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Biomedical subjects

Y Lanson

Publications and source records attributed to Y Lanson.

At least 37 records · Page 2Linked to original sources
PubMed1990

Papillary tumour of the vagina resembling transitional cell carcinoma.

A case of a peculiar papillary neoplasia of the vagina resembling a urothelial tumour is presented. Four vaginal tumours were excised from a 76-year-old woman. Five years before this patient had undergone a uretero-nephrectomy for a non-invasive papillary transitional cell carcinoma of the renal pelvis. The four vaginal tumours demonstrated gross and microscopic similarities to low-grade papillary transitional cell carcinoma of the urinary tract. This observation indicates that multicentric, non-invasive, papillary tumours may affect the whole uro-genital area. The vaginal wall was not overlaid by a normal squamous epithelium, but by a peculiar "transitional-like" epithelium. Variegated endocrine cells were documented within this lining, using immunohistochemical and ultrastructural techniques. The eventuality of a histogenetic link between the tumour and the adjacent epithelial lining remains unresolved.

Aged↗
PubMed1990

[Wilms' tumors in adults].

Two cases of Wilms' tumors in adults are reported according to the criteria defined by Kilton. The study of the literature allows defining the pathogenetic hypothesis for these embryonic tumors, as well as their peculiarities in comparison with those occurring in childhood. The prognosis seems to be improved by an aggressive treatment. A schedule of treatment including initial surgery, radiation therapy and chemotherapy varying according to the tumoral group (NWTS 2 staging) is proposed.

Adult↗
PubMed1990

[Descriptive epidemiology of tumors of the renal parenchyma in adults, in Indre-et Loire from 1980 to 1987].

296 solid renal tumors were studied retrospectively, i.e. the total number of renal tumours diagnosed in the Indre-et-Loire region between 1980 and 1987 inclusive. The crude incidence rate increased from 5.4 per 100,000 in 1980 to 8 per 100,000 in 1987. The standardised rates were 6.7 per 100,000 for men and 3.2 per 100,000 for women. These figures being quite high for France. The mean age at the time of diagnosis, 67 years for women and 65 years for men, decreased during the study, especially for women. Patients in whom the renal cancer was discovered accidentally, tended to be older than those in whom the tumour was symptomatic. The percentage of tumours discovered at stage I rose from 29 to 49% the percentage of tumours at stage IV fell from 45 to 23.5%. In parallel, the percentage of nephrectomies rose from 40 to 70%. The overall 5 year survival rate was 43.5%, rising to 71% for stage I tumours. It appeared that patients who consulted in the private sector tended to be younger and were therefore at an earlier stage in the natural history of the disease. From an epidemiological viewpoint, the introduction of ultrasonography in the Indre-et-Loire region and its more widespread use did not produce any change in the means of diagnosis of renal cancer.

Adenocarcinoma↗
PubMed1990

[Ureteral stenosis in pancreatitis. Role and value of the double J tube].

One case of right ureteral stenosis due to a flow of necrosis from an acute lithiasic pancreatitis, treated with the insertion of a double J tube, is reported. 14 cases of ureteral stenosis following pancreatitis have been found in the literature. They occur whatever the severity of pancreatitis and can either reveal it or, on the contrary, be asymptomatic. The ureteral lesions are of three kinds: compression by a pseudocyst of the pancreas, sheathing of the ureter and "ureteritis" in the flows of necrosis, necrosis of the ureteral wall. The management of these ureteral stenoses involves treating both the pancreatitis and the obstruction, according to its type. In cases of compression or sheathing of the ureter, ureteral endoprostheses inserted in an early stage allow maintaining the patency of the ureter during the healing phase. In case of ureteral necrosis, nephrostomy, then ureteral resection prove to be necessary.

Aged↗
PubMed1990

[ The law, indispensible images and superfluous images in cancer of the kidney].

