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Biomedical subjects

L Boccon-Gibod

Publications and source records attributed to L Boccon-Gibod.

At least 163 records · Page 9Linked to original sources
PubMed1993

[Urinary lithiasis and pregnancy].

The incidence of renal stones in pregnant women is 1 in 1500. The diagnosis may be made more difficult by the particular anatomo-physiological conditions of pregnancy. Ultrasonography is not always sufficient to localise the stone and can be completed by intravenous urography, which is not contraindicated in pregnant women. In more than one half of cases, the stones are eliminated spontaneously during conservative treatment. The urologist may need to intervene in the case of complicated stones: internal or external urinary diversion is generally sufficient to palliate the problem until term. As extracorporeal lithotripsy is contraindicated in pregnant women, some authors recommend ureteroscopy or percutaneous nephrolithotomy when radical treatment is required. Surgical treatment is very rarely indicated.

Cystoscopy↗
PubMed1993

[Treatment of sexual impotency by intra-cavernous injections of prostaglandin E1. Report of 180 patients].

As already reported, PGE1 induces a valid erection, when administered intracavernously, without causing prolonged erection or general side effects. We have tested PGE1 (< 20 micrograms) in 180 patients suffering from organic erectile impotence, a complete erection was observed in 130 (72.2%), while incomplete erection was noted in 37 (20.5%). In both groups (92.7%) erection was sufficient for sexual intercourse. Among the best results, 41 patients had previously received high doses intracavernous injection of papaverine, without any benefit, and 15 patients have cavernosal venous leakage documented by cavernosometry and cavernosography before prostaglandin E1 test. Tumescence without rigidity was noted in 13 (7.2%). Of these 167 patients, 95 entered an autoinjection protocol for treatment of erectile dysfunction, using special device. In our series neither systemic reaction nor prolonged erection occurred. No fibrosis of cavernous tissue or scar formation was observed after up to 125 injections. However, 19 patients (10.5%) reported burning sensations during the entire period of erection and one patient (0.5%) had an haematoma at the site of the injection. PGE1 is effective in inducing artificial penile erection and it has a role in the diagnosis and treatment of erectile dysfunction, it is considered to be a more suitable agent than other vasoactive drugs.

Adult↗
PubMed1993

[Intravesical instillations of BCG and bladder carcinoma in situ].

32 patients with bladder carcinoma in situ (CIS) were treated by intravesical instillations of BCG immun F Pasteur between 1988 and 1991. The CIS was isolated (13 cases, 40.6%) or associated with a pTa papillary tumour (10 cases, 31.2%), pT1 tumour (8 cases, 25.1%) or pT2 tumour (1 case, 3.1%). The protocol consisted of a series of weekly instillations of 150 mg of BCG for 6 weeks, repeated once in the case of persistent lesions on the first endoscopic follow-up examination. Patients were reviewed in the outpatients department every 3 months for 1 year, then every 6 months for 2 years in the absence of recurrence. Follow-up consisted of clinical examination, urine cytology and histology. The overall success rate, defined by complete resolution of the cytological and histological lesions for the total population was 81.25% (25/32) with a mean follow-up of 22.5 months. 18.75% (6/32) of cases were considered to be failures. Complications of treatment were observed in 59% of patients, but only required discontinuation of instillations in five patients (15.6%). In conclusion, intravesical BCG is the treatment of choice of bladder carcinoma in situ in the absence of detrusor invasion and contraindications to BCG.

Administration, Intravesical↗
PubMed1993

[Posterior vertical lumbar approach in the treatment of pyelo-ureteral junction syndromes in the adult].

Posterior vertical lumbar incision is an alternative incision for the treatment of hydronephrosis due to ureteropelvic junction anomaly in adults. The authors have performed 18 pyeloplasties via this incision in adults between the ages of 19 and 72 years (mean 36 years). The results of pyeloplasty (88% success rate) were comparable to those obtained via other incisions. The operating time varied between 50 and 110 minutes (mean: 75 minutes) and the mean hospital stay was of the order of one week. The morbidity was low and essentially consisted of parietal complications such as hypoaesthesia or hypotonia. The technique is simple to perform provided the contraindications, especially those related to patient anatomy, are respected.

Adult↗
PubMed1993

[Is the urodynamic assessment of enuresis in young adults justified?].

