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L Cormier

Publications and source records attributed to L Cormier.

At least 19 recordsLinked to original sources
PubMed2003

[Advantages of using robotic Da Vinci system for unilateral adrenalectomy: early results].

STUDY AIM: The goal of this study was to report the early results of unilateral transperitoneal adrenalectomy using robotic Da Vinci system, and to compare them to the results of the laparoscopic standard adrenalectomy. METHODS: Prospective study included all patients operated on for unilateral laparoscopic or robotic adrenalectomy from November 2000 to November 2002. RESULTS: Twenty-eight patients underwent unilateral adrenalectomy using either standard laparoscopy (14 patients) or robotic Da Vinci system (14 patients). Mean duration of robotic adrenalectomy seemed to be longer than standard laparoscopy (111 vs. 83 min; P = 0.057). This tendency decreased while surgeons' experience was increasing. Mean duration of operating room activity was similar for both types of surgery. Peroperative events without conversion, conversion rate (7%), drainage, morbidity (21%), duration of hospitalisation were similar for both types of surgery. Duration of standard laparoscopic adrenalectomy was positively correlated to patients body mass index. This correlation was absent in patients operated on by robotic Da Vinci system. CONCLUSION: This preliminary study found no objective data demonstrating that robotic Da Vinci system was superior to standard laparoscopic approach for unilateral adrenalectomy. However, we think that it is necessary to continue further evaluation of this system to demonstrate its possible superiority.

Adrenalectomy↗
PubMed2003

Urinary morbidity after 125I brachytherapy of the prostate.

OBJECTIVE: To assess urinary morbidity within the first 6 months after transperineal prostate brachytherapy (TPBT) with 125I for localized prostate adenocarcinoma. PATIENTS AND METHODS: Between September 2000 and July 2001, 50 consecutive patients with favourable early-stage prostate cancer were treated with TPBT. Clinical and objective investigations, including uroflowmetry and postvoid residual urine measurements, were evaluated for short-term urinary morbidity; predictive factors were also sought. RESULTS: Thirty-eight (76%) patients developed urinary disorders, but severe urinary complications were exceptional. The International Prostate Symptom Score (IPSS) changed significantly during the first and third month after implantation and then improved during the sixth month. Concomitantly, the maximum and the average urinary flow rate deteriorated significantly. The variations in postvoid residual were less significant. An initial IPSS of > 8 and previous alpha-blocker treatment were identified as significant predictive factors of urinary morbidity, as were the TPBT dose received by 90% of the target volume and by 30% of the urethra, and the volume of prostate receiving 144 Gy. CONCLUSION: Urinary morbidity after TPBT is frequent but rarely exceptionally severe; patients must therefore be given full information. Patients with a higher initial IPSS or having had previous alpha-blocker treatment, with their associated dosimetric factors, are at greater risk of these urinary morbidity.

Adenocarcinoma↗
PubMed2002

[Usefulness of intraoperative 123I-MIBG during reoperation for malignant pheochromocytoma: a case report].

Intraoperative MIBG radionuclear scanning has been used to improve pathological foci localization and surgical accuracy in patients with neural crest derived tumors. This intraoperative detection has been reported in less than 10 patients during reoperation for pheochromocytoma. We report a case of 123I-MIBG intraoperative detection allowing to improve surgical resection quality during reoperation for pheochromocytoma. The use of intraoperative MIBG radionuclear scanning is helpful when reoperation for pheochromocytoma is performed.

3-Iodobenzylguanidine↗
PubMed2002

[Does the size of pheochromocytoma influence the results of its laparoscopic excision?].

BACKGROUND: The tumor size is considered as a limitation for laparoscopic adrenalectomy. The aim of this study was to assess diagnostic characteristics, hemodynamic modifications, and outcome of intraperitoneal laparoscopic adrenalectomy according to the size of pheochromocytoma. METHODS: Retrospective study from January 1997 to December 2000. Results were evaluated according to the size of pathologic study (< or > or = 5 cm). RESULTS: Forty two patients underwent laparoscopic adrenalectomy during this period. Among them, 11 (26%) were operated on for adrenal pheochromocytoma (6 patients < 5 cm and 5 patients > or = 5 cm). Preoperative systolic hypertension was 138 mmHg and 178 mmHg respectively (p = 0.01). Urinary metanephrine/normetanephrine rate was 1.259 and 0.268 respectively (p = 0.08). Capsular tumor effraction rate was 27%. Tumor size was 37% larger than that estimated by CT scan (24% versus 52%). Mean hospital stay was 10 days and 8 days respectively. Morbidity and mortality were 18% and 0%. All these criteria were not statistically significant among the two groups of patients. CONCLUSIONS: Pheochromocytoma size > or = 5 cm do not modify outcome of patients but is responsible for preferential noradrenaline secretion and stronger hemodynamic modifications. Tumor fragmentation rate and CT scan size underestimation seem important in this group of patients. These characteristics have to be integrated to improve laparoscopic adrenalectomy outcome of patients with pheochromocytoma > or = 5 cm.

