Biomedical subjects

C Coulange

Publications and source records attributed to C Coulange.

At least 37 records · Page 2Linked to original sources

PubMed1999

Kinetics of postbiopsy levels of serum free prostate-specific antigen and percent free prostate-specific antigen.

OBJECTIVES: We evaluated the effects of transrectal ultrasound-guided biopsy of the prostate on serum total and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting variations in PSA levels. METHODS: Serum total and free PSA levels and the free/total PSA ratio were determined in 48 men (mean age 66+/-7 years) before and 1 hour, 8 days, and 30 days after prostate biopsy. At least six cores were taken using a biopsy gun with an 18-gauge needle. The coefficient of variation of PSA was calculated as the postbiopsy/prebiopsy PSA ratio. Changes in PSA levels and the coefficient of variation were studied. RESULTS: Fifteen (31%) of 48 men had adenocarcinoma on biopsy. Total and free PSA values were significantly increased 1 hour and 8 days after biopsy, and both returned to baseline 30 days after biopsy. The free/total PSA ratio was significantly increased (55%) 1 hour after biopsy and significantly decreased (12%) 8 days after biopsy. Thirty days after biopsy, the median of the free/total PSA ratio (18%) was not significantly different from the prebiopsy ratio (16%). The median of the coefficient of variation of the free/total PSA ratio was 3, 0.7, and 1 at 1 hour, 8 days, and 30 days after biopsy, respectively. Age, prostate volume, number of cores, and digital rectal examination and histologic findings were not significantly associated with variation in percent free PSA. Variation in percent free PSA at day 8 was associated with prebiopsy total PSA value and the free/total PSA ratio. CONCLUSIONS: Prostate biopsy dramatically alters the percent free PSA. The free/total PSA ratio was decreased 8 days after biopsy and returned to prebiopsy levels in 75% of patients at 1 month after biopsy. Measurement of free PSA levels and the free/total PSA ratio should not be done within 4 weeks of prostate biopsy.

Adenocarcinoma↗

PubMed1999

Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen.

OBJECTIVES: To evaluate the effects of digital rectal examination (DRE) on serum total, calculated complexed, and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting variations of PSA. METHODS: Serum total and free PSA and the percent free PSA ratio were determined in 91 urologically referred men (mean age 64 +/- 9 years) before and 30 minutes after DRE, with the Hybritech Tandem-R assay. Complexed PSA was calculated as the difference between total and free PSA. DRE effects on PSA were analyzed comparing pre-DRE and post-DRE values and by calculating the difference between pre-DRE and post-DRE PSA and the post/pre-DRE geometric ratio as a coefficient of variation. RESULTS: Thirty minutes after DRE, the increase in total, calculated complexed, and free PSA and the percent free PSA ratio was statistically significant. The difference between post-DRE and pre-DRE values of serum total, calculated complexed, and free PSA and percent free PSA was +0.9, +0.3, and +0.6 ng/mL and + 10%, respectively. The post/pre-DRE ratio of serum total, calculated complexed, and free PSA and percent free PSA was x1.5, x1.22, and x2.5 and x1.7, respectively. Patient age, DRE findings, prostate volume, prostate histologic features, and the initial value of total PSA had no statistically significant effect on the change of percent free PSA after DRE. The initial percent free PSA had a statistically significant effect on the change of percent free PSA after DRE. The values of calculated complexed PSA before and after DRE were significantly higher in patients with a prostate volume greater than 40 cc, prostate cancer on biopsy, and an initial free/total PSA ratio greater than 18%. CONCLUSIONS: In this study, DRE significantly increased total, calculated complexed, and free PSA and percent free PSA. The increase of PSA immediately after DRE was mainly due to the increase of free PSA. The change of percent free PSA after DRE depended on the initial percentage of free PSA. Complexed PSA seems less sensitive to DRE, and its changes after DRE were clinically modest. Free PSA measurement should be done before DRE and percent free PSA should be used only when the venipuncture is done before the DRE.

