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P Dubernard

Publications and source records attributed to P Dubernard.

14 recordsLinked to original sources
PubMed2004

[Abdominal management of rectocele and elytrocele: place of the laparoscopic approach].

AIM OF THE STUDY: To report the results of abdominal promontory rectopexy and douglassectomy in the management of rectocele and enterocele. PATIENTS AND METHODS: Between 1992 and 2002, 72 patients were operated by one colorectal surgeon. Laparotomy was used in 37 cases between 1992 and 2001 and the laparoscopic approach in 35 cases from 1995 to 2002. Promontory rectal fixation required only one mesh secured between the anterolateral right side of the rectum and the lumbosacral ligament. The same mesh was used to fix the vagina or the cervix. Combined therapeutic or prophylactic urinary interventions are frequent in the series. RESULTS: The follow-up was more than one year in 63 patients with a mean value of 58 months with no patient lost. Recurrence of posterior vaginal prolapse was noted in only two cases. Dyschesia and urinary incontinence were improved respectively in 80 and 70% of the cases and a significant improvement in anal incontinence was observed in 95% of the patients. CONCLUSION: The abdominal way allows a suitable treatment in patients with advanced stage rectocele and enterocele and evidence of pelvic organ prolapse. The laparoscopic approach is superior in terms of morbidity and functional results.

Adult↗
PubMed2000

Intra-operative electron radiotherapy as a conservative treatment for infiltrating bladder cancer.

The intent of this feasibility study was to evaluate the use of intra-operative electron radiotherapy (IOERT), after transurethral resection (TUR), combined with external beam radiation with concurrent chemotherapy for the conservative treatment of infiltrating bladder cancer. From November 1988 to June 1998, 27 patients with histologically proven non-metastatic infiltrating bladder cancer were included in this protocol. The treatment consisted of: TUR, external beam irradiation (x18 MV:48 Grays (Gy)/24 fractions/5 weeks), with concurrent chemotherapy (cisplatin 30 mg/day for 3 days-two cycles during irradiation), followed by control cystoscopy and cystotomy with IOERT (e 9 MeV:15 Gy). 14 patients received two cycles of neoadjuvant methotrexate, vinblastine and cisplatin (MVC) and folinic acid chemotherapy. Patients were evaluated for toxicity, local control and survival. The 5-year overall and cystectomy-free survival rates were 53.3% +/-11.1% and 48.1%+/-11.4%, respectively. 4 patients developed infiltrating intravesicular recurrence (3 were treated by salvage cystectomy), and an additional patient developed a superficial recurrence. 2 patients subsequently developed regional recurrence in pelvic nodes and 10 patients were found to have distant metastases. The protocol was found to be feasible and associated with acceptable toxicity. Early and late toxicities consisted of 3 cases of bladder mucosal necrosis or ureteral stenosis which resolved with medical management. These preliminary results indicate that IOERT combined with TUR and neoadjuvant external beam radiation with concurrent chemotherapy is feasible. It could be considered as an alternative therapy for infiltrating carcinoma of the bladder, especially in patients unfit for radical surgery, and is well adapted to treat lesions of the fixed portion of the bladder.

Adult↗
PubMed1999

RER(+) phenotype in prostate intra-epithelial neoplasia associated with human prostate-carcinoma development.

The mutator (RER(+)) phenotype has been shown to be a mutational mechanism for tumour-suppressor-gene inactivation in colorectal cancer. A group of 60 prostate-carcinoma patients was studied to determine the frequency, intratumour distribution and timing of mutator phenotype in this cancer. Ten microsatellite loci were analyzed in 172 carcinoma foci (CF) and in 57 associated non-cancerous prostate tissues, including 31 areas of prostate intra-epithelial neoplasia (PIN) and 26 non-dysplastic areas with glandular hyperplasia (HP). We detected lesions with the RER(+) phenotype in 42% (25/60) of the prostate tumours. Clonal foci with RER(+) phenotype were detected at similar frequencies in pre-cancereous PIN (16%, 5/31) as in associated carcinoma foci (22%, 37/172), but were detected in only one of the 26 non-dysplastic prostate tissues studied (4%). Thus, clonal RER(+) foci were significantly more frequent in CF than in HP (p < 0.05). MI itself was significantly more frequent in CF (53%, p < 0.0001) and in PIN (35%, p < 0.05) than in HP (12%). Furthermore, 5 PIN harboured microsatellite mutations also detected in the associated cancer. Our overall results therefore strongly suggest that the mutator phenotype may occur as an early event in prostate tumorigenesis.

Carcinogenicity Tests↗
PubMed1997

[Adjuvant radiotherapy after radical prostatectomy. Apropos of a series of 73 patients in Lyons (France)].

