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Biomedical subjects

D Grasset

Publications and source records attributed to D Grasset.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Extracorporeal lithotripsy in gallbladder calculi. Results of a single-center experience of 31 patients].

The authors studied thirty one cases (18 women, 13 men) of extracorporeal shock-waves lithotripsy on symptomatic gallbladder stones realized with piezoelectric generators. There were one to six stones per patient with individual stone size from 8 to 40 mm; among them 16% were calcified. Any anesthesia was necessary. Shock-wave frequency was 1.25 and 2.5 Hz. The average number of shock waves administered was 4,600 per treatment. Fragmentation occurred in 67% after first treatment and in 74% after second treatment. Gallstones disappeared in 9.5% and 19.5% of patients after 6 weeks and 4 months respectively. There was no modification after four treatments in 22.5% of patients. Minor side effects were noted: back pain (29%) probably because of uncomfortable position during treatment; increased thickness of gallbladder wall (26%); biliary pain (22%). Two episodes of biliary tract obstruction by stone fragments (one mild pancreatitis, one jaundice with liver enzymes elevation) disappeared spontaneously. These results were comparable with those of other groups using the same shock waves lithotripter.

Adult↗
PubMed1989

Pharmacodynamic and pharmacokinetic study of propranolol in patients with cirrhosis and portal hypertension.

1. The aim of this study was to investigate the pharmacokinetics and the beta-adrenoceptor blocking activity according to time of conventional (C) and long acting (LA) propranolol in cirrhotic patients. Twenty-four patients with alcoholic cirrhosis and oesophageal varices were randomly assigned to receive either 160 mg C propranolol, 160 mg LA propranolol or placebo acutely and then following repeated administration (acute and chronic phases). Thereafter propranolol concentrations and beta-adrenoceptor blockade (resting and exercise heart rates) were measured at different intervals. 2. The Cmax was significantly higher with C propranolol in both phases. The time of Cmax was significantly later with LA propranolol in both phases. The AUCs were significantly higher after chronic administration with both formulations of propranolol. 3. The exercise peaks of beta-adrenoceptor blockade were similar between the two formulations and between the two phases of administration of propranolol. The duration of effective beta-adrenoceptor blockade was significantly longer in the chronic phase and seemed to be longer with LA than with C propranolol although this was not significant (72 +/- 31 vs 48 +/- 18 h, respectively). 4. There was a significant correlation between the log propranolol concentration and exercise heart rate but not with resting heart rate. No correlation could be demonstrated between pharmacological data and the Child Pugh score. 5. We conclude that in cirrhotic patients exercise testing was a reliable method in the assessment of beta-adrenoceptor blockade. Pharmacology of propranolol was found to be different according to the formulation or to the phase of administration.

Adrenergic beta-Antagonists↗
PubMed1989

[Early surgery of obstructive uropathies discovered antenatally. First results apropos of 56 cases].

Between September 1984 and April 1988, 56 children underwent surgery for an obstructive uropathy discovered on antenatal ultrasound examination. These included 31 cases of stenosis of the pyelo-ureteral junction (PUJ), 9 cases of vesicorenal reflux, 6 mega-ureters (MU), 6 ureteroceles, 3 posterior urethral valves and 1 ectopic ureteral orifice. Major reflux (type III and IV) was included within the obstructive uropathy classification in that it opposes the normal pressure gradient which ensures progression of urine towards the bladder. The nature of the obstruction, morphological study of the kidneys and the renal function itself were very precisely studied and monitored (IVU, ultrasound, isotope tests, DTPA with frusemide and DMSA). In 46 children reconstructive and conservative surgery was possible. Analysis of the various groups of uropathy showed that: 1. Stenosis of the JPU had a very favorable or sometimes spectacular outcome both functionally and morphologically. 2. Cases of reflux showed excellent results, except in the presence of preexisting major renal dysplasia. 3. Mega-ureters had a less good prognosis. Renal growth depended above all on the degree of renal dysplasia which was often associated. 4. This was also true for sever forms of posterior urethral valves. A discussion follows which tries to reply to the following questions: 1. Why does early surgery for stenosis of the JPU give better results? 2. On the other hand, why is the same benefit not obtained in the other obstructive uropathies?

