Biomedical subjects

C Pfister

Publications and source records attributed to C Pfister.

At least 55 records · Page 3Linked to original sources

PubMed1998

The value of endoscopic treatment for ureteroceles during the neonatal period.

PURPOSE: We report a series of 35 neonates presenting with ureterocele diagnosed during the antenatal period or during the first weeks of life. The first line treatment was an endoscopic incision. MATERIALS AND METHODS: Immediate postnatal evaluations detected 37 ureteroceles (bilateral in 2 cases), including 16 of the intravesical type and 21 that were ectopic. Endoscopic incision permitted decompression of the majority of ureteroceles and improvement in renal function in most cases. Secondary low grade vesicoureteral reflux appeared in 9 neonates (ectopic in 8 cases) and had already been present in 14 patients. RESULTS: Endoscopic treatment alone proved effective in 14 of the intravesical ureteroceles, while the other 2 cases requiring upper pole nephrectomy (1) and ureterovesical reimplantation using the Cohen technique (1). In contrast, among patients with the ectopic form additional surgery was necessary in 18 cases. Treatment comprised resection of the ureterocele with bladder reconstruction and ureteral reimplantation without remodeling according to the Cohen technique in 15 cases, total ureteronephrectomy in 1 and pole nephrectomy in 2. CONCLUSIONS: We suggest that early endoscopic incision be used for first line treatment of ureteroceles. The aim of this procedure is to ensure better urine drainage, preserve function of the parenchyma and reduce the risk of severe infection in the neonate. The principal complication remains secondary vesicoureteral reflux onset, which can be controlled well by antibiotic prophylaxis but requires regular radiological monitoring.

Endoscopy↗

PubMed1998

[The value of examination and treatment using laparoscopy in non-palpable testes: apropos of a series of 48 cases].

OBJECTIVES: Laparoscopy now constitutes the reference technique for the diagnosis and treatment of cryptorchid testes. We report our experience over the last three years (1993-1996). MATERIAL AND METHODS: 48 strictly impalable testes were investigated in 46 boys between the ages of 11 months and 14.5 years (mean age: 40 months). The intraperitoneal investigation assessed both deep inguinal regions looking for gonads, vas deferens and pedicles. Intra-abdominal gonads were ligated and their pedicle was sectioned laparoscopically allowing transinguinal descent 6 months later according to the Fowler-Stephens technique. RESULTS: We found 21 cases of typical antenatal torsion, including one bilateral case (pedicle and vas deferens present, but gonad absent), one case of total unilateral agenesis and 3 cases of incomplete agenesis (only the vas deferens was detected) and performed three resections of the gonadal rest for histological examination. The first-stage of cryptorchid testis descent was performed in 20 cases, by laparoscopy in 19 cases (1 failure of insufflation). Definitive descent was possible in 13 cases, with early onset of atrophy in only one case. CONCLUSION: Laparoscopy is therefore a simple technique, allowing a definitive diagnosis and two-stage descent without increasing the risk of testicular atrophy.

Adolescent↗

PubMed1998

[ST52 treatment of cancer of the prostate during the hormonal resistance phase].

OBJECTIVE: Stilboestrol phosphate (ST 52) was evaluated on pain, general status, life expectancy and PSA, in a retrospective study of patients with prostatic carcinoma and relapse to hormonal treatment. MATERIAL AND METHODS: 32 patients were treated by infusion of Stilboestrol phosphate at a daily escalating dose from 1.2 to 3 g over a period of 10 days, then subsequently oral administration. RESULTS: Minor complications, especially nausea were observed in 12 cases but no major complication or interruption of treatment. Improvement for pain alone or with general status was obtained in 50% (16 cases) at 3 months, but at one year only 10% were still improved. Median survival was 8 months, with 19.4 months for responders at the end of infusions and 4.2 months for non-responders-respectively. CONCLUSION: Stilboestrol phosphate can obtain a clinical response with low morbidity when relapse to hormonal treatment occurs. Infusion responders have a better life expectancy.

Administration, Oral↗

PubMed1998

[Percutaneous colposuspension with fixation to the suprapubic fibrous tissues].

