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Biomedical subjects

D Chopin

Publications and source records attributed to D Chopin.

162 records · Page 9Linked to original sources

[Scintigraphy with technetium dimercaptosuccinic acid (99 m TC DMSA). Contribution to the functional assessment of individual kidneys (author's transl)].

Renal uptake of 99m Tc DMSA was used to evaluate the renal function of 16 healthy subjects (controls) and 115 patients with various urinary tract diseases. Scintigraphic examination was carried out 6 hours after an intravenous injection of the product. In the 16 controls Tc DMSA uptake was 25.7 +/- 2.48% in the right kidney and 24.4 +/- 2.86% in the left kidney. In 36 patients with one single hypertrophied kidney, there was a correlation (r = 0.850) between creatinine clearance and Tc DMSA uptake, which was higher than in normal subjects (39.23 +/- 9.9%). In the group of 68 patients with unilateral (31) or bilateral (37) renal disease, a significant correlation (r = 0,725) was observed between kidney-to-kidney ratios of urea clearance and Tc DMSA uptake, so that renal impairment could be quantified. Quantitative scintigraphy did not appear to be of assistance in the remaining 11 patients with obstructive uropathy, as it overestimated renal function. The results obtained with 99 m Tc DMSA scintigraphy should be helpful in choosing between nephrectomy and conservative surgery and in assessing the degree of compensatory hypertrophy in single kidneys.

Creatinine↗

[Diagnostic value of computerized tomography in severe renal tissue infections (author's transl)].

A patient with severe acute pyonephritis and septicaemia had persistent symptoms of infection despite appropriate chemotherapy. Although no obstruction was seen on ascending ureteropyelography, exploratory lumbar incision was considered. However, computerized tomography (CT scan) failed to show any obstacle or collection of pus but indicated diffuse infection of kidney. Medical treatment was continued and the patient recovered. This case and a review of the literature has prompted the authors to compare CT scan with conventional contrast-radiography methods in septicaemias of renal origin. It appeared that intravenous and ascending uretero-pyelography are often at fault, and the latter is known to carry iatrogenic risks. CT scan is of considerable help when looking for foci of infection and is proposed as a deciding examination in septicaemias with or without signs suggestive of renal lesions.

Acute Disease↗

[Atraumatic microsurgical nephrotomy. Experimental study on canine kidney (author's transl)].

Microsurgical transversal section and repair of canine kidney was presented as a model to study the condition required for an atraumatic nephrotomy. The investigation was carried out by two methods. In a first series five kidneys were injected by coloured resins after transection and microsurgical repair. Results were evaluated by cast examination of vascular net work. In a second series, transection and repair were made by an "ex-situ" procedure on seven dogs. The repaired kidney was autotransplanted in the opposite fossa iliaca. Long term renal function was evaluated after controlateral nephrectomy, by arteriography, biologic data and DMSA Tc 99 m scintiscan. The good results showed that microsurgery is useful in atraumatic nephrotomy and now a new tool in intrarenal access.

Animals↗

[Treatment of prostatic cancer with diethylstilboestrol and detection of the vascular risk (author's transl)].

A retrospective study of immunologic behavior of patients suffering from cancer of the prostate and treated with oestrogens permits the proposal of the utilisation of a test that separates a high thromboembolic risk population due to oestrogens from a population that can benefit from this hormonotherapy. The so-called "oestrogen tolerance test" consists of seeking the presence of immune complexes by the method of precipitation of serum by 25% saturated ammonium sulphate. The group of patients where precipitates exceeds 700 micrograms/ml has a thrombo-embolic risk above 30% (41% in our series with serious complications such as pulmonary embolus and arterial thrombosis. The group of patients where precipitates are less than 300 micrograms/ml has a lower risk of arterial thrombosis (2,5%) and the observed accidents are benign. Finally, a test test when precipitate exceed 700 micrograms/ml should exclude diethylstilboestrol treatment.

Diethylstilbestrol↗

[Treatment of ureteral obstructions due to prostatic carcinoma. Prognostic value of response to medical treatment (author's transl)].

A retrospective study concerning 146 patients with prostatic cancer showed that 30 of them (20 p.cent) presented ureteral obstacles at some time during the evolution of the disease. The majority of these cases were T3-T4 tumors. When a strickly medical approach allowed to reduce the obstruction, the 1 year survived rate was 71 p.cent. When surgery became necessary due to persistent renal insufficiency, in spite of medical treatment the 1 year survival rate was 15 p.cent.