Primary or secondary nocturnal enuresis in adults (over the age of 15 years) is rare, but is associated with considerable psychosocial repercussions. The aim of this retrospective study was to determine whether urodynamic studies have any predictive value for the efficacy of the treatments proposed in these patients. This study was based on 20 patients (8 females and 12 males) between the ages of 15 and 33 years (mean: 23.75 years), studied between 1982 and 1990 with a mean follow-up of 13.35 months. Enuresis was primary in 12 patients and secondary in 8 patients. 11 patients had already received one or more treatments without success. Patients with clinically obvious neurological disease were excluded from the study. The urodynamic assessment included water cystomanometry, water urethromanometry with a perfused catheter and uroflowmetry. In addition to the investigation of other associated disturbances of micturition, the following complementary investigations were performed: urine culture in every case, IVU and/or cystography (n = 18), cystoscopy (n = 3), renal and vesical ultrasonography (n = 1). The urodynamic assessment was abnormal in 16 out of 20 cases: marked detrusor hyperactivity (n = 15), impaired compliance (n = 6), significant urethral instability (n = 7), isolated premature urge (n = 1). 15 patients presented with diurnal disorders dominated by frequency (n = 13), urgency (n = 9) and urge incontinence (n = 4); detrusor hyperactivity was detected in every case. The abnormalities observed on the urodynamic assessment guided treatment, allowing correction of enuresis in 3/4 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Color echo-doppler of the ureterovesical stream. Normal aspects. Application to the acute ureteral obstruction].

A colour Doppler ultrasound study of the ureterovesical was performed to define the normal features, variants and abnormalities of the ureteric stream by comparing 50 normal subjects and 19 subjects with renal colic due to ureteric stones. The examination included assessment of the frequency, intensity, morphology and symmetry of the ureterovesical stream. In normal subjects, the stream was either absent, especially in the case of fluid restriction (36%), present and symmetrical (34%) or asymmetrical (30%). In patients with ureteric stones, during a non-painful period and in the absence of obstruction on IVU, the stream was normal and symmetrical (9%) while during a painful period with obstruction on IVU, the ureteric stream was either absent (47%) or abnormal and asymmetrical (31%). A continuous stream, very suggestive of obstruction, was observed in 5 cases. Colour Doppler ultrasound is a new, simple method which may be helpful in the diagnosis of renal colic, particularly in cases in which the pyelocaliceal cavities are not dilated.

Acute Disease↗
PubMed1993

[Computerization in private urologic practice with multiple practice locations: the use of medical software and a portable microcomputer].

The authors have used a medical programme, Medistory, since June 1990 to computerize a private urological practice. This programme allows personalization of data collection adapted to urology: interview sheets related to the disease, standard report forms, edition of letters, creation of a multi-entry file and entering of accounts. The consultation was always held without a paper support with real-time data acquisition and the accounting was performed at the end of the visit. Letters were printed separately at home, at the end of the day, so as not to delay the patient. A back-up was performed every second day on hard disk. We used a portable Macintosh with 20 mega octets of REM and a 40 mega octet internal hard disk as our practice is based at several sites. This computerisation benefited from the Macintosh interface which facilitated learning and use of the programme. No time loss and no patient discomfort were recorded in comparison with a conventional consultation. The possibility of opening several files at the same time allowed a simple reply to any demands for other information. Two files out of 700 were lost (0.3%) due to an error when saving data. No accounting errors were detected. The use of a medical programme is particularly well adapted to private urological practice with multiple offices. The advantages of a personal computer include the gain of place, rapidity, unlimited storage capacity and the possibility of recovering data with other standard programmes. Medistory, a programme created for general practitioners, is perfectly adapted to this use due to the ease of personalization allowing the creation of interview sheets related to the disease and the edition of reports and various letters.

Computer Security↗
PubMed1992

[Risk factors for tumors of the bladder. Epidemiological study of 701 patients in Ile-de-France].