OBJECTIVES: The authors conducted a long-term evaluation of a modification of the Peyrera-Raz procedure by creation of a fixed point in the suprapubic fibrous tissue. MATERIAL AND METHODS: The authors report a series of 38 patients who, despite pelvi-perineal rehabilitation, presented urinary stress incontinence corrected by Bonney's manoeuvre. Treatment consisted of Peyrera-Raz percutaneous colposuspension modified by superior anchoring of the sutures to the suprapubic fibrous plane. Preoperative assessment consisted of clinical and urodynamic examination. Postoperatively, patients were regularly reviewed in the outpatients department and long-term evaluation of the results was performed by means of a telephone questionnaire. RESULTS: The technical modification did not introduce any particular practical difficulty or any specific infectious or painful morbidity. Postoperative self-catheterizations, for an average of 14 days, were required in 6 patients. 9/38 (24%) presented recurrence of their incontinence within the first 6 months; reoperation by a suburethral sling allowed definitive correction of the disorders. 29/38 (76%) were satisfied or very satisfied with the result of their operation with a mean follow-up of 3.2 years, although 6 of them presented minimal incontinence on very intense, unusual efforts. CONCLUSION: Percutaneous colposuspension, modified by superior anchoring of the sutures to the suprapubic fibrous tissue, allows effective treatment of urinary stress incontinence with limited morbidity in 3/4 of cases, with a mean follow-up of more than 3 years.

Adult↗

PubMed1998

[Spontaneous rupture of the bladder. Apropos of 2 cases with an unusual presentation].

Spontaneous bladder ruptures is the accepted term of bladder rupture not associated with trauma. This rare condition occurs when an obstacle to urinary outflow is associated with a diseased bladder wall. The diagnosis is usually made on the retrograde cystogram. We report two cases of atypical spontaneous bladder rupture with intravesical herniation of the small bowel. The diagnosis was not suspected clinically but was made on CT and MRI.

Ascites↗

PubMed1998

[Recurrent febrile infections of the urinary tract and diverticulum of the urachus].

The urachus can present a partial or complete obliteration defect. If the defect is situated in its vesical extremity, it then forms a diverticulum. The authors report a case of diverticulum of the urachus in a young adult, responsible for recurrent febrile urinary tract infections since the beginning of adolescence. The diagnosis was suggested by ultrasonography and magnetic resonance imaging and confirmed by cystoscopy and histological examination. Treatment consisted of complete surgical resection via a suprapubic incision.

Adolescent↗

PubMed1997

Comparative bioavailability of letrozole under fed and fasting conditions in 12 healthy subjects after a 2.5 mg single oral administration.

Letrozole is a new non-steroidal inhibitor of the aromatase enzyme system. It is currently under development for the treatment of postmenopausal women with advanced breast cancer. To investigate the influence of food on the bioavailability of letrozole, 12 healthy male volunteers were treated under fed and fasted conditions with single oral doses of 2.5 mg letrozole in film-coated tablets. Plasma concentration profiles were determined. No significant difference in the extent of absorption (AUC or AUC0-8 h) was observed between the two treatments but the rate of letrozole absorption decreased slightly under fed conditions. However, in view of the half-life of about 2 d this small change in the absorption rate is not considered to be of clinical relevance for treatment with repeated administrations.

Absorption↗

PubMed1997

Absolute bioavailability of letrozole in healthy postmenopausal women.

Letrozole is a new non-steroidal inhibitor of the aromatase enzyme system. It is currently under development for the treatment of postmenopausal women with advanced breast cancer. Absolute bioavailability of letrozole when given orally as one 2.5 mg film-coated tablet in comparison to the same dose given intravenously as a bolus injection was studied in 12 healthy postmenopausal women. Letrozole absolute systemic bioavailability after p.o. administration was 99.9 +/- 16.3%. Elimination of letrozole was slow. Total-body clearance of letrozole from plasma after i.v. administration was low (2.21 L h-1). The calculated distribution volume at steady state (1.87 L kg-1) suggests a rather high tissue distribution. Biotransformation of letrozole is the main elimination mechanism with the glucuronide conjugate of the secondary alcohol metabolite being the predominant species found in urine. The two study treatments were tolerated equally well.

Administration, Oral↗

PubMed1997

Surgical treatment of buried penis.

