Bladder replacement by detubed ileo-caecal graft after radical cystectomy.
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Carcinoma, Transitional Cell↗
Biomedical subjects
R Gaston
Publications and source records attributed to R Gaston.
[Vesical replacement by ileo-caecal graft detubulized after total prostato-cystectomy].
Following total prostato-cystectomy, the nearest substitute to a physiological reservoir is a constructed ileo-caecal pouch. The non-mesenteric sides of the caecum and ileum are incised on a length of 15 cm for each apex of the caecum which is anastomosed with the urethra, respecting the striated sphincter. The ureters are implanted into the caecal portion of the pouch. Owing to the length of the ileo-caecal mesenterium, this technique can be used in every case of prostato-cystectomy. Twelve cases followed up for 6 to 18 months are reported.
Cecum↗
[Cisplatin-based chemotherapy in the treatment of advanced-stage tumors of the bladder].
Since October 1984, 39 patients have been treated with cisplatin based chemotherapy for advanced bladder tumour of for pelvic recurrence or metastasis after total cystectomy. Cisplatin-methotrexate protocol (23 cases): 2 cases died during the first two cycles and 21 were evaluated after three cycles: only 39% of objective responses (2 CR-5 PR-2 MR) were observed with a mean survival not exceeding 12.6 months (7 deaths, 2 patients alive at the present time). All of the non-responders died within 4 to 16 months following the start of treatment (mean survival: 8.7 months). These particularly disappointing results led to the suspension of this protocol. Cisplatin-methotrexate-vinblastine protocol: 16 cases since September 1986. Eleven patients have been evaluated after three cycles: 3 CR-3 PR-5 PROG. The C.M.V. protocol appears to have a superior efficacy, principally on bladder, lymph node or lung lesions, at the cost of a higher but acceptable toxicity. Hepatic and central nervous system metastases were observed secondarily in this case.
Adult↗
[Use of the laser in urology].
The usage of laser therapy in urology is based upon thermal effects that lead to tissue destruction by coagulation necrosis and volatilization. The endoscopic treatment of bladder tumors has been its most important utilization. The authors report their experience with 681 bladder tumors in 198 patients and present the technical details of laser therapy, the indications and the results. The recurrence rate at the previously treated tumor area was found to be rather improved: 0.75/100 months/patient for stage pTa and 0.92/100 months/patient for stage pT1. Other utilizations for laser therapy exist: upper tract urothelial tumors mainly in selected cases as solitary kidney; urethral localizations of urothelial tumors and condylomata acuminata; urethral stenosis, as a complement of optical urethrotomy; hemorrhagic cystitis after radiotherapy and some forms of chemotherapy. The pulsed dye laser may become an important advance in endoscopic treatment of ureteral calculi.
Cystitis↗
[Bladder replacement with colon segments].
The authors report their experience of 81 cases of bladder replacement with colonic grafts between 1980 and 1986. The operative technique is presented and its complications and functional results analysed. Bladder tumors were the most frequent indication although some cases of tuberculosis, bilharziosis and neurogenic bladder were also included. After a critical study of the literature, the authors state that the ileocecal segment has become their preferred material. Over the last fourty months, 42 patients have been treated by the latter form of bladder replacement.
Cecum↗
[Experience in the treatment of erectile impotence by the intracavernous auto-injection of vasoactive substances].
Eleven selected patients participated in a programme of intracavernous auto-injections for erectile impotence. This treatment provided these patients with an erection allowing sexual relations which were considered to be satisfactory at the beginning, but more than one half of them progressively abandoned the technique after six months; as the majority of partners expressed feelings of frustration. Auto-injections represent a valid alternative in the treatment of erectile impotence of essentially neurological origin.
Adult↗
[Apparently isolated tumors of the adrenal gland. Apropos of 12 cases surgically treated].
12 patients with an adrenal tumour were observed in the absence of any known history of neoplasm at the stage of dissemination. In 9 cases the tumour was discovered accidentally. On the basis of the conclusions of the histological analysis following surgical exploration, the authors define the respective advantages of various examinations: laboratory assays, ultrasonography, CT scan, NMR and discuss the management of chance discovery of an adrenal mass.
Adenoma↗
[Current strategy in the treatment of urinary calculi since the introduction of the EDAP lithotripter].
The extracorporeal lithotripter has radically changed the treatment of urinary stones. Three-hundred and seventy-four stones in 356 patients were treated over an eight-month period. Extracorporeal lithotripsy (262 cases) is mainly indicated in pelvic and calyceal stones measuring less than 2.5 cm, stones located in the lumbar ureter and previously flushed, and some stones of the pelvic ureter. Analysis of results showed that extracorporeal lithotripsy achieved fragmentation in 80% of cases and complete elimination 3 months after the procedure in 70% of cases. Repeat procedures were needed in 23% of patients. Complementary procedures were required to relieve obstruction in 4% of patients. Percutaneous nephrolithotomy now has very few indications but remains useful in large pelvic stones, failures of EDAP (7 cases), and some staghorn stones with few ramifications. Open surgery (24 cases) is still useful for complex staghorn stones, soft stones in febrile patients, calyceal stones with destruction of the neighboring renal parenchyma, incarcerated lumbar stones, and stones associated with an obstructive malformation of the urinary tract. Ureteroscopy (69 cases) proved highly reliable in stones located in the pelvic ureter. An improvement, therefore, but no miracle.
Endoscopy↗
[Bilateral cancer of the kidney and cancer of a solitary kidney].
The analysis of a series of 31 cases of bilateral renal cancers and cancers of solitary kidneys revealed the following findings: 1) conservative in situ surgery with clamping of the renal pedicle and dopamine, when it is possible, appears to be by far the most logical and simplest solution (17 cases); 2) ex-vivo surgery with auto-grafting represents an extreme solution (2 cases); 3) cases of technical impossibility, in the absence of distant metastases, require radical nephrectomy followed by dialysis (3 cases); 4) in advanced forms, surgical abstention followed by hormone therapy (8 cases) or highly selective embolisation (1 case) sometimes provides surprising survivals.
Adenocarcinoma↗
[Treatment of intradiverticular pyelocaliceal stones].
Nine patients with symptomatic intradiverticular stones have been treated, 3 by open surgery (excluded cavity and abscess formation) and 6 by endoscopy. When possible (4 cases), direct puncture of the diverticular cavity seems to be much simpler and more effective than indirect intrarenal access. The percutaneous approach constitutes a valuable alternative to open surgery in the treatment of symptomatic intra-diverticular stones, although secondary obliteration of the cavity is not always obtained, which leaves a potential risk of long term recurrent stones.
Humans↗
[Renal cancer in the pregnant woman].
The authors report three cases of adrenal cancer in pregnant women. The diagnostic, pathogenic and therapeutic problems are discussed with particular emphasis on the considerable interest of ultrasound scanning. The surgical indications are always difficult and depend on the stage of evolution of the cancer, and the term of the pregnancy.
Adult↗
Current trends in the care of burned patients.
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Burns↗