Aged↗

PubMed1999

Retrograde Acucise endopyelotomy: long-term results.

PURPOSE: We evaluated the long-term outcome of retrograde endopyelotomy with the Acucise cutting balloon as a first-line treatment of ureteropelvic junction obstruction (UPJO) in 36 patients (median age 44 years). PATIENTS: Twenty-three patients had a primary UPJO. The median follow-up in the series was 24 (6-42) months. RESULTS: Success, defined as a subjective and objective improvement, was obtained in 27 (75%). In multivariate analysis, only the presence of a crossing vessel (45% v. 81%) was a significant covariate for success. The success rates for primary and secondary UPJO were 74% and 77% respectively. The grade of obstruction had no impact on results. The median time to the nine failures was 3 months, and no failure occurred more than 6 months after the endopyelotomy. In 75% of the failures with no crossing vessel, redo retrograde Acucise endopyelotomy was successful. CONCLUSION: Retrograde Acucise endopyelotomy is an efficient long-term treatment of UPJO with low morbidity. This technique is a reasonable choice for first-line treatment of UPJO.

Adolescent↗

PubMed1999

[Role of flexible mini-ureteroscopes in diseases of the upper urinary tract].

INTRODUCTION: The management of upper urinary tract disease has been improved by miniaturization of endoscopes. Our objective was to assess the value of flexible mini-ureteroscopes for the diagnosis and treatment of upper urinary tract lesions. PATIENTS AND METHODS: 33 consecutive patients (mean age: 49 +/- 16 years; 23 men) underwent first-line flexible ureteroscopy for upper urinary tract disease, consisting of: stones: 21, filling defect: 6, stenosis: 3, haematuria: 2, positive cytology: 1 and situated in the kidney + renal pelvis: 14 or ureter: 19. The 21 stones were situated in: the calyx: 5, renal pelvis: 1, lumbar ureter: 8, iliac ureter: 3, pelvic ureter: 4. Their mean dimensions were 9.7 +/- 4 x 5.3 +/- 2.3 mm. Previous treatment had failed for 13 stones. There 7.5 F flexible ureteroscopes of various brands were used. RESULTS: All patients were operated under general anaesthesia. Antegrade ureteroscopy was performed in 2 patients. Advancement of the ureteroscope was considered to be difficult in 5 cases, including the 2 antegrade cases. 13 stones were fragmented by hydroelectric waves. The mean duration of ureteroscopy was 40 +/- 15 min. The mean hospital stay was 2.8 +/- 1 days. There was no intraoperative or perioperative morbidity. Ureteroscopy was considered to be successful in 27 cases (82%) and a failure in 6 cases: fragmentation: 3 and progression: 3. Fifteen patients were reviewed after more than one month (3 +/- 2 months) with no morbidity. CONCLUSION: Ureteroscopy with flexible mini-ureteroscopes is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique. It is particularly useful for lesions situated above the iliac vessels and is indicated for diagnostic assessment and stones, but also upper tract malformations and strictures.

Adolescent↗

PubMed1999

[Pelvic endometriosis with urologic involvement. Therapeutic principles: apropos of 2 cases].

The authors report 2 clinical cases of vesicopelvic endometriosis. The urinary symptoms and the radiological appearance of endometriosis of the bladder are nonspecific. The diagnosis was established by histological examination of the resection specimen. The authors describe the therapeutic approach based on radical surgery designed to eradicate the endometriosis, while remaining as conservative as possible in order to allow subsequent pregnancy, and the place of urological surgery combined with medical treatment with LHRH analogue.

Adult↗

PubMed1998

A French national epidemiologic survey on renal cell carcinoma. Oncology Committee of the Association Française d'Urologie.

