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P Rischmann

Publications and source records attributed to P Rischmann.

At least 19 recordsLinked to original sources
PubMed2005

A third renal transplantation: is it relevant and is it worth it?

INTRODUCTION: The aim of this retrospective study was to determine the outcome of third cadaveric renal transplantations performed between 1989 and 2004 among a cohort of 35 patients whose immunosuppression included induction therapy and calcineurin inhibitors. Most patients were highly sensitized with 1 (0-4) HLA (classes I + II) incompatibility between donor and recipient. RESULTS: The median follow-up time was 57 months (range, 1-190). Fourteen patients experienced delayed graft function that required posttransplantation hemodialysis. The current patient and graft survival rates were 91.4% and 82.8%, respectively. At last follow-up, 6 grafts had been lost: 1 due to primary nonfunction; 1 due to an urinary leak (day 45); 2 deaths with functioning grafts; and 2 chronic allograft nephropathies (CAN) at 85 and 60 months posttransplantation, respectively. Among the 10 patients who experienced acute rejection episodes, half were steroid-sensitive, whereas the others required OKT3 therapy. Overall, when excluding the 2 patients who presented with early loss of their grafts, 13 of 33 patients (39.4%) developed CAN, which led to the graft loss in only 2 cases. The mean creatinine clearance was 57 +/- 23 mL/min at year 5. Of the 35 recipients, 12 (34.3%) developed graft/perigraft complications, among whom 10 (83.3%) required treatment. The most frequent complication was lymphocele (M = 4; 11.4%) or infections that led to rehospitalization (n = 17). CONCLUSION: Results from third transplantations were encouraging. Thus, despite the organ shortage, a third graft was worth it!

Adult↗
PubMed2003

Infliximab treatment of Crohn disease ileovesical fistula.

Ileovesical fistula is a rare inaugural complication of Crohn disease. Current approaches associate antibiotics, total parenteral nutrition and various combinations of immunomodulatory agents. However, only a minority of fistulas subside under conventional treatment, as most of them ultimately require complex surgery to excise and close the structures involved. We report the case of a 31-year-old patient successfully treated by targeting the local production of tumour necrosis factor alpha with infliximab.

Adult↗
PubMed2001

[Kidney transplantation. Results and indications].

Results of renal transplantation are better than those of dialysis. The indications of transplantation are constantly increasing and comprise more and more populations at risk, notably older patients and diabetics. Specific evaluation of such potential recipients can lead to indication for transplantation and registry on the waiting list. The insufficient number of available cadaver kidneys leads to harvesting borderline organs particularly from the elderly or patients with vascular disease. Before definite decision for transplantation is made, case-by-case evaluation has to be made of the potential risks of donor-recipient matching regarding the risk/benefit for the recipient. Only a significant increase in the number of available organs will relieve the constraints of the problem.

Adult↗
PubMed2001

Complications for radical cystectomy. Impact of the American Society of Anesthesiologists score.

OBJECTIVES: To report the perioperative events after radical cystectomy and urinary diversion in bladder cancer in terms of major and minor complications and to seek statistical relationships with patient's characteristics and surgical procedures. METHODS: One hundred and sixty-one radical cystectomies performed in the modern era in two academic hospitals were reviewed. Preoperative patients characteristics (age, sex, hemoglobin, total protein, weight and height) and perioperative data (operative time, type of urinary diversion, associated procedures, blood transfusion, seniority of the surgeon) were recorded. Perioperative morbidity was defined by any adverse event during hospital stay or within 30 days after surgery, those requesting an additional stay of more that 3 days in the intensive care unit or a reoperation being classified as major complications. Significant relationships were sought for classes by Student's t test for comparison of quantitative variables and Yate's corrected chi(2) test for categorical variables. Spearman's rank correlation test was used for comparison of quantitative variables. RESULTS: Major complications were observed in 41 patients (25.5%) and resulted in 14 reoperations (8.7% reoperation rate). Most of them were diversion-related and were statistically related to the ASA score > or =3 (p<0.01, 5.7 odds ratio). Compared to sophisticated means of diversion, cutaneous diversion resulted in minimal operative time and hospital stay. No relationships between age, body mass index, biological parameters, type of diversion, associated procedure, surgeon's experience and postoperative complications could be evidenced. Uneventful recovery resulted in a 16.6 days mean hospital stay, minor complications induced a significant 3.8 days additional stay and major complications resulted in major lengthening of hospital stay (21.2 days mean additional stay). CONCLUSION: ASA scores equal to or greater than 3 were associated with major complications and most specially those related to the type of urinary diversion. Therefore, we recommend special care in the selection of the type of urinary diversion and further preoperative evaluation inclusive of nutritional assessment.

