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Biomedical subjects

L Boccon-Gibod

Publications and source records attributed to L Boccon-Gibod.

At least 73 records · Page 4Linked to original sources
PubMed1998

Radical prostatectomy for prostate cancer: the perineal approach increases the risk of surgically induced positive margins and capsular incisions.

PURPOSE: We compare the incidence of positive surgical margins in patients who underwent perineal or retropubic radical prostatectomy for clinically localized (stage T1, T2) prostate cancer. MATERIALS AND METHODS: In this retrospective, nonrandomized study we reexamined the specimens of 94 consecutive patients who underwent radical perineal (48) or retropubic (46) prostatectomy for clinically localized prostate cancer (stage T1, T2) and with pathological stage pT2 (intracapsular), pT3A (established extracapsular extension without positive margins) or pT3B (extracapsular extension with positive margins) without lymph node involvement (N0). We assessed the presence or absence of extracapsular cancer with or without positive margins, incisions of the prostatic capsule exposing cancer (surgically induced positive margins) or benign glandular tissue. Patients were followed for 3 to 66 months (mean 25) using an ultrasensitive prostate specific antigen assay with a lower detection limit of less than 0.05 ng./ml. RESULTS: The overall incidence of positive margins in cancer tissue was 56% in the perineal and 61% in the retropubic group, and biochemical failure-free survival was 67% each. However, surgically induced positive margins in patients with organ confined disease were more frequent in the perineal than retropubic group (43 versus 29%, p < 0.05) and associated with a 37% risk of biochemical failure (prostate specific antigen greater than 0.1 ng./ml.) at mean followup. In addition, capsular incisions exposing benign tissue were more frequent in the perineal than retropubic group (90 versus 37%, p < 0.05) irrespective of pathological stage. CONCLUSIONS: Although overall positive margins and biochemical failure rates are similar or identical for the perineal and retropubic approaches for organ confined prostate cancer, the perineal approach is associated with a significantly higher risk of capsular incisions and surgically induced positive margins and, thus, a higher risk of biochemical failure.

Aged↗
PubMed1998

Adjuvant radiation therapy for recurrent PSA after radical prostatectomy in T1-T2 prostate cancer.

To evaluate retrospectively the efficacy of adjuvant radiation therapy (ART) in patients with T1-T2 prostate cancer (CaP) in whom extracapsular cancer (pT3) was detected after radical prostatectomy (RP), together with biochemical failure characterized by a recurrent level of serum prostate-specific antigen (PSA)>0.1 ng/mL. Twenty-two patients with T1-T2 CaP treated by RP who subsequently were found to have pT3 CaP with (13) or without (9) positive surgical margins and/or seminal vesicle invasion, exhibited biochemical failure characterized by a recurrent level of serum PSA, 2-40 (mean: 25) months after RP and were treated with ART (65 Gy). Bone and CT scans were negative in every patient, 15 of whom were submitted to TRUS biopsy (Bx) of the anastomosis (resection site), which was positive in 8. Patients were followed up for between 6 and 60 (mean: 32.5) months. Transient side effects (urgency, proctitis, diarrhea) were experienced by 9 patients after ART. A decrease in serum PSA was observed in 19 patients; however, only 14 of these achieved an undetectable level (<0.1 ng/mL) on one or more occasions after completion of ART (in 12 cases this was after 3 months). Of the 14 patients, 8 achieved a persistently unmeasurable PSA level at a mean follow-up of 20.4 (range: 9-48) months. There was no difference between patients in whom an undetectable level of serum PSA was attained and those in whom it was not, with regard to specimen pathology, PSA doubling time, timing of ART, and the result of Bx. Patients who achieved an undetectable PSA had a lower mean PSA at the time of ART (1.1 vs 2.9 ng/mL, P<0.05) and a lower preoperative mean PSA. Although ART for biochemical failure after RP may lead to undetectable PSA levels in a significant proportion of patients for a significant period of time, a longer follow-up shows that such unmeasurable levels persist in only 36.4% of such patients.