BACKGROUND: In this multicenter study, the yearly national evaluation of tumors of the kidney was out by the Oncology Committee of the French Association of Urology. METHODS: During the period from April 1, 1992, to March 31, 1994, 1486 patients from 54 centers were included in this study. For each patient, an individual chart was created, in which age, gender, discovery circumstances of the tumor, radiologic and biologic workup, treatment, TNM classification, and histologic features of the tumor were recorded. RESULTS: The mean patient age was 62.1 years, and the male-to-female ratio was 2:1. Forty percent of the tumors were discovered accidentally. A radical nephrectomy was performed in 93% of the cases, and in 7% of the cases, conservative management was adopted. Medical treatment was chosen in 5% of the cases. The patient distribution according to classification was as follows: pT1 = 8%, pT2 = 53%, pT3a = 21%, and pT3b = 18%. Lymph node involvement was observed in 9% and visceral metastasis in 6% of the cases. The incidental tumors were intracapsular in 80% of the cases. From the histologic point of view, the majority of the tumors were clear cell adenocarcinoma (66%). The mean tumor maximum dimension was 6.4 +/- 3.5 cm; it was significantly greater in symptomatic patients and patients with poor prognostic indicators (involvement of the adrenal gland, inferior vena cava, and/or lymph nodes and visceral metastasis). Adrenal gland involvement or inferior vena cava involvement were each observed in 4% of the cases. Fourteen percent of the patients had multicentric tumor spread, which was influenced by neither the tumor size nor the cell type. The nuclear grade was established in 66% of the cases and was significantly correlated with involvement of the perirenal fat and the lymph nodes. CONCLUSIONS: This study allowed the authors to centralize one-fifth of all new cases of adenocarcinoma of the kidney in France in the course of a year. It enabled them to evaluate precisely the current epidemiologic profile of this disease among those patients.

Adult↗

PubMed1998

Posttransplantation acute tubular necrosis: risk factors and implications for graft survival.

Previous studies aimed at identifying the causes, risk factors, and outcome of kidney transplant recipients with delayed graft function (DGF) have yielded controversial results. We retrospectively analyzed the causes and risk factors for DGF in 263 cadaveric kidney transplantations from November 1988 to March 1997 in one center. Causes of DGF were assessed by postoperative graft evolution and graft biopsy. Univariate and multivariate analysis were used to investigate the risk factors for DGF induced by acute tubular necrosis (ATN). Seventy-six patients (29%) had DGF, which was caused by ATN in 70 patients (92.1%) and acute rejection (AR) in 6 patients (7.9%). Therefore, we focused on risk factors and consequences for ATN-induced DGF. In monofactorial analysis, ATN was significantly associated with greater weight and presence of an atheromatous disease in both donor and recipient. Other risk factors for ATN were older age of donor, recipient American Society of Anesthesiology (ASA) physical status category IV, cold ischemia time (CIT), and transplantation using the right kidney. The multivariate analysis showed that donor and recipient weight, donor age, transplantation using the right kidney, preservation in Eurocollins solution, ASA score, and CIT were associated with ATN. The incidence of rejection and renal function were not different at 3 months or 1 and 5 years. ATN is the main cause of DGF in kidney transplant recipients. ATN is caused by donor and recipient vascular background, grafting the right kidney, and CIT. ATN does not appear to have an adverse effect on long-term kidney function.

Adult↗

PubMed1998

[Malignant Leydig cell tumor of the testis secreting progesterone].

Malignant Leydig cell tumours of the testis occur in only 0.1-0.3% of patients with testicular tumours. Less than 50 cases of malignant Leydig cells tumours have been previously reported. A report of a new case is presented. This tumour was unusual because of high progesterone level. We analyzed malignant pathologic signs of Leydig cell tumours as immunohistochemical proliferation index. Management of this tumour, for which chemotherapy is not yet available, is discussed.

Aged↗

PubMed1997

[Epidemiology and diagnosis of bladder tumors].

Bladder cancer affects more often the male and accounts for about four per cent of death from cancer each year in France. Numerous factors may be responsible, first of which are smoking and certain carcinogens found in the workplace. Haematuria is well known as the main presenting symptom of bladder cancer but bladder tumors may present with and bladder symptom. Cystoscopy remains the key examination. Tumor resection brings details about the stage and the grade. In the case of an invasive tumor, staging procedures is necessary. This examination under estimates the stage in nearly 20% of cases. Superficial tumors are characterised by the risk of recurrence (40%).