The buried penis is a rare congenital entity, whose treatment is surgical. There are few publications concerning this matter. The authors report on their experience in 10 cases (1990-1995). In this abnormality, the tip of the glans does not project from the pubic or scrotal skin. It is due to: 1) an excessive development of the penile fascia which retracts the penis; 2) insufficient attachment of the penile skin at the base of the penis; 3) often excessive prepubic fat worsens the appearance of the abnormality but does not by itself totally explain it; 4) a tight phimosis is often present. Surgical treatment is necessary because this aspect tends to persist even after puberty. One cannot indeed count on the development at the age of puberty, neither on the diminution of the fat, nor on the simple cure of the phimosis. One must above all ban circumcision which causes the risk of eliminating the skin necessary for reconstruction. The surgical procedure will comprise: 1) a longitudinal dorsal incision extended circumferentially; 2) resection of the thickened fascia penis; 3) anchoring of the deep face of the dermis to the proximal part of the fascia penis at the base of the penis. This surgical procedure has always brought a significant improvement to the appearance of the penis.

Child↗

PubMed1997

[Intradiverticular bladder tumors. Five case reports].

OBJECTIVE: To define the diagnostic and therapeutic approach to intradiverticular bladder tumour. METHODS: Five cases are reported in which initial diverticulectomy was followed by cystectomy in one case, systemic MVAC chemotherapy in 2 cases and concomitant radiotherapy-chemotherapy (CRC) in 2 cases. RESULTS: One patient has died (MVAC), one patient is in partial remission (MVAC) and three patients are in complete remission (1 cystectomy and 2 CRC). CONCLUSION: Intradiverticular bladder tumour is a disease with a poor prognosis, whose histological features require aggressive treatment. Concomitant radiotherapy-chemotherapy appears to be a useful alternative.

Aged↗

PubMed1997

[Value of helical CT scan in the preoperative assessment of the ureteropelvic junction syndrome].

INTRODUCTION: The search for anatomical variants of the renal blood supply is an important element in the choice of surgical technique for the treatment of ureteropelvic junction syndrome. MATERIAL AND METHODS: Prospective study of 17 patients (mean age: 33 years), assessed by spiral CT with acquisition of overlapping thin sections during the arterial phase. The renal blood supply anatomical findings were then compared with operative findings in all patients. RESULTS: We observed a solitary renal artery in 8 cases, a lower pole pedicle crossing the junction in 9 cases and vascular abnormalities in 4 cases. All of these radiological findings were confirmed intraoperatively. Spiral CT, with rapid acquisition during the arterial phase and overlapping thin sections, allows accurate analysis of the renal blood supply. Axial sections are sufficient to provide the necessary anatomical information. Three dimensional reconstructions allow a better spatial visualization of the various structures. CONCLUSION: This examination allows visualization of a possible lower pole artery associated with UPJ syndrome, with identical accuracy to that of renal arteriography, but constitutes a less invasive and less expensive investigation.

Adolescent↗

PubMed1997

[Ultrasonography of the urethra: prognostic value of the ultrasonographic structure of corpus spongiosum peristenotic fibrosis: prospective study of 33 patients].

OBJECTIVES: The contribution of ultrasonography to pretreatment morphological assessment of strictures of the anterior urethra and assessment of the risk of recurrence after internal urethrotomy. MATERIAL AND METHODS: 33 patients (16-89 years) operated by internal urethrotomy for stricture of the anterior urethra and followed for at least 6 months. Preoperative urethral ultrasonography, recording the number, length and degree of strictures and echostructure of the peristenotic fibrosis of the corpus spongiosium. RESULTS: Ultrasound visualization of all urethral strictures, with no false-positives and no false-negatives. 11 patients relapsed after a mean interval of 5.7 months (1-16 months), 22 patients did not present recurrence: mean interval: 15.5 months (6-36 months). Corpus spongiosum fibrosis associated with urethral stricture is isoechoic to the corpus spongiosum (19 cases) or hyperechoic to the corpus spongiosum (14 cases). No statistical correlation was observed between the echostructure of the fibrous tissue and the risk of recurrence after internal urethrotomy. CONCLUSION: Ultrasonography allows excellent analysis of the morphological characteristics of a stricture of the male anterior urethra. In our experience, and in contrast with the limited data of the literature, no correlation was observed between the echostructure of the peristenotic fibrosis and the risk of recurrence after internal urethrotomy.

Adolescent↗

PubMed1997

Preliminary results of muscle cuff cervicoplasty in the ewe for the treatment of urinary incontinence.