The authors present the results of an investigation conducted, under the aegis of the PETRI association, on 701 patients living in the Paris region who, over a 1-year period, had asked the medical advisers of the Social Security Sickness Benefits department to dispense them from paying their portion of the cost of treatment on the ground that they had cancer of the bladder*. The purposes of the investigation were to obtain accurate data concerning the role played by tobacco and alcohol abuse in bladder cancer and to look for possible occupational exposures. The smoking and drinking habits of 636 patients could be analyzed: 89 percent of the men were, or had been, smokers with an average consumption of 33 packs per annum, and with a frequent overconsumption of alcoholic drinks. The professional cursus of 665 patients (31 percent active, 64 percent retired) could be established. The study confirmed that tobacco smoking and alcohol abuse, as well as certain occupational factors, play a role in the development of bladder cancer. Some professional sectors, such as the plastic industry or the hide and leather work, were better represented among these patients than would have been expected from their distribution in the active population. Surveillance of the population exposed by industrial doctors, and follow-up of people who have retired from some sectors of activity are as essential as anti-smoking campaigns.

Adult↗
PubMed1992

Ureterorectal diversion with rectal augmentation. Morphological and manometric study in the dog.

Uretersigmoidostomy in the adult has progressively been abandoned because of its high complication rate (both metabolic and functional). We have studied the feasibility of a new model of ureterorectal diversion in 12 Beagle dogs, with the aim of increasing rectal capacity and decreasing rectal pressure. A segment of the ileum was isolated and opened along its antimesenteric border to obtain a patch into which the right ureter was implanted, the left ureter being left intact to allow comparison of the kidneys postoperatively. The patch was then sutured to the edges of a large anterior rectotomy. Modifications of rectal physiology were studied by recording the rectal pressure after distension by a latex balloon both preoperatively and 3 months postoperatively, so that it was possible to evaluate the elasticity of the rectal wall. Radiographic studies and examination of autopsy specimens after 3 months yielded the impression of a reservoir added to the rectal space. Intrarectal pressure was significantly decreased (50% of the preoperative value) for a given distension volume following rectal augmentation (P less than 0.01). The elasticity of the rectal wall was not modified but the capacity of the reservoir was increased. The ureteroileal implantation was patent in two of the five evaluable dogs out of seven implantations performed. In these cases, signs of pyelonephritis were found in the right kidneys. In the remaining cases the implantation became obstructed for reasons mainly related to canine anatomy and experimental conditions. These technical difficulties in the dog make it impossible to assess the quality of this reimplantation technique in this model.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Advantage of systematic random ultrasound-guided biopsies, measurement of serum prostate-specific antigen level and determination of prostate volume in the early diagnosis of prostate cancer.

Two hundred and sixteen patients, presenting with a suspicious digital examination (stage T3 excluded) or a level of prostate-specific antigen (PSA) greater than or equal to 2.5 ng/ml, assessed by radioimmunoassay, underwent a transrectal ultrasound examination. Prostate volume was systematically calculated and correlated to PSA level. Biopsies were performed: (1) on suspicious peripheral hypoechoic areas; ultrasound-guided biopsies; (2) systematically on the 2 prostate lobes, whatever the result of transrectal ultrasound imaging:random systematic ultrasound-guided biopsies. In the 186 patients who had never undergone prostate surgery, ultrasound-guided biopsies showed 42 prostate cancers and random systematic ultrasound-guided biopsies showed 75; 14 of the 76 patients with normal digital rectal examination and transrectal ultrasound imaging had a prostate cancer. In the 30 patients who had previously undergone surgery for benign prostatic hypertrophy, random systematic ultrasound-guided biopsies showed 18 prostate cancers, 13% more than ultrasound-guided biopsies; 75% of patients with a serum PSA greater than 5 ng/ml had a prostate cancer. A very significant correlation was found between PSA level and prostatic volume (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1992

[Uretero-rectal diversion with rectal enlargement. Clinical results].

In some patients, after total cystectomy, the urethra cannot be used, preventing the creation of a replacement enterocystoplasty. In these cases, ureterocolonic or ureterorectal diversion constitutes an alternative to cutaneous diversion if its classical complications could be minimized. A ureterorectal diversion technique with rectal enlargement was performed in 6 patients: a segment of small intestine was raised, opened along its antimesenteric border, folded into a U-shape and sutured to the edges of a large rectotomy. The ureters were implanted into this patch of small intestine according to the mucosal tunnel technique. This technique was used in 4 men after total cystectomy with invasion of the prostatic urethra by their bladder tumour and in 2 women for incontinence due to sphincter destruction who refused cutaneous diversion. There was no mortality in this series. The postoperative complications consisted one prolonged but resolving fever in 2 cases. Out of 12 ureteric units, 4 cases of severe stenosis had to be reoperated and 3 cases of moderate stenosis were observed. All patients were continent during the day except for one women who complained of incontinence when changing positions. All patients were continent at night and had to get up to urinate twice. This preliminary experience shows that rectal enlargement as part of a ureterorectal diversion is followed by very satisfactory functional results. The creation of a colorectal invagination valve to prevent metabolic disturbances does not appear to be necessary. The ureteric implantation technique in the mucosal tunnel should be abandoned in favour of a procedure using an ileal tube interposed between the ureters and the rectum.

