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Biomedical subjects

B Lobel

Publications and source records attributed to B Lobel.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Conservative treatment of stage III kidney injuries].

OBJECTIVE: The aim of this study is to evaluate the safety and effectiveness of conservative management in stage III renal trauma. MATERIAL AND METHODS: We reviewed the records of 150 patients who presented in our institution with renal trauma between 1986 and 1995. RESULTS: Minor injuries (stage I and II: 100 cases) were treated with expectant management. Only 3 patients required nephrectomy in this group. Stage III injuries were seen in 40 patients. The great majority (85%) were treated conservatively with renal sparing procedures such as endourologic techniques (14 cases), nephrorraphy or partial nephrectomy (20 cases). Total nephrectomy was performed in 15% of the cases and only for severely injured kidney or major associated intraabdominal injuries. In this group, none of the patients suffered from hypertension at follow-up. All patients (10 cases) with pedicle injury (stage IV) required total nephrectomy. CONCLUSION: Stage III renal trauma with urinary extravasation can safely be treated conservatively.

Adolescent↗
PubMed1998

[Endoscopes in urology: disinfection, sterilization, labeling and tracking. Circulars and decrees. Modes of application and commentary. The Committee of Infectious Diseases of the French Association of Urology. Congressional forum UFA--Paris, November 1996. DGS Circular 20 October 1997].

Administrative texts published in 1995, 1996 and 1997, have reinforced materiovigilance and impose disinfection precautions for endoscopes. The steps of disinfection of non-sterilizable endoscopes are: preliminary treatment, rinsing, actual disinfection, final rinsing, storage (see: Progrès en Urologie, 1997, 7, 505-507). Each procedure from collection of the endoscope until storage must be defined by written standard operating procedures validated by CLIN. The risk of transmission of Creutzfeld-Jakob disease requires autoclaving, which is only possible, at the present time, with the most recent rigid endoscopes. Until disinfection has become generalized, the traceability of endoscopes (labelling, utilization files) must be established on the model recommended for haemovigilance (circular of 02/04/96).

Creutzfeldt-Jakob Syndrome↗
PubMed1998

[Outcome of renal function in 114 patients who underwent uninephrectomy for renal cancer].

OBJECTIVE: To evaluate the medium-term and long-term impact of radical nephrectomy on renal function and to identify prognostic factors able to help predict deterioration of renal function in patients treated for renal cancer by radical nephrectomy, with a functionally and morphologically healthy remaining kidney. MATERIAL AND METHODS: Between January 1992 and June 1996, 114 patients (72 males, 42 females) with renal cancer were treated by radical nephrectomy. The contralateral kidney was healthy. The mean age of the patients was 64 years (31-85 years). Pre- and postoperative renal function was assessed by serum creatinine assay, in micromol/l. RESULTS: 105 patients were alive (16 with metastases) and 9 had died. The mean follow-up of the survivors was 19.6 months (3-53 months). A slight elevation of mean serum creatinine was observed in this group after nephrectomy compared to preoperative figures (117.9 micromol/l versus 95.6 micromol/l). 37 patients (35.2%) had a postoperative serum creatinine greater than or equal to 121 micromol/l, most of them were elderly, male (81%) and/or hypertensive (43%) and/or diabetic (11%). 6 (5.7%) of these 37 patients had a serum creatinine greater than or equal to 170 micromol/l and all were hypertensive and/or diabetic. CONCLUSION: This study shows that HT, diabetes, advanced age and male sex constitute risk factors for deterioration of renal function. The indication for conservative surgery for T1 T2 N0 M0 tumours should be discussed in the presence of these factors. In their absence and provided the remaining kidney is healthy, renal function remains relatively stable after radical nephrectomy for cancer.

Adult↗
PubMed1998

[Current state of knowledge concerning the mechanisms of action of BCG].

The better understanding of antitumour immunity has improved our knowledge concerning the mechanisms of action of BCG. There are three phases in the immune response to BCG: first of all, BCG adheres and is then phagocytosed by antigen-presenting cells, but also by urothelial cells. This phase corresponds to the early release of so-called inflammatory cytokines (IL-1, IL-6, IL-8). These cytokines may be responsible for certain adverse effects, but may also participate in the cytotoxic phenomenon. The second phase consists of recognition of bacterial antigens by CD4 lymphocytes, which release mainly IL-2 and IFN-gamma(TH1 response). This cell activation leads to the third phase, which consists of amplification of cytotoxic-populations: CD8, gamma delta lymphocytes, macrophages, NK, LAK, BAK. All these cells also release cytokines which then regulate the response. The identification of these modulations allows rationalization of BCG instillation protocols, but identification of the truly cytotoxic elements would allow the proposal of more effective immunization protocols.

