Disseminated lymphonodular cryptococcosis in a child with X-linked hyper-IgM immunodeficiency.
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Agammaglobulinemia↗
Biomedical subjects
L Boccon-Gibod
Publications and source records attributed to L Boccon-Gibod.
Perineal versus retropubic radical prostatectomy for T1, T2 prostate cancer.
OBJECTIVE: To compare retrospectively the efficacy of radical perineal and retropubic prostatectomy in patients with T1, T2 cancer of the prostate. PATIENTS AND METHODS: From January 1991 to January 1993, 71 patients with T1, T2 carcinoma of the prostate aged 52-74 years underwent radical retropubic prostatectomy (36) or radical perineal prostatectomy (35); this was preceded by endosurgical lymphadenectomy. The two groups were identical with regard to age (64 vs 66 years), clinical stage (T1a 17% vs 25%, T2 82% vs 74%), mean and median pre-operative prostate-specific antigen (PSA) (20 vs 26, 11 vs 15 using the YANG polyclonal assay n < 2.5 ng/ml). Radical retropubic prostatectomy and radical perineal prostatectomy were performed using standard procedures. Specimens were inked and analysed; operative time, volume of blood transfusions, duration of hospital stay, peri-operative complications, sexual function, urinary continence and quality of the specimens were assessed retrospectively. RESULTS: Both groups were identical as far as operation time, hospital stay, complications (one rectal injury in each group), specimen weight and pathology were concerned. The proportions of organ-confined (54% in radical perineal prostatectomy group vs 55% in radical retropubic prostatectomy group) and margin-positive cancers (37% in radical perineal prostatectomy group vs 39% in radical retropubic prostatectomy group) were identical. The volume of blood transfusion was significantly less in the radical perineal prostatectomy group: 54% required transfusion compared with 100% in the radical retropubic prostatectomy group), 7% of radical perineal prostatectomy patients received homologous transfusion vs 38% of the radical retropubic prostatectomy patients; 11 and 3% of the patients were potent 3-6 months after surgery. Two anastomotic strictures developed after radical retropubic prostatectomy and none after the radical perineal prostatectomy. Continence was achieved at 3 months in 71% of the radical perineal prostatectomy group and in 82% of the radical retropubic prostatectomy group; by 6 months 88% of the patients were dry in both groups. CONCLUSION: When nodal status has been assessed by lymph node dissection (open or endosurgical), radical perineal prostatectomy is a reasonable, minimally invasive alternative to radical retropubic prostatectomy provided that impotence and a slower return to full continence are accepted.
Aged↗
Prostate-specific antigen density: a means to enhance detection of prostate cancer.
The ability of serum prostate-specific antigen (PSA) and PSA density (PSAD) to distinguish patients with prostate cancer from those with benign diseases of the prostate was assessed in 495 men. All men were evaluated with PSA determination, digital rectal examination (DRE), transrectal ultrasonography (TRUS) and ultrasound-guided prostatic biopsies. PSA was analysed by the polyclonal (Yang) assay. Prostate volume was estimated from TRUS. PSAD was determined by dividing the serum PSA by the volume of the prostate. Prostatic biopsies identified cancer in 246 of the 495 patients (49.7%). The entire group was divided into 6 subgroups according to PSA level at presentation. Cancer and noncancer patients were compared in each subgroup with respect to the values of PSA, prostate volume and PSAD. For the entire group of patients, there was no statistically significant advantage, for PSAD over serum PSA alone, in distinguishing between benign and malignant prostatic conditions. However, when patients were stratified according to PSA level, PSAD was statistically significantly superior to serum PSA alone in the detection of prostate cancer for PSA values in the intermediate range (2.6-30 ng/ml). This analysis with respect to the DRE and TRUS results showed PSAD to be superior to PSA when both examinations are normal. Our results demonstrate that the influence of PSAD level on cancer detection proportionally increases as the PSAD value increases. Curves constructed from the incidence of prostate cancer according to PSAD values may be useful to select patients with intermediate levels of serum PSA, and normal DRE and TRUS for prostatic biopsies.