Female↗
PubMed1992

[Extraperitoneal endoscopic lymph node dissection with insufflation in the staging of bladder and prostate cancer].

Endoscopic pelvic lymph node dissection was performed in 30 patients as part of the staging of prostate (19) or bladder (11) cancers. The technique, using a procedure of detachment of the retroperitoneal space with CO2 insufflation, is described. Complete bilateral dissection of the ilio-obturator lymph nodes was performed in 24 patients (80%) using conventional laparoscopic surgical equipment. Only a unilateral dissection could be performed in 6 other patients because of technical difficulties. The mean operating time was 72 minutes. The intraoperative and postoperative complications consisted of 2 venous injuries and one infection. A prospective study of systemic diffusion of CO2 demonstrated that the blood Co2 level increased significantly during the procedure, but could be controlled by adaptation of the ventilation. Postoperative monitoring of blood CO2 levels using a capnograph is recommended. 4 out of 30 patients (13%), 2 with prostate cancer and 2 with bladder cancer, had lymph node metastases. Amongst the other 26 patients, 12 were treated by radiotherapy (bladder cancer), 12 patients underwent perineal prostatectomy and 12 others underwent retropubic prostatectomy (5) or prostatocystectomy (7]). No intraoperative and postoperative morbidity related to endoscopic lymph node dissection was observed in the patients subsequently undergoing a radical operation. Endoscopic retroperitoneal lymph node dissection with CO2 insufflation is a rapid, safe and effective technique for staging of malignant pelvic tumours and constitutes an alternative to open surgery and to endoscopic transperitoneal surgery.

Endoscopy↗
PubMed1992

[Penile endoscopy: technique, results].

The authors report their experience based on 200 consecutive examinations. Peniscopy is an outpatient examination of the penis using a magnification system: commercial magnifying glass or colposcope. It consists of examining the whole penis in detail with the naked eue and then with a magnitification system after application of 5% acetic acid to the glans and prepuce in order to identify subclinical lesions. Biopsies can be performed when necessary. Three basic types of lesions may be observed: concylomas, macules, papules. However, the signs of mucocutaneous lesions are difficult to interpret, especially when they are subclinical. There are 2 types of false lesions: physiological papules of the corona of the glans and a diffuse acidophilic reaction. Topical treatment or laser destruction of the lesions can be performed at the same time as the examination, when necessary. The current indications for this technique are discussed. When learning this technique, the authors recommend the extensive use of biopsies and training with an experienced examiner.

Humans↗
PubMed1992

[Rhabdoid tumor of the kidney].

The clinical and pathological features of a rhabdoid tumor of the kidney in a 4 month boy are presented. The precise diagnostic criteria (light and electron microscopy, immunohistochemistry) of this rare and usually unresponsive and rapidly fatal tumor are underlined.

Humans↗
PubMed1992

[Atypical congenital mesoblastic nephroma (atypical Bolande's tumor)].

A case of atypical or cellular variant of mesoblastic nephroma is reported. This rare tumor, variant of the classical congenital mesoblastic nephroma, described in 1967 by Bolande, has no pejorative prognostic significance in the child under 3 months. It must be distinguished from the highly aggressive clear cell sarcoma of the kidney.

Female↗
PubMed1992

[Neurectodermal malignant tumor of the soft tissues after treatment with immunosuppressive agents of lipoid nephrosis].

Immunosuppressive drugs are known to increase the risk of inducing neoplasia, especially acute leukaemia when high doses are used. A case of nephrosis in a 10 year-old boy treated with chlormethine (cumulative dose: 0.8 mg/kg) and chlorambucil (cumulative dose: 10 mg/kg) is reported. Four years after the beginning of the treatment an extraskeletal Ewing's sarcoma occurred. Since the review of literature failed to find any malignancy induced by such an immunosuppressive treatment for nephrosis, the question whether or not this extraskeletal Ewing's sarcoma was attributable to this treatment remains unanswered.

Adrenal Cortex Hormones↗