Aged↗
PubMed2001

[Secondary biological recurrence after radical prostatectomy: multivariate analysis of prognostic clinical, biological, and histologic factors].

OBJECTIVES: To define the clinical, laboratory and histological variables associated with secondary elevation, after an undetectable phase, of PSA after radical prostatectomy. MATERIALS AND METHODS: This was a prospective study of 83 consecutive patients undergoing retropubic radical prostatectomy with an undetectable postoperative PSA at 3 months. The predictive value of five preoperative criteria (age, total PSA, Gleason score on biopsies, positive apical biopsies, clinical stage) and four postoperative criteria (pathological stage, Gleason score on the operative specimen, positive margins, follow-up) for secondary laboratory progression was studied by univariate and multivariate analysis. RESULTS: With a median follow-up of 36 months, the laboratory recurrence rate was 19%. Laboratory recurrence was associated with a biopsy Gleason score greater than or equal to 7 (p = 0.04), a high pathological stage (p = 0.03), a high histological score (Gleason > or = 7) (p < 0.01) and positive margins (p = 0.04). Logistic regression identified a Gleason score on the operative specimen greater than or equal to 7 to be the only element predictive of secondary laboratory progression. CONCLUSION: The concept of positive margins or high pathological stage is insufficient to identify the risk of laboratory progression after radical prostatectomy. The Gleason score, which evaluates tumour aggressiveness, the risk of micrometastases or periprostatic extension, therefore appears to be more useful.

Adenocarcinoma↗
PubMed2001

[Periurethral collagen injections: results after 2 years in 25 patients with severe urinary incontinence].

OBJECTIVES: To study the efficacy and safety of periurethral collagen injection in the treatment of severe urinary incontinence. PATIENTS AND METHODS: From 1994 to 1998, 25 periurethral collagen injections were performed in 25 women with a mean age of 65 years presenting with urinary incontinence classified as grade III in 17 cases and grade II in 9 cases, under local anaesthesia in 5 cases, spinal anaesthesia in 10 cases and general anaesthesia in 10 cases. Twenty patients were treated for recurrent incontinence. One injection was performed in 20 cases and two injections were performed in 5 cases. None of the patients presented disorders of pelvic muscles. The preoperative urodynamic assessment did not reveal any cases of detrusor instability, and showed a mean urethral closure pressure of 35 cm H2O. A skin test was performed in each case at least 30 days before the injection. RESULTS: The mean hospital stay was 2.75 days. The mean quantity of collagen injected was 5.7 ml. With a mean follow-up of 24 months, 33% of patients were continent, 39% were improved and 28% were considered to be failures. No complications were observed. CONCLUSION: Due to its safety, this method can be proposed in outpatients with good results, in patients of all ages, either as first-line treatment or for recurrent incontinence, as, in the case of failure, this technique does not comprise subsequent treatment by another operation.

Aged↗
PubMed2001

Evaluation of male sexual function by the International Index of Erectile Function after deep dorsal vein arterialization of the penis.