OBJECTIVE: Muscle cuff cervicoplasty consists of dissecting a strip of the superior slip of the levator ani muscle, by sectioning it flush with the symphysis pubis, and applying it like a cuff around the urethra below the bladder neck. METHODS: We conducted a preliminary study in 12 ewes, including preoperative urodynamic assessment, intravenous urography with retrograde cystography on day 15, and another urodynamic assessment 1 and 3 months after the operation. Two animals died, but the other 10 animals were able to be evaluated. An increase in the urethral functional length with an infracervical plateau was revealed on all postoperative urethral profiles. Only transrectal electrostimulation, performed on the last 5 ewes, demonstrated an elevation of the closure pressure by 5-10 cm H2O. At sacrifice of the animals at 4 months, in situ stimulation of the muscle strip induced muscle contraction in 7 of 10 cases. Histological examination demonstrated persistence of muscle fibers in the cuff, despite the presence of marked fibrosis. RESULTS: The preliminary results are encouraging: urinary continence was improved with a minimal risk of retention, and cervicoplasty appears to retain its contractile activity, suggesting the possibility of a long-term sphincteric and proprioceptive action. CONCLUSION: This technique could be proposed in women suffering from urinary stress incontinence with sphincter hypoactivity.

Animals↗

PubMed1996

Long-term bladder dysfunction in boys with posterior urethral valves.

We report a series of 60 children operated on for posterior urethral valve (PUV) before the age of 5 years and followed up for 10 years. This work aims to study the vesico-sphincteric sequelae of this malformation. 38 patients showed early urinary incontinence post-operatively. Of them, 20 were re-evaluated 10 years later by pelvic ultrasonography, pressure flow studies combined with EMG and assessment of renal function. 8 patients refused to undergo these investigations and 10 were lost to follow-up. Of the 28 evaluable patients, 22 are currently continent and a complete urodynamic study was performed for the 6 (10%) incontinent patients. Of them, 3 showed uninhibited detrusor contractions. The vesical compliance was frequently within the normal limits. No case of detrusor-sphincteric dyssynergy or urethral hypotony was found. 2 were successfully treated by oxybutinin and biofeedback reeducation, 2 were partially improved but their prostates are still in growth and the possibility of implanting an artificial sphincter was discussed in the remaining 2. The urodynamic evaluation of those patients in the long-term is encouraging.

Child↗

PubMed1996

Letrozole, a new oral non-steroidal aromastase inhibitor in treating postmenopausal patients with advanced breast cancer. A pilot study.

PURPOSE: To evaluate the endocrine effects as well as the pharmacokinetic parameters, efficacy and safety of letrozole, a new fourth-generation non-steroidal aromatase inhibitor. PATIENTS AND METHODS: Fourteen postmenopausal women with progressive metastatic breast cancer, previously treated with endocrine therapy and/or chemotherapy for advanced disease, were treated with 0.5 mg daily doses of letrozole, orally. Endocrine and pharmacokinetic measurements were made before treatment and on days 14, 28, 56, and 84 of therapy. RESULTS: Letrozole induced a >86% decrease in plasma estrone and a approximately 67% reduction in circulating estradiol from day 14 on. There was a statistically significant decrease in plasma cortisol, which appeared clinically irrelevant since all values remained within the normal range. No significant changes in aldosterone concentration were noted. One patient achieved a complete response (CR) and 4 patients a partial response (PR), with an objective response rate of 36% (95% CI 13% to 65%). Median duration of response was 24 months, ranging from 4 to 44 months. No toxic effects attributable to letrozole were noted in any patient. CONCLUSION: Letrozole appears to be a very promising new antiaromatase drug. The characteristics of the patients more likely to respond, taking into account prior systemic treatment, should be defined by future studies. Further phase II and phase III studies comparing letrozole to other available second or even first-line endocrine-therapy agents, are warranted.

Adult↗

PubMed1996

Immunoassays in monitoring biotechnological drugs.

