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Biomedical subjects

B Pascal

Publications and source records attributed to B Pascal.

At least 55 records · Page 3Linked to original sources
PubMed1981

[Assessment of the renal consequences as related to operative technique in surgery for 190 staghorn or calyceal calculi. Comparative value of renal scintigraphy and intravenous urography (author's transl)].

The authors have studied 86 patients with staghorn calculi who underwent preoperative quantitative renal scintigraphy. 50 of them (63 kidneys) had one or two follow-up scans between 1 and 9 years after the operation. These scintigraphic data were compared with those of I.V.U. These 50 patients had undergone surgery on 60 kidneys (12 pyelotomies only, 26 pyelotomies associated with limited nephrotomies, 18 extended nephrotomies and finally 4 bi-value nephrotomies). In 46 of these patients, the urine became definitively sterile and there was no recurrence of lithiasis in any of them. These quite exceptional conditions were such that it is possible to bear in mind only the operative technique in assessing the possible harmful consequences of each type of operation. The authors clearly show that the threat to function of the kidney which has been operated upon is more threatened when there has been a nephrotomy and when such a nephrotomy has been more extensive. A limited nephrotomy is associated with a mean loss of (% of renal function. Extended nephrotomies or more than 3 cm result in a loss of function of approximately 22%. Large bi-value nephrotomies result in a 36% loss of function. Simultaneous study of scintigraphic scans and I.V.U. revealed that a loss of 1 cm in height of the renal parenchyma corresponds to a functional loss of 10% as determined by scintigraphy. Of basic importance is the fact that the impairment caused by nephrotomies remains stable and does not worsen with the passage of time.

Adult↗
PubMed1981

[Extrasinusal ureterocaliceal anastomoses. Review of 27 cases (author's transl)].

Extrasinusal ureterocaliceal anastomoses have been conducted in 27 patients, 21 adults and 6 children, in the Urological Clinic of the Hôpital Necker over the last 10 years. Principal indications, of much greater importance than tuberculosis, are pyelocaliceal lithiasis and certain anomalies of the pyeloureteral junction. In 15 cases, the operation was first choice therapy, while in the other 12 patients it was employed to treat a postoperative cicatriceal stenosis of the subpyelic portion of the ureter. "Peripheral" ureterocaliceal anastomosis (the ureter is sutured to a section of a calyx opened by partial nephrectomy) was carried out in 21 cases, and a "central" anastomosis, suturing the ureter to the base of a calyx after partial nephrectomy, in the 6 others. The most effective drainage method, employed in 14 patients without secretion leak, was nephrostomy at the side of a ureteral sound intubating the anastomosis. The two main postoperative complications were early anastomosis stenosis (6 cases), requiring a repeat operation, and fistulae necessitating prolonged ureteral drainage. Results have remained constant, and of the 25 cases followed up for an average of 2 years, 19 are still perfectly satisfactory (3 of these patients had had repeated ureterocaliceal anastomoses). Results were better after first than second choice ureterocaliceal anastomoses. It should logically be performed as the initial operation, therefore, when required because of the existing pathological condition: destroyed or inaccessible renal pelvis, inability to use the subpyelic portion of the ureter, or very marked pyelocaliceal distension requiring dependent drainage.

Adolescent↗
PubMed1981

[Persistent urinary incontinence after posterior urethral valve endoscopic section in boys. Urodynamic study (author's transl)].

Urinary incontinence persisted in 8 boys of school age after posterior urethral valve endoscopic section. An essential fact is that all the boys had urinary incontinence before operation. Other lesions, particular infection, vesico-ureteral, reflux, or upper urinary tract affections, were absent. The obstructive nature of the urethral valves was suggested by the clarity of the valvular image on radiography, moderately increased vesical pressure during micturition, and supravalvular dilatation of the posterior urethra. Postoperative micturition urethrography was normal in nearly all cases, and yet urinary incontinence from vesical instability, as demonstrated by dynamic tests in each child, persisted unchanged. The authors consider that in children shown to have a posterior urethral valve with urinary incontinence from vesical instability, and in the absence of other manifestations apart perhaps from some dysuria, endoscopic section of the valve may modify micturition, but cannot completely suppress vesical instability. The persistence of this instability could be the cause of the continuing incontinence.

Child↗
PubMed1981

[The psoas bladder. Experience with 88 operations (author's transl)].