Female↗
PubMed1989

[Acute epididymitis and antibiotherapy. Measurement of the epididymal diffusion of pefloxacin].

Acute epididymitis is a common infection in the young sexually active adult. Etiologically, the organisms most frequently found are Chlamydia trachomatis, Neisseria gonorrhea and gram negative bacilli. Pefloxacin is a novel quinolone whose antibacterial spectrum and bactericidal activity allow it to be considered for use in the treatment of orchitis and epididymitis Prior to clinical study the authors investigated the degree of epididymal diffusion of Pefloxacin. Ten subjects underwent extraction of an epididymal sample by direct access to the epididymis through a transverse scrotal incision under peridural anesthesia. Three days before surgery, Pefloxacin was administrated at the rate of 400 mg every 12 hours by the oral route. On the day of the operation, the subject receive a 400 mg infusion over one hour, 2 hours before epididymal biopsy. Blood specimens were also extracted. Pefloxacin assays were performed by HPLC following a method derived from that of Montay. The trough concentration of Pefloxacin inhibiting 90% of sensitive strains (MIC 90) is less than or equal to 2 micro-g/ml. The majority of sensitive organisms have minimum bactericidal concentrations equal to twice the MIC 90. The epididymal concentrations that the authors measured are situated at values of 8.15 to 21.80 miro-g/g tissue (mean 13.44). These data allow the use of Pefloxacin to be considered an option in the treatment of epididymitis.

Acute Disease↗
PubMed1987

[Trans-intestinal cutaneous ureterostomy].

On the basis of a personal series of 243 cases of transintestinal cutaneous ureterostomy, including 216 cases following total cystectomy, the authors initially review the technical factors determining success, stressing in particular the quality of the uretero-intestinal anastomoses and the careful formation of the parietal tract and the cutaneous stoma. They then analyse their results, defining successively the operative mortality attributable to the diversion (reduced by 2% once the technique has been mastered) the early non-fatal complications (14.8% of intestinal obstructions, only requiring re-operation in 4.5% of cases; 11% of urinary fistula, most of which resolved spontaneously; 8% of faecal fistulae, requiring re-operation in 2/3 of cases; 3.7% of ischaemic necroses of the cutaneous stoma) and finally the late complications affecting the uretero-intestinal anastomoses (17% of stenoses, mostly unilateral), the intestinal graft (0.8% of calculi on non-absorbable sutures: 5.3% of stenoses of the cutaneous stoma; 6% of mucosal prolapses) and the equipment, which has made enormous progress in recent years. Renal function is only preserved when renal failure was not present pre-operatively. The authors conclude on the unquestionable value of transintestinal cutaneous ureterostomy as a high urinary diversion procedure, while recognising that it does not constitute either the ideal solution nor the exclusive solution, particularly after total cystectomy.

Colon, Sigmoid↗
PubMed1986

[Cancer of the prostate. Results and causes of failure after exclusive radiotherapy in 131 cases treated at in locoregional stage between 1972 and 1981].

