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Biomedical subjects

Nicolas Morel-Journel

Publications and source records attributed to Nicolas Morel-Journel.

4 recordsLinked to original sources
PubMed2006

[Chemical destruction of sacral nerve roots by alcohol injection for the treatment of overactive bladder].

INTRODUCTION: This study retrospectively reviewed the value of alcohol injection of sacral nerve roots after a lidocaine test in two indications: detrusor instability-detrusor hyperactivity syndrome and cystalgia. MATERIAL AND METHODS: Single-centre retrospective study from January 1992 to March 2003. Twenty-eight patients (1 man, 27 women) were admitted to the urology department for lidocaine test injection because of detrusor hyperactivity 24 cases (idiopathic = 13, neurological = 11), and cystalgia in another 4 cases. RESULTS: After the lidocaine test, infiltration of the sacral nerve roots (bilateral S3) by 70% alcohol was performed in 24/28 cases. The therapeutic effect was assessed at 1 month: 14 out of 24 patients reported that they were globally improved by the alcohol injection. The mean duration of the therapeutic effect was 3.8 months. In the longer term, only one of the 14 patients initially improved did not subsequently experience deterioration of the clinical features (with a follow-up of 8 months). A second alcohol injection was performed in 5/28 patients, with a positive result in only one case (4%). COMPLICATIONS: 6/24 (25%) patients developed lower limb pain that resolved over 2 to 3 months; 3/24 (12%) presented immediate postoperative urinary retention (that persisted in the long term in 1 case); 1/24 (4%) presented cicatricial anal incontinence. CONCLUSION: Alcohol injection of sacral nerve roots is a simple and inexpensive technique, but is associated with morbidity, and has inconstant and only transient effects. It can only be considered exceptionally in highly selected cases when no more effective treatments are available, such as botulinum toxin injection or sacral nerve root neuromodulation.

Adult↗
PubMed2003

[Two indications for bilateral neuromodulation].

The authors report two cases of patients presenting with complex voiding disorders treated successfully by bilateral neuromodulation. In the first patient, bilateral neuromodulation (left S2 and right S3) was indicated after failure of a first trial of conventional neuromodulation. In the second case, a complementary electrode in addition to the S3 electrode was placed at S1 to treat nerve root pain associated with urinary symptoms. The preoperative and postoperative findings are reported together with the course and possible explanations for the success of this treatment modality.

Adult↗
PubMed2002

Endocrine screening in 32 consecutive patients with hypospadias.

PURPOSE: Various endocrine studies performed in the hypospadias population show an unsatisfactory response to the human chorionic gonadotropin (HCG) test and abnormal androgen biosynthesis with possible enzyme defects. We evaluated the incidence of disorders in androgen production in boys with isolated hypospadias. MATERIALS AND METHODS: A total of 32 consecutive children (46,XY) with hypospadias were prospectively enrolled in the study. Severity of the defect was assessed with a new classification based on the location of the division of the corpus spongiosum. Endocrine evaluation consisted of measuring luteinizing hormone, follicle-stimulating hormone, anti-müllerian hormone (AMH), testosterone, dihydrotestosterone, progesterone, 17alpha-hydroxypregnenolone, 17alpha-hydroxyprogesterone, dehydroepiandrosterone sulfate and delta4-androstenedione. In all but 3 patients gonadal stimulation with 1,500 IU HCG every other day for 12 days was performed and steroid concentrations were reassessed after the test. An adrenocorticotropic hormone test was performed in 2 patients and molecular study of the androgen receptor was performed in 28. RESULTS: An increase to 37.37 nmol./l. progesterone (normal 0.1 to 0.5) and 17alpha-hydroxyprogesterone to 25.48 nmol./l. (normal 1.18 +/- 0.66) before HCG stimulation was noted in 1 patient. These abnormal results were not found after HCG stimulation but reappeared after the adrenocorticotropic hormone test. This result might be related to a partial mix of 17alpha-hydroxylase/17,20-lyase deficiency but no mutation was found after complete sequencing of gene CYP17. Of the 32 patients 4 had an insufficient response to HCG stimulation (testosterone less than 10 nmol./l.), including 1 with a low AMH level of 180 pmol./l. (normal 451 +/- 198) and an increased dehydroepiandrosterone sulfate level of 1,995 nmol./l. (normal 59 +/- 41) before HCG stimulation. Partial androgen insensitivity was suspected in 1 patient because he had a high testosterone response (29.96 nmol./l.) after HCG stimulation but no mutation of the gene of the androgen receptor was detected. Two patients with proximal hypospadias had isolated decreased AMH levels, which was evidence of Sertoli cell insufficiency. CONCLUSIONS: Although our series of 32 patients had several abnormal endocrine screenings, these results indicate no significant endocrine defects.

Adolescent↗