PURPOSE: The objective of vascular surgery for erectile dysfunction is to provide long-term improvement of erectile function. We evaluated that claim after deep dorsal vein arterialization by a cross-sectional study of multifaceted male sexual function with the validated International Index of Erectile Function (IIEF). MATERIALS AND METHODS: We performed a mail survey of male sexual function after deep dorsal vein arterialization in 68 consecutive literate men who underwent surgery between 1984 and 1998 for severe erectile dysfunction. The IIEF questionnaire and a questionnaire on patient characteristics were answered in a self-administered and nominative manner. Scores of the responders pertaining to the 5 domains of male sexuality were compared with those of the control groups used for the psychometric validation of the IIEF. RESULTS: Of the patients 38 (55.9%) with a mean age plus or minus standard deviation of 46.5 +/- 11.9 years responded. Mean followup was 61.2 +/- 34.7 months. Compared to controls with erectile dysfunction controls men who underwent deep dorsal vein penile arterialization had significantly higher scores for erectile function, sexual desire, orgasmic function, intercourse satisfaction and overall satisfaction. Conversely compared with normal controls these patients reported significantly lower erectile function, orgasmic function, intercourse satisfaction and overall satisfaction scores, whereas sexual desire scores were similar in the 2 groups. No correlations were noted of the 5 IIEF domains with the duration of followup after arterialization. When erectile function scores were graded, 25.0% and 28.1% of patients reported no and or mild dysfunction, respectively, while 15.6% still complained of severe erectile dysfunction. CONCLUSIONS: Long-term improvement in the various aspects of male sexual function was observed after deep dorsal vein penile arterialization in a significant proportion of patients.

Coitus↗
PubMed2001

[Acute epididymitis disclosing tertiary tuberculosis].

The authors report the case of a 50-year-old drinker and smoker presenting with isolated acute on chronic epididymitis, leading to the diagnosis of tertiary tuberculosis. This now exceptional case emphasizes the value of scrotal ultrasound and complementary investigations looking for other sites of tuberculosis.

Acute Disease↗
PubMed2000

High prevalence of erectile dysfunction after renal transplantation.

BACKGROUND AND METHODS: A cross-sectional study of multifaceted male sexual function in 323 consecutive kidney transplant recipients was conducted by mail by means of the validated International Index of Erectile Function (IIEF). All five IIEF domains (IIEF-5), i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction, were scored for each responder. IIEF-5 scoring that conformed to the National Institutes of Health definition of erectile dysfunction (ED) was computed for all patients sexually active within the past 4 weeks. RESULTS: Two hundred and seventy-one patients replied. Compared to the controls used for IIEF psychometric validation, kidney transplant recipients gave lower erectile function (P<0.01) and intercourse satisfaction (P<0.05) scores, despite their being younger. ED, according to the IIEF-5 method, was demonstrated in 55.7% of the sexually active patients (n=212). Age, time on dialysis, and iterative transplants were significantly and negatively related to erectile dysfunction. CONCLUSION: IIEF proved to be a valuable means of unveiling highly prevalent erectile dysfunction in male kidney transplant recipients. The negative impact of the time on dialysis was emphasized in the results.

Adult↗
PubMed2000

Evaluation of male sexual function after pelvic trauma by the International Index of Erectile Function.

OBJECTIVES: To assess the multifaceted male sexual function after pelvic ring fracture. METHODS: A cross-sectional study of male sexual function after pelvic ring fractures was conducted, using the International Index of Erectile Function (IIEF). The department of traumatology database was scanned (June 1996 to April 1999) for 30 to 70-year-old male patients with pelvic fracture. Seventy-six consecutive, literate patients were then contacted by mail. IIEF domain scores were calculated for all responders. Cappelleri's method for identification and grading of erectile dysfunction was applied for patients sexually active within the past 4 weeks. Student's t test was used to compare the domain scorings of patients with those of the control population used for the IIEF psychometric validation. Relationships between IIEF results and patient characteristics were sought by Spearman's rank correlation coefficient for quantitative variables and Student's t test for classes. RESULTS: Forty-six patients answered (60.1% response rate). Thirty-seven patients had experienced sexual intercourse in the past 4 weeks during which 11 patients (29.7%) had exhibited various degrees of impaired erection. As a whole, compared with the published controls a significant decrease in overall satisfaction (P <0.05) was demonstrated. Pubic diastasis was further related to impaired erectile function and overall satisfaction; we suggest that cavernosal nerves might be damaged at the time of diastasis. CONCLUSIONS: This study evidenced the impairment of sexual overall satisfaction after pelvic trauma and the specific decrease in erectile function and erection firmness and confidence associated with pubic diastasis. The IIEF questionnaire might be considered at the time of rehabilitation to identify those patients that could benefit from supportive treatments.