For the evaluation and interpretation of pharmacokinetic data reliable quantitative determinations are a requirement that can only be met by well-characterized and fully validated analytical methods. To cope with these requirements a method is being established that is based on an integrated and automated fiber-optic biospecific interaction analysis system (FOBIA) for immunoassays. Performance characteristics of this system used in monitoring of recombinant hirudin (CGP 39 393) are presented. Recombinant hirudin is a highly potent and selective inhibitor of human thrombin. Owing to its size and charge, recombinant hirudin is mainly eliminated by glomerular filtration. But only a fraction of the hirudin dose seems to be reabsorbed at the proximal tubule by luminal endocytosis and hydrolyzed by lysosomal enzymes, leaving approximately 50% of the dose to be extracted in the urine. Thus, renal clearance of recombinant hirudin in the absence of renal insufficiency appears to depend primarily on the glomerular filtration rate. During a 3-month i.v. tolerability study in dogs, some of the dogs developed antibodies against recombinant hirudin. The hirudin-antibody complex accumulated in plasma and apparent hirudin plasma concentrations were therefore much higher than expected from single-dose kinetics. Hirudin captured by antibodies showed an extended half-life and the hirudin-antibody complex is still pharmacologically active, as demonstrated by the observed increase in thrombin time. In conclusion, only appropriate analytical methods allow adequate monitoring and pharmacokinetic characterization of biotechnology drugs in biological materials.

Animals↗

PubMed1996

Power Doppler sonographic pattern of acute pyelonephritis in children: comparison with CT.

OBJECTIVE: Focal areas of decreased perfusion may be shown by power Doppler sonography in children with acute pyelonephritis. The purposes of this study were to assess the ability of power Doppler sonography to reveal acute pyelonephritis and to compare the sonographic images with enhanced CT images. SUBJECTS AND METHODS: We performed B-mode sonography, power Doppler sonography, and enhanced CT (reference method) of the kidneys of 30 children with symptoms suggesting upper urinary tract infection. All imaging studies were obtained within 24 hr of admission of each child to our hospital. Power Doppler sonography was performed with the same equipment and the same settings for all children. Imaging studies were performed before the results of urine cultures were obtained. Triangular areas of decreased perfusion visible on both longitudinal and axial scans were considered indicative of acute pyelonephritis on power Doppler sonographic images. On CT images, areas of decreased attenuation of the renal parenchyma visible immediately after IV injection of iodinated contrast agent or areas of increased attenuation on delayed scans were considered indicative of acute pyelonephritis. Power Doppler sonography and CT were compared for each renal pole (n = 120). RESULTS: For 17 (89%) of the 19 patients with CT-proven acute pyelonephritis, power Doppler sonography diagnosed this condition on the correct side. Seventeen (77%) of the 22 poles showing acute pyelonephritis on CT scans were also revealed by power Doppler sonography. The two patients in whom acute pyelonephritis was not revealed by power Doppler sonography were an obese 15-year-old girl and a 7-year-old boy with right upper pole pyelonephritis. This boy was one of the first patients to be included in the study. Also, in an obese 11-year-old girl, a false-positive indication of pyelonephritis was given by power Doppler sonography. CONCLUSION: Power Doppler sonography seems to be significantly more sensitive than conventional sonography for the detection of acute pyelonephritis in children. This noninvasive technique should be able to replace CT or dimercaptosuccinic acid scintigraphy in many children with urinary tract infections.

Acute Disease↗

PubMed1996

[Spontaneous perirenal hematoma: diagnostic and therapeutic approach].

OBJECTIVE: Spontaneous perirenal haematomas are relatively rare. The authors report 6 recent cases and try to propose a diagnostic and therapeutic strategy based on the aetiology. MATERIAL AND METHODS: From January 1993 to May 1995, 6 patients between the ages of 36 and 61 years were admitted to hospital for spontaneous perirenal haematoma, presenting in the form of acute lumbar pain associated, in one half of cases, with signs of internal bleeding. RESULTS: In each case, CT examination allowed precise assessment of the haematoma, but the aetiology was determined preoperatively in only 3 out of 6 patients, corresponding to a neoplastic lesion in each case (1 corticoadrenaloma, 1 adenocarcinoma, 1 angiomyolipoma). All patients were operated (3 radical nephrectomies, 2 haemostatic nephrectomies, 1 drainage of the haematoma with biopsies). No cause was found in 2 cases. CONCLUSION: Spontaneous perirenal haematomas essentially raise the problem of the aetiological diagnosis, but can sometimes be inadequate. Arteriography is useful when CT scan is negative or in the case of vascular disease. The therapeutic attitude, nephrectomy or conservative treatment remains controversial, but in view of the frequency of renal neoplastic lesions, the authors recommend nephrectomy at the slightest doubt concerning renal integrity. When no cause can be found, the assessment must be completed postoperatively with long-term, close surveillance, due to the risk of an undiagnosed neoplastic lesion.

Adult↗