Adjuvants, Immunologic↗
PubMed1998

[Injuries of the renal pedicle: is renal revascularization justified?].

OBJECTIVE: Renal trauma with pedicle lesions may require emergency vascular repair, a surveillance in a surgical unit or immediate or secondary nephrectomy. The objective of this study was to evaluate these various treatment modalities. MATERIAL AND METHODS: 28 patients presenting with renal pedicle trauma, treated in two urological centres between 1985 and 1995 were reviewed. All cases of trauma were investigated by intravenous urography, CT and/or arteriography. 16 patients had associated intra-abdominal lesions. RESULTS: 7 patients underwent vascular repair after a mean interval of 4.8 hours. There were 5 nephrectomies and 2 functional kidneys, including 1 with hypertension. 13 patients underwent first-line nephrectomy: 4 performed as an emergency for haemodynamic instability, and 9 performed as a deferred emergency for silent kidney or secondary haemodynamic disorders. The mean time to diagnosis was 20 hours. No complication was observed in this group. Non-surgical management was decided in 8 patients. The mean time to diagnosis was 7.5 hours. One death was observed in this group, due to associated cerebral lesions. 3 patients subsequently underwent late nephrectomy for severe hypertension and 4 had a persistent silent kidney without sequelae. Overall: 21 nephrectomies, 2 functional kidneys (1 patient was hypertensive), 4 silent kidneys without hypertension and one death were observed. CONCLUSION: In cases of renal pedicle trauma seen after the 4th hour, the severity of ischaemic lesions and renal sequelae and the small number of kidneys saved despite revascularization surgery argue in favour of immediately elective nephrectomy.

Emergencies↗
PubMed1998

[Therapeutic strategies in urinary tract infections in women].

Simple acute cystitis is cured by single-dose or 3-day treatment. Complicated acute cystitis requires clinical, bacteriological and imaging examinations. Treatment must be continued for 10 days and controlled. Acute pyelonephritis in women requires bacteriology, ultrasonography and plain x-rays and must be rapidly treated by fluoroquinolone or cephalosporin. High-risk acute pyelonephritis justifies admission to hospital, more elaborate examinations and active treatment.

Acute Disease↗
PubMed1997

[Surgery of infiltrating bladder tumors].

Surgical treatment of transitional bladder tumours is based on liberal resection of the bladder. After cystectomy, reconstitution of the urinary tract is required for urinary excretion and patient comfort. The bladder can be replaced by a segment of intestine detached from the digestive tract. Another mean is urinary diversion at the abdominal wall by a direct or continent fistula. The patient should be seen 6 weeks after surgery to assess the quality of the surgical assemblage, the absence of distension of the upper urinary tract and the degree of patient comfort. Subsequently, the patient should be seen every 6 months. Early treatment of bladder cancer leads to cure at 5 years in 50 to 75% of cases.

Cystectomy↗
PubMed1997

Autogenous skin graft in the treatment of large incisional lumbar hernias and bulges.

OBJECTIVE: Repair of large incisional lumbar hernias or muscular bulges is a challenge to the surgeon as reflected by the high recurrence rate. We evaluated a surgical procedure using a running strip of autogenous skin graft as a retention suture. METHODS: Eight patients with large incisional lumbar hernias (> or = 20 cm, n = 6) or muscular bulges (n = 2) underwent a parietal reconstruction with this procedure. Two patients had previously been treated with synthetic meshes without success, and one had a colocutaneous fistula. RESULTS: No recurrence was observed in 6 patients (75%) with a mean follow-up of 14 months. After significant weight gain, 2 repairs failed at 6 months and 1 year (partially in 1 case). No recurrence was noted for muscular bulges. CONCLUSION: The use of a running strip of autogenous skin graft is a simple and reliable procedure for the repair of large lumbar hernias or muscular bulges for patients with stable weight conditions.

Hernia↗
PubMed1996

Pretherapeutic erythrocyte polyamine spermine levels discriminate high risk relapsing patients with M1 prostate carcinoma.

