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A Jardin

Publications and source records attributed to A Jardin.

At least 55 records · Page 3Linked to original sources
PubMed1997

Doxazosin in the treatment of benign prostatic hyperplasia. A review of the safety profile in older patients.

The objective of this paper is to review the safety of doxazosin in older patients (>/=65 y) with benign prostatic hyperplasia (BPH) as reported in seven international clinical trials. Data from seven double-blind, placebo-controlled, phase III trials, in both normotensive and hypertensive patients with BPH were collated and analysed. Data on doxazosin were available for 341 men 65 y and over. Even though older patients can be at particular risk of adverse drug reactions, there was no apparent evidence of poor tolerability with doxazosin in older patients with BPH. The percentages of younger normotensive BPH patients (<65 y) experiencing at least one adverse event were 47 and 44% for doxazosin and placebo groups, respectively; for older normotensive BPH patients (>/=65 y) the corresponding values were 42 and 38%. For the younger hypertensive BPH patients the incidence rates for adverse events were 55% (doxazosin) and 42% (placebo) and for older hypertensive BPH patients 43 and 30%, respectively. The most commonly reported adverse events for all groups were dizziness, headache and fatigue and few serious adverse effects were reported throughout these trials. It can be concluded that doxazosin is well tolerated in young and old, normotensive and hypertensive patients with BPH.

Journal Article↗
PubMed1997

[Central nervous system control of erection].

Relaxation of arterial and cavernous smooth muscle fibers, leading to the filling of the sinusoidal spaces with blood, are the local mechanisms of erection. Smooth muscle relaxation results from activation of parasympathetic neural pathway and probably simultaneous inhibition of the sympathetic outflow. Reflexive erection elicited by recruitment of penile afferents conveyed by the dorsal penile nerve involves both autonomic and somatic efferents. This reflex is mediated at the spinal cord level and modulated by supraspinal influences. Serotonergic pathways originating in the raphe nuclei mediate inhibitory control on reflexive erection. Several hypothalamic areas such as the medial preoptic area and the paraventricular nucleus are the source of descending pathways and/or represent important integrating centers. Dopamine acting at the medial preoptic area level may regulate penile erection. Neuroendocrine regulation may vary depending on the context in which erection occurs, for example, coitus, in response to extrinsic or psychogenic stimuli, and rapid eye movement sleep.

Afferent Pathways↗
PubMed1997

[The peripheral pharmacology of erection].

The peripheral control of local mechanisms of erection and detumescence has now been more clearly elucidated. This knowledge has been acquired as a result of the recent development of pharmacological research designed to study the regulation of erectile smooth muscle tone. Smooth muscle fibres of the corpora cavernosa and arteries supplying the penis relax in response to a reduction of intracellular calcium. This relaxation allows both an increase of the blood flow to the penis and opening of sinusoid spaces. Cyclic nucleotides, cAMP and cGMP, are intracellular messengers of the mediators acting on smooth muscle fibres and regulating these intracellular calcium movements. Gap-junctions, greatly facilitating rapid ion exchanges between smooth muscle fibres, make erectile tissue a real functional syncytium. Nonadrenergic, noncholinergic neurotransmitters, mainly nitric oxide (NO), are synthesized by parasympathetic neurons present in cavernous nerves and act directly on smooth muscle fibres. NO increases the intracellular cGMP concentration. Other proerectile mediators, such as acetylcholine, CGRP or substance P, act via endothelial cells by promoting the synthesis and release of NO by these cells. In contrast, neurotransmitters of the sympathetic nervous system, norepinephrine and neuropeptide Y, and endothelin, secreted by endothelial tissues, induce contraction of cavernous smooth muscle fibres, thereby opposing erection. Oxygenation of the cavernous tissue is also an important factor in the regulation of local mechanisms of erection. Poor oxygenation prevents the synthesis of cGMP and predisposes to cavernous fibrosis due to increased synthesis of collagen via TGF beta. A better understanding of the peripheral pharmacology of erection opens the way to new pathophysiological and therapeutic prospects in the broad symptomatic context of erectile dysfunction.

Acetylcholine↗
PubMed1997

[Concomitant radiochemotherapy in invasive bladder tumors].