Aged↗

PubMed1997

[Prostatic urothelial location of a tumor of the bladder].

Prostatic urothelial carcinoma concomitant with a bladder tumour is rare, but its incidence is increasing due to the precision of histological examination and the prevalence of bladder carcinoma in situ. Its prognosis depends on the depth of the prostatic lesion: carcinoma in situ, involvement of the ducts or even the stroma. In the case of high grade bladder tumour, multifocal tumour or bladder carcinoma in situ, a transurethral resection of the prostate is the best way of detecting this lesion. The therapeutic options depend on the depth of the prostatic invasion.

Carcinoma in Situ↗

PubMed1997

[Malignant histiocytofibroma of the bladder. A case report].

Malignant histiocytofibroma of the bladder is a rare (16 cases reported in the literature) and very aggressive sarcoma. It is sometimes associated with a haematological malignancy. The authors report a case of malignant histiocytofibroma of the bladder in a 72-year-old haemodialysed woman with a poor general status. She had a history of chemotherapy and radiotherapy for gastrointestinal lymphoma 6 years previously. Treatment consisted of palliative cystectomy for bladder pain and haematuria. A massive pelvic and abdominal wall recurrence occurred two months after cystectomy and the patient died. The authors review the 16 cases of malignant histiocytofibroma of the bladder reported in the literature. Histiocytofibroma is a tumour which requires aggressive treatment with a combination of radical surgery and systemic chemotherapy.

Aged↗

PubMed1997

[Infiltrating bladder tumor in a renal transplant patient: cystectomy with prostatic conservation and enterocystoplasty].

OBJECTIVE: The principles of treatment of de novo bladder tumours in renal transplant patients are comparable to those applied in non-transplant patients. In the case of an invasive tumour, techniques can be used to restore urinary tract continuity after cystectomy. A case of cystectomy with enterocystoplasty for invasive bladder tumour in a renal transplant patient is reported. MATERIAL AND METHODS: An invasive urothelial bladder tumour was discovered in a 62-year-old man, 3 months after a 2nd renal transplantation. Treatment consisted of cystectomy with prostatic preservation and nontubulized enterocystoplasty. RESULT: With a follow-up of 21 months after cystectomy, the patient is alive without recurrence. He is perfectly continent during the day, with normal sexual intercourse and no reflux or residual urine. Renal function is normal. CONCLUSION: Cystectomy with enterocystoplasty can be an effective treatment for invasive bladder tumour in renal transplant patients. This treatment ensures oncological control and acceptable comfort while preserving the transplant.

Carcinoma, Transitional Cell↗

PubMed1997

[Acucise endoureterotomy for distal ureteral stenosis in a renal transplant patient].

The treatment of ureteric strictures in renal transplantation used to be surgical, but has recently benefited from progress in endourology. The authors report the case of a renal transplant recipient who developed late stricture of the ureterovesical reimplantation of the transplant. After percutaneous nephrostomy, which restored good renal function, retrograde endoureterotomy was performed using an Acucise ureterotome balloon, followed by ureteric modelling on a 7F double J stent for 2 months. With a follow-up of 18 months, renal function was normal and ultrasonography showed residual hypotonia of the transplant cavities and no vesicorenal reflux was detected by retrograde voiding cystourethrography. Acucise retrograde endoureterotomy can constitute a simple endourological treatment for late ureteric strictures in renal transplantation.

Catheterization↗

PubMed1997

[Contralateral perirenal metastasis of renal adenocarcinoma].