Adult↗
PubMed2000

Modified extrafascial radical retropubic prostatectomy technique decreases frequency of positive surgical margins in T2 cancers <2 cm(3).

OBJECTIVES: In an effort to decrease the frequency of postoperative positive surgical margins (+SM), a modified extrafascial radical prostatectomy technique was developed and evaluated. METHODS: 402 consecutive radical prostatectomy specimens removed for clinical stage T2 cancers from 1987 to 1994 were histologically examined prospectively for tumor volume, extraprostatic extension and +SM. Surgical technique modification was introduced in 1990. We compared the histologic status and biological outcome of the prostatectomy cases in 1987-1989 (n = 166) to those treated from 1990 to 1994 (n = 236). RESULTS: The two series were comparable in (1) clinical stage and preoperative (PSA, (2) tumor volume, grade and location, and (3) capsular penetration, seminal vesicle and lymph node status. +SM fell from 32 to 25% overall, but for 146 (36%) prostates with a tumor volume <2 cm(3), +SM fell from 21 to 6% which was statistically significant. Outcome measured by biological progression showed a decrease from 33% for +SM to 13% for -SM for cases with a tumor volume <2 cm(3). For cancer volumes >2 cm(3), the incidence of +SM did not vary significantly. We describe the anatomic details necessary for exposure of periprostatic fascias and extrafascial dissection at (1) the prostatourethral junction which ensures wide excision of the anterior and apical aspect of the prostate, (2) the posterior and apical area (development of the prerectal space), lateral and posterior areas at the base of the prostate which ensures wide excision of the rectoprostatic fascia (Denonvilliers's fascia) and lateral prostatic fascia. CONCLUSIONS: Differences in surgical technique probably accounted for the significant decrease in +SM for those T2 cancers with volumes < or =2 cm(3) which represents 36% of the T2 cancers in our series. Recent screening with PSA (T1c cancers) increases the incidence of these cancers < or =2cm(3). This modified uni- or bilateral anatomic extrafascial prostatectomy with improved +SM and biological progression rates for T2 cases should be evaluated for T1c cases.

Fascia↗
PubMed2000

Role of preoperative positive apical biopsies in the prediction of specimen-confined prostate cancer after radical retropubic prostatectomy: a multi-institutional study.

OBJECTIVES: A multi-institutional study of 280 radical prostatectomy specimens obtained from three independent academic hospitals was undertaken to validate a nomogram developed for the prediction of specimenconfined protstate cancer after prostatectomy. METHODS: Three preoperative factors - the Gleason score, prostatespecific antigen (PSA) and apical location of positive biopsies - that were identified with a previous logistic regression formula were collected. Links between margin status and preoperative criteria were confirmed by univariate methods. Subsequently, the predictive indexes of positive margins were calculated and compared to the actual margin status in terms of predictive characteristics. RESULTS: This control series, independent of the initial series that was used to identify the relevant preoperative factors, confirmed that positive apical biopsies(p<0.001), PSA (p<0.005) and the Gleason score (p<0.005) were strongly linked to the occurrence of positive margins. Different cutoff values for the predictive index were compared in a receiver operating characteristic curve. A value of 0.5, similar to the one described in the original series, gave an adequate compromise between sensitivity and specificity with respective values of 68 and 73% and a test accuracy of 72%. In practical terms, it was possible to predict 85% of negative margins, and to delineate two groups with different rates of positive margins (14.5 vs. 50%). CONCLUSIONS: We demonstrated that PSA, the Gleason score and apical biopsy status are cumulative risk factors for positive margins. Risk of positive margins increases when it is not possible to obtain a wide excision of periprostatic fascia, as at the apex. This study substantiates the independent prognostic value of positive preoperative apical biopsies for predicting positive surgical margins.

