, appears to be insufficiently clear, as PSA assay is sometimes incorrectly ordered or interpreted.

Aged↗

PubMed2003

[Intraperitoneal bladder rupture during transurethral resection of the prostate].

Bladder explosions are a rare complication of endoscopic surgery caused by massive cellular hydrolysis during electrocoagulation, releasing a mixture of gases that becomes explosive in contact with oxygen. Oxygen may enter the bladder as a result of manipulation of the resector, incorrect use of the Ellick evacuator bulb or introduction of air bubbles via the irrigation tubing. This risk can therefore be limited by taking certain precautions. The authors report a new case of intraperitoneal bladder rupture during transurethral resection of the prostate.

Adenoma↗

PubMed2003

[Neuroendocrine differentiation of bladder tumors].

Neuroendocrine bladder tumours (NET) constitute a group of various tumours with a common neuroendocrine phenotype. This is a very well defined entity (morphological, immunohistochemical, and ultrastructural). The great majority of bladder NETs reported in the literature are high-grade small cell carcinomas, but large cell carcinoma are probably underestimated due to the lack of systematic investigation. This paper reviews these rare, poorly known tumours, which require specific management. All bladder NETs are described. The frequency and diagnostic and therapeutic strategy of neuroendocrine bladder tumours are described.

Humans↗

PubMed2002

Intravesical Bacillus Calmette-Guerin treatment improves patient survival in T1G3 bladder tumours.

OBJECTIVE: To study the clinical and pathological factors that affect recurrence, progression and survival in pT1G3 bladder tumours treated conservatively. MATERIAL AND METHODS: From January 1979 to December 1996, 80 patients were conservatively treated for pT1G3 bladder tumours. All patients were studied for potential prognostic factors such as: age, sex, previous tumour recurrence, tumour size, multiple tumours, carcinoma in situ, and intravesical instillations. A longitudinal, retrospective, observational and analytical study was conducted to evaluate four different types of events: recurrence, progression, overall survival, and disease-specific survival. The chi(2) (Fischer exact test) and student t tests were used to assess the prognostic value of the qualitative and quantitative variables. Estimations of the survival distributions were calculated according to the Kaplan-Meier method and compared with the Log rank test. Multivariate analysis of the data was performed with Cox proportional hazard models. RESULTS: Among the 80 patients, 67 (84%) were men and 13 (16%) were women, with median age of 65.5 years. The median tumour size was 20 mm, most had single tumour (58.8%) and carcinoma in situ was found in six patients (7.5%). Thirty patients were treated with transurethral resection (TUR) of the bladder tumour and 50 patients were treated with TUR followed by BCG. The two groups of patients were comparable and followed up during a median time of 61 and 65 months, respectively (p=0.454). Kaplan-Meier estimators and Log rank tests demonstrated that patients with TUR alone recurred (p<0.0001), progressed (p<0.040) and died (overall survival: p<0.009; disease-specific p<0.040) earlier than patients who received intravesical instillations of BCG. The results were confirmed with Cox models and odds-ratios are presented. CONCLUSION: In this study, BCG adjuvant immunotherapy was the only factor affecting recurrence, progression and survival. Conservative treatment using TUR followed by BCG may improve disease-specific survival.

Adjuvants, Immunologic↗

PubMed2002

Management of vascular access for hemodialysis after successful kidney transplantation.

OBJECTIVE: There is a lack of data concerning the fate of arterio-venous fistulas (AVF) after successful kidney transplantation. The objective of this study was to assess the evolution of AVF in transplanted patients and to discuss the management of such vascular access once dialysis has been stopped. MATERIAL AND METHODS: We reviewed 160 renal transplant patients who had undergone an AVF 0 to 312 months (mean 29) before transplantation. 136 (85%) of AVF were created in the forearm/wrist region and 21 (13%) at the elbow. RESULTS: The mean follow-up was 69 months from renal transplantation and 95 months from constitution of the AVF. Vascular access had to be closed in 7.5% of cases. Thrombosis occurred in 31% of cases, mainly in distal fistulas (85%). AVF was still functional in 61% of patients at the end of follow-up. CONCLUSION: AVF remains functional in the majority of patients after renal transplantation and is not usually associated with any significant morbidity. Systematic closure of AVF does not seem warranted as it would deprive patients of a useful vascular access should dialysis become again necessary in the long term.

Adolescent↗

PubMed2002

Production of the chemokines monocyte chemotactic protein-1, regulated on activation normal T cell expressed and secreted protein, growth-related oncogene, and interferon-gamma-inducible protein-10 is induced by the Sendai virus in human and rat testicular cells.

Several viruses infect the testis, inducing inflammation, which may lead to infertility. In this study we investigated the production in rat and human testicular cells exposed to the Sendai virus of several chemokines that play a major role in inflammatory processes. Exposure of rat testicular macrophages and Sertoli, Leydig, and peritubular cells to the Sendai virus led to the production of mRNA and protein for monocyte chemotactic protein-1 (MCP-1), regulated on activation normal T cell expressed and secreted protein, growth-related oncogene-alpha, and interferon-gamma-inducible protein-10. In rat peritubular cells exposed to the Sendai virus, MCP-1 production was time and dose dependent. In contrast, rat germ cells did not produce these chemokines. Chemokine synthesis was detected in human Leydig cells exposed to the Sendai virus, but not in human total germ cells, suggesting that rats and humans display similar responses in terms of chemokine production. MCP-1, regulated on activation normal T cell expressed and secreted protein, growth-related oncogene-alpha, and interferon-gamma-inducible protein-10 have been reported to be chemoattractants for a large variety of leukocytes. The ability of the Sendai virus to induce chemokine production in somatic cells (mostly peritubular and Leydig cells) may therefore increase the recruitment of leukocytes to sites of infection.

