Musculoskeletal pain in renal-transplant recipients.
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Cyclosporine↗
Biomedical subjects
P Glemain
Publications and source records attributed to P Glemain.
[Achieving urinary continence].
Development of urinary continence, which is necessary for species survival and comfort of human being, begins with the organization of vesico-sphincteric automatism, as part of nervous system growth. Micturitional reflex are successively integrated inside the ganglionic plexuses in the foetus, the sacral spinal cord in the newborn and the pontine center in the child. Voluntary control of this automatism needs, at first, feeling an sensitive information about the bladder fullness, that is to say a "desire of urinate". Child first controls his striated sphincter, what makes him able to avoid urine leakage and enlarges his bladder capacity. Latter, he can initiate or refuse, voluntarily, bladder contraction, doing his bladder the most intelligent organ and, consequently, the most psychologically vulnerable one. Timing of these different steps is variable; in addition to the natural maturity processes which progress more or less quickly, training adds it effects, more useful for developing continence during daytime than during night-time.
Adolescent↗
[Bibliography of a year in urodynamics and neuro-urology].
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Aged↗
[Anatomical study of the infratemporal fossa].
The infratemporal fossa (ITF) is a hidden, subracranial part of the retrofacial region, which is concealed by the mandible. While its definition corresponds to bony relationships, it goes far beyond these. The classical pyramid with a lateral mandibular base and a superomedial apex, the pterygopalatine fossa, actually is a passage for the neurovascular elements it contains. It also is the hidden aspect of the manducatory apparatus, accommodating the pterygoid muscles. Besides these bony limits, the ITF has fasciomuscular boundaries formed posteriorly by the sphenomandibular ligament and the lateral insertion of the styloidian curtain on the angle of the mandible. The anterior limit, under the maxillozygomatic bones, is formed by the pterygomandibular ligament, on which spread the fibers of the buccinator muscle. The inferior limit is only theoretic and corresponds to the lower margin of the mandible. Within these limits, the ITF is connected with the mandible and the lateral manducatory muscles, the parotid gland, the peripharyngeal spaces, the submandibular region. However, it primarily is a passage into the neighboring regions with which it communicates through openings that are either endo- or exocranial, parotid, pharyngeal, nasal, orbital. Thus this fossa is one of the paths of the expansile processes that arise from the neighboring regions and invade it, being guided by the various anatomical openings we have described.
Humans↗
[Urodynamic consequences of urethral stenosis. Hydrodynamic study with a theoretical model].
An urethral model was designed to assess the hydrodynamic consequences of stenosis of the bulbar urethra. This model was based on the geometric and hydrodynamic analysis of micturing urethrograms in a patient whose maximum flow rate was 24 ml/s for a bladder pressure of 40 cm of water. It corresponds to the conditions of flow observed wit maximum bladder pressure and flow rate. During this short period, the shape of the urethra is regarded as stable. Calculation took account of the characteristics of a turbulent flow of urine, of the head loss due to friction of the urine on the walls and of the head loss caused by the geometrical changes of the urethra from the neck of the bladder to the meatus. In these conditions, applying Bernouilli's equation allowed plotting of bladder pressure for various levels of urethral resistance. If there is no stenosis, the theoretical maximum flow rate of the model with a bladder pressure of 40 to 80 cm of water should be 19 to 26 ml/s. Calculation showed that a sudden reduction of the diameter to less than 2.5 mm occurring in a segment of the urethra with a diameter of 4 mm accounts for a flox rate lower than 15 ml/s, except when bladder pressure can exceed 100 cm of water. The decrease in the maximum flow rate caused by urethral stenosis is all the greater as bladder pressure remains low or normal, with other causes of head loss or with associated upstream dilatation. Lastly, progressive narrowing leads to a smaller head loss and will therefore be better tolerated than sudden narrowing to the same caliber. Inversely, a long stenosis will be less well tolerated as the head loss due to friction in a long and narrow passage is increased. The diameter of a stenosis accounting for a maximum flow rate of less than 15 ml/s cannot be determined in the absolute. Analyzing the hydrodynamic consequences of stenosis also requires knowing the associated urodynamic and geometric parameters.
Adult↗
[Prevention of complications in inguinal lymphadenectomy].
Inguinal lymphadenectomy, as indicated in the treatment of metastases of carcinoma of the penis and of malignant melanoma in the inguinal lymph nodes, involves considerable mortality and morbidity. From February, 1988, to January, 1990, we performed 15 inguinal lymphadenectomies in 10 patients with an average age 51.9 +/- 5.3 years. The technique used combined a transverse incision parallel to the inguinal fold, complete inguinal lymphadenectomy, transposition of the sartorius muscle and vaporization of a film of fibrin glue. The last 2 operations, besides the effectives protection of the femoral pedicle, aim at suppressing dead spaces that may produce hematomas, subcutaneous infection or lymphoceles, and at avoiding the insertion of an aspiration drain, which causes persistent lymphorrhea. Out of the 15 cases of lymphadenectomy, 5 presented with a small- (48 ml in average) or medium-volume (200 ml) lymphocele, which was treated by a simple evacuating puncture. No necrosis of the skin edges, subcutaneous infection or lymphorrhea were observed. These results are encouraging, since our patients can rapidly resume their social life and have an acceptable quality of survival.
Adult↗
[Electrocoagulation of the paraurethral glands (Reiser's operation) in women with urethro-cystalgia].