Adrenal Gland Neoplasms↗
PubMed2002

[Acute urinary complications after prostate iodine-125 brachytherapy: evaluation and risk factors].

PURPOSE: Evaluation of acute urinary toxicity following prostate Iodine-125 brachytherapy and determination of risk factors. PATIENTS AND METHODS: Between September 2000 and July 2001, 50 men were entered into the study. A clinical follow-up accompanied by an objective measurement of urinary morbidity, including uroflowmetry and post-void residue, enabled the evaluation of acute toxicity before and then at one, three and six months of the implantation. Predictors were also searched for. RESULTS: 38 (76%) patients developed urinary disorders but those remained minor or moderate. The IPSS, as well as uroflowmetry deteriorated significantly at the first and third month post-implant, before improving during the sixth month. Besides, the variations of the post-void residue were less significant. Concerning the factors of risk, an initial IPSS superior to eight and a prior alpha-blocker treatment were the preoperative identified risk factors. Regarding dosimetric parameters, preoperative U30 and postoperative D90, D95, V100, V150 and V200 were identified. CONCLUSION: Though remaining minor or moderate, the great frequency of acute urinary toxicity following prostate brachytherapy requires frank and open dialogue with the patient in conjunction with an evaluation of the urinary status before implantation Patients with higher initial IPSS or having required a prior alpha-blocker treatment are more exposed to these disorders and their correlated postoperative dosimetric factors.

Acute Disease↗
PubMed2001

[Ischemia of a transplanted kidney and hyperlactatemia].

The authors report four cases of patients presenting with hyperlactatemia following renal transplantation. The post-transplantation course of three patients who underwent renal transplantation was complicated by occult haemorrhage. Excessive blood loss was not evident, the patients were haemodynamically stable and their blood pressure, pulse rare and filling pressure (central venous pressure) were unremarkable. Late examinations revealed an early increase in arterial lactate concentrations a non-aniograp acidosis or lactic acidaemia occurred. Surgical decompression was carried on in all patients. An increase in the intraabdominal pressure might have caused renal impairment in the absence of haemodynamic disturbance, and retroperitoneal haematoma a change in the distribution of intrarenal blood flow. Another patient developed a partial renal venous thrombosis associated with hyperlactatemia. During this re-operation, a renal lactate production was measured. The renal cortex is a site of lactate clearance. Impaired renal perfusion should result in decreased lactate clearance and when the kidney is hypoperfused a lactate production was occur. In the absence of any signs of clinical shock, patient at risk of retroperitoneal haematoma or presenting with oliguria should benefit from lactate measurements, which could help diagnosing severe hypoperfusion of the graft.

Adult↗
PubMed2001

[Kidney cooling during multi-organ harvesting. Descriptive study].

OBJECTIVE: To describe kidney cooling during multi-organ harvesting (MOH) from brain-dead donors and to evaluate harvesting practices. MATERIAL AND METHOD: The temperature of 12 kidneys (6 left and 6 right kidneys) was monitored continuously during MOH from brain-dead donors. After in situ cooling, the kidneys were separated on the table and washed for several minutes with UW preservation solution. The kidney temperature was studied as a function of the main phases of the operative procedure. RESULTS: The mean minimum kidney temperature of 10.8 degrees C (3.7 degrees C to 16.6 degrees C) was reached at the beginning of mobilization of the liver, i.e. an average of 20 minutes (13 to 37 min) after cannulation. The mean cooling rate was 1.37 degrees C/min (0.73 to 2.19 degrees C/min). The mean temperature of the UW cooling solution was 9.4 degrees C (3.8 degrees C to 14 degrees C). For hepatic followed by renal dissection, the kidneys slowly reheated at a mean rate of 0.20 degree C/min (0.12 to 0.37 degree C/min) to reach a mean temperature of 21 degrees C (13.5 degrees C to 26.3 degrees C) at the time of resection. The mean kidney temperature at the time of placement in the container was 17.5 degrees C (13.2 degrees C to 22 degrees C). CONCLUSION: The course of kidney temperature during MOH has not been previously described. This study, performed under usual harvesting conditions, demonstrated sometimes imperfect cooling that could be harmful to he kidneys, but which could be improved by simple measures: rapid dissection of the liver and kidneys and correct application of contact cooling.