Animals↗

PubMed2002

[Mumps virus and orchitis: towards a physiopathologic approach].

Mumps orchitis is a dreaded complication of mumps is pubescent men. The literature on this subject includes epidemiological, clinical, histological and endocrine findings, indicating a marked variability of the clinical features from one patient to another, an alteration of endocrine function that can persist in the long term and finally post-mumps infertility, which is exceptional. On the other hand, relatively few studies have investigated the pathophysiological mechanisms, and suggest replication of the mumps virus in the testis. Based on these data from the literature, this article reviews or proposes various hypotheses concerning the various pathophysiological aspects of this disease and discusses the lines of research that could advance the current knowledge in order to improve the therapeutic management of patients, while also providing a better knowledge of the mumps virus and basic testicular physiology.

Humans↗

PubMed2002

[Local immune tolerance mechanisms in kidney cancer].

Many arguments suggest that renal tumours are immunogenic. However, the immune cells present around or within the tumour are unable to induce tumour rejection and the results of immunotherapy in metastatic renal cancer remain disappointing regardless of the protocols used. The objective of this study was to review the main mechanisms by which a renal tumour can escape immune destruction. These mechanisms can concern: tumour antigens, antigen-presenting molecules on the cell surface or defects of the cell machinery leading to the preparation of these molecules. Defects may also concern intercellular communications, especially adhesion and co-stimulation molecules. The immune cells present may also be defective, presenting qualitative or quantitative deficits, abnormalities of the T receptor, defect of cytokine production and these defects may concern both effector cells and antigen-presenting cells. The capacity of tumour cells to release anergic substances, i.e. substances which paralyze the immune system, also constitutes another very powerful immunosuppressive mechanism. These substances are cytokines, especially TGF-b. This anergy can also be mediated by intercellular contacts between tumour cells and lymphocytes, especially via the Fas system. It is important to study these mechanisms for several reasons: 1/Understanding of anergy mechanisms in order to discover new therapeutic targets or to short-circuit these mechanisms in vitro; 2/Definition of an "immune phenotype" of the tumour which should be evaluated as a prognostic marker both for survival after radical surgery of localized tumours as a prognostic factor for response to immunotherapy in metastatic forms.

Antigen Presentation↗

PubMed2002

Renal cell carcinoma in young adults: incidence, disease outcome and review of the literature.

OBJECTIVE: To study the incidence, clinical presentation and pathological prognostic factors affecting disease outcome of RCC in young adults less than 40 years old. METHODS: The charts o medical records of 400 patients treated surgically for RCC between January 1984 and December 1999 were reviewed. 29 (7.25%) patients were under 40. We used ANOVA regression and Chisquare (Fisher exact test) to assess the prognostic value of the quantitative and qualitative variables, respectively. Estimation of the survival distributions were calculated according to Kaplan-Meier method and compared with Log rank test. Multivariate analysis of the entire population utilizing Cox models was performed. RESULTS: The most common histological cell type was clear cell carcinoma, found in 20 (69%) patients. At a median follow-up of 80 months, 20 (69%) patients were disease free and 9 (31%) died of the disease. Incidental discovery (p = 0.05), tumor stage (p = 0.043), grade (p = 0.011), lymphatic invasion (p < 0.0001) metastasis (p = 0.003), adrenal invasion (p = 0.024), and renal vein invasion (p < 0.0001) were associated with prognosis (Kaplan-Meier). When comparing patients less than 40 years vs. older than 40 years, we found significant differences in histology type (clear cell carcinoma 69% vs. 91%; p = 0.0001), and tumor stage at presentation (pT2 = 34.5% vs. 17.3%; p = 0.04) (pT3 = 20.7% vs. 42%; p = 0.03). Disease free survival was not significantly different between the two groups (69% vs. 65.7%; Log rank test p = 0.4). CONCLUSION: Although rare, RCC in young adults seems to follow a course similar to the disease seen in older patients. Among the prognostic factors studied incidental discovery, pathological stage of the tumor and grade, were associated with survival. Stage at presentation was different between the two populations however survival was not affected by age.

Adenocarcinoma↗

PubMed2002

[Renal cell carcinoma before the age of 40: prognostic factors].

OBJECTIVE: To study the prognostic value of tumour diameter, TNM stage, Führman's nuclear grade and CD44 adhesion molecule expression in renal cell carcinoma (RCC) before the age of 40 years. MATERIAL AND METHODS: Nineteen patients under the age of 40 (12 males and 7 females; mean age 30.8 years), undergoing total nephrectomy for RCC were included in this study. Tumour diameter, TNM 1997 stage, and Führman's nuclear grade were defined for each tumour. Standard CD44 adhesion molecule (CD44H) expression was evaluated semiquantitatively by immunohistochemistry on each tumour. The prognostic value of the various variables was determined by Mann-Whitney and Chi-square tests and survival analysis was performed by the Kaplan-Meier method. RESULTS: Six patients (31.5%) died from their cancer with a mean follow-up of 81.4 months. Mean tumour diameter was 9 +/- 4.5 cm. Tumours were Führman I/II in 4 cases, Führman III/IV in 15 cases, T1/T2 in 14 cases and T3/T4 in 5 cases. CD44H expression was high (> or = 20%) in 9 cases (47.3%). The prognostic factors identified in this study were: tumour stage (p = 0.01), grade (p = 0.04), venous extension (p = 0.001) and CD44H overexpression (p = 0.003). CONCLUSION: Prognostic factors of renal cancer in patients under the age of 40 years do not appear to be different from those of older patients. The prognostic factors identified in this study must be validated by multicentre studies based on larger populations.

Adult↗