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T Flam

Publications and source records attributed to T Flam.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Treatment of cancer of the prostate].

The incidence of prostate cancer has increased constantly over the last years. Treatment, whatever the stage of disease, remains controversial. Poor prognosis in patients with a localized tumor and lymph node metastases usually excludes curative therapy. Simple resection could be a reasonable option in cases with well or moderately well differentiated localized cancer, especially if life expectancy is less than 10 years. The real problem is to identity potentially aggressive cancers since an improvement in quality of life is an important element in caring for patients with cancer of the prostate. Survival rate at 15 years in patients with localized tumors after total prostatectomy appears to be comparable with that in the general population of the same age without cancer of the prostate. Conformational radiotherapy could allow more extensive irradiation of the prostate gland without touching the neighboring organs (rectum, bladder, head of the femoral bone). The dose should reach 80 Gy. Hormone treatment is currently used as first intention treatment in patients with metastase prostate cancer. Response rate is approximately 80%. Within 2 years, 8 out of 10 patients develop hormone resistance. Complete androgen suppression could improve survival times and quality of life in approximately 15% of the patients, although it is not possible at the present time to identify prior to treatment those patients who are susceptible responders. Chemotherapy has not been shown to be particularly effective in hormone-resistant cancer of the prostate. Prevention of cancer of the prostate is the next step to be accomplished.

Humans↗
PubMed1996

Local staging of prostate cancer by endorectal MRI using fast spin-echo sequences: prospective correlation with pathological findings after radical prostatectomy.

OBJECTIVE: To evaluate the accuracy of endorectal magnetic resonance imaging (MRI) with fast spin-echo sequences in the local staging of clinically localized prostate cancer. PATIENTS AND METHODS: Seventy-one patients with a clinical T1 (18 patients) or T2 tumour (53 patients) underwent endorectal MRI 2-12 weeks before radical prostatectomy. Extraprostatic tumour was diagnosed if MRI showed signs of capsular penetration and/or invasion of the seminal vesicle and/or distal urethra or bladder neck. If the pathological examination showed a single positive margin with no periprostatic tissue, the tumour was classified as indeterminate and not as a T3 tumour. RESULTS: Of the 25 cases of capsular penetration. MRI correctly identified 10 (sensitivity 42%, specificity 100%). Of the 14 cases with seminal vesicle invasion, MRI correctly identified six (sensitivity 43%, specificity 100%), but showed other signs of extraprostatic tumour spread in seven of the eight unidentified cases. Overall, MRI identified 16 of the 30 patients (53%) with occult extraprostatic spread of tumour; there was only one false-positive result. The sensitivity, specificity and accuracy of MRI were 53, 96 and 74%, respectively. CONCLUSION: Endorectal MRI can reduce the rate of preoperative understaging from 42% to 22% and it can be used for a given individual because it can detect extraprostatic invasion with 96% specificity, ensuring that very few, if any, patients will be deprived of curative surgery.

Aged↗
PubMed1996

[Results of endorectal MRI in local staging of prostatic cancer. Correlation with specimens from prostatectomy. Apropos of 47 cases].

Endorectal surface coil magnetic resonance imaging (MRI) was used in the local staging of prostate cancer in 47 patients. We used an 1.5 Tesla General Electric magnet. Fast spin echo sequences were acquired in all cases. All pathological specimen were reviewed by one pathologist. Pathological study showed that 19 patients had a locally confined cancer of the prostate (pT2), and 28 had an extraglandular extension (pT3). MRI correctly predicted a pT3 tumor in 15 of 28 cases, and a pT2 tumor in 18 of 19 patients. MRI was 70% accurate in the differenciation of stage pT2 from stage pT3 cancer. One case was overestimated and 13 cases were underestimated. The latter 13 patients had microscopic extracapsular invasion only.

Aged↗
PubMed1996

[A rare variety of urothelial carcinoma. Apropos of 2 cases].

We report two cases of grade 1 papillary transitional cell carcinoma which have a distinct pathological. The tumor was infiltrating the lamina propria in the first case (pT1) and the superficial muscle in the second case (pT2). These tumors were composed by nests and tubules with few cytological atypias, making the diagnosis of cancer difficult. The prognosis of these tumors is not well defined.

Carcinoma, Transitional Cell↗
PubMed1996

[Electroconductive extracorporeal lithotripsy with Sonolith 4000+. A prospective study of the ECG desynchronization using a fixed-rhythm simulator].