Adolescent↗
PubMed2000

[Severe chronic renal failure subsequent to acute pyelonephritis in alcoholic patients].

BACKGROUND: Chronic alcoholism and malnutrition are uncommon causes of complicated acute pyelonephritis (APN). CASE REPORTS: Since 1997, we have seen 5 patients with chronic alcoholism (3 women and 2 men, mean age 53.4 +/- 13 years) without cirrhosis, diabetes or renal failure who developed severe APN in a state of malnutrition (albumin 22 +/- 3 g/l, total cholesterol 0.86 +/- 0.2 g/l). Diagnosis was made 14.6 +/- 9 days after onset of atypical symptoms which the patients neglected. There was a major bacterial inoculum: Escherichia coli 10(6.2 +/- 2) (3 multisusceptible and 2 amoxicillin-resistant strains); positive blood cultures in 3 cases. The imaging study showed bilateral diffuse lesions with focal swelling and kidney enlargement, without obstacle, abscess, or papillary necrosis. All patients had severe acute renal failure (maximum serum creatinine: 582 +/- 210 mumol/l; 3 patients underwent dialysis). Mean duration of antibiotic therapy was 40 +/- 7 days (i.v.: 22 +/- 3 d). Renal scarring occurred since creatinine clearance was 33 +/- 22 ml/min 2 months after the initial episode. One patient progressed to end-stage renal failure. CONCLUSION: In malnourished alcoholic patients, APN may be unusually severe due to late diagnosis leading to the risk of irreversible renal damage and severe chronic renal failure.

Acute Disease↗
PubMed2000

Successful surgical thrombectomy of renal allograft vein thrombosis in the early postoperative period.

We report the successful surgical treatment of two cases of renal vein thrombosis, each occurring early after kidney transplantation. Prompt intervention was a result of accurate diagnosis by color Doppler ultrasonography. Invasive radiological procedures were not useful. Although recent advances in thrombolytic therapy have created several alternatives to open surgery, the rationale for surgical exploration in these cases was to remove the thrombus quickly, to avoid the postoperative bleeding complications of thrombolytic therapy, and to correct any technical or anatomic problems.

Adult↗
PubMed1998

Treatment of end-stage renal failure after heart transplantation.

BACKGROUND: Five to 10% of heart-transplant recipients develop end-stage renal failure (ESRF). Little is known about the outcome of these patients under renal replacement therapy. METHODS: We conducted a retrospective study in 16 men (mean age 52.8+/-7.4 years at heart transplantation) who developed ESRF 5.3+/-2.1 years later. Results. Haemodialysis (HD) was the first-line treatment (mean Kt/V 1.35+/-0.4). Vascular access was unsuccessful in six patients (37.5%) due to peripheral arteriopathy and they were treated with tunnelled catheters for an average 15 months without bacterial infection. Mean weight was 68.4+/-10 kg at onset of HD and 61.7+/-9 kg one month later. Despite this reduction in extracellular overload, one antihypertensive drug was required in 75% of patients and two drugs in 12.5%. One patient tolerated automated peritoneal dialysis (PD) for 16 months (weekly Kt/V 2.1) despite persistent anuria. Renal transplantation (RT) was contraindicated in eight patients because of aortoiliac arteriopathy (n=5), poor general status (n=2), or ischaemic heart disease (n=1). RT was performed in eight patients with no acute episode of heart or renal graft rejection. There were no serious infectious complications. Three months after RT, mean serum creatinine was 115 micromol/l. One patient developed post-transplant lymphoproliferative disorder 3.5 months after RT and was successfully treated with transplant nephrectomy. Sudden death occurred in two patients 18 and 33 months after RT. Overall patient survival was 100, 78, and 59%, 1, 2 and 3 years after HD onset respectively. Using a time-dependent variable, the Cox model analysis demonstrated that heart-transplant recipients with ESRF have a relative risk of death 3.2 times higher than those without ESRF (95% CI = 1.3-7.8). CONCLUSIONS: HD, PD, and RT can be useful for the treatment of ESRF after heart transplantation. After initiating HD, patient survival is nearly the same as that reported in patients in Europe undergoing HD for other causes. But ESRF seems to reduce life expectancy in heart-transplant recipients.