In France, a physician is considered liable for a medical error only if the appropriate diagnostic and therapeutic means were not used. The urologist who evaluates a patient is responsible for the diagnosis of renal carcinoma and for assessing the spread of the disease and deciding whether surgery is indicated. The urologist coordinates the various investigations and interprets results in the light of each individual patient's characteristics. In most renal carcinomas, only simple imaging techniques are needed: renal ultrasonography and an intravenous urogram or a CT scan. Further techniques may be required to assess disease spread according to the French Urology Association's Oncology Committee, only abdominal ultrasonography and a chest film are "absolutely required", the other imaging techniques being "desirable" or "optional".

Diagnosis, Differential↗
PubMed1990

[Imaging and the court of law: useful images and useless images].

The expert who review a medical record in a liability suit is required to determine whether the tests performed were necessary and, above all, whether they were adequate. In France, physicians are legally required to use adequate diagnostic and therapeutic means, especially in complicated cases. When this obligation is not fulfilled, the urologist is often held responsible since he or she is in charge of interpreting the tests and drawing final conclusions. Urologists are rarely criticized for performing too many investigations. The urologist is not considered liable for complications that occur during the performance of a necessary test: in this case, the physician who performed the test is legally responsible.

Diagnosis, Differential↗
PubMed1989

[Urologic surgery and risks of complaints in medical responsibility].

The card-index study of specialized insurance companies allowed the analysis of 82 cases concerning urological surgical procedures. Forty-two cases went to the Civil Court, 10 to the Penal Court and 5 to the Administrative Tribunal, while 5 cases were simply declared to insurance companies without judiciary consequences. Sixty-two cases concerned private plaintiffs surgeons and 34 cases concerned non specialist urologic surgeons. Sixteen plaintiffs were compensated, 9 after a conciliatory agreement and 7 after trial. There were no penal condemnations (one case on the waiting list). Impotence was the most frequent cause for complaint which was compensated. Next, came incontinence generally secondary to endoscopic resection. Retrospectively, 19 cases seemed to be unwarranted due to the dishonesty of patients (3 patients were prosecuted for unwarranted procedures). On the other hand, 32 cases seemed to be due to a lack of information given to the patients themselves or to their families, either before of after the incriminated act. The risk of prosecution is relatively low in urology. It could be decreased by careful management of the medical chart, by rapid analysis of complications and by a constant effort to inform the patient and his family.

France↗
PubMed1989

[Epidemiology of tumors of the testis in Indre-et-Loire from 1978 to 1987].

All the testicular tumors found among the inhabitants of the Indre-et-Loire department between 1978 and 1987 were reviewed. There was a total of 122 tumors, i.e. a direct standardised incidence rate of 4.55/100,000. The incidence increased over the years 1978-1982, with an abrupt decrease at 50% in 1983 and the increase since then has been minimal. There was an excessive morbidity rate of 22% for patients living in an urban environment. There was no preferential side for the tumor. The histological types of the tumors permit to distinguish three types of populations: non seminiferous germ cell tumors (51.3%) at the age of 30 years; seminoma (41.3%) at the age of 40 years and lymphoma (7.4%) at the age of 74 years. An indirect standardisation revealed an excessive rate of 22% for the socioprofessional category of employers and a rate of 28% for artisan, business men and company directors. The study confirms the known notions about the age and the histologic distribution of testicular tumors. The highest incidence rate of all the French departments, the drop in the rate of this growth curve in 1983 and the over representation of the employee category appear to be the most specific notions in the Indre-et-Loire department.

Adolescent↗
PubMed1988

Low molecular weight heparin compared with unfractionated heparin in prevention of postoperative thrombosis.