INTRODUCTION: Electrohydraulic lithotripters use a R-wave triggering system as episodes of cardiac arrhythmia were observed during early clinical experiments. This study was designed to assess the safety of non triggered shock wave treatments using an external fixed rate device (120/min) on the Sonolith 4000 Plus (*), a non bathtub electroconductive lithotripter. METHODS: Our study is the first prospective evaluation of non-EKG-gated lithotripsy where the patient under continuous Holter monitoring served as his own control during a randomized alternation of periods with or without R-wave triggering. This design allowed for a direct comparison of the effect of EKG-gated and non-EKG-gated lithotripsy respectively. The sequence of the different periods was randomly assigned. The recordings were compared to a pre-treatment recording, the cardiologist ignoring the randomization. RESULTS: 25 consecutive patients without cardiac history have been treated for urinary stones. Ventricular and supraventricular excitability disorders have been noted in 7 patients, always during a non-EKG-triggered period. There was no correlation with stone location. No cardiac rhythm disturbances have been observed during triggered periods in the 25 patients. Auricular extrasystoles (0.1-0.5/min) were observed in 6 patients, and auricular couplets (0.5/min) in one. Ventricular extrasystoles were noted in 4 patients, and ventricular couplets in one. One patient had an asymptomatic non sustained ventricular tachycardia which resolved spontaneously. No clinically significant disorder occurred. Treatment time and analgesics requirements were reduced by non-EKG-triggering. CONCLUSIONS: Non-EKG-triggering lithotripsy has a definite potential for cardiac disturbances, but appeared to be clinically safe in these patients with no cardiac history.

Adult↗
PubMed1996

[Stress urinary incontinence in women caused by severe sphincter hypotonia. Goebbel-Stoeckel intervention as alternative to artificial sphincter. Apropos of 26 cases treated between January 1985 and January 1994].

Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation. 13 patients were continent (68.4%) in the sling procedure group and 5 in the sphincter group. Continence remained stable with a mean follow-up of 77 months (range: 39-110 months). 2 patients had urgency and none had dysuria. The sling procedure gave us the same results as sphincter with less morbidity.

Adult↗
PubMed1996

[Severe algoneurodystrophy of the right foot associated with prostatic cancer].

The authors report 1 case of particularly severe reflex neurovascular dystrophy whose clinical course was marked by the discovery of a carcinoma of the prostate. There was improvement in the reflex neurovascular dystrophy despite hormonal therapy of the cancer. Reflex neurovascular dystrophy cannot be considered as a form of a paraneoplastic syndrome.

Adenocarcinoma↗
PubMed1995

[Closure of a hypogastric urinary fistula after replacement enterocystoplasty with a flap of the rectus abdominis muscle].

Urinary fistulization to the skin is a rare complication of cystoprostatectomy with replacement enterocystoplasty. In two cases, fistulization did not respond to continuous drainage of the urine and was treated with a muscle flap using the abdominus rectus. This method offers rapid parietal repair giving a reliable rapid cicatrization since the interpositioned flap is well vascularized in an area of poor tissue quality.

Aged↗
PubMed1995

[Urinary calculi, consisting of dehydrated calcium phosphate. Clinical, biological, radiologic aspects, clinical course and management].

Seventeen cases of urinary calculi analyzed by infrared spectrophotometry were found to be composed entirely or nearly entirely of bihydrated calcium hydrophosphate. The observations are summarized here. This type of stone occurs with a frequency of about 1% (0.85% in our experience) of all urinary calculi, predominantly in men (14 of our 17 cases). Diagnosis is based on the physical and chemical analysis of the stone and on infrared spectrophotometry. Most of these stones are pure or nearly pure compounds. The macroscopic aspect of the stones or fragments of stones can guide diagnosis. These stones are cream coloured stones with a smooth regular outer surface. Broken fragments show the same cream colour, sometimes with strips radiating from the centre of the fracture surface. Radiologically, these stones are homogeneously radio-opaque, often oval-shaped with a regular outline. Blood tests can demonstrate suspected or proven hyperparathyroidism (4 out of 10 cases in our 17 observations) with hypercalcemia, hypophosphatemia and hypercalciuria. Complementary examinations may be needed to search for a parathyroid adenoma. With or without hyperparathyroidism, 24-h urinalysis usually shows hypercalciuria up to ro over 500 to 600 mg/24 h. Crystallization usually occurs in the upper urinary tract, in the bladder or in indwelling catheters. These stones are extremely hard and are difficult to break in vitro. To be successful, lithotripsy requires prolonged treatment: up to 3000 to 6000 shockwaves at 22-23 kv with the Dornier apparatus. Despite the notion of hypercalciuria, the pathogenesis of bihydrated calcium hydrophosphate calculi remains to be elucidated.