The treatment of muscle-invasive bladder tumors currently consists of radical cystectomy with lymph node dissection. A combined radio-chemotherapy treatment could allow to preserve a functional bladder without greater risk of relapse. We present a review of 38 available publications found in the international literature concerning this combination treatment. Only 9 publications with appropriate analysis were considered, including 552 evaluable patients, 44% of whom were suitable for radical cystectomy. Cisplatin is the most often used drug. The protocols are variable and generally well tolerated. The median follow-up time is 36 months. The immediate complete response rates vary between 48 and 92% and the overall survival rate is between 42 and 82%. The survival with bladder preservation is between 38 and 75%, while the disease-free survival with bladder preservation is between 33 and 53%. 11% of the initially complete responders had a superficial recurrence and 30% had distant metastases. There is no proven advantage of neoadjuvant polychemotherapy, there is no consensus for the therapeutical protocol, the follow-up protocol remains to be defined, and the function of the preserved bladder has to be studied. Only a prospective randomized trial could precise the role of this experimental technique compared to surgery despite the major evident difficulties (ethical and practical) to conduct such a trial.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Stimulation of the medial preoptic area of the hypothalamus in the rat elicits increases in intracavernous pressure.

Penile erection can be elicited by various stimuli integrated in the spinal cord and/or higher central nervous structures. The medial preoptic area (MPOA) of the hypothalamus is known to play a key role in the regulation of the male sexual behavior. In anesthetized male rats we performed MPOA stimulation via stereotaxically implanted electrodes or canulae delivering L-glutamate. An erectile response, assessed by an increase of intracavernous pressure (ICP), was recorded during electrical stimulation of the MPOA. Stimulating the posterior region of the MPOA elicited a greater erectile response than stimulation applied to the anterior region. Microinjections of L-glutamate also elicited an ICP increase. Stimulation of MPOA neurons therefore elicits activation of neural pathways controlling penile erection.

Analysis of Variance↗
PubMed1996

Prospective study of men with clinical benign prostatic hyperplasia treated with alfuzosin by general practitioners: 1-year results.

OBJECTIVES: To investigate in men with benign prostatic hyperplasia (BPH) treated in the general practitioner setting (1) the magnitude and durability of symptom score improvement with alfuzosin; (2) the effect on patients perceived health-related quality of life (HRQL) and sexuality, (3) adverse outcomes and treatment failure; and (4) progression to acute urinary retention and prostate surgery. METHODS: A large, open outcome study was undertaken in the general practitioner setting in France, and a cohort of men with symptomatic BPH who received alfuzosin for 12 months was established. A total of 5849 patients (mean age 66.7 years) were enrolled by 1508 general practitioners in France. Men were examined at baseline and at 3 months, 6 months, and 1 year. To produce standardized outcome measures of disease-specific health status, under the conditions of routine care in the community, patients in the study completed a self-administered symptom questionnaire (score range 0 to 40) and a new, validated BPH-specific HRQL questionnaire (score range 0 to 200). Questionnaires were completed at baseline and during follow-up at 3, 6, and 12 months. RESULTS: Alfuzosin was effective in reducing symptoms; 98% (420) of severely and 85% (2479) of moderately symptomatic patients experienced improvement. At 3 months, the global symptom score was reduced by 9.49 +/- 0.08 (-53%), and this reduction persisted for the remainder of the study (-9.76 +/- 0.11). In contrast to the global reduction of symptom scores, there was a time-dependent improvement (+18.41 +/- 0.32 [+30%], +18.45 +/- 0.54 [+37%], and +23.42 +/- 0.57 [+43%] at 3, 6, and 12 months, respectively), in patients' perception of HRQL status. The magnitude of the improvement in HROL status was significantly more pronounced for those patients who had moderate or severe nocturia and daytime frequency at baseline than for those who had mild levels of the same symptoms. Sexuality score at baseline was significantly related to age and was significantly (P < 0.0001) higher in patients less than 70 years old than in older patients. Improvement in patients' perceived sexuality was significant at 12 months (P < 0.0001) and was correlated with age. CONCLUSIONS: The results of this large cohort study demonstrate the effectiveness of alfuzosin in reducing symptom severity and improving HRQL status over a 12-month period in men with BPH. It also suggests that HQRL and symptom severity are different and complementary entities. The results of the present study highlight the improvement in HRQL and patients' perceived sexuality that can be achieved in symptomatic patients with BPH receiving a 12-month course of alfuzosin therapy.

Adrenergic alpha-Antagonists↗
PubMed1996

[Double kidney-total pancreas transplantation with bladder reimplantation. 25 cases].