The objective of this paper is to report an exceptional case of solitary contralateral perirenal metastasis from a renal cell carcinoma. Investigation of this 62-year old patient, presenting with isolated haematuria, revealed a tumour, 9 cm in diameter, in the upper pole of the right kidney, associated with contralateral metastasis in the left perirenal fat. A right radical nephrectomy and left lumpectomy including the fat around the tumour were performed via a bilateral subcostal incision. Pathological staging was pT3b N0 M1, Fuhrman grade III. With a follow-up of eight months, this patient was asymptomatic with a normal radiological assessment.

Adenocarcinoma↗

PubMed1997

[The AMS 800 sphincter in urinary incontinence after prostatic surgery. Apropos of 16 patients].

OBJECTIVE: To present the results of a series of artificial sphincters implanted for urinary incontinence after prostatic surgery. PATIENTS AND METHODS: From 1987 to 1996, artificial sphincters were implanted for urinary incontinence after prostatic surgery, consisting of one transvesical prostatectomy, 11 prostatic resections and 4 radical prostatectomies. All these patients were evaluate by urine culture, cystourethrography and urethrocystoscopy. Eleven patients underwent urodynamic assessment. The AMS 800 artificial sphincter was used. RESULTS: The mean interval between onset of incontinence and implantation was 18 months. The mean follow-up after implantation of the sphincter was 6 years. An operative wound of the bulbar urethra did not prevent implantation of the sphincter, but required repair and prolonged catheterization (12 days). The mean duration of catheterization was 6 days. The overall functional result was 81% (13 case), and 75% of sphincters were functional at 5 years. Five revisions were necessary to maintain functioning of the sphincter in 2 cases of rupture and 1 displacement of the balloon, 1 case of urethral atrophy and 1 rupture of the pump. Three explanations, 2 total and 1 partial, were performed. Two reimplantations were performed after 12 months and 26 months respectively. CONCLUSION: The AMS 800 artificial sphincter currently represents an effective treatment for urinary incontinence due to sphincter insufficiency after prostatic surgery. However, an old artificial sphincter may require revision to restore function.

Aged↗

PubMed1996

Transplantation of a horseshoe kidney into 2 recipients.

We report the case of a transplantation of a horseshoe kidney to 2 recipients after isthmic section of the kidney. A review of the literature since 1975 mentions only 14 cases of transplantation of a horseshoe kidney. In the absence of a significant urological clinical history of the donor, the presence of a horseshoe kidney, in the case of multiorgan harvesting, does not represent a contraindication for transplantation.

Adult↗

PubMed1996

[Urachal adenocarcinoma associated with urothelial tumor of the bladder. Report of a case].

The authors report a rare association of adenocarcinoma of the urachus and urothelial bladder carcinoma. Treatment consisted of cystoprostatectomy with removal of the urachus and cutaneous ureterostomy. A review of the literature indicates that adjuvant treatment has yet to be defined. This is a chance association whose prognosis depends on the invasive nature of the urothelial tumour.

Adenocarcinoma↗

PubMed1996

Impact of recombinant human granulocyte colony stimulating factor on dose intensity and toxicity of three cycles of methotrexate, vinblastine, doxorubicin and cisplatin in patients with previously untreated urothelial bladder carcinoma.

This single arm, open labeled, non randomized study was aimed to evaluate the toxicity of 3 cycles of MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) with rhG-CSF (5 micrograms/kg/day from day 3 to day 14), on 14 patients with previously untreated infiltrating bladder carcinoma, 42 cycles were administered. Chemotherapy toxicity was very low, with 7% of neutropenia grade 3 or 4.4% of thrombocytopenia grade 2, no mucositis above grade 2 and no nadir sepsis. Bone pain related to rhG-CSF occurred in 14% of cycles. 88% of the cycles were given at full dose without any delay and mean relative dose intensity was 96.4% (RDI was 100% for 9 patients). One patient achieved a complete pathological response (cystectomy: 1) and 6 clinical responses with negative transurethral resection. Addition of rhG-CSF to MVAC chemotherapy allows a high dose intensity of MVAC with very low toxicity over 3 cycles. This association should be compared to standard MVAC or intensified regimens to evaluate efficacy, toxicity, and cost effectiveness.

Adult↗