Adult↗
PubMed1995

[Limitations of ultrasonography in the detection of small cancers of the left kidney].

Renal ultrasound seems to be more difficult on the left than on the right side. In a retrospective analysis of 343 patients in whom a radical nephrectomy for renal tumor diagnosed by abdominal ultrasonography had been carried out, we analyzed the characteristics of these tumors. TNM classification was used. Right kidney tumors (n = 170) were smaller than the left ones (n = 172), 58 +/- 31.7 mm and 66.8 +/- 31.5 mm respectively, the difference being statistically significant (p = 0.01). Right kidney tumors of a less advanced stage (p < 0.05). Asymptomatic renal tumors were found more frequently on the right side (58.7%) than on the left (41.3%) (p = 0.03) and were smaller on the right (44 mm +/- 19.6 vs 54.5 mm +/- 27.2) (p = 0.04). In conclusion, Ultrasound exploration of the left kidney seems to be more difficult, mostly because the exploration of the right kidney is facilitated by the acoustic window of the liver.

Aged↗
PubMed1995

[Treatment of stress urinary incontinence in women using the Goebell-Stoeckel surgical method. Study of 59 operated patients. Long-term review].

Stress urinary incontinence may be treated by different techniques. This study is based on a retrospective analysis of 59 patients treated between 1985 and 1993, by the Goebell-Stoeckel technique. 48 patients were questionned by phone in March 1995 to estimate the long term results. Two groups were defined; group A: follow-up between 15-60 months and group B: follow-up between 72-120 months (Total average follow-up: 68 months). The majority of patients were elderly, menopaused (88%) and had had one or more surgical procedure for incontinence (60%). Among 59 patients, 8 developped minor early complications. The mean length of hospital stay was 14 days and the mean duration of indwelling catheterization was 6.5 days. 60% of patients have had urinary retention after catheter ablation and have required intermittent catheterization at home for a mean duration of 14 days. Continence was achieved in 84% of cases at 3 months and had persisted in 96% of cases for group A and 91.5% of cases for group B. With a mean follow-up of 68 months, 37.5% of cases had irritative symptoms, 12.5% had minor urethral obstruction. 52% of patients obtained a very excellent result (normal continence, no urgency, no dysuria), 9% obtained an excellent result (normal continence, urgency with no leaked, and/or minor dysuria); 12 obtained a moderate result (normal continence, urgency with minor leakage without toilet set, and/or minor dysuria) and 27% obtained a poor result (incontinence, urgency with leakage necessitating toilet set, and/or dysuria).

Adult↗
PubMed1994

[Electroconductive lithotripsy: experimental and clinical results with the Sonolith 4000].

Electroconductive lithotripsy uses a highly conductive liquid to bathe the electrodes rather than water. The effect is to channel energy between the electrodes and force it to pass directly from the anode to the cathode, exactly at F1. The Sonolith 4000 (Technomed Medical Systems) uses this new generation of "electroconductive" shock waves. Experimental and clinical results are presented. The typical electroconductive technique creates a linear relationship between energy level, in kilovolts, and the amplitude of the acoustic shock at F2 over a wide range of power. There is also a linear relationship between power and effectiveness of desintegration. More than 800 patients have been treated to date. Follow-up has reached 3 months in the 166 treatments reported here. Overall success rate without residual stone was 82%. The percentage of patients with residual stones smaller than 5mm was 5%. The rate of clinical success was 87%. The rate of retreatment in patients without residual stone was 10%. For 11 to 20 mm stones, the success rate (0 fragments), the rate of retreatment and the rate of auxiliary procedures were 83%, 4% and 2% respectively for stones < or = 10 mm and 78% for 11 to 20 mm stones. The electroconductive generator used in this study provided very satisfactory results, better than those generally obtained with classical generators. Tolerance was excellent.

Humans↗