Twenty five double kidney-pancreas transplantations were performed according to the total pancreas transplantation technique with drainage of exocrine secretions into the bladder via a vesicoduodenostomy. 72% of kidney-pancreas grafts were functional at one year and 59% were functional at four years. The authors observed a slightly higher rejection rate (0.56 versus 0.34) and a higher incidence of urinary tract infection (60% versus 35%) following double pancreas and renal transplantation than after isolated renal transplantation. Complications were rare: two venous thromboses and two cases of urethritis requiring of rediversion of the duodenum into the intestine. These good results, comparable to those reported in the international registry, reflect the value of the pancreatic and renal transplantation technique using a total pancreas drained into the bladder. It would probably be preferable to transplant patients earlier, when chronic renal failure secondary to insulin-dependent diabetes induces end-stage renal failure and the need for haemodialysis.

Adolescent↗
PubMed1996

[Experimental approach to reflex erection in rats: modeling and functional neuroanatomy of the involved nerve pathways].

The neurophysiology of erection remains poorly elucidated, particularly at the spinal cord level. We studied variation of intracavernous pressure (ICP) in rats. Tactile stimulation of the prepuce in conscious rats induces the appearance of sequences of reflex erectile responses affecting the corpora cavernosa and/or corpus spongiosum and glans. During this test, implantation of a telemetric pressure transducer allowed us to record ICP increases occurring simultaneously to erectile responses. These increases were characterized by brief suprasystolic peaks preceded by an infrasystolic plateau. Each type of reflex erectile response was accompanied by a characteristic profile of ICP increase. Participation of the corpora cavernosa was demonstrated, particularly during erections of the glans. In anaesthetised rats, electrical stimulation of the dorsal nerve of the penis induces an increase of intracavernous pressure which tends to reach blood pressure values. This erectile response of the corpora cavernosa is abolished by proximal section of the dorsal nerve of the penis, markedly decreased by section of the homolateral pelvic nerve, and abolished after bilateral section of the two pelvic nerves. Striated muscle paralysis does not abolish the erectile response. These data help to define the neurophysiology of the reflex erection. In particular, they provide a clearer explanation of the spinal integration of reflex erection.

Animals↗
PubMed1996

Occurrence and treatment of kidney graft lithiasis in a series of 1500 patients.

In a series of 1500 patients transplanted between 1976 and 1992, 12 patients presented urinary calculi. The symptoms presented included obstructive anuria in 3 patients and abdominal pain in 1 patient. There were 8 asymptomatic patients. The risk factors were mainly hyperparathyroidism and non-absorbable sutures. The occurrence of renal graft calculi is now ten times less frequent than in the 1980s. In all, 5 of the patients were treated using incisional surgery, 5 with ESWL and 4 using ureteroscopy; a double J stent was inserted for the 3 cases of obstructive anuria. Nine patients are currently calculus-free and 2 have relapsed. One asymptomatic patient was not treated. The renal function of these 12 patient was not modified and no hypertension was noted after treatment. Calculi are generally asymptomatic when they are diagnosed by ultrasonography and in our experience they can be treated using ESWL or by ureteroscopy. In our opinion all patients can be treated successfully but with a high rate of relapse if the causal factors are not treated.

Adult↗
PubMed1995

Haematogenous dissemination of prostatic epithelial cells during radical prostatectomy.

Radical prostatectomy is one treatment for organ-confined prostatic adenocarcinoma. Dissemination of malignant prostatic cells after radical prostatectomy could be partly due to prostate manipulation during dissection. We confirmed by assay of prostate-specific membrane antigen by reverse-transcription nested PCR that prostate manipulation seeded prostatic epithelial cells in the general circulation in 12 of 14 consecutive patients operated on for organ-confined prostate adenocarcinoma. Our results suggest that surgeons should approach radical prostatectomy with care to avoid seeding from the prostate gland. Antiandrogen therapy might reduce the haematogenous spread of prostatic cells during radical prostatectomy.

Adenocarcinoma↗
PubMed1995

[Treatment of male infertility].

Progress in medically assisted procreation has made it possible to obtain an embryon with a single spermatozoid or even a single spermatid. But such advanced technology must not overshadow the basic principles of patient management since there are many other medical or surgical possibilities for improving male fertility. Although the physiological mechanisms leading to azoospermia are relatively well understood, many questions remain as to the origin of oligo-asthenoteratospermia. Varicocela had been incriminated by many authors: in 25% of the cases, surgical care is followed by pregnancy. Other factors including autoimmunity, infection, environment and drugs also have an effect. Careful history taking can identify the main causes of male infertility before the problem of procreation occurs and in cases of definitive azoospermia the principles of management are relatively simple. The true problem is the fact that new techniques such as in vitro fertilization have acquired popularity in the general population but cannot be accepted as the gold standard by the medical community. It must not be forgotten that these artificial techniques cause a major psychological trauma to the couple and can lead to difficult situations (multiple pregnancies, extra embryos) with no totally satisfactory solution.