Three consecutive randomized open studies have been carried out to determine the optimal dosage of low molecular weight heparin (LMWH) in the prevention of postoperative thrombosis in general surgery (892 patients). All patients undergoing abdominal, gynaecological, thoracic or urological surgery were over 40 years old and presented at least one of the following risk factors for thrombosis: previous thromboembolism, obesity, varicose veins, malignancy (30 per cent), pre-operative hospitalization over 5 days, oestrogen therapy, chronic cardiac disease or bronchitis. Isotopic venous thrombosis and bleeding complications were assessed after subcutaneous administration of a LMWH fragment (LMWH, Enoxaparine) or unfractionated heparin (UH). The three studies compared 3 X 5000 units UH daily with 1 X 60 mg, 1 X 40 mg, 1 X 20 mg LMWH daily. Thromboembolic events rates were not significantly different from group to group (UH: 3.8 per cent, 2.7 per cent, 7.6 per cent respectively compared with LMWH: 2.9 per cent, 2.8 per cent, 3.8 per cent). Bleeding episodes including wound haematoma formation, perioperative blood losses and systemic haemorrhage were not significantly different in patients receiving LMWH or UH. Significant decreases in haematocrit and haemoglobin were only observed in patients receiving 60 mg Enoxaparine (as compared to UH). An analysis using the 'intention to treat' approach gave results consistent with those of an analysis of good compliers. An overview of isotopic thromboses in the three studies gave no evidence of differences amongst the effects of the three doses of LMWH (P = 0.20), and pooling the results of the three studies using the Mantel-Haenszel procedure gave no evidence of a global difference between Enoxaparine and UH (P = 0.54). These results suggest that an optimal dosage of 20 mg/day of Enoxaparine is safe and effective in the prevention of postoperative thrombosis in this population.

Aged↗
PubMed1988

Endocrine cells in the excurrent duct system of the testis. An immunohistochemical analysis.

A systematic search for endocrine cells in the excurrent duct system of the testis was carried out by means of histochemical and immunohistochemical techniques. A panel of antibodies against amine and polypeptide hormones was used. 80 specimens comprising representative areas of rete testis, ductuli efferentes, ductus epididymis and 30 examples of ductus deferens were investigated. Cells immunoreactive for serotonin were detected in four out of 110 specimens. They were invariably in normal-appearing ductuli efferentes. A salient feature was their rarity and focal distribution. We failed to detect any endocrine cells in other segments of the excurrent duct system and notably not among epididymal epithelium. It seems of interest that serotonin cells are specifically distributed throughout remnants of excretory mesonephric tubules in both males and females.

Endocrine Glands↗
PubMed1988

[Metastatic cancer of the kidney. What can be done today?].

Metastatic cancer of the kidney kills one half of the patients concerned within one year and there are no survivors two years later. All of the treatments used up until the present time have been disappointing. Nephrectomy does not prolong survival, does not induce regression of metastases and does not modify the mode of metastatic dissemination. It only has a palliative role. Lymphadenectomy associated with nephrectomy only has a prognostic value. Hormone therapy and chemotherapy are ineffective. Resection of a single metastasis is justified by 5-year survival rates of 30 to 50% in certain series. At the present time, the hopes for effective treatment are raised by the use of recombinant alpha interferon. Therapeutic trials obtain an overall complete response rate of 2.5% (disappearance of all signs of tumour for 4 weeks) and a partial response rate of 14% (decrease in the neoplastic lesions by at least 50%). The combination of interferon with vinblastine ensures much better results with complete and partial response rates of up to 43%. The characteristics of responder patients are discussed in terms of the natural history of renal cancer and the respective results of other treatments. There is a sub-population of patients with metastatic renal cancer suitable for this combination of interferon-vinblastine: they are young patients, in good general condition, previously nephrectomised and preferably suffering from lung metastases. The essential limiting factor of this treatment is the high cost of interferon.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Glycoprotein hormone alpha-chain-immunoreactive endocrine cells in prostate and cloacal-derived tissues.

All cloacal-derived tissues contain a similar endocrine cell population. Human chorionic gonadotropin (hCG)-like immunoreactivity has been reported in some prostatic endocrine cells. On the other hand, immunoreactivity to alpha-hCG is well known to occur in a variety of extraprostatic endocrine elements. Most cloacal-derived tissues were tested with a panel of monoclonal antibodies against hCG and subunits. The previously described hCG-like positivity was found to be exclusively related to the free alpha-subunit of hCG. Moreover, alpha-chain immunoreactivity was more broadly distributed in most cloacal-derived tissues, including those from the anal canal. In the anal canal, alpha-chain was an excellent marker of the anal transitional zone. alpha-Chain-immunoreactive endocrine cells were normal and nonneoplastic constituents of these tissues; they corresponded to a subpopulation of serotonin cells. In addition, certain prostatic argyrophil cell carcinomas might be exclusively alpha-subunit producing.

