The ICE regimen (ifosfamide, carboplatin, etoposide) for the treatment of germ-cell tumors and metastatic trophoblastic disease.
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Adolescent↗
Biomedical subjects
B Gattegno
Publications and source records attributed to B Gattegno.
[Cancer of the prostate. Diagnosis, clinical course, prognosis, treatment].
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Aged↗
[The value of PSA density for the diagnosis of prostatic cancer and for the indication of radical prostatectomy].
We evaluated the diagnostic and prognostic value of PSA density (PSAD) in a prospective study of 100 men consulting for various urinary tract disorders. PSAD was calculated by the ratio of serum PSA over the ultrasonographic volume of the prostate gland, and was expressed in ng/ml/ml. The mean PSAD of 31 patients with prostate cancer was significantly higher than that of the 69 patients without prostate cancer (p = 0.0003). The patients were classified into two groups according to the serum PSA value. Forty nine patients had a serum PSA < or = 10 ng/ml, 31 of whom had a PSAD < or = 0.15 ng/ml/ml and 29 of these 31 patients (94%) did not have prostate cancer; 18 patients had a PSAD > 0.15 ng/ml/ml and six of them (33%) had prostate cancer (p = 0.04). Fifty one patients had a serum PSA > 10 ng/ml and 23 of them (45%) has prostate cancer; 14 of these 51 patients had a PSAD < or = 0.30 ng/ml/ml and two of them (14% à had prostate cancer; 37 patients had a PSAD > 0.30 ng/ml/ml, 21 of whom (57%) had prostate cancer (p = 0.016). Twenty one of these 31 patients with prostate cancer were candidates for radical prostatectomy. Four patients were N+ and 17 underwent radical prostatectomy. Capsular invasion was significantly correlated with PSAD. None of the four patients with PSAD < or = 0.30 ng/ml/ml showed capsular invasion, while 11 of the 13 patients (85%) with PSAD > 0.30 ng/ml/ml had capsular invasion. In conclusion, in patients with PSA < or = 10 ng/ml, calculation of the PSAD avoids approximately two-thirds of prostatic biopsies, with a very low risk of missing a clinically significant cancer. On the other hand, PSAD is of more limited value in patients with PSA > 10 ng/ml. In cancers considered to be operable clinically, the cut-off value of 0.30 ng/ml/ml for PSAD is predictive of capsular or lymph node invasion with a diagnostic accuracy of 94%.
Aged↗
[Kidney surgery using lumbar endoscopy: initial experiences].
OBJECTIVES: To evaluate the feasibility, safety and clinical value of lumboscopy for the treatment of upper urinary tract diseases. METHODS: Six nephrectomies, one renal biopsy and one renal cystectomy were performed by retroperitoneoscopy (lumboscopy) in 7 patients. These cases represent the beginning of our experience. The operating time, incidence of intraoperative or postoperative complications and length of hospital stay were studied. RESULTS: The mean operating time was 134 min for nephrectomy, 180 min for cystectomy and 30 min for renal biopsy. No complications were observed. No conversion into laparotomy was required. The mean postoperative hospital stay was 3 days in the patients who were submitted to a single operation. CONCLUSION: Lumboscopy is a relatively easy, safe and reliable technique, and its use in urology warrants further study and development. Dissection of the retroperitoneal space with low pressure CO2 is possible and simplifies the procedure, without increasing the risks for the patient. The indications, especially for nephrectomy, are currently under evaluation.
Adult↗
Laparoscopic pelvic lymph node dissection for staging of prostatic cancer.
Assessment of the pelvic lymph node status is a major concern in prostatic cancer staging. In spite of a normal abdominopelvic CT scan examination in patients with organ-confined disease, 7-30% will have lymph node metastases at pathological examination and will not benefit from radical prostatectomy. Laparoscopy enables pelvic lymph node dissection via a minimally invasive approach. Twenty-nine patients underwent laparoscopic pelvic lymph node dissection (LPLND) for prostatic cancer staging. The average duration of the bilateral dissection was 90 +/- 40 min (range 35-180 min). One patient died of a stroke on postoperative day 1, without local complication. The peroperative complications were 1 injury of the external iliac vein, 1 ileal injury, 1 ureteral injury, all 3 (11%) requiring immediate or delayed laparotomy. One patient had a self-resolving bilateral obturator nerve paresis. A previously irradiated patient had perineal lymphedema for 4 weeks. The average number of lymph nodes removed was 8.4 +/- 3.4 (range 4-17) for bilateral LPLND. Five patients had lymph node metastases. The median length of stay for patients undergoing LPLND as a single procedure was 2 days (range 2-11 days). After an operational period, during which the complication rate was relatively high, we now consider LPLND as a safe and effective procedure for the staging of patients with organ-confined prostatic cancer, but considering the increased risk of complications during the application period, we do not encourage the generalization of this technique which should remain restricted to some particular strategies, as in combination with perineal radical prostatectomy.