Journal Article↗
PubMed1998

Balloon catheter dilatation in the treatment of ureteral and ureteroenteric stricture.

Balloon catheter dilatation is a low-cost alternative to open surgery in patients with ureteral strictures, leading to low morbidity and short hospitalization. The goal of this study was to evaluate the results of this technique in patients with inflammatory ureteral strictures or ureteroenteric strictures after radical cystectomy. Twenty-five ureteral strictures in 20 (15 male, 5 female) patients were consecutively treated by high-pressure balloon dilatation: 14 cases of ureteroenteric stricture (9 after ileal cutaneous diversion, and 5 after orthotopic enterocystoplasty) and 11 of ureteral stricture from various inflammatory causes (tuberculosis, iatrogenic injury, radiation therapy, parasitosis). Dilatation was performed by an antegrade (ureteroenteric strictures) or retrograde (inflammatory strictures) approach using a balloon insufflated up to 10 to 20 atm for 5 to 15 minutes. The ureter was stented for a mean time of 2.1 months (range 1-5 months). Results were evaluated clinically and radiologically (intravenous urogram or CT scan). Immediate success was assessed by intraoperative radiologic monitoring. Long-term success was defined as the absence of recurrence of the stenosis after 6 months. Nineteen procedures were successful among the 23 evaluable cases. With a mean follow-up of 16 months (range 6-39 months), the long-term success rate was 52%: 40% in ureteral strictures and 61% in ureteroenteric strictures. Five strictures secondary to cutaneous diversion and six caused by radiation therapy recurred after dilatation. After cutaneous diversion, the failure occurred mostly at the anastomosis and involved the crossed-over ureter. This study shows that high-pressure balloon dilatation of ureteral strictures has a high early success rate and a long-term success rate of 52%. It can therefore be considered as an alternative to open surgery.

Adult↗
PubMed1998

Are non-steroidal anti-androgens appropriate as monotherapy in advanced prostate cancer?

OBJECTIVES: To evaluate the efficacy of non-steroidal anti-androgen monotherapy in the treatment of advanced prostate cancer. METHODS: The pertinent literature regarding the use of nilutamide, flutamide, and bicalutamide as monotherapy in the treatment of prostate cancer has been reviewed. RESULTS: The clinical utility of non-steroidal antiandrogen monotherapy is currently under investigation. As with other endocrine therapies, this approach appears to provide effective palliation of symptoms, but offers certain quality-of-life benefits, including preservation of libido and sexual potency, issues which may be important in certain patients, particularly younger men. Available data indicate that flutamide may be as effective as orchidectomy in terms of prolonging progression-free survival in selected patients. Nilutamide has been less extensively investigated, but the clinical utility of this agent, except for use in combined therapy, would appear to be somewhat limited by a high incidence of drug-related side effects. Bicalutamide, however, is well tolerated as monotherapy and appears to be as effective as castration in patients with locally advanced non-metastatic disease. In metastatic disease, the improved subjective response and quality of life gains with bicalutamide may outweigh the slightly inferior survival. CONCLUSION: These promising preliminary findings, a number of issues remain to be determined before non-steroidal antiandrogen monotherapy can be considered to be routine clinical practice. These include optimum indication and dosage, long-term clinical efficacy and tolerability, and response to second-line therapy.

Androgen Antagonists↗
PubMed1998

Clearance of free and total serum PSA after prostatic surgery.

INTRODUCTION: Although the biology and sites of secretion of PSA are well known, its pharmacokinetics are still unclear. This study analyzes the differences between the clearance of total and free serum PSA following open surgery for BPH and radical prostatectomy. METHODS: Free and total PSA were measured in 27 patients submitted to radical prostatectomy for clinically localized prostate cancer (group I) and in 27 patients submitted to open surgery for BPH (group II). In both groups, the clearance of free and total PSA was studied. RESULTS: Group I-the mean half-life was 1.416 +/- 0.723 days for free PSA and 2.43 +/- 0.688 days for total PSA. After prostate removal, free PSA showed a marked increase. Group II-the mean half-life of free PSA was 2.157 +/- 1.792 days and 3.391 +/- 2.337 days for total PSA. CONCLUSIONS: The increase in free PSA shortly after manipulative procedures of the prostate was higher than the increase in total PSA. Serum clearance of free PSA after eradicative prostatic surgery was related to the indication and type of procedure used.