Cryptorchidism↗
PubMed1995

[Neoplastic ureteral obstruction: drainage by percutaneous nephrostomy or double J catheterization].

OBJECTIVES: Neoplasic obstruction of the ureter is observed in patients with pelvic or extra-pelvic cancer. Indications of upper urinary tract drainage need to be clarified. METHODS: Percutaneous nephrostomy or double J catheter drainage was performed in 104 patients with ureteral obstruction due to pelvic cancer (bladder, prostate, uterus, ovary, rectum) or extra-pelvic cancer (usually breast and digestive cancers). Percutaneous nephrostomy or double J catheter was the first drainage procedure in 85 and 76 patients respectively. RESULTS: Success rate in first intention drainage was 74.5% with the double J catheter. When this procedure was impossible, percutaneous nephrostomy was always performed. In 52 cases we attempted to convert the nephrostomy to double J catheter drainage. Success rate was 68.8%. The main complications observed were ineffective drainage (12.5%) and infection (10.5%). CONCLUSION: These patients have a mean survival of 6.8 months despite the chemotherapy which is facilitated by the improved renal function.

Adult↗
PubMed1995

[Antibioprevention of recurrent cystitis. A randomized double-blind comparative trial of 2 dosages of pefloxacin].

OBJECTIVES: The aim of this randomized double-blind trial was to compare two 400 mg pefloxacin regimens either once-a-week or once-a-month applied for 48 weeks for the prophylaxis of recurrent urinary tract infection in women. METHODS: The main outcome measures were symptomatic and bacteriological reinfections during the period of prophylaxis and rates of reinfections during the three months of surveillance following the end of prophylaxis. 361 women of 18 to 51 years of age suffering from recurrent lower urinary tract infection were randomly allocated to receive pefloxacin 400 mg once-a-week (group A: n = 185) or 400 mg once-a-month (groupe B: n = 176) for 48 weeks. RESULTS: Seventeen of the 185 patients in group A (9.1%) and 52/176 patients in group B (29.5%) experienced at least one reinfection during the period of prophylaxis (p < 0.0001). The rates of reinfection during the three months of surveillance following the end of the treatment were not significantly different between the two groups with 14/101 (13.8%) patients with at least a reinfection in group A and 8/75 patients (10.6%) in group B (p = 0.51). In group A, 49/174 (28.1%) patients reported at least an adverse event compared with 33/169 (19.5%) patients in group B (p = 0.06). CONCLUSIONS: Once-a-week treatment with 400 mg of pefloxacin can be considered as a new effective and well tolerated approach for the prophylaxis of recurrent urinary tract infection in women and does not entail excessive emergence of pefloxacin resistant bacteria, even after 48 weeks of treatment.

Acute Disease↗
PubMed1995

Transrectal and transurethral hyperthermia versus sham treatment in benign prostatic hyperplasia: a double-blind randomized multicentre clinical trial. The French BPH Hyperthermia.

OBJECTIVE: To compare the safety and efficacy of hyperthermia for the treatment of benign prostatic hyperplasia (BPH), by either the transrectal or transurethral approach, relative to sham treatment. PATIENTS AND METHODS: Two hundred patients from seven urological departments were randomized and treated in a single centre. Principal inclusion criteria were a peak flow rate (PFR) < 15 mL/s and residual urine < 300 mL/s. Comparisons were made between transurethral hyperthermia (TUH) and transurethral sham (TUS) and between transrectal hyperthermia (TRH) and transrectal sham (TRS) 12 months after treatment. Outcome was assessed by improvements in the Madsen score and PFR, and the incidence of side-effects. RESULTS: After 12 months, 145 patients were evaluated; 12 patients withdrew during treatment, 43 withdrew during follow-up and two were lost to follow-up. Withdrawals were mainly due to side-effects during treatment (17% in the TRH and 1.5% in the TUH group) and to a lack of improvement during follow-up (14% in the TUH group, 19% in the TUS, 15% in the TRH and 10.5% in the TRS group received other treatments for BPH). Complications during treatment consisted mainly of local pain, urethral bleeding, urethral pain and acute retention, and were five times more frequent in the TRH than the TUH group (34% versus 6%). There was no improvement in PFR after TUH and TRH (response < 20%). Only TUH improved the Madsen score (TUH, +50% and TUS, +17%). CONCLUSION: Hyperthermia was not an effective treatment for BPH.

