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Biomedical subjects

L Boccon-Gibod

Publications and source records attributed to L Boccon-Gibod.

At least 91 records · Page 5Linked to original sources
PubMed1997

Free/total prostate-specific antigen ratio--hope and controversies.

Prostate-specific antigen (PSA) forms in serum two stable complexes with alpha 1-antichymotrypsin and alpha 2-macroglobulin. PSA complexed to alpha 1-antichymotrypsin is the predominant fraction of PSA. A minor fraction of serum PSA is not associated with proteinase inhibitors. These molecular differences explain the possibility to distinguish free from total PSA (F/T ratio). Free and complexed PSA have different clearances and significant differences between clearance of free PSA after radical prostatectomy (RP) and after open surgery for benign prostatic hyperplasia (BPH) are observed. These differences are explained by the entire removal of prostatic cells responsible for PSA synthesis and storage during RP, i.e. the source of free PSA present in the intravascular pool. The proportion of free PSA is significantly lower in patients with prostate cancer than in patients with BPH. Thus, the mean F/T ratio in prostate cancer is lower than that in BPH and may be helpful to distinguish cancer from BPH especially in the gray zone of total PSA (4-10 ng/ml). The reason why complexed PSA increases in patients with prostate cancer remains unknown but could be explained by the requirement of an enzymatically active PSA released by the malignant prostate tissue to bind to alpha 1-antichymotrypsin. However, a consensual threshold value for L/T ratio is yet to be found to be of widespread clinical use in the differential diagnosis between cancer and BPH.

Blood Proteins↗
PubMed1997

[A case of pulmonary mesenchymal hamartoma in a 9-year-old child].

This case of mesenchymatous hamartoma in a nine-year-old boy, was an incidental finding on a chest X ray. CT and MRI suggested the diagnosis showing a large (9 x 11 x 14 cm) mass developed in the right lower lung with sharp margins, without any sign of pulmonary or mediastinal compression. This lesion contained fatty areas on both CT and MRI. It showed no calcification. It enhanced slightly after IV contrast. On T2 WI, it appeared lobulated with low signal intensity septa. Presence of fatty tissues and lobulated margins were suggestive of the diagnosis of mesenchymatous hamartoma. A 1.2 kg mass was surgically removed. The tumor was attached to the right lower lobe by a small pedicle. Pathological examination disclosed fatty and connective tissues. This rare observation shows a good correlation between CT, MR, surgery and pathological examination.

Child↗
PubMed1997

Value of the preoperative detection of prostate-specific-antigen-positive circulating cells by nested RT-PCR in patients submitted to radical prostatectomy.

OBJECTIVE: To assess the value of the detection of circulating prostate cells [prostate-specific antigen (PSA) positive] by reverse-transcriptase nested polymerase chain reaction (nested RT-PCR) to improve the staging of clinically localized prostate cancer. METHODS: Nested PCR was performed on blood samples of 29 patients submitted to radical prostatectomy for clinically localized (T1-T2) prostate cancer. Nine patients with various benign urologic diseases comprised the negative control group. Incubation was for 25 cycles for each PCR, using beta 2-microglobulin to test the integrity of RNA samples. Each sample was tested in quadruplicate and analyzed by agarose gel electrophoresis, blotted and hybridized with specific internal primers. Nested PCR results were compared with the pT stage of the prostate specimen, processed according to the Stanford method. RESULTS: In 6 out of 29 patients (20.7%) with clinically localized prostate cancer, circulating prostate cells were detected by nested PCR. There was no relationship between pathologic stage and RT-PCR results. Eleven out of 14 pT2 patients (78.6%) were PCR negative and only 3 out of 15 pT3 patients (20%) were PCR positive. All control samples were PCR negative. CONCLUSIONS: In selected patients with T1-T2 prostate cancer, there was no relationship between pathologic stage and the presence of circulating PSA-positive cells detected by nested PCR. However, in 20.7% of patients with clinically localized prostate cancer, circulating prostate cancer cells were detected. A further follow-up based on PSA is necessary to clarify the clinical relevance of this biologic anomaly.

Aged↗
PubMed1997

[Treatment of ureteral stenosis using high pressure dilatation catheters].