The authors report their experience with 88 cases of psoas bladder in children and in adults. The essential indications have been failure of previous ureterovesical implantation, certain megalo-ureters, tuberculous stenosis, and pelvic fibrosis in adults. In 32 operations on children there was only a single case of stenosis, but six cases of residual reflux all linked to a too short submucous passage. In the 56 operations in adults there were four ureteral stenoses. Note the almost constant good results in children operated for the first time, and in adults operated for tuberculosis. The authors stress several points: - the psoas bladder is the first type or reparative surgery to consider when one is confronted with loss of substance of the ilio-pelvic ureter; - in reparative surgery of the terminal ureter, the psoas bladder is indicated each time it is not possible to prevent reflux by simple advancement of the ureter submucously. The psoas bladder seems to the authors to be an advantageous alternative to the Leadbetter-Politano operation; - the need to amply dissect the dome of the bladder and, if necessary, the lateral aspects of the bladder, the ureter, even the kidney and the renal pedicle in difficult repairs when there is extensive loss of tissue; - the obligation to renounce this technique whenever the dissection pushed to the limit does not allow an anastomosis without tension.

Adolescent↗
PubMed1981

[Neonatal screening for duchenne myopathy by serum elevation of creatine phosphokinase activity. 5 years experience].

The systematic seek of an increased activity of the SCK among all newborns has permitted the detection of the Duchenne-type muscular dystrophy in the "Rhone-alpes" area. By the survey of 40,000 births during 5 years and the detection of 16 Duchenne-type muscular dystrophies the authors estimate the incidence of DMD at 1/6500 living new born boys. The number of false positives (1,5 p. 1000) is little and, up to now, no false negative has been recorded. A few boys and girls keep and increased activity of the SCK, and 3 boys hae a Becker-type muscular dystrophy.

Clinical Enzyme Tests↗
PubMed1980

[Therapeutic trials in inoperable carcinoma of the bladder (author's transl)].

The authors report the preliminary results of attempts at treatment using radiotherapy and chemotherapy for inoperable carcinoma of the bladder. Chemotherapy alone (cis diamine dichloropalatinum : CDDP) used twice for metastases gave 1 regression of more than 50 % and 1 failure, used twice for non-irradiated pelvic tumours gave 1 regression of more than 50 % and finally was associated with no improvement in 7 patients already irradiated. Chemotherapy (CDDP) associated with a series of flash doses of radiotherapy was used in 6 cases and gave one regression of more than 50 % and one of less than 50 %. Bleomycin in continuous infusion associated with flash radiotherapy was used in 3 cases and gave a regression of more than 50 % of pelvic tumours in two. These poor though not completely nil results have lead the authors to develop a cooperative treatment programme involving the urologist, radiotherapist and chemotherapist.

Adult↗
PubMed1980

[Calyceal diverticula : review of 80 diverticula in 70 patients (author's transl)].

The authors review 70 patients with calyceal diverticula, 20 of these patients had an associated urological congenital malformation and 7 of them a lithiasis. The majority of these diverticula were discovered by chance but complications in the form of pain (26 cases), fever (11 cases) or macroscopic haematuria were the essential presenting symptoms. Clinical manifestations occur in relation to large diverticula and, in particular, those containing calculi. Patients with lithiasis are far more often infected than the others. The latent nature of diverticula is such that the onset of clinical symptoms and signs (lumbar pain, fever and pyuria) should lead to a search for an associated malformation, in particular vesico-ureteric reflux and direct cystography is essential. The virtually sole complication of a calyceal diverticulum is lithiasis. 43 of the 90 diverticula studied contained one or more calculi. Infectious complications may result from those diverticula containing stones and are rare in the absence of lithiasis. Only 18 patients underwent surgery (20 diverticula) : 9 by partial nephrectomy (polar in 9 cases and cuneiform in 2), 6 simple incisions of the diverticulum and 2 excisions of the diverticulum. In view of the rarity of complications, it is evident that only poorly tolerated diverticula require operation. In the view of the authors, two essential surgical techniques should be used : polar nephrectomy and resertion of the diverticular protrusion with closure of the neck. Finally, in the presence of associated vesico-ureteric reflux, it is the symptoms and signs of the latter which must influence the choice of treatment. When necessary, it would appear preferable to start by the correction of reflux.

Adult↗
PubMed1980

[Haematuria as the presentation of a vascular abnormality of the kidney or its excretory system (author's transl)].