Adult↗
Predictive value of pathological features for progression after radical prostatectomy.
OBJECTIVE: 10-30% of patients with T1/T2 prostate cancer submitted to radical prostatectomy ultimately fail. It may be important to detect failure as early as possible in order to evaluate the extent of recurrent/residual disease and initiate adjuvant therapy. SUBJECTS AND METHODS: 100 consecutive patients with localized prostate cancer treated by radical prostatectomy have been monitored using the hypersensitive Pros-check prostate-specific antigen (PSA) assay (detection level 0.1 ng/ml). The predictive value of positive surgical margins, involvement of seminal vesicles and perineural spaces as well as Gleason's score for biological failure (persistent or recurrent detectable PSA) has been retrospectively evaluated. RESULTS: Overall 40% of the patients had biological failure (defined as persistence of a detectable or rising PSA after undetectability) and 38% had positive surgical margins. The three main predictive criteria of biological failure were capsular perforation, involvement of seminal vesicles and/or positive margins. All patients in whom these criteria were positive progressed. Seminal vesicle invasion was associated with biological failure in 95% of the cases. 66.7% of the patients with extracapsular disease but no seminal vesicle invasion progressed. 15% of pT2 patients experienced a persistent/recurrent postoperative PSA and were upstaged to pT3 after reevaluation of the specimen. CONCLUSION: Efforts should be made to increase the preoperative evaluation of seminal vesicle and pericapsular status by a more sophisticated technique of prostate biopsy in order to avoid noncurative surgery.
Adult↗
[Role of biological and anatomo-pathologic criteria in the prognosis evaluation of patients before and after radical prostatectomy].
Radical prostatectomy is the treatment of choice for organ-confined prostatic cancers (T1-T2). However, it has been reported to improve the long-term survival of patients and achieve its oncological objectives in only one half of patients despite a serious morbidity. Based on a consecutive series of one hundred patients, the authors performed univariate statistical analysis to determine the predictive value of eight preoperative criteria for biological progression and capsular effraction: clinical stage, PSA (using a highly sensitive test derived from the Yang Proscheck and lowering the limit of detection to 0.1 ng/ml), PSA density (PSAD), percentage and topography of positive biopsies, capsular effraction, perineural spaces and Gleason's score. The predictive value for progression of five postoperative histological criteria (Gleason's score, capsule, perineural spaces, seminal vesicles and resection margins) was also studied in the same group of patients. The presence of capsular effraction on the biopsy was shown to have a positive predictive value of 90%. The three preoperative criteria most closely correlated with tumour progression were PSA, PSAD and percentage of positive biopsies (p < 0.001). Analysis of the combined predictive value of PSAD, percentage of positive biopsies and capsular effraction revealed that progression was always present when two of these criteria were positive. Seminal vesicle invasion on the operative specimen is the most pejorative element for progression. In conclusion, analysis of the histological features of biopsies associated with PSA and PSAD allows a more accurate selection of patients with a high risk of progression and seminal vesicle invasion is so pejorative that it could be detected in subjects with a preoperative PSA greater than 25 ng/ml.
Adult↗
[Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the assessment of prognostic factors based on the specimen of orchiectomy. Proposal of an anatomopathological examination report defined by the Study Group of the Committee of Cancerology of the French Association of Urology].
Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the definition of the prognostic factors based on examination of the orchidectomy specimen. Proposal of a pathological examination report form defined by the study Group of the Oncology Committee of the French Urological Association.
Carcinoma, Embryonal↗
[Cytomegalovirus pneumopathies in pediatric intensive care units].