Aged↗
PubMed1998

[W enterocystoplasty with resorbable staples: technic and functional results. Preliminary study].

INTRODUCTION: The use of absorbable staples for enterocystoplasty allows a marked reduction of the operating time. The long-term results on continence need to be evaluated at result term before adopting this technique. METHODS: Eight patients underwent "W" enterocystoplasty performed with absorbable staples according to the so-called "Detroit" technique, with direct uretero-ileal anastomosis. The continence of these patients was evaluated by clinical follow-up and urodynamic assessment (3 patients). Quality of life was studied by a questionnaire sent to the patient. RESULTS: The mean operating time was 5 hours 20 minutes, the plasty was performed in 25 to 35 minutes. The mean follow-up was 18.7 months, during which two uretero-ileal strictures were diagnosed. 7 of the 8 patients have a good diurnal continence (no leaks) and 1 patient has moderate continence (1 protection). Nocturnal continence was considered to be good in 3 cases, moderate in 2 cases and poor in 3 cases (> 1 protection). Four of the patients evaluated by questionnaire reported urinary disorders. CONCLUSION: The use of absorbable staples allows a definite reduction of the operating time, for a modes excess cost and satisfactory functional results.

Absorption↗
PubMed1998

[Complete perineal prostatectomy carries an increased risk of capsular incision in healthy and cancerous tissue].

OBJECTIVES: To compare positive resection margin rates in tumour tissue and healthy tissue according to whether total prostatectomy for cancer is performed via a retropubic or transperineal approach. PATIENTS AND METHODS: This retrospective, non-randomized study was based on 94 patients suffering from clinically localized cancer (T1-T2) of the prostate operated either via a retropubic (46: group 1) or perineal (48: group II) approach. All slides were reviewed by two pathologists not informed about the clinical course. The frequency of tumour margins associated with extracapsular invasion, capsular incision, without extracapsular extension of the tumour, and finally the incidence of capsular incisions exposing tumour tissue, were determined. RESULTS: While the number of positive resection margins was equivalent in the two groups (61% for group I versus 56% for group II), it was higher in the perineal group (43% versus 29%, p < 0.05) when the tumour was confined to the gland (pT2). A higher incidence of resection margins in healthy tissue was also observed in group II (90% versus 37%). CONCLUSION: Transperitoneal prostatectomy is associated with a higher incidence of resection margins in tumour tissue in patients with prostate-confined cancer. Analysis of the resection margins in healthy tissue suggests that the surgical incision is a predisposing factor to their creation.

Aged↗
PubMed1998

[Inverted Y partial ureteral duplication. Apropos of an unusual case].

Inverted Y partial ureteric duplication corresponds to the presence of a variable length of duplicated ureter before entering the bladder in an orthotopic or ectopic position. A case od inverted Y partial ureteric duplication with ureteric confluence in the hilum of the kidney associated with anastomosis of an ectopic ureter in the epididymis is reported. The description of this original case is compared with the data of the literature.

Adult↗
PubMed1998

Progressive osseous heteroplasia. Report of a family.

We report a case of progressive osseous heteroplasia in a female infant who had progressive ossification of the skin and deep connective tissues. Isolated dermal ossification is present in her father and younger sister suggesting an autosomal dominant mode of inheritance with variable expressivity or possible somatic mosaicism. This report of a family with progressive osseous heteroplasia contributes to the understanding of this uncommon genetic disorder, which must be distinguished from fibrodysplasia ossificans progressiva and Albright's hereditary osteodystrophy. The paucity of familial cases of progressive osseous heteroplasia currently limits the use of a genome-wide linkage analysis, but linkage exclusion analysis with promising candidate genes is a possibility.