Aged↗
PubMed2000

BCG intravesical instillations: recommendations for side-effects management.

Adverse events following intravesical BCG therapy are related to strain virulence, allergic reactions or to nosocomial urinary tract infections. Low grade fever and irritative symptoms are common side-effects of BCG. They subside within 48 hours and do not require any specific treatment, apart from standard painkillers and antispasmodics. Further instillations should be postponed until symptoms have resolved completely. If symptoms do not resolve, complementary investigations are recommended including urine culture, and isoniazid may be prescribed for 15 days. The BCG dose should be reduced if symptoms increase after subsequent instillations. Complications of BCG infection - either local or systemic - have been reported with an incidence of 10-15%. These complications include: granulomatous prostatitis or epididymitis (treated with isoniazid and rifampicin for 3 months), contracted bladder may occur, mainly during maintenance courses, systemic infection such as granulomatous nephritis and abscesses, pneumonitis, hepatitis, osteomyelitis (treated with isoniazid, rifampicin and ethambutol for 6 months), and life-threatening adverse events may be related to septicaemia or to immunoallergic reactions, the onset of which may be delayed several months after the end of BCG therapy. Such conditions require urgent treatment with standard antituberculous antibiotics and prednisolone. These complications are an absolute contraindication for further BCG instillations. Despite its toxicity, the risk-benefit ratio favours the use of BCG in patients who have moderate- and high-risk tumours.

Administration, Intravesical↗
PubMed2000

[Treatment of chronic urinary retention after surgical treatment of urinary incontinence with bladder neck transurethral resection].

OBJECTIVE: To evaluate the efficacy and safety of transurethral resection of the overcorrected posterior lip of the bladder neck in patients with chronic urinary retention after repair of incontinence. MATERIAL AND METHODS: Transurethral bladder neck resection was performed in 26 women with a median age of 59 years. Incontinence repair consisted of a Burch procedure in eight cases, a Raz procedure in eight cases, a Marshall-Marchetti-Krantz procedure in five cases, an aponeurotic sling in three cases and a synthetic sling in two cases. The median preoperative maximum urine flow rate was 11.5 ml/s and the median residual urine was 150 ml. Preoperative cystourethrography and cystoscopy revealed overcorrection of the bladder neck in each case. RESULTS: With a median follow-up of 39 months, 65.5% of patients were cured (resolution of symptoms, maximum urine flow rate greater than 15 ml/s and residual urine less than 50 ml), 23% were improved and 11.5% were considered to be failures. No complications or secondary urinary incontinence were observed. Patients not cured by this technique were treated by urethrolysis in three cases, Uroflow stent in one case and section of a Raz cervicocystopexy suture in one case. CONCLUSION: Transurethral bladder neck resection can be used as first-line treatment for chronic urinary retention after repair of incontinence, as it is an effective, rapid, minimally invasive technique not associated with any morbidity. Urethrolysis can always be performed in the case of failure.

Adult↗
PubMed2000

[Current treatment of bladder cancer: from epidemiology to surgical treatment].

Urothelial carcinoma of the bladder accounts for over 95% of bladder tumours in France. The incidence of this disease is increasing in industrialised countries. Several types of bladder cancer can be distinguished: (1) superficial tumours which have a risk of recurrence and progression, although conservative treatment based on endoscopic resection possibly followed by adjuvant therapy is a feasible option; (2) muscle-invasive tumours which require radical treatment; and (3) a group of so-called superficial tumours which require particularly close monitoring since they present a high risk of progression. Management of bladder tumours requires assessment of their potential to progress to a more invasive stage, and also consideration of a number of prognostic factors including endoscopic, histological and biological findings.