Aged↗
[Urethro-vesical stenosis after radical prostatectomy].
Stricture of the urethrovesical anastomosis is an uncommon complication of radical prostatectomy, but it can affect the patient's quality of life. From January 1991 to December 1993, 50 patients underwent radical prostatectomy for clinically localised prostatic cancer (41 via a retropubic incision and 9 via a perineal incision). We retrospectively studied the influence of several factors on the incidence of anastomotic stricture: history of prostatic surgery, surgical incision, blood loss, pathological stage, presence of a contrast agent leak during follow-up urethrocystography, postoperative adjuvant treatment, oncological status at the time of the stricture. Seven patients developed clinically significant anastomotic stricture (14%). The time to onset was 1.5 to 10 months (median: 3 months). We were unable to demonstrate any pre-, intra- or postoperative or histological factors able to predict the development of anastomotic stricture. The transperineal approach appears to be associated with a lower incidence, but this finding must be confirmed in a larger series of patients. The seven patients with an anastomotic stricture were treated by endoscopic scalpel incision of the stricture, followed by insertion of a 22 F Foley catheter for 48 hours. No patient has developed a recurrent stricture with a mean follow-up of 8 months (0 to 13 months). Postoperative continence was normal in every case.
Aged↗
[Radical prostatectomy: comparison of the perineal and retropubic route (40 patients). Preliminary results].
Transperineal radical prostatectomy, described at the beginning of the century for the treatment of prostatic cancer, is currently being reappraised following the development of surgical techniques allowing the dissection of subvenous external iliac nodes via a limited incision. Twenty four patients (group 1) underwent transperineal prostatectomy and 16 (group 2) underwent retropubic prostatectomy. The choice of surgical approach was left to the operator. We retrospectively compared the two groups. All patients had histologically proven prostatic cancer, clinically confined to the prostate. The operating time, the development of complications. the preoperative-postoperative haemoglobin difference, the number of patients transfused and the number of units transfused, urinary continence at three months and the histological results were studied. Three patients operated via the perineal approach and one patient operated via the retropubic approach suffered an operative rectal injury. The number of transfused patients (12.5% in group 1 and 37.5% in group 2) and the preoperative-postoperative haemoglobin difference for non-transfused patients (mean of 2.9 g/100 ml in group 1 vs 4.6 g/100 ml in group 2) were significantly different. No significant difference was observed between the two groups in terms of invasion of the prostatic capsule or seminal vesicles. Overall, only 106 out of 40 patients had a truly intraprostatic tumour, corresponding to understaging of the cancer in 60% of cases. Although the number of patients with imperfect continence was higher in group 1, the difference observed was not significant. The transperineal approach allows prostatectomy to be performed under similar oncological conditions to those of retropubic prostatectomy, while decreasing the operative blood loss.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[The results of a 1993 AFU survey on laparoscopy in urology].
The development of laparoscopy in the field of urology has been considerable since 1991. In order to evaluate the use of this technique in the French urology community and the need to develop evaluating and teaching structures for this technique, a postal questionnaire was sent to 714 members of the Association Française d'Urologie (AFU) on June 23, 1993. The reply rate was 22% and 72 of the responders (46%) performed urological laparoscopy. A total of 684 laparoscopic urological procedures were reported, corresponding to an average of 9.5 procedures per operator. 45 operators had performed fewer than 16 laparoscopic procedures. The complication rate was 5% with a perioperative mortality of 0.3%. These figures should be considered to be minimal values. Eighty six responders (54%) did not perform laparoscopy. Forty seven of them (57%) were waiting for these techniques to demonstrate their practical value. Eighty two urologists thought that laparoscopic lymph node dissection had a role to play in the diagnostic and therapeutic strategy of prostatic cancer. One hundred and thirteen urologists (85%) considered that the development of urological laparoscopy would be moderate. Eighty nine urologists answer the question concerning possible training in these techniques and 77 of them intended to learn laparoscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
Academic Medical Centers↗
Urinary tract infection prophylaxis in transurethral surgery: oral lomefloxacin versus parenteral cefuroxime.