Aged↗

[The school for patients with chronic backache. Retrospective study of 93 severely handicapped patients with backache and their socio-occupational status].

A small percentage of low back pain sufferers are resistant to the various types of treatment tried and the problem becomes chronic. It is for this severely incapacitated group, threatened by socio-occupational misfortune, that we created: the School for Chronic Low Back Pain Sufferers. One hundred and five patients in whom treatment had failed were included after insurance programmes had agreed to provide cover. The system is of a multidisciplinary nature with hospitalisation for 5 days. The fate of 93 of these patients is known with a mean follow-up of 1 year. Quantified initial evaluation on an obstacle course confirmed that even severe low back pain sufferers were unaware of the basic rules for protection of the spine (mean score of 14/50 on admission). Socio-occupational fate analysed on the basis of a questionnaire showed: a high satisfaction index (90%) regardless of the subsequent outcome, and a correlation between follow-up time after the programme and the decrease in painful attacks (p less than 0.03, r = 0.23) or consumption of medications (p less than 0.01, r = 0.29). The relative simplicity of the system proposed, the situation of therapeutic impasse in which the patients for whom it is intended find themselves, the short time required and the results obtained confirm the importance of this multidisciplinary management approach being able to best envisage the possibilities of rehabilitation of the chronic low back pain sufferer, in particular when there are repeated periods off work.

Adult↗

Protection of the small intestine against irradiation by means of a removable prosthesis.

In radiation therapy of tumors, several techniques are used to prevent injury of the intestinal loops. Their purpose is to drive the intestine out of the external beam. Understanding the disadvantages they present, a temporary prosthesis which effectively protects the small bowel, and is easy to remove, has been developed. The device is a 600 to 1,000 ml, silicone rubber, expandable balloon. When implanted in the pelvis or retroperitoneal cavity, and filled, this balloon displaces the intestinal loops out of the pelvic irradiation field. It may remain either filled or empty between each irradiation session. Due to its particular elliptical shape, once empty, the balloon can be removed through a 3 cm incision under local or peridural anesthesia at the completion of radiotherapy. Eleven patients with recurrent (8) or primary (3) cancer have been implanted. The protective effect has been evaluated on successive biologic tests, performed during treatment. No problem related to the prosthesis, no alteration of the biologic tests, nor bowel injury have been observed after several months follow-up. This device is suitable for preventing intestinal complications during therapy, allowing a higher dose of radiations in some cases.

Adult↗

[Reconstructive microsurgery of the deferens duct. Experimental study of suture material].

The choice of optimal suture material for reconstructive microsurgery of the deferens duct was investigated in the rat. The study was performed on normal deferens ducts and those dilated by proximal ligatures. The absorbable thread (10.0) studied provided a more satisfactory morphological and functional result than a non-absorbable single-filament thread of identical caliber. These findings suggest that this material should be used in clinical practice.

Animals↗

[Laparoscopically-controlled lymphadenectomy in localized cancer of the prostate].

Laparoscopic lymphadenectomy was performed among 15 patients. The average age was 65.5 years. The group was made of 13 T2 and 2 T3. The average time of procedure was 175 min (90 à 240 min). The average number of lymph nodes removed laparoscopically from these patients was 5.3 on the left and 6.4 on the right. Metastatic nodes were found in 5 cases (33%) and among all these 5 patients the PSA level was above 30 and/or the Gleason score > 6. We noticed 3 major complications (2 bowel and 1 vascular injuries). Radical prostatectomy was made in 8 patients and nevertheless this intervention did not become more difficult. As a conclusion, this is a procedure which allows a good node staging but the complication rate is still high and will decrease with experience. The merits of such a method are still to be evaluated in localized prostatic cancer.

Aged↗

[Survey of instillation methods of BCG in the preventive treatment of superficial tumors of the bladder. Subcommittee of Superficial Tumors of the Bladder, the Committee of Cancerology of the French Association of Urology].

In an attempt to appreciate urological practices concerning BCG instillations a study was performed with members of university urological centers. Questions concerned instillation modalities, persons performing instillations and criteria for survey. Main differences concerned doses (low doses versus high doses) and duration of treatment. These results suggest the need of development of new parameters for the rationalisation of this treatment.

Administration, Intravesical↗