Adult↗
PubMed1998

[Why are auto-intracavernous injections abandon in the long-term?].

OBJECTIVES: Self-administered intracavernous injections are proposed in the treatment of impotence, but are frequently discontinued in the long-term. The objective of this study was to assess the reasons for discontinuation of treatment. MATERIALS AND METHODS: Between 1991 and 1996, 250 patients consulting for impotence, to whom self-administered injections were proposed, received a questionnaire at home concerning the frequency of use, duration of erections and acceptability of self-administered injections, as well as the reasons for discontinuation of treatment. The sensitivity of the study was increased by contacting the patient by telephone. The results were analysed according to the aetiology of impotence. RESULTS: 144 patients (57.6%) answered the questionnaire. Of the 106 patients who failed to answer the questionnaire, the telephone call revealed that 66 patients had changed address, 36 had not received the questionnaire and 4 did not wish to participate. Of the 144 patients answering the questionnaire, 35 did not continue treatment at home (group I, 24.3%) because they were dissatisfied (22% of answers), encountered technical problems (22%) or had regained spontaneous erections (15%). 57 of the remaining 109 patients (group II, 57/144 (39.5%)) subsequently discontinued treatment after a mean duration of 6.9 months, because of personal dissatisfaction (33%), financial problems (20%), and erections insufficient to allow penetration (19.4%). Fifty two patients continued treatment (group III, 52/144 (36.2%)). The discontinuation rate was equivalent regardless of the drug used. The three groups did not differ in terms of mean age. The distribution of the causes of impotence was essentially similar in the 3 groups with 35% of psychogenic causes, 40% of mixed causes and 25% of organic causes. CONCLUSION: Intracavernous injections appear to be a reliable and lasting solution for the treatment of erectile impotence requiring selection of motivated couples, regularly reviewed in the outpatients department and having totally integrated the concept of self-administered intracavernous injection.

Adult↗
PubMed1998

[Florid glandular cystitis: study of 3 cases and review of the literature].

The authors report three cases of florid, recurrent cystitis glandularis in white men, inducing dilatation of the upper urinary tract due to invasion of the ureteric meatus. Treatment consisted of cystectomy, with preservation of the prostatic capsule, allowing preservation of continence and sexual potency. Cystitis glandularis is a rare, generally asymptomatic, benign metaplasia; it is favoured by chronic irritation and is sometimes associated with pelvic lipomatosis. Its transformation into adenocarcinoma is exceptional and occurs in the case of persistence of the predisposing factor. However, annual surveillance by cystoscopy with bladder biopsies is necessary. The florid form is much rarer and more disabling and usually requires wide resection of the lesions.

Adult↗
PubMed1998

[Diagnostic value of 10 systematized and ultrasound-guided transrectal prostatic biopsies].

OBJECTIVE: To study the improvement of prostatic cancer detection provided by ten strictly systematized transrectal prostatic biopsies. MATERIAL AND METHODS: This prospective study was conducted in 162 patients submitted to a series of 10 ultrasound-guided transrectal prostatic biopsies due to the presence of elevated PSA and/or an abnormality on digital rectal examination. Five biopsies were taken from different sites in each lobe: 2 biopsies were inserted between the 3 biopsies usually performed in the standard protocol, while maintaining the angle of entry of the needle recommended in this protocol. RESULTS: The complication rate was 1.85% with the 10-biopsy technique. Prostatic cancer was detected in 40.1% of the 162 patients. The percentage diagnostic improvement provided by the 10-biopsy protocol in the overall patient population was +3.1% compared to the standard protocol. The highest percentage diagnostic improvement was observed in the group of patients with PSA < or = 10 ng/ml (+4.9%) and in the group of patients with an ultrasound prostatic volume < or = 40 cc (+4%). CONCLUSION: The most marked diagnostic improvement appears to be related more to sampling of prostatic zones presenting a statistically increased risk of cancer (peripheral zone) than to the increased number of prostatic biopsies performed.

