Biomedical subjects

Philippe Thibault

Publications and source records attributed to Philippe Thibault.

25 records · Page 2Linked to original sources

PubMed2004

[Management of dog bite trauma of the external genital organs].

Animal bites to the scrotum are rare, but potentially serious. In the light of a personal case, the authors discuss the management of these lesions. An animal bite comprises a triple infectious risk: bacterial, tetanus and rabies. Surgical exploration is indicated for assessment of the structures involved and debridement. The morbidity is related to the severity of the bite and the waiting time before consultation, and complications are rare. Orchidectomy is sometimes necessary, as in the case reported here, and the patient must be warned about this possibility. Antibiotic therapy is empirical: tetracycline and anti-anaerobe antibiotic. Rabies and tetanus prophylaxis must be performed according to vaccine guidelines.

Aged↗

PubMed2004

[Spontaneous renal haematoma: diagnostic and therapeutic approach in 7 cases].

OBJECTIVE: Spontaneous renal haematomas are rare. The authors discuss the aetiological diagnosis and management of these haematomas. MATERIAL AND METHODS: Seven cases (3 females and 4 males) of spontaneous renal haematoma were managed between July 1999 and December 2002 and the case files were studied retrospectively. RESULTS: The circumstances of discovery were nonspecific. One patient presented with haemorrhagic shock. Radiological work-up comprised abdominal ultrasound and CT scan in almost every case. Ultrasound failed to demonstrate the aetiological diagnosis. CT revealed the cause of bleeding in 7 cases. MRI was performed in 4 cases, but urgent angiography was not performed. Four total nephrectomies were necessary, while two patients were treated by conservative surgery. One patient was simply followed by repeat CT scan. The short-term course was favourable with a mean follow-up of 23 months. CONCLUSION: Spontaneous renal haematomas raise 2 problems, that of their aetiology: tumours are the commonest causes (angiomyolipoma and renal cell carcinoma), and that of their management. Three therapeutic approaches are possible: radical surgery in the case of uncontrollable bleeding, conservative surgery or surveillance in the absence of a life-threatening emergency and when the aetiological diagnosis has not been established. Rigorous and repeated radiological surveillance can identify the cause of the bleeding allowing conservative surgery to be performed when indicated.

Aged↗

PubMed2004

[Giant parathyroid adenoma causing early recurrence of renal stones].

Primary hyperparathyroidism (PHPT) is not a rare disease. Renal stones are the most frequent complication of PHPT The authors report the case of a patient with giant parathyroid adenoma responsible for early recurrence of renal stones. Ultrasound examination of the neck, parathyroid MRI and Technetium99m-Sestamibi scintigraphy confirmed the parathyroid adenoma. Surgical exploration allowed resection of a giant adenoma (6.5 x 2.5 x 1.5 cm weighing 17 g). In the light of this case, the authors describe the characteristics of HPT define the place of preoperative imaging and emphasize the need for systematic aetiological work-up looking for HPT in all patients with a first episode of renal stones.

Adenoma↗

PubMed2003

[Flexible double active deflection ureterorenoscopy].

INTRODUCTION AND OBJECTIVE: Secondary deflection of a flexible ureterorenoscope (FUR) is a passive mechanism, which can only be performed under certain anatomical conditions. The objective of this study was to present a new double active deflection FUR and to assess its value based on our initial experience. MATERIAL AND METHODS: From October 2002 to February 2003, we performed flexible retrograde ureterorenoscopy in 30 consecutive patients (34 renal units) using a double active deflection FUR (ACMI DUR 8 Elite). Bilateral ureterorenoscopy was performed during the same operating time in four patients. Ureterorenoscopy was diagnostic for 9 patients (macroscopic haematuria, urinary tract tumour), and therapeutic for 21 patients (stones, urinary tract tumour, ureteropelvic junction stenosis with stone). The value of double deflection as well as the efficacy and morbidity of the technique were evaluated. RESULTS: The main indication for flexible ureterorenoscopy was the treatment of urinary stones (73.6%), followed by the diagnosis of macroscopic haematuria and urinary tract tumours (26.4%). Ureteric dilatation was necessary in 38.3% of cases. The use of active secondary deflection was essential in 20% of cases (7/34) for complete investigation of the pyelocaliceal cavities. Access to the lower calices was not possible in one patient with a left pelvic kidney. 19 patients with urinary stones had no fragments (79.2%) at the end of the operation, while 4 had residual fragments in the lower calices. The global success rate for all operations was 85% (29/34). Two patients developed acute pyelonephritis during the 48 hours after the procedure and another two patients experienced acute renal colic. CONCLUSIONS: Our study confirms the data of the literature on flexible ureterorenoscopy in terms of indications and efficacy. The URS DUR 8 Elite allowed complete exploration of the pyelocaliceal cavities in more than 97% of cases. The use of active secondary deflection was unnecessary for the majority of patients (80%), but it represents a major technical progress which should be taken into account in the design of future flexible ureterorenoscopes.

Adult↗

PubMed2003

[Cystectomy with preservation of the prostate in the treatment of bladder tumours: anatomical basis, surgical techniques, indications and results].

OBJECTIVE: To evaluate cystectomy with preservation of the prostate in the treatment of bladder tumours. MATERIAL AND METHODS: A review of the literature (Medline, key words: cancer, bladder, cystectomy, prostate, urinary incontinence, sexual impotence) was performed. Three cystectomy techniques with preservation of the prostate were recently described; their anatomical basis, surgical techniques and indications are reported. Their morbidity and oncological and functional results were then studied and compared to contemporary total cystectomy series. RESULTS: The morbidity is not worsened. The functional results were globally improved, especially in terms of erectile function. In terms of cancer control, local recurrences were not more frequent, but metastatic recurrence rates appeared to be higher. CONCLUSION: Compared to total cystectomy, cystectomy with preservation of the prostate is not associated with increased morbidity, improves functional results, but does not appear to ensure an equivalent level of cancer control.

Cystectomy↗

PubMed2003

[Vitamin C and stone risk. Review of the literature].

The popularity of vitamin C can be attributed to Linus Pauling who, in the 1970s, recommended the use of vitamin C for the prevention of influenza. Vitamin C has subsequently been used extensively in a wide range of diseases. Ascorbic acid (vitamin C) has been incriminated as a possible risk factor for calcium oxalate stones due to its enzymatic conversion into oxalate. However, this lithogenic role has never been clearly established. Studies evaluating the effect of ascorbic acid on lithogenesis have reported contradictory results. Ascorbic acid has also been extensively used as an urine acidifier for the treatment of chronic or recurrent urinary tract infection. Once again, the data of the literature are contradictory. The purpose of this article was to review the effects of ascorbic acid on lithogenesis and urinary pH based on a review of the literature.

Ascorbic Acid↗

PubMed2002

[Pseudo-tumor form of bladder scleroderma: unusual cause of hematuria].

The bladder is a rare site of scleroderma. The frequency of bladder involvement is difficult to estimate, as only about thirty cases have been reported in the literature. Scleroderma bladder involvement usually presents in the form of frequency and burning, but may sometimes cause urgency or recurrent urinary tract infections. The authors report a case of bladder scleroderma responsible for severe haematuria in a 56-year-old woman and discuss this rare cause of macroscopic haematuria in the light of the histological findings and a review of the literature.

Female↗