BACKGROUND: Androgen deprivation is currently the standard treatment for patients with metastatic prostate carcinoma. Few reliable prognostic markers are able to select, at diagnosis, patients who will respond favorably and durably to hormone ablation. Circulating polyamines, markers of cell proliferation that are elevated in prostate carcinoma, have been evaluated as a prognostic tool. METHODS: Eighty-eight patients with untreated, M1 classified prostate carcinoma who received endocrine therapy between 1988 and 1993 were included in this study. Performance status, hemoglobin, alkaline phosphatases, prostate specific antigen, Gleason tumor grade, extent of disease by bone scan, and circulating erythrocyte spermidine and spermine were correlated with observed progression free and cause-specific survivals. Multiple correspondence analysis and ascending hierarchical classification were performed to determine significant pretreatment prognostic factors. RESULTS: Pretreatment performance status, alkaline phosphatase, hemoglobin, and erythrocyte spermine levels were correlated with progression, with hemoglobin and erythrocyte spermine level being the most significant independent variables (P < 0.00001 and P < 0.0001, respectively). With regard to cause specific survival, only hemoglobin and spermine erythrocyte levels were significant independent variables (P < 0.0001 and P < 0.0005, respectively). Patients with spermine levels of less than 9 nmol/8.10(9) had a statistically better outcome than patients with 9 nmol/8.10(9) or more erythrocytes. Erythrocyte spermine was the best sole determinant of progression. A test combining spermine with performance status or hemoglobin improved each variable's predictive values. CONCLUSIONS: Circulating erythrocyte spermine levels, extracted from a blood sample, can discriminate, at diagnosis, patients with hormone-refractory from those with hormone-responsive metastatic prostate carcinoma.

Aged↗
PubMed1996

[General practitioners' approach to urination disorders in men over the age of 50. A survey of 250 physicians in Brittany].

A questionnaire was set to 250 general practitioners in the Brittany region, to determine the impact of information campaigns concerning benign prostatic hyperplasia (BPH) and prostatic cancer on their everyday approach to disorders of micturition in men over the age of 50 years. 225 questionnaires were interpretable. 75% of general practitioners systematically investigated the presence of disorders of micturition. In the presence of such symptoms, 76% of general practitioners conducted further investigations to exclude prostatic cancer. 89% of general practitioners performed first-line digital rectal examination, and 34% of them systematically performed this examination once a year. The investigations most frequently performed after digital rectal examination concerned the state of urine (50%) but only 30% of general practitioners used reagent dip-sticks and 43% ordered urine cultures. Other investigations consisted of transrectal ultrasonography (31%) an PSA assay (26%). 3% of PSA assays were ordered before digital rectal examination. Renal and vesical ultrasonography occupied 5th place, although distension of the upper urinary apparatus was a source of concern for 51% of general practitioners. In the presence of symptomatic BPH, general practitioners readily prescribed medical treatment (96%). They assessed the results of this treatment on the course of disorders of micturition (95%), digital rectal examination (91%), and PSA (50%). General practitioners are familiar with disorders of micturition after the age of 50 years. However, 25% of them do not systematically question patients about these symptoms. Digital rectal examination is now performed more frequently, although systematic examination of the prostate is rare (34%). PSA assay is not the doctor's first priority (3rd place in the list of examinations). Two examinations are rarely used and should be developed: reagent dip-sticks (30%) and renal and vesical ultrasonography (5th place). Only 4% of general practitioners did not prescribe any treatment in the case of uncomplicated BPH, which is not in line with current recommendations. There is certainly a need for better information of general practitioners, but this information is only valid when a consensus has been reached among urologists.

Age Factors↗
PubMed1996

[Diagnostic value of recording nocturnal erections].

The recording of tumescence and rigidity during nocturnal erections is considered to be the reference examination to differentiate between the organic or psychogenic origin of erectile dysfunction. However, its diagnostic value is more doubtful in the absence of normal rigidity values. 170 consecutive patients were submitted to this type of recording (RigiScan, Dacomed, USA). With the exception of patients suffering from multiple sclerosis, all patients with erectile dysfunction considered to be psychogenic obtained a rigidity > or = 60%. 59% of these patients were detected by this method (sensitivity: 59%, specificity: 87%). In contrast, no conclusion can be drawn from a pathological nocturnal recording (32% of psychogenic patients) and finally, in view of the aetiologies of this series, this examination was considered to be useful in 29% of patients.

Adolescent↗
PubMed1996

[Pelviscopy: a good solution].

With the ongoing evaluation of laparoscopic techniques in urology, the transperitoneal access used initially has been progressively replaced by the much simpler retroperitoneal route. The applicability of these new techniques has now been proven though their application still requires a delicate procedure. A long training period is usually required to be able to perform safe operations of reasonable duration. We present a different technique using a modified vaginal speculum and a laparoscopic optic positioned between the valves of the speculum to give a good visualization and expose the operative field. Several retroperitoneal procedures can be performed with this technique using the video-assisted pelviscope, including nephrectomy, pyeloplasty, lymphadenectomy in the pelvis... This video-assisted surgical technique is an interesting compromise between classical surgery and laparoscopic surgery. It is both simple and safe causing little tissue damage and has the advantage of a short postoperative recovery period.

Endoscopy↗