Adenocarcinoma↗
PubMed1998

[Effects of a 6F urethral catheter on uroflowmetry in men with benign prostatic hypertrophy].

OBJECTIVE: To determine whether the presence of a 6F catheter in the urethra modifies uroflowmetric parameters in a population of men with benign prostatic hyperplasia. PATIENTS AND METHODS: 260 patients, 45 to 86 years old, presenting with benign prostatic hyperplasia, underwent two uroflowmetries, one with the urethra free, the other with a 6F urethral catheter. Patients with a history of neurological disease, diabetes mellitus, prostatic cancer, lower urinary tract surgery or taking drugs likely to affect micturition, were excluded from the study. Maximum flow rate (Qmax) and voided volume were then compared during the 2 recordings, using Wilcoxon's non parametric test. RESULTS: No significant difference was observed between voided volumes in the 2 groups (m: 207 ml versus m: 226 ml), but a very significant difference was observed for maximum flow rate measurements (m: 8.62 ml/s versus m: 6.97 ml/s p = 0.0001). CONCLUSION: The presence of an urethral catheter, even small calibre (6F), modifies the flow rate by more than 1.5 ml/s. This element must be taken into account when performing and interpreting measurements of the pressure-flow relationship in men.

Aged↗
PubMed1997

Idiopathic pulmonary fibrosis in infants.

Idiopathic pulmonary fibrosis is a poorly characterized disease in infants. In the present report, we reviewed our experience with 10 infants during a 10-year period. In 9 patients, onset of symptoms occurred before the age of 2 months and included tachypnea, cough, and inadequate weight gain. However, despite the presence of these symptoms, diagnosis was delayed for 3 months at which time the infants were referred to the pediatric pulmonary department, when the diagnosis was confirmed by open lung biopsy. At the time of admission, bronchoscopy with alveolar lavage was performed in 9 children and showed severe alveolitis with an increase in the neutrophil count. Nine infants were treated with prednisone alone or in combination with chloroquine, colchicine, or cyclophosphamide; all these patients died despite treatment. One infant was treated with pulses of methylprednisolone because of a failure in response to oral prednisone. This girl who displayed similar clinical, radiological, and histological abnormalities as the other children at the time of diagnosis is the only child still alive after 3 years of follow-up. She is now free of respiratory symptoms and has a normal growth curve. The present report raised two important points: (1) a thorough evaluation of characteristic symptoms should lead to an early diagnosis of pulmonary fibrosis in infants; and (2) administration of pulse therapy using corticosteroids has been helpful and needs to be evaluated further.

Biopsy↗
PubMed1997

Bronchoalveolar lavage.

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AIDS-Related Opportunistic Infections↗
PubMed1997

Assessment of endpoints for clinical trials for localized prostate cancer.

OBJECTIVES: The AUA Practice Guidelines Panel convened to address the issue of appropriate endpoints for assessment of treatment modalities for localized carcinoma of the prostate. METHODS: A review of the literature and the design of existing clinical trials produced a consensus, which was presented to and critiqued by the members of the general conference. RESULTS: The pitfalls associated with identification of local failure endpoints were discussed, and the more accurate endpoints of freedom from metastatic progression and overall survival were recognized. The strict definition that must be fulfilled for intermediate endpoints to become surrogates for metastasis free and/or survival endpoints was stressed. For more efficient and rapid conduct of future clinical trials, the urgent need to validate such surrogate endpoints by evaluation in randomized control trials is obvious. PSA, while an indicator of disease activity and a critical marker for estimating disease progression or regression in response to therapy, is not a surrogate for metastasis free or overall survival. CONCLUSION: Until surrogate endpoints are validated, the committee has evaluated the endpoints in current use, reviewed their limitations, and stressed the importance of quality-of-life assessment together with the traditional endpoint assessment.

Clinical Trials as Topic↗