INTRODUCTION: High-pressure dilatation catheters have been proposed as an alternative to open surgery in the treatment of ureteric strictures because of the low morbidity and short hospital stay. The objective of this study was to evaluate the results of this technique in patients with inflammatory ureteric strictures or uretero-ileal strictures. METHODS: From April 1991 to September 1996, 25 strictures were treated by antegrade or retrograde dilatation with a high-pressure balloon catheter followed by stenting with a double J stent for an average of 2.1 months (1-5): 14 uretero-ileal strictures (tuberculosis, schistosomiasis, iatrogenic, radiotherapy). A good immediate result was defined as intraoperative rupture of the stricture under fluoroscopic control. A good long-term result was defined as absence of recurrence of the stricture, evaluated clinically and radiologically (IVU and/or ultrasonography). RESULTS: The good immediate result rate was 82% (19 out of 23 strictures, with 2 non-evaluable cases). One intraoperative complication was observed (double J stent advanced too for into the ureter). 22 strictures were evaluable after removal of the double J stent and the good long-term result rate was 64% with a mean follow-up of 8.5 months (0.3-24). 8 patients developed a recurrence: 4 after Bricker, 3 with inflammatory strictures after radiotherapy and J with peritoneal carcinomatosis. CONCLUSION: This study shows that high-pressure balloon catheter dilatation of non-neoplastic ureteric strictures provides good results and can be considered to be the first-line treatment for these lesions.

Adult↗
PubMed1997

[Diagnosis of cancer of the prostate (I): Advancements in knowledge and practice since the consensus conference of 1989. The "Cancer of the Prostate" subcommittee of the Committee of Oncology of the French Association of Urology].

The prostatic cancer screening policy in France is defined by recommendations established at the 1989 consensus conference. Mass or individual screening by serum specific prostatic antigen (PSA) assay is not recommended. The Oncology Committee of the Association Française d'Urologie has up-dated the knowledge concerning prostatic cancer screening since 1989. The results are published in the form of a series of articles referring to the criteria used as prerequisites for cancer screening programmes. This article describes: 1) Current screening and treatment recommendations in France and in other countries. 2) The progress in our understanding of the prognosis, diagnosis and treatment of prostatic cancer, justifying revision of the screening policy. 3) The methodology and results of prospective screening studies and the projections of these results on the basis of the French population. Despite the 1989 recommendations, individual screening by serum PSA assay is widely performed both due to the characteristics of the test (simple blood test, low cost, high positive predictive value) and information of the public by the media concerning the morbidity and mortality related to prostatic cancer. The current data of the literature are unable to define the impact of PSA screening on the morbidity and mortality of prostatic cancer. Randomized prospective studies are currently underway. The absence of proof of a favourable impact of PSA screening is only one of the causes of the controversy concerning this screening technique, as another source of controversy is the magnitude of iatrogenic disorders induced by screening. In patients with raised PSA, the diagnostic examinations (biopsy) and curative treatments (surgery or radiotherapy) proposed are invasive, responsible for considerable morbidity and non-negligible mortality. Finally, the cost of screening remains unknown. Future recommendations must adapt their conclusions to changes in the current situation, in which prostatic cancer is simultaneously considered to be a non-serious disease which does not justify screening and a serious disease, as soon as the diagnosis is made, justifying, for 95% of urologists, an invasive and mutilating treatment in men with a life expectancy of more than 10 years.

Attitude to Health↗
PubMed1997

[Anatomic study of the pubic-urethral ligaments in women: role of urethral suspension].

OBJECTIVE: In 1963, the studies by Zacharin emphasized the importance of the suspensory apparatus of the female urethra, consisting of two non-extensible fibrous bands composed of 3 distinct ligaments. The objectives of this study were to evaluate the role of these ligaments in support of the urethra and to define the value of their preservation in cystectomy with bladder replacement in women. MATERIAL AND METHODS: Five fresh female cadavres with a mean age 78 years (range: 75-82) were used for dissection of the suspensory apparatus of the urethra via a suprapubic then sagittal approach by section of the pelvis 2 cm from the midline. Histological studies of the urethra were then performed. RESULTS: The suspensory apparatus of the urethra was found to be a paired, symmetrical system composed of 2 paired and symmetrical fibrous bands. Dissection of these bands revealed three anterior, intermediate and posterior pubourethral ligaments. The posterior pubourethral ligament was inserted on the anterior and lateral surfaces of the urethra and vagina (underneath the bladder neck) on anatomical studies, but also on histological sections. Section of the posterior pubourethral ligament allowed great mobility of half of the urethra. Section of these ligaments totally released the urethra from the pubis. CONCLUSION: Our study confirmed the importance of this ligamentous system in suspension of the urethra and demonstrated the value of preservation of these structures in cystectomy with bladder replacement in women.