The authors report 18 cases of a vascular pathology of the kidney or of its excretory system presenting with heavy and recurrent haematuria. In contrast to data in the literature, their series includes a majority of capillary angiomas (8 cases), as against 6 aneurysms, 2 arteriovenous fistulae and 2 peripyelo-ureteric varices. Of the six arterial aneurysms, all recognised by arteriography, 4 underwent surgery: 2 endo-aneurysmorrhaphies with success, 1 nephrectomy for rupture of the aneurysm and 1 nephrectomy made necessary by the multiplicity of aneurysms inaccessible in situ. Both cases of arteriovenous fistula were recognised by arteriography. One was treated by polar nephrectomy (success) whilst the other underwent nephrectomy after failure of an attempt at embolisation. Of the two cases of peri-uretero-pelvic varices identified by selective phlebography under cover of an intra-renal-artery injection of angiotensin, only one was treated successfully by excision of the varicosities. The eight cases of capillary angioma were divided into two groups: one, of 4 cases where the diagnosis was made by selective renal phlebography without angiotensin and renal arteriography; and another of 4 cases not identified by these vascular investigations. In these 4 cases, after elimination of Berger's disease by a surgical renal biopsy, the authors exposed the kidney, performed a pyelocalyscopy during a period of haematuria, localised the haemorrhagic segment of the kidney and treated the lesion by partial nephrectomy in the presence of a pathologist to immediately identify the haemorrhagic lesion and examine it histologically. Amongst the 7 angiomas treated, 5 partial nephrectomies gave successful results whilst two nephrectomies were necessary: one because of a diagnostic error and the other following failure of an attempt at hyperselective arterial embolisation.

Adolescent↗
PubMed1980

[Primary uretero-vesical malposition without radiological reflux (author's transl)].

Amongst a series of 190 cases of unilateral vesico-ureteric reflux detected by cystography, 94 children had a contralateral malformation identical to that where there was radiological reflux. They underwent a bilateral anti-reflux operation which in the majority of cases prevented any recurrence of acute pyelonephritis. The authors add a series of 18 cases of children who had suffered from several episodes of acute pyelonephritis without it being possible to demonstrate the radiological existence of vesico-ureteric reflux and in whom there was no obstructive disorder or lithiasis of the upper urinary tract. Nine of these patients showed corticopapillary involvement (unilateral in 8, bilateral in 1) similar to that seen in children with cystographic reflux. All the children of the group had a malformation of uretero-vesical implantation similar to that seen in the other children with cystographic reflux. After antireflux surgery (unilateral in 3 cases and bilateral in 15), almost all the children were free of further episodes of acute pyelonephritis. In the opinion of the authors, these two series of surgical patients validate the individualisation of this special group of "reflucing uretero-vesical malpositions without radiological reflux".

Child↗
PubMed1980

[The treatment of stress incontinence in women by aponeurotic "supporting" of the neck of the bladder. A new improved technique (author's transl)].

The authors describe a number of new technical details concerning surgery for stress incontinence in the woman using a sub-cervical strip. This involves the taking of a free aponeurotic strip from the upper lip of a Pfannensteil incision (which eliminates all possibility of incisional hernia), extensive pre-vesico-cervico-urethral dissection which is particularly important during reoperation (which allows the neck to rise up into its "normal" position in a patient placed in the Trendelenburg position), preparation of the sub- and latero-cervical course via a vaginal approach (avoiding tearing of the bladder and malposition of the strip), accurate placing along a straight line of the two "legs" of the U-shape given to the strip under visual control, without any tension (which avoids dysuria and should be adequate to ensure continence during stress) and finally attachments of the free ends of the aponeurotic strip to the medial end of the ligaments of Cooper using non-absorbable sutures (which leaves the strip at the desired length). Results : nine patients who had never undergone previous surgery, with nine cures ; ten patients operated upon after the failure of previous surgery for stress incontinence (8 successes and 2 failures including one reoperation with success using the same technique) ; finally, five patients operated upon for stress incontinence occurring after pelvic surgery of another type : 3 successes and 2 imperfect results. The authors briefly mention the 21 failures seen in a series of 26 cases of uplifting of the neck using a strip of skin and the 18 failures in a series of 30 reoperations for the treatment of stress incontinence in which there was no cervico-urethrolysis prior to passage of the strip.

Female↗