Aged↗
PubMed1995

Randomized, double-blind comparison of single-dose regimens of rufloxacin and pefloxacin for acute uncomplicated cystitis in women. French Multicenter Urinary Tract Infection-Rufloxacin Group.

In a double-blind, randomized, multicenter study, 463 adult women with symptomatic acute uncomplicated cystitis were treated orally with either a 400-mg single dose of rufloxacin (n = 226) or an 800-mg single dose of pefloxacin (n = 237). Escherichia coli (78%) and Proteus mirabilis (7%) were the most common isolates from 350 patients with significant pretreatment bacteriuria (uropathogens, > or = 10(5) CFU/ml). In the intention-to-treat analysis of patients with significant pretreatment bacteriuria, 343 patients were assessed for bacteriological outcome and 345 were assessed for clinical outcome. The bacteriological cure rate was 88% in the rufloxacin group and 84% in the pefloxacin group (95% confidence interval [CI] for difference in proportions, -4 to 12%), while the clinical resolution rate was 85 and 84%, respectively (95% CI, -8 to 9%). The per-protocol analysis demonstrated that among the 264 assessable patients, the bacteriological cure rate obtained with rufloxacin at 4 weeks of follow-up was comparable to that with pefloxacin (91 versus 85%; 95% CI, -3 to 15%). Among 295 clinically assessable patients, the clinical resolution rate at 4 weeks of follow-up was 89% in the rufloxacin group and 88% in the pefloxacin group (95% CI, -6 to 10%). Potentially drug-related adverse events occurred in 19% of the rufloxacin patients and in 18% of the pefloxacin patients. A single oral dose of 400 mg of rufloxacin is as effective and safe as a single oral dose of 800 mg of pefloxacin for the treatment of acute uncomplicated cystitis in women.

Administration, Oral↗
PubMed1995

Frequent occurrence of the CFTR intron 8 (TG)n 5T allele in men with congenital bilateral absence of the vas deferens.

Isolated congenital bilateral absence of the vas deferens (CBAVD) is an autosomal recessive disorder which has recently been shown to be associated with cystic fibrosis (CF) mutations. As part of an effort to understanding the genetic basis of this disorder, we have analysed the entire coding sequence and all the intron/exon boundaries of the cystic fibrosis transmembrane conductance regulator (CFTR) gene from 45 azoospermic individuals with this phenotype. We were able to detect a CFTR gene defect in 86% of chromosomes from these subjects. In addition to identifying 9 novel CFTR gene mutations, we found that a surprisingly high proportion (84%) of men with CBAVD who are heterozygous for a CF mutation carry the intron 8 polypyrimidine 5T CFTR allele on one chromosome. We hypothesise that this tight and significant (p < 10(-6)) linkage reflects the very mild impact of this mutation on CFTR gene expression. Although genetic heterogeneity cannot be excluded, CBAVD patients in whom no CFTR mutation has been detected are likely to harbour additional unidentified mild mutations. These observations have implications for the genetic counselling of CBAVD patients and CF families, and couples undergoing in vitro fertilisation procedures.

Alleles↗
PubMed1995

Neural control of penile erection.

Filling of the sinusoidal spaces with blood due to smooth muscle relaxation results from parasympathetic neural pathway activation and probably simultaneous inhibition of sympathetic outflow. The final common pathway for proerectile fibers is represented by the cavernous nerves and fibers controlling detumescence and flaccidity originating in the sympathetic chain. The hypogastric nerve could represent an accessory proerectile pathway unmasked by a sacral spinal cord lesion. Nitric oxide, which can be colocalized with VIP and acetylcholine, is the main proerectile neurotransmitter and noradrenaline is considered to be the major antierectile agent. Reflexive erection elicited by recruitment of penile afferents involves both autonomic and somatic efferents. This reflex is mediated at the spinal cord level and modulated by supraspinal influences. Serotonergic pathways originating in the raphe nuclei may mediate inhibitory control on reflexive erections. The hypothalamic medial preoptic area is an important integrating center and dopamine may regulate penile erection at this level. Neuroendocrine regulation may vary depending on the context in which erection occurs, for example, coitus, in response to extrinsic or psychogenic stimuli, and rapid eye movement sleep.

Animals↗