France↗
PubMed1999

Prostate-specific antigen in acute hepatitis and hepatocellular carcinoma.

BACKGROUND: Prostate-specific antigen (PSA) is the most important tumor marker in prostate cancer diagnosis and follow-up. Its catabolism by the liver has not influenced its use as a prostate marker until the recent report of a significant increase in a man and a woman with acute hepatitis. In addition, PSA was detected in liver tumor extracts, which warranted its evaluation in liver cytolysis and hepatocellular carcinoma. In this study, PSA was evaluated in a cohort of both sexes presenting either acute hepatitis or hepatocellular carcinoima. METHODS: Forty-two patients with acute hepatitis (21 male patients, 21 female patients) and 54 patients with hepatocellular carcinoma (31 male patients, 23 female patients) were tested for PSA by equimolar immunoassay (Abbott AxSYM Total PSA, Abbott Diagnostics, Rungis, France) and for relevant liver biological parameters (alpha-fetoprotein, alanine aminotransferase, aspartate aminotransferase, total bilirubin, and prothrombin rate). RESULTS: PSA was undetectable in all the female patients and was consistent with age in the males (PSA median and range in acute hepatitis, 0.36 microg/l (range, 0.05-1.3); in hepatocellular carcinoma, 0.36 microg/l (range, 0.02-3.9)). It did not correlate with alpha-fetoprotein and aminotransferases. CONCLUSIONS: Our results confirm the well-established reliability of PSA, and show that PSA remains a valid prostate marker in patients with acute hepatitis and hepatocellular carcinoma.

Acute Disease↗
PubMed1999

Second non-germ cell malignancies in patients treated for stage I-II testicular seminoma.

PURPOSE: To measure the incidence of second non-germ cell malignancies (SNGCM) in patients treated for a stage I-II testicular seminoma. MATERIALS AND METHODS: From 1970 to 1992, 131 evaluable patients received in the Institut Claudius Regaud a post-orchiectomy treatment for a stage I-II testicular seminoma. The therapeutic modalities, including salvage treatment for six recurrences, were as follows: infradiaphragmatic radiotherapy (IDRT) (n = 55); infra- and supradiaphragmatic radiotherapy (IDRT + SDRT) (n = 64); IDRT + SDRT with chemotherapy (n = 12). The mean follow-up was 11 years. The cumulative incidence of SNGCM was compared to the overall cancer incidence in the general male population on the basis of the Tarn Cancer Registry; the relative risk was expressed as a standardized incidence ratio (SIR). RESULTS: Overall, the cumulative incidence of SNGCM was 10.7% (14/131 cases). The SIR was equal to 2.81 (95% confidence interval (CI) 1.54-4.72; P < 0.001) and increased with follow-up duration. The SIR was significantly increased in 64 patients treated with IDRT + SDRT (SIR = 3.08; 95% CI 1.47-5.66; P = 0.002) but not in 55 patients treated with IDRT alone (SIR = 0.62; 95% CI 0.01-3.43; P = 0.8). The 12 patients who received chemotherapy had an SIR of 26.2 (95% CI 5.48-77.69; P < 0.001), while the SIR was 2.26 in the 119 patients who did not receive any chemotherapy (95% CI 1.13-4.04; P = 0.01 ). Of four hematologic malignancies, three appeared in the 12 patients who received chemotherapy. CONCLUSIONS: An increased risk of SNGCM after SDRT + IDRT has been demonstrated. After IDRT alone, the risk of second cancer is not incremented after a median follow-up of 6 years, but further observation of the patients is necessary to achieve final conclusions. Our results suggest that the risk of second cancer and especially of hematologic malignancy is increased by the association of chemotherapy and radiation.

Adult↗