Aged↗
PubMed1997

[Prostate cancer screening (III): risk factors, natural history, course without treatment. Characteristics of detected cancers].

The Oncology Committee of the Association Française d'Urologie has up-dated the knowledge concerning prostatic cancer screening since the 1989 Consensus Conference. The results are published in the form of a series of articles referring to the criteria used as prerequisites for cancer screening programmes. This article reports the data of the literature concerning risk factors, natural history, course without treatment and histological characteristics of the cancer detected. 1) Certain populations have an increased risk due to genetic factors. A family history (first degree relative) is associated with a 2- to 3-fold higher risk of prostatic cancer. This familial aggregation can be used to define a high-risk group constituting a primary target for screening. 2) The natural history of the disease, especially the progression from the asymptomatic stage to the clinical stage and the natural history of the disease at the clinical stage are now sufficiently well known. The concept of latent cancer has not been confirmed as the disease inevitably progresses. Cancers of insignificant volume, less than 0.5 cc (discovered at autopsy) are classically distinguished from cancers of significant volume, greater than 0.5 cc, but asymptomatic (risk of progression with mortality within 15 years), and local and/or metastatic symptomatic cancers. The histological prevalence of prostatic cancer is 43% in a group of men with a mean age of 64 years and increases with age. 92% of histological cancers have a volume less than 0.5 cc. It takes an estimated 12 years (3 doubling times) for a 0.5 cc cancer to reach a volume of 4 cc, the volume beyond which there is a risk of distant metastases. In the absence of curative treatment, a cancer diagnosed at the localized stage before the age of 65 years is associated with a specific survival of less than 30%. The median survival of metastatic prostatic cancer is 2 to 3 years. 3) The disease can be detected at an early stage. Cancers diagnosed by an isolated elevation of PSA in a screening setting have a significant volume in more than 3 out of 4 cases, can be entirely removed by prostatectomy in more than 3 out of 4 cases and have a less advanced pathological stage than cancers diagnosed on the basis of classical criteria.

Age Distribution↗
PubMed1997

Flutamide versus orchidectomy in the treatment of metastatic prostate carcinoma.

PURPOSE: To compare in a randomized clinical trial the therapeutic efficacy of the nonsteroidal antiandrogen flutamide 250 mg tid to testicular androgen suppression by orchidectomy in patients with metastatic prostate cancer. PATIENTS AND METHODS: Between 1989 and 1991, 104 patients aged 74 +/- 8 years with newly diagnosed metastatic prostate cancer, an ECOG performance status 0-2 and no prior hormone manipulation or chemotherapy, were randomized to receive flutamide 250 mg tid (54 patients) or orchidectomy (50 patients). Patients were evaluated at entry and at months 3, 6, 12, 18 and 24. The primary endpoint was duration of progression-free survival, progression being defined as an increase in PSA> 50% over the nadir value at 2 consecutive months or a single PSA rise > 50% over the nadir value with another objective parameter. At progression, the treatment was left to the discretion of the attending urologist. RESULTS: 16 patients (10 flutamide, 6 orchidectomy) are not evaluable. 86 had a minimum follow-up of 36 months, 36/42 and 41/44 have progressed in the orchidectomy and flutamide group with a time of failure of 419 and 496 days (p = 0.32); median time to progression was almost identical in both groups (370 vs. 396 days p = 0.9); overall survival at 69 months irrespective of treatment at relapse was identical in both groups. Side effects were dominated by gynecomastia, hot flushes in both groups, breast tenderness and diarrhea in the flutamide group. Overall, 4 (10%) of the patients in the flutamide group withdrew from therapy because of side effects. The impact of flutamide on sexual potency was not assessed because of the advanced age of the patients. Serum testosterone rose by 50% over baseline level at month 3 to plateau at 25% over baseline level at month 12. CONCLUSION: Although affected by the lack of a clear statistical power due to the small number of patients in each arm, this study shows that in spite of a constant elevation of serum testosterone (25% over baseline) flutamide 250 mg tid may be a reasonable alternative to castration in highly selected patients with well to moderately differentiated low volume metastatic prostate cancer and wishing to avoid the side effects of androgen deprivation, provided they are closely monitored and ready to switch to standard androgen deprivation in the presence of untolerable side effects or suboptimal treatment efficacy as assessed by the inability to achieve a low PSA nadir.

Aged↗
PubMed1997

T3 prostate cancer: how reliable is clinical staging?