BACKGROUND: Cytomegalovirus (CMV) infection can result in major complications in immunocompromised infants and children. CMV pneumonia may be difficult to diagnose and the true pathogenic role of the virus in the disease is not always clear. This report describes a cohort of 20 children who suffered from CMV pneumonia. POPULATIONS AND METHODS: Twenty children aged 1 month to 11 years 10 months were admitted to our intensive care unit between 1981 and 1990 because of pneumonia with evidence of CMV infection. They were classified into three groups: group I (cases 1-10) with hemopathy or cancer, group II (cases 11-14) with AIDS, and group III (cases 15-20): non immunodeficient or immunosuppressed children. CMV infection was diagnosed after isolation of CMV from bronchoalveolar lavage (BAL) fluid (15 patients), lung biopsy revealing intranuclear inclusions or CMV antigens, or CMV-positive cultures (four patients), CMV-positive urine cultures (one patient). RESULTS: Clinical manifestations and X-rays findings were unspecific; interstitial pneumonia was found only in immunodeficient patients. CMV pneumonia was diagnosed only in two patients on post mortem examination. Concomitant pneumocystis carinii was found on BAL in two patients (group I) and two others (group II). Thirteen patients required ventilation. Eleven patients were given ganciclovir for 2 or 3 weeks; one of them was given a single dose. This treatment was well tolerated. Mortality was 90% in group I, 100% in group II and 33% in group III. CONCLUSION: Ganciclovir did not appear to benefit the immunocompromised patients with CMV pneumonia. Future treatment should include hyperimmune CMV immunoglobulins plus ganciclovir. Careful hand washing is important for all those caring for these patients to prevent contamination as is the use of CMV-negative blood products.
Child↗
[Endoscopic retropubic colpopexy for stress urinary incontinence in women (Stamey's operation). 55 cases].
Fifty five women with a mean age of 59 years, suffering from urinary stress incontinence (U.S.I.), were treated by endoscopic percutaneous cervicocystopexy (Stamey's operation), 39 patients (71%) suffered from pure U.S.I. and 16 (29%) presented a combination of stress and urge incontinence. Bonney's manoeuvre was positive in every case. With a mean follow-up of 21.5 months, 30 patients (58.8%) were completely continent, 9 (17.6%) presented occasional incontinence with intense effort, 12 (23.5%) were failures and 4 patients were lost to follow-up. The complications were minimal. The results were less favourable in patients with a history of pelvic surgery, particularly for correction of U.S.I., associated urge incontinence, detrusor hyperactivity or low urethral closure pressure, although one half of the patients in this group were nevertheless cured. Stamey's operation is a simple, reliable, easily reproducible technique which gives good results at the cost of low morbidity, short hospital stay and a low cost.
Adult↗
[Traumatic rupture of the urethra. Diagnosis and emergency treatment].
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Emergencies↗
Pulmonary sarcoidosis in children: serial evaluation of bronchoalveolar lavage cells during corticosteroid treatment.
The clinical course of sarcoidosis in children has not been well defined. Eight children with symptomatic sarcoidosis included in this study underwent pulmonary function tests and bronchoscopy with bronchoalveolar lavage (BAL) before treatment and during steroid therapy. At the start of therapy, functional parameters, mostly dynamic lung compliance and lung transfer factor for CO, were impaired. This was associated with abnormalities of BAL cell populations: increased total cell number with a high proportion of lymphocytes, modifications of lymphocyte subpopulation with an elevated CD4+/CD8+ ratio, and enhanced ability of alveolar macrophages to release hydrogen peroxide. Although respiratory abnormalities seemed to be similar at the initial stage of sarcoidosis in children and adults, the course of the disease appeared to be different. Despite the absence of respiratory symptoms and disappearance of chest radiographic abnormalities on prolonged steroid treatment, we found slow improvement of pulmonary functions associated with persistence of BAL lymphocytosis and elevated CD4+/CD8+ ratios. However, the ability of alveolar macrophages to release hydrogen peroxide was significantly reduced after 6 months of steroid treatment, and it remained identical to the control group. Therefore, the evaluation of disease activity appears to be critical for therapy in pediatrics, and for this purpose studies of alveolar macrophage activation may be of particular interest.
Adolescent↗
Mechanisms of action of bacillus Calmette-Guérin in the treatment of superficial bladder cancer.