PURPOSE: Descriptive analysis of adjuvant radiation therapy after radical prostatectomy. MATERIALS AND METHODS: From 1986 to 1993, 73 patients (median age, 64.5 years; Gleason score > or = 7 : 36 pts; T1:22; T2:40; T3:11) were included into the study. On the operative specimen, the cancer grades were pT2:5 (involvement of the apex), pT3:67, pT4:1, pN1-2:8. Radiation therapy was performed after a mean resting period of 112 days. The target volume was the prostatic area. The technique used was a four-field box with an 18 MV-X photon beam. The dose was 50 Gy/20 fractions/5 weeks. No hormonal treatment was administered, except for 5 patients for a short duration. RESULTS: The median follow up was 46 months. One anastomotic local failure was salvaged by trans-urethral resection, three distant metastatic failures. Out of 72 patients with a PSA < 3 ng/mL at the end of radiotherapy, 13 showed an isolated elevation. The 5-year overall survival rate was 93%. The event-free survival was 72% after 5 years. Pathological differentiation and Gleason score were significantly correlated with the survival. There was no complication related to radiotherapy. CONCLUSION: Elective adjuvant radiation therapy for pT3 prostate adenocarcinoma after radical prostatectomy provides a good local control with minimal morbidity.

Adenocarcinoma↗
PubMed1997

[Peroperative radiotherapy in the conservative treatment of infiltrating bladder cancers].

OBJECTIVE: Descriptive analysis of an intraoperative radiotherapy protocol (IOR) in the context of conservative management of invasive bladder cancer. METHOD: From November 1988 to September 1994, 24 patients with invasive bladder carcinoma (20 T2, 3 T3) were included in this protocol consisting of: transurethral resection (TUR), neoadjuvant chemotherapy (M.V.C.) in 14 patients, external irradiation (x 18 MV: 48 Gy/24 F/5 weeks) with concomitant chemotherapy (cisplatin 30 mg/day-3 days-2 cycles during irradiation)-follow-up cystoscopy then surgery with IOR (E 9 MeV: 15 Gy). RESULTS: The global 3-year survival was 69%. An invasive intravesical relapse developed in 3 patients (1 salvaged by cystectomy) and a superficial relapse occurred in 1 patient. One patient developed pelvic lymph node progression and 7 developed distant metastases. The early and late toxicity was acceptable with 3 cases of ureteric necrosis or stenoses resolving after medical treatment. CONCLUSION: This series shows encouraging preliminary results. IOR appears to be a technique well adapted to lesions of the fixed portion of the bladder.

Adult↗
PubMed1981

[Arteriovenous fistula for vascular access in childhood leukemia. Value of microsurgical technique (author's transl)].

Acute leukemia are now in progress with intensive and prolonged polychimiotherapy but such medicine is difficult to manage because veins are rapidly unserviceable. In order to simplify hematological treatment and psychological approach of this patients we have constructed arterio-venous fistula in children with malignancy. The operation of choice is a subcutaneous cephalic-vein to-radial-artery arterio-venous fistula on the fore arm at the distal part. 103 of this vascular access procedures are performed in 93 children and in infants weighing less than 10 kg: 57 are performed without magnification, 46 with the aid of operative microscope. The comparative study of this two procedures show that microsurgical technique is necessary to improve results, especially in the youngest patients. This vascular access are well accepted by the children and his families, and very useful for the medical staff.

Adolescent↗
PubMed1978

[Bladder neck urethral obstructions of neurogenic bladder in children (author's transl)].

The study of 62 bladder neck and urethral obstructions among 210 neurogenic bladder in children, allow to give an urologic definition, corroborated by urodynamic exploration.--28 boys show lesions of external sphincer as described in traumatic paraplegia in adult. The treatment in external sphincterotomy: by perineal approach (5 cases : 1 success--4 failures), or retropubic (3 cases : 2 successes--1 failure) and mainly endoscopic (12 successes over 21 primary resections, and 8 successes over 10 repeated interventions). The results are given according to the obstruction, the continence and urinary upper tract. Ureteroneocystostomy il allowed by obstruction release. The pathogeny of obstruction is discussed according to the paralysis of the sphincter, as well as the therapy with the comparison between sphincterotomy and self-catheterism.--34 girls present 3 kinds of obstruction;--bladder neck dysectasia (5 cases) with obvious radiologic findings: YV plasty was done with in 2 cases ureteroneocystostomy;--posterior downfall of the bladder where intermittent catheterization provides excellent results;--pure urethral obstruction is also observed, like in boy's external sphincter lesion. Various types of therapy are discussed, specialy TV plasty extented to the urethral meatus, but in girls the intermittent catheterization which respects continence and which can be associated to an ureteroneocystostomy or a pharmacologic therapy is at present the most appropriate method.

Adolescent↗