The purpose of this study was to compare the efficacy and safety of single-dose oral lomefloxacin and single-dose parenteral cefuroxime for the prevention of urinary tract infection following transurethral surgery. A total of 63 patients were enrolled in this prospective, randomized open-label study, which was conducted at two medical centers in France. Patients were randomized to receive either 400 mg of oral lomefloxacin 2-6 hours before surgery or 1.5 g parenteral cefuroxime 30-90 minutes before surgery. Postoperative clinical evaluation was performed daily, and bacteriologic evaluation included urine cultures performed 24 hours after surgery, just before and 1 day after removal of the indwelling catheter, and 3-5 days after surgery. Another urine culture was optionally performed 1-3 months after surgery. Infection was defined as a urinary bacteria count greater than or equal to 10(5) colony-forming units (CFU)/mL of urine. Of the 63 patients enrolled, 54 were evaluable for efficacy, 27 in each group. The success rate of prophylaxis was 88.9% in the lomefloxacin group and 88.5% in the cefuroxime group (p = nonsignificant). None of the 16 lomefloxacin-treated patients who were re-cultured at 1-3 months was found to be infected. Adverse events were minor in both groups. A single oral dose of lomefloxacin was as efficacious and as safe as a single intravenous dose of cefuroxime for prevention of postoperative urinary tract infection in patients undergoing transurethral surgery.
Administration, Oral↗
[Sub-venous iliac lymphatic dissection with celioscopy for the staging of prostatic cancer (16 patients)].
Subvenous external iliac lymph node dissection is an essential element for the staging of prostatic cancer. 7 to 30% of patients with intracapsular prostatic cancer have lymph node metastases despite normal imaging examinations. Laparoscopic surgery allows lymph node dissection through a limited incision. Sixteen patients underwent laparoscopic lymph node dissection (LLND) for prostatic cancer. The mean duration of the operation was 100 +/- 50 minutes (35-180 min: 130 minutes for the first nine operations, then 60 minutes for the last seven operations). One patient died on the second day from a cerebral vascular accident. There was one technical failure (pneumoperitoneum leak), one vascular injury, one ureteric injury, one transient paresis of the obturator nerves and one case of perineal lymphoedema. The mean number of lymph nodes removed in bilateral lymph node dissection was 7.5 +/- 2 (14-20) per patient. Three patients had lymph node metastases. The mean hospital stay related to laparoscopy was 4 +/- 2 days with a median of 2 days. Laparoscopic surgery, like any conventional or innovative surgical technique, requires specific training to become safe and effective. It allows complete histological examination of the lymph nodes removed and planning of prostatectomy, which may be subsequently performed through a perineal approach.
Abdomen↗
[Vesico-ureteral reimplantation on psoas bladder in lesions of the pelvic ureter. Review of 50 patients].
Between 1979 and 1991, the authors performed 50 psoas bladder ureterovesical reimplantations for lesions of the pelvic ureter. 90% of very good results were obtained with this technique at the cost of a low morbidity. This series confirms the influence of previous pelvic radiotherapy on the postoperative complication rate. On the basis of the excellent results in this series, confirmed by those reported in the literature, this technique can be proposed as treatment of choice for lesions of the pelvic ureter when suture-resection or simple reimplantation cannot be performed after failure of endoluminal dilatation in patients with a life expectancy greater than 6 months to one year.
Adolescent↗
Bladder reconstruction with ileum after cystoprostatectomy for bladder cancer: analysis of the micturition and continence of 44 consecutive patients.