Local immunotherapy with bacillus Calmette-Guérin (BCG) is an effective treatment to prevent recurrence and progression of superficial bladder cancer, but the antitumor mechanism of action of BCG remains unclear. There are some experimental and clinical data suggesting that BCG antigens are processed not only by immunocompetent cells but also by urothelial cells and tumor cells. The foreign antigen may be presented at the cell surface by major histocompatibility complex (MHC) class II molecules and recognized by CD4 cells. The cytotoxic effect could result from the direct activity of CD4 cells or from the cytotoxic effect of released cytokines and the activation of other cytotoxic cells [cytolytic T-lymphocytes CTLs; CD8 cells), macrophages, natural killer (NK) or lymphokine-activated killer (LAK) cells]. These mechanisms are also involved in tumor rejection, and the identification of some specific tumor rejection antigens presented to specific CTLs could provide new therapeutic approaches.
BCG Vaccine↗
Invasion of Denonvilliers' fascia in radical prostatectomy specimens.
Denonvilliers' fascia consists of a single fibromuscular structure covering the posterior aspect of the prostate and surrounding the seminal vesicles. This structure has multiple layers that are fused together, and to the stroma of the prostate and seminal vesicles. A separate posterior layer of Denonvilliers' fascia was not seen during radical prostatectomy. The cleavable interprostatorectal plane extends posteriorly throughout the thickness of Denonvilliers' fascia and anteriorly to the muscular wall of the rectum. Medially this fascia is fused with the prostatic capsule into a single sheath and contains thick smooth muscle bundles in continuity with the prostatic stroma. In a series of 243 radical prostatectomy specimens for prostate cancer, we studied the morphological relationship of Denonvilliers' fascia with the prostatic capsule and stroma, and traced the progression of prostatic cancer in relation to the anatomical landmarks. In 19% of the cases tumor was found progressing within Denonvilliers' fascia, in the medial posterior area of the prostate, unrelated to perineural space invasion. For specimens with an intracapsular cancer volume of less than 12 cc, which may be cured by radical prostatectomy alone, the frequency of invasion of Denonvilliers' fascia was 13%. In these cases cephalad progression of cancer was seen almost exclusively in Denonvilliers' fascia overlying the central zone at the prostate base and surrounding the seminal vesicles. Invasion of Denonvilliers' fascia can lead to positive surgical margins if complete excision of this fascia is not performed during radical prostatectomy. Even among large tumors in our series there were no cases of tumor invasion completely through the full thickness of Denonvilliers' fascia at the posterior medial area and, therefore, rectal wall invasion was never suspected at this level.
Adenocarcinoma↗
Extraperitoneal endosurgical lymphadenectomy with insufflation in the staging of bladder and prostate cancer.
A new technique of endosurgical pelvic lymph node dissection was performed for the staging of 10 prostate and 8 bladder cancers. The technique, involving an exclusive extraperitoneal space development with CO2 insufflation, is described in detail. Using the standard endosurgical (laparoscopic) equipment, we performed a complete bilateral ilio-obturator lymph node dissection in 15 patients (83%). In the remaining three patients, because of technical difficulties, only unilateral dissection was performed. The average operating time was 84 minutes. Morbidity was low (one instance of sepsis). Prospective assessment of CO2 homeostasis showed that arterial CO2 pressure (PaCO2) increased significantly but could be controlled by increasing minute ventilation output. Our results show that perioperative assessment of end-tidal CO2 partial pressure is necessary and sufficient for the adaptation of minute ventilation output. Two patients with prostate cancer had positive nodes. No intraoperative or postoperative morbidity related to the procedure was observed in patients submitted to radical surgery. Extraperitoneal endosurgical pelvic lymphadenectomy with CO2 insufflation is a rapid, safe, and effective method in the staging of urologic pelvic malignancies and represents an alternative to traditional open surgery as well as to conventional transperitoneal laparoscopic lymphadenectomy.
Carbon Dioxide↗
Occupational risks of bladder cancer in France: a multicentre case-control study.