The treatment of locally advanced stage T3 prostate carcinoma remains controversial. The reliability of the clinical assessment of extracapsular extension by digital rectal examination (DRE) is therefore crucial. Results from series of patients with T3 prostate cancer treated by radical prostatectomy indicate that DRE has shown a wide range of accuracy from 44% to 82%. The assessment of capsule perforation on biopsy provides a 96% specificity rate and a positive predictive value of 60%. Furthermore, if the apparent clinical status of the seminal vesicle is incorrect, sampling errors on biopsy may be substantial. Biopsy therefore appears to provide a more accurate assessment of the capsule than of the seminal vesicle. Information regarding the correlation between T3 clinical staging and conventional/endorectal coil magnetic resonance imaging staging is still needed. Finally, the accuracy rate of DRE for T3 staging increases to more than 90% if the prostate-specific antigen level is greater than 15 ng/mL.

Biopsy↗
PubMed1996

[Early diagnosis of prostate carcinoma with reference to the density of prostate-specific antigen].

Early diagnosis of prostate cancer is based on determination of serum prostate specific antigen (PSA) and digital rectal examination (DRE). In men with PSA values above 10 ng/ml and where there is a positive DRE, the indication for prostatic biopsy is given. However, there is controversy as to whether men with an intermediate PSA level of 4-10 ng/ml should undergo further evaluation. Since cancer secretes 12 times more serum PSA per volume than benign prostatic hyperplasia, PSA density (PSAD, serum PSA divided by the volume of the entire prostate) has been suggested as an additional diagnostic criterion. In 153 men with prostatism and PSA values between 4 and 10 ng/ml (Hybritech assay), the volume of the prostate was determined by transrectal ultrasonography and 6 systematic biopsies were performed. The groups with positive and negative biopsies respectively were compared according to age of the patient, results of DRE and PSAD. Histological grade of positive biopsies and pathological stage of patients who underwent radical prostatectomy were also compared with diagnostic criteria. Prostate cancer was found in 45 of 153 men (29.4%). Patient's age had no influence on detection rates. The positive predictive value of a PSAD of 0.2 or more was twice the value of a PSAD below 0.2, irrespective of DRE findings. An increasing number of positive biopsies was associated with increasing PSAD and histological grade. Only half of the tumors operated on were still confined to the prostate. Pathological stage could be predicted by the number of positive biopsies. We conclude that PSAD may be useful as a diagnostic parameter in men with prostatism and PSA values of 4-10 ng/ml. The prostate cancers that were detected in this setting are of clinical significance.

Adult↗
PubMed1996

Is the percentage of cancer in biopsy cores predictive of extracapsular disease in T1-T2 prostate carcinoma?

BACKGROUND: Information regarding the quantity of biopsy material invaded by cancer may supplement the usual criteria for the preoperative staging of patients suffering from clinically localized prostate carcinoma (T1-T2). However, conflicting conclusions have been drawn and this topic needs further investigation. METHODS: A total of 170 patients had radical prostatectomy for T1-T2 prostate carcinoma. Patients' mean age (+/- standard deviation [SD]) was 66.05 +/- 6.12 years and mean prostate specific antigen (PSA) level (+/- SD) was 22.5 +/- 21.4 ng/mL (Yang Proscheck). Of the patients, 110 underwent transrectal ultrasound-guided biopsy with removal of 6 cores, from whom we had the percentage of biopsy, material invaded by cancer, the Gleason score, and the preoperative PSA. These parameters were compared with the pathologic features of the surgical specimen (capsule penetration, surgical margins, and Gleason score) and biologic progression (defined as persistent/recurrent postoperative PSA > 0.1 ng/mL). RESULTS: The most valid threshold of biopsy material invaded by cancer for predicting surgical margins and capsule status, as well as biologic progression, was 10%. When < 10% of biopsy material was invaded by cancer, positive surgical margins (SM+) were present in 30.3%, capsular penetration (pT3, pathologic extracapsular involvement) in 27.3%, and biologic progression (P+) in 21.7%. The Gleason score did not improve this prognostic evaluation. The mean quantities of tissue invaded by cancer differed significantly between positive and negative surgical margin groups, between pT2 and pT3 groups, and between P- and P+ groups (no biologic progression/biologic progression). There was statistical significance (log rank test, P = 0.0320 in the survival without biologic postoperative progression between patients with < or = or > 10% of one core biopsy invaded by tumor. If < or = 10% of tissue in only 1 of 6 cores of a biopsy was invaded by tumor, the status was pT2, SM-, and P- in 87.5% of the patients. CONCLUSIONS: On an individual basis, the percent of tissue containing carcinoma in core biopsies was a factor that lacked the statistical power to predict the status of the capsule and surgical margins, and the biologic progression. The finding of < or = 10% of carcinoma in 1 of 6 cores of a biopsy was correlated with a good prognosis.