Adult↗
PubMed1998

[Should we screen for prostate cancer?].

The controversy concerning the justification for prostatic cancer screening is now about ten years old. It is the consequence of several convergent phenomena: the routine use of new diagnostic tools such as prostate specific antigen, ageing of Western populations, increased life expectancy and finally public health economic aspects. Is screening justified before the age of 50 years? The answer is no, except in high-risk families with several cases of prostatic cancer, in which screening should be started at the age of 40 years. Is screening justified after the age of 70 years? The answer is no, except in men between 70 and 75 years whose general state and physiological age suggest that they have a life expectancy exceeding ten years. Is screening justified between 50 and 70 years? There is no global "medico-economic" answer to this question, as medical truth, i.e. the individual's interests, appears to be diametrically opposed to economic truth, i.e. the community's interests, due to the high cost of screening. How can screening be envisaged for the future? In families with no particular risk, screening should be clinical, but will probably start earlier and will continue later, because of the improvement of diagnostic tools and prolongation of life expectancy. In high-risk families, the development of genetic tests will be able to determine whether or not a man has inherited predisposition genes. If he has inherited these genes, he will then be submitted to particularly early, meticulous and repeated screening.

Age Factors↗
PubMed1998

[Renal harvesting from donors in cardiac arrest: report of 3 cases and surgical technique].

During periods of transplant organ shortage, techniques designed to "salvage" transplants must be developed. The authors report three cases of renal harvesting from donors in cardiac arrest, in which the use of in situ perfusion-cooling with transfemoral introduction of Gillot's catheter resulted in six good quality transplants. The indications, surgical technique, alternatives and results are discussed.

Adult↗
PubMed1998

[Which is the best performing imaging method for demonstrating residual renal calculi?].

OBJECTIVES: To compare the results of plain abdominal films, tomography, ultrasonography and spiral computed tomography in the detection of residual stone fragments after extracorporeal lithotripsy or percutaneous nephrolithotomy. MATERIAL AND METHODS: Prospective study on 31 patients and 40 renal units comparing the results obtained by plain abdominal films, tomography, ultrasonography and spiral CT. RESULTS: This study demonstrates the superiority of spiral CT over the other examinations for detection of renal stones (sensitivity of 100% for spiral CT, 89.2% for tomography, 82.1% for plain abdominal films and 67.8% for ultrasonography), determination of their number (n = 68, 58, 60 and 27, respectively) and demonstration of millimetric stones (100%, 69.4%, 67.8% and 2.7%, respectively). CONCLUSION: Spiral CT is the method of renal stone imaging which provides the most reliable diagnosis of radiopaque, non radiopaque, millimetric or centimetric stones, regardless of local anatomical conditions.

Adult↗
PubMed1997

Three-dimensional CT-scan reconstruction of renal calculi. A new tool for mapping-out staghorn calculi and follow-up of radiolucent stones.

OBJECTIVES: The development of CT scanners (CT scan) with continuous rapid spiral acquisition now allows three-dimensional reconstructions of mobile organs such as kidneys. The aim of this study was to appreciate the merits of this new technique in the field of renal lithiasis. METHOD: This non-invasive technique was applied in 27 renal calculi (23 staghorn and 4 radiolucent stones). The acquisition does not require any injection of contrast material. Reconstruction was carried out by three-dimensional (3D) shaded surface display. RESULTS: 3D reconstruction of calculi permits a precise study of the shape of the stone, and of the number, size and direction of its branches. Therefore, it allows for better planning of the PCNL (number of ports, per-operative pelvi-caliceal exploration ...). Large radiolucent calculi are clearly defined with 3DS, facilitating the follow-up under medical treatment. CONCLUSION: 3D CT scan reconstruction is a noninvasive, cost-effective method which offers high quality 3D images of renal calculi. These results should spur the more widespread use of this technique.

Cost-Benefit Analysis↗