Calcitonin↗
PubMed1987

[Solid tumors of the renal parenchyma in the adult. Does the absence of symptoms modify the prognosis?].

Of 220 solid tumors of renal parenchyma reviewed, 26% (57 tumors) were asymptomatic and discovered by chance, either by radiology (45.5%), ultrasound (21%), biology (16%), clinical (10.5%) or histopathology examination (7%). The asymptomatic tumors were benign in 20% of cases whereas this was the case with only 3% of symptomatic tumors. For a given age, asymptomatic malignant tumors were in a less advanced stage than symptomatic tumors. These findings suggest the need for routine investigation for renal tumor syndromes. Whenever possible and whatever the indication for an examination.

Adolescent↗
PubMed1986

Calcitonin immunoreactive cells in prostate gland and cloacal derived tissues.

Calcitonin- and serotonin-storing cells have been immunocharacterized in prostate gland, urethra, urinary bladder and anal canal. In addition, a few hCG and somatostatin immunoreactive cells have been detected in prostate gland. All these cells were dispersed throughout the epithelial lining. In the anal canal, calcitonin cells were exclusively confined to the anal ducts and anal transitional zone epithelium. Calcitonin and serotonin cells were seen in some examples of prostatic adenocarcinoma. Combined techniques most often showed coexistence of calcitonin and serotonin immunoreactivities in the same endocrine cell. hCG immunoreactive cells corresponded to a subpopulation of serotonin-, calcitonin-storing cells. Calcitonin and serotonin cells were present in most organs which originated from the cloaca. In this territory, this distinctive endocrine pattern could be regarded as an excellent marker of cloacal derived tissues. These tissues constitute an additional site for extrathyroid C-cells. It is likely that calcitonin cells are a component of some prostatic adenocarcinomas.

Adenocarcinoma↗
PubMed1986

Endocrine cells in renal pelvis and ureter, an immunohistochemical analysis.

A systematic detection of endocrine cells in the renal pelvis and ureter was carried out, using Grimelius stain and immunohistochemical techniques. Ninety specimens of pelvic and ureteral mucosae were investigated. Throughout the pelvic urothelium, endocrine cells were very uncommon, patchily distributed, and serotonin-storing. They have been disclosed in only two cases among normal-appearing transitional epithelium. Whether cells so scanty are normal and permanent inhabitants of this territory is debatable. The material examined did not provide opportunity to demonstrate endocrine cells throughout the normal ureter. Surprisingly, one case of supernumerary ureter with an ectopic distal orifice into the urethra harbored abundant serotonin cells. This remarkable endocrine profile, which departed appreciably from that of normal ureter, showed a close similarity with that of the urethra. This raises the question whether such endocrine differentiation might reflect, for this ectopic ureteric bud, urogenital sinus origin rather than wolffian origin.

Fluorescent Antibody Technique↗
PubMed1986

[Urinary lithiasis after using mechanical suture procedures for Bricker's operation. Apropos of a case].

A further case is reported of urinary tract lithiasis developing around a metallic clip used to suture an ileal fragt during Bricker's operation. Although the calculus developed without provoking complications and was evacuated spontaneously through the stoma, the question is asked, after a literature review, whether it is justified to use mechanical suturing for transintestinal cutaneous anterostomies. The moderate gain in time (15 to 20 min) seems counterbalanced by the increased cost and definite risk (2 to 4%) of lithiasis on metallic clips.

Humans↗
PubMed1985

[Tentative classification of the ultrasound symptomatology of the prostate by an anatomo-ultrasonic comparison of 34 cases].

Ultrasound and histological sections were taken of 34 prostate units removed from fresh cadavers. Ultrasonography seems to raise more problems than it solves; only 73% of the normal prostates were homogeneous under ultrasound. Ultrasonography visualized nodular structures requiring biopsy in 71% of the cases of prostatic adenoma. There were too few cases of malignant tumors in the sample to warrant a conclusion. They were highly evolved. Ultrasonography gave strong grounds for suspicion, but they could be easily diagnosed clinically.

Adenoma↗