Adult↗
PubMed1996

[Detection of prostatic cancer in symptomatic patients with serum levels of prostate-specific antigen between 4 and 10 ng/ml].

OBJECTIVES: Determine the incidence of prostate cancer in patients consulting for common miction disorders and serum prostatic specific antigen (PSA) between 4 and 10 ng/ml. METHODS: A total of 153 patients consulted for miction disorders. In 107 of them, the digital examination was abnormal and PSA was between 4 and 10 ng/ml. Transrectal sonography and prostatic biopsies were performed in these 107 patients. We determined the number of cancers detected and assessed the contribution of PSA density (PSAD) to diagnosis. In patients undergoing radical prostatectomy, invasion of the capsule (C+) and positive exeresis section (M+) were recorded. RESULTS: Cancer of the prostate was diagnosed in 29.4% of the patients on the basis of at least 1 of the 6 biopsies. This rate was 47.8% in patients with an abnormal and 21.5% with a normal digital examination. Radical prostatectomy was performed in 32 patients: 50% of them were C+ and 33% M+. CONCLUSION: Biopsy of the prostate is indicated in patients with an abnormal prostate at digital examination when PSA is between 4 and 10 ng/ml. When the prostate appears to be normal, PSAD may be helpful in determining when to perform a biopsy. Intermediary serum PSA levels do not guarantee favorable pathological characteristics.

Adenocarcinoma↗
PubMed1996

Ventral tethering of the vagina and its role in the kinetics of urethra and bladder-neck straining.

Based on the principle that the urethra forms an integral part of the ventral wall of the vagina, the aim of this study was to determine the elements of fixation of this wall and their role in the maintenance of urethral statics during strain exertion. Eight dissections of the female pelvis were performed by a simultaneous high and low approach. The anatomic data were compared with a study of the kinetics of the urethra by dynamic MRI. The lower part of the ventral vaginal wall is tethered to the pubis and the ischiopubic rami by a complex mixed system containing elements of both suspension and support. These elements simultaneously allow a complex and asymmetric movement around the inferior border of the pubic symphysis and maintain urinary continence during straining.

Aged↗
PubMed1996

[Sarcoidosis in children with digestive manifestations].

BACKGROUND: Gastric involvement is the least rare among digestive localizations of sarcoidosis, as well in adults as in children. When it is to be seen at the beginning of the disease, it may cause difficulties in the diagnostic, especially with Crohn's disease. CASE REPORT: Gastric ulcers were detected in a 12 year-old girl, of African origin, who complained about epigastric pain. Eighteen months later, diarrhea, poor growing, uveitis and inflammatory biological signs led to a probable diagnostic of Crohn's disease. Endoscopy seemed to confirm this diagnostic with granulomatous lesions on gastric biopsies. The absence of radiological anomalies of the digestive tract and the poor efficiency of the medical treatment led to question this diagnosis and to assert that of sarcoidosis. CONCLUSIONS: This case allows to emphasize the rare involvement of the digestive tract in sarcoidosis and the aspects common both to Crohn's disease and sarcoidosis.

Adolescent↗
PubMed1996

[Bronchial mucoepidermoid carcinoma: apropos of 3 cases].

BACKGROUND: Mucoepidermoïd carcinomas (MEC) are very rare (less than 20 cases reported in the literature) and potentially malignant bronchial gland carcinomas. PATIENTS: Three children, two boys (11 and 7 years old) and one girl (5 years old) suffered from respiratory symptoms such as cough, recurrent pneumonia and/or hemoptysis for 2 to 12 months. Bronchial endoscopy showed a mass into the left (two cases), or the right main bronchus (one case). Chest CT scan identified local extension, and lung-associated lesions. Histopathological study concluded to MEC in the three cases. The patients were treated by segmental bronchial resection, completed with left upper lobectomy (two cases), bronchotomy (one case). All the tumor could be removed; there was no metastasis. The outcome was uneventful with a 8 to 24 months follow-up. CONCLUSION: Bronchial tumors of children must be considered in patients with chronic cough, recurrent pneumonia and/or hemoptysis and require bronchial endoscopy for their diagnosis.

Bronchial Neoplasms↗