From October, 1987, to August, 1990, 47 patients underwent an ileal low pressure bladder replacement using the Hautmann procedure after radical cystoprostatectomy for bladder cancer. The qualities of micturition and continence were evaluated from a questionnaire mailed to the patients and by urodynamic examinations in 44 consecutive patients over a follow-up period of more than 3 (mean 10.7) months. The 44 patients (100%) were perfectly dry during the daytime and voided every 4 (2-6) h with a micturitional volume of 357 (200-500) ml. Forty-two of the 44 patients had no residual urine. Thirty-three of the 44 patients (75%) were perfectly dry at night with a voiding frequency of 1.5 (0-3). Seven of the 44 patients (16%) were occasionally incontinent (spotting less than 2/week). Four of the 44 patients (9%) had night incontinence and used as external device. Only two patients showed high pressure waves of greater than 50 cm H2O. The maximum urethral pressure was 59.07 +/- 13.6 (30-80) cm H2O. The maximum flow rate was 17.2 +/- 9.7 (4.5-35) ml/sec. The different factors responsible for the new micturitional balance were discussed. With its very good functional results and its ease of performance, the ileal neobladder is, for us, the procedure of choice for bladder reconstruction after cystectomy.
Adult↗
[Pulmonary carcinomatous lymphangitis of prostatic origin, disclosed by acute respiratory insufficiency, regressing by treatment with an LH-RH agonist].
Carcinomatous lymphangitis of prostatic origin is infrequent and usually carries a poor prognosis. The authors report a case of pulmonary carcinomatous lymphangitis related to a prostatic carcinoma. This case was remarkable for its acute mode of revelation and for its favourable outcome under treatment with LH-RH agonists.
Follow-Up Studies↗
[Symptomatic prostatic cysts. 4 case reports].
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Adult↗
[Adrenal myelolipoma. Review of the literature and case report].
Adrenal myelolipoma is a rare, benign tumour composed of adipose and haematopoietic cells. It is usually an incidental finding or may present in the form of a complication, the most severe being spontaneous retroperitoneal rupture. Computed tomography is the best examination, providing a preoperative diagnosis in 90% of cases. Adrenal aspiration cytology is useful in the case of a persistent doubt concerning the diagnosis. The principal differential diagnosis consists of an angiomyolipoma of the upper pole of the kidney. The indications for surgical resection are limited to symptomatic tumours, tumours larger than 5 cm in diameter and in the case of a doubtful diagnosis.
Adrenal Gland Neoplasms↗
[Should adrenalectomy be performed systematically as part of radical nephrectomy for renal cancer? Review of 119 cases].
Systematic histological examination of 119 operative specimens of radical nephrectomies performed for renal cell carcinoma revealed adrenal invasion in 6 cases (5.04%). Preoperative computed tomography visualised the adrenal lesions with a sensitivity of 100%. Adrenal involvement was due to either contiguous invasion (3 cases) or metastatic spread (3 cases). Other visceral or lymph node metastases were detected in every case. The mean survival of patients with an adrenal lesion was 16.5 months. These data and those reported in the literature suggest the value of systematic adrenalectomy as part of radical nephrectomy.
Adrenalectomy↗
[Functional analysis of micturition and continence after a Hautmann type enterocystoplasty (27 patients)].
Twenty seven patients treated by Hautmann enterocystoplasty completed a detailed questionnaire concerning the quality of their micturition and continence. The mean capacity of the neobladder was 250 cc with a diurnal interval between micturitions of about 3 hours. 79% of patients experienced an urge to micturate. The mean frequency of nocturnal micturition was 1.6. Diurnal continence was perfect in 100% of patients, while nocturnal continence was excellent in 78% of cases and good in 18% of cases, while one patient (4%) suffered from nocturnal incontinence. Hautmann enterocystoplasty is therefore an excellent technique for bladder replacement, ensuring diurnal and nocturnal continence for the great majority of patients.
Aged↗
[Chemotherapy in cancer of the prostate].
The most classical treatment of metastatic prostatic adenocarcinoma is hormone therapy. Most often, chemotherapy is proposed only when the tumor becomes hormonally unresponsive. But evaluation of its efficacy is impaired by the diversity of inclusion criteria used and by the different criteria of response assessment. Results of randomized, comparative studies show that all cytotoxic agents currently available have a similar response rate (about 30 to 40%). Use of combined chemotherapy does not seem to significantly improve these results. Several others ways have been proposed which attempt to improve the efficacy of chemotherapy (androgen stimulation, priming chemotherapy, adjuvant or neo-adjuvant chemotherapy...) but, most probably, progress will come from the discovery of more effective and selective cytotoxic agents, and not from the increase of clinical trials with the same agents.
Antineoplastic Agents↗