One hundred nineteen cases of women with chronic urethrocystalgia were reviewed. The symptoms were dominated by urethral burning (83%) and pollakiuria (75%). Electrosection of the paraurethral glands according to Rieser's technique and resection of the urethral floor (100% of cases) were combined with hymeneoplasty in 9% of cases. The results concern 67 women with a mean follow-up of 6 years: cure: 36%; marked improvement: 34%; no change: 30%. The authors discuss the presence of paraurethral glands, their role in the urethrocystalgia syndrome and the place of Rieser's operation in their treatment.
Adult↗
Management of regional lymph nodes in carcinoma of the penis.
In the management of carcinoma of the penis, standard treatment of the primary tumor is by radiotherapy for small lesions (Tis, T1, T2 located in the glans) and by amputation in other cases (T2 with invasion of the shaft). The diagnosis and treatment of regional lymph nodes are thus the essential problems with this cancer. In our series of 45 patients with a minimum 5-year follow-up, clinical assessment was incorrect in 22.5% of cases (22% of the patients with negative bilateral biopsy of the superficial inguinal nodes developed metastases), and many of the complications (flap necrosis, lymphedema) occurring after inguinal lymphadenectomy contributed to a poorer quality of patient survival. A therapeutic approach to the management of regional lymph nodes in order to combat the carcinoma more effectively and improve patient survival quality is suggested.
Adult↗
[Clinical, neurophysiologic and therapeutic remarks from anatomic data on the pudendal nerve in some cases of perineal pain].
Clinical observations in patients suffering from positional perineal pain have led us to performing an anatomical study of the pudendal nerve in order to demonstrate compression of this nerve trunk by elements likely to compress it in the sitting position. Thus we observed that the falciform process of the sacrotuberous ligament may act in this way. Besides helping us to understand the clinical symptoms, this anatomical study allowed choosing the technique we found most appropriate for the anatomical conditions observed out of the various neurophysiological examinations described in the literature. Lastly, we describe the surgical technique that allows releasing the trunk of the pudendal nerve under an operating microscope.
Evoked Potentials, Somatosensory↗
[Does perineal muscle testing provide information on the quality of the urethral sphincter in women?].
A prospective study was carried out on 100 women presenting with urinary incontinence with the intent of determining whether a relationship could be found between the quality of the perineal musculature, as assessed by testing the levatores, and that of the urethral sphincters, as assessed by a study of the urethral pressure profile, thereby defining the respective importance of each of these tests. The mean maximum closing pressure values were compared for three groups whose testing was scored good, fair or nil. Evidence of a positive relationship existing between the levatores testing and the maximum closing pressure against rest (p less than 0.05) and stress (holding-back) (p less than 0.01) urethral pressure profiles was brought forth. However, this relationship does not allow to extrapolate the testing results to the sphinters. In practice, at the individual patient level, one may be satisfied by merely testing the pelvic musculature in case of reeducational treatment of incontinence. Nevertheless, whenever surgery is indicated, objective assessment of the urethral sphincters by ways of an urethral pressure profile study is mandatory.
Adult↗
[Changes in bladder contractility in spinal cord diseases].
Changes in bladder contractility were studied by repeated cystomanometry in 147 patients suffering from central medullary lesions of sudden onset, including 93 cases of spinal shock. The morphology of contraction was always modified in the same fashion though intermediate stages were apparent, some being quite characteristic of neurological dysfunction. This process, which ends in a phasic contraction reproduces the stages of ontogenesis. When contractions are present, but do not produce complete bladder emptying, spontaneous improvement is unlikely in the presence of a complete lesion; sphincterotomy should therefore be considered at an early stage.
Adolescent↗
[Urodynamic examination of prostatic adenoma. For what purpose?].
In order to demonstrate that the quality of the functional result after surgery for prostatic adenoma depends on the initial urodynamic equilibrium, the authors performed preoperative cystomanometry and urethral pressure profile, in addition to the standard assessment, in 115 patients. Only vesical acontractility clearly appeared to be a factor of residual dysuria, as it multiplied the risk by a factor of 3. In contrast, the values for the urethral pressure profile did not have any predictive value on incontinence, probably because they were modified by the operation. However, and understanding of the vesico-sphincteric equilibrium can lead to a modification of the therapeutic indications in certain circumstances in which this equilibrium appears to be particularly precarious.
Aged↗
[Factors of the urinary prognosis of myelomeningoceles].
Based on a retrospective series of 200 patients with myelomeningocele followed over a period of 3 to 17 years (mean = 9.02 years), the authors define the prognostic elements of the radiographic and urodynamic assessment. Their aim was to define a population at risk presenting a possibility of deterioration of the upper urinary tract. The mean age at the time of the first assessment by the authors was 12 years (range: 2 to 38 years), at which time the upper urinary tract was not dilated in 73% of cases and dilated in 27% of cases. Evaluation of the clinical course revealed that 7% of the upper tracts were dilated at the first consultation and only 1% of them remained so, 26% became dilated secondarily and 67% were never dilated throughout the observation period. The last cystometric assessment provided the following mean values: --for the overall population (200 patients): a premicturating pressure (P2) of 32 cm of water and a compliance (CPL) of 20 ml/cm of water; --for the population in which the upper tract was dilated at the last consultation (54 patients): a P2 of 45 cm of water and a CPL of 7 ml/cm of water; --for the population in which the upper tract was not dilated at the last consultation (146 patients): the P2 was 27 cm of water and the CPL was 24 ml/cm of water. These 2 parameters therefore appeared to be essential and their prognostic value should be evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