The relationships between occupational risk factors in France and bladder cancer were assessed from a hospital-based case-control study conducted between 1984 and 1987 in five regions representing various industries, including mining, textile manufacture, metallurgy and the production of rubber and chemicals. The study concerned 765 cases (658 men and 107 women) and the same number of controls. Odds ratios (OR) adjusted for matching variables (age, place of residence and hospital), and tobacco smoking were estimated by unconditional logistic regression. A significantly increased risk of bladder cancer was observed among men employed in coal mining (OR = 2.42; 95% confidence interval (Cl) : 1.25-4.67) and the chemicals industry (OR = 2.36; 95% Cl : 1.23-4.53). Aircraft and ship's officers (OR = 11.8; 95% Cl : 1.46-95.7), managers (OR = 1.64; 95% Cl : 1.11-2.43) and street vendors (OR = 3.60; 95% Cl : 1.15-11.3) also had an increased risk. Among women, employment in the clothing industry was associated with a high OR (= 3.21; 95% Cl : 1.34-7.71). Assessment of individual exposures by a panel of industrial hygiene experts showed that significantly more cases than controls had been exposed to the following substances: chlorinated solvents (OR = 1.86; 95% Cl : 1.19-2.90), industrial oils and greases (OR = 1.44; 95% Cl : 1.10-1.89), welding fumes (OR = 1.40; 95% Cl : 0.98-2.01), coal dust (OR = 1.71; 95% Cl : 1.02-2.89) and metallic oxide dust (OR = 2.99; 95% Cl : 1.12-8.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Nonsteroidal antiandrogen monotherapy of metastatic cancer of the prostate.
The use of nonsteroidal antiandrogens as first-line therapy for the treatment of cancer of the prostate is discussed. The results of studies using flutamide as monotherapy are reviewed and show flutamide to be an effective agent in the treatment of metastatic prostate cancer. Comparative studies have shown that flutamide monotherapy is as effective as standard hormonal treatment, with no difference in the two treatments. In one study, treatment with diethylstilbestrol was found to be superior to flutamide in terms of survival. Further studies are required before the use of pure antiandrogen monotherapy can be recommended for the treatment of metastatic prostate cancer.
Androgen Antagonists↗
[Urodynamic ultrasonography in the management of urinary disorders in women].
The authors report the preliminary results of a study on the use of perineal sonography with a vaginal probe as a complement to urodynamic investigation, in patients with stress urinary incontinence or other urinary symptoms. This technique seems useful especially in stress urinary incontinence to precise the existence and the importance of bladder neck hypermobility, and in the evaluation of post-opérative outcome after surgical suspension of the bladder neck.
Female↗
[Complications of prostatic biopsy. An analysis of a series of 4764 biopsies].
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Anti-Bacterial Agents↗
[Sub-urethral diverticulum in women. Apropos of 6 cases].
Six female patients with a mean age of 40 years presenting with a suburethral diverticulum were treated between August 1990 and October 1992. The commonest functional symptoms were recurrent urinary tract infections (2/3 of cases) and post-voiding urethral discharge (1/2 of cases). Clinical examination revealed a tender anterior vaginal mass in only one half of cases. Only retrograde and voiding cystourethrography and transvaginal ultrasonography always demonstrated a direct or indirect image of the diverticulum. The suburethral diverticulum was resected via a transvaginal approach in the ventral supine position after sterilisation of the urine by prolonged antibiotic therapy. Urine drainage was generally ensured by a suprapubic catheter allowing antegrade cystography on the 15th day, prior to clamping then removal of the catheter. All but one of the patients immediately regained satisfactory micturition without dysuria or stress incontinence. Restoration of micturition was delayed in one patient with feelings of incomplete bladder emptying, but she urinated normally at three months. Postoperative imaging (retrograde and voiding cystourethrography, transvaginal ultrasonography) demonstrated resolution of the diverticulum in 5 cases. One patient had persistent signs of a small, residual diverticulum on antegrade cystography on the 15th day. Suburethral diverticulum is a rare disease of middle-aged women for which transvaginal surgical excision in the ventral supine position gives very good results.
Adult↗