A retrospective study was carried out to evaluate results of exclusively physical treatment by external radiotherapy of 131 cases of cancer of prostate treated between 1972 and 1981. Median follow up has been for 8 years in 19 cases (stage A), 61 cases (stage B) and 51 cases (stage C). Patients were treated exclusively by external irradiation after histopathologic diagnosis and assessment of possible extension of tumor. High energy photons were developed by a linear accelerator and irradiation carried out through four portals, two anteroposterior, two lateral, with precise guidance by rectal and bladder opacification. Irradiation delivered to a pelvic volume over 5 weeks was subsequently reduced to the prostate bed until a total dose of about 65 to 70 Gy has been given. Primary glandular chains received 60 to 65 Gy, and critical organs, bladder, rectum, small intestine a smaller dose of less than the tolerance levels for these organs. Clinical, biologic and scintiscan examinations were repeated every three months. Results are presented as actuarial survival, as survival without local recurrence and a detailed analysis of failure of treatment. The 8-year survival rate was 60% for stage A, 47% for stage B and 33% for stage C. Unsuccessful cases were evaluated in terms of isolated metastases, metastases associated with local recurrence and isolated local recurrence. The highest incidence of ineffectiveness of therapy was noted in patients with distant metastases (26%), the rate being higher (41%) in stage C cases than in stage B cases (19%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1986

[Vesico-sphincter dyssynergia in the central paraplegic patient. Physiopathological reflections].

The vesico-sphincter dyssynergia is generally observed in paraplegic patients with supra sacral lesions (40% of our cases). The neurophysiologic basis of the vesico-sphincter dyssynergia are the field of controversies. The animal experimentations have shown that a section below the ponts, induce a neural reorganization, enough to produce a normal micturation, rising sacral short loop reflexes. The reality of such mechanism is discussed by different authors who consider a normal micturation as a brain stem reflex rather than a simple sacral reflex. These factors allow the authors to undergo a neurophysiologic, neuropharmacologic and urodynamic investigation, with the intention of shedding light on the pathophysiology of the vesico-sphincter dyssynergia in 20 cases of paraplegic patients. On the basis of our data the following conclusions were made: the importance of the polysynaptic reflexes evoked by cutaneous or vesical stimulation (below the neurologic lesions) on the different degrees of vesico-sphincter dyssynergia; the quality of voiding depends on the equilibrium between extension and flexor reflexes in paraplegic patients; the presence of a neural reorganization using short loop reflexes who are the expression of a complex system rather than a simple sacral reflex; the effect of chronic intrathecal morphinic drugs on the reflex equilibrium and the quality of voiding and the eventual relation between opiate receptors and vesical sphincter dyssynergia.

Electrophysiology↗
PubMed1986

[Nuclear magnetic resonance imaging in the urologic study of the male pelvis. Apropos of 60 examinations].

Theoretical concepts underlying the principle of nuclear magnetic resonance imaging are defined and the technical basis for its use in medical imaging described (sequences, accumulations, contrast media). Results are presented of a spectrometric study of 23 operative specimens from the bladder, prostate and seminal vesicles with analysis in vitro of relaxation time of the various tissues. Findings confirmed the value of NMR imaging for evaluation of macroscopic extension of tumors within the affected organs, as well as the interrelations of the organs, but the impossibility of identifying histologic structure of tumors and organs explored by this technique. Two groups of subjects were studied: a first group of 20 healthy volunteers to define NMR semeiology of male pelvis and a second group of 40 patients with mainly tumoral lesions of vesicles or prostate. Details are provided of the diagnostic value of NMR imaging with respect to the tumor, local and regional invasion and bone metastases. Excellent images of the tumor were obtained, with the possibility of determining its macroscopic stage, but its histologic nature could not be ascertained. Multiplane examination allowed better assessment of local and regional spread than by a CT scan, particularly for prostatic tumors (bladder, prostate bed or seminal vesicle extension). A negative feature of major importance exists, however, in that early glandular involvement is not detected by NMR imaging, which also fails to identify one case in two with bone metastases. Current research should allow progressive correction of present NMR imaging insufficiencies, notably in the field of tissue characterization.

Humans↗
PubMed1985

[Adenocarcinoma of the kidney with invasion of the inferior vena cava. Apropos of 32 cases].

The authors present 32 cases of renal cell carcinoma with inferior vena cava involvement. Three sub-groups of patients can be distinguished on the basis of the level of this involvement: A (24 patients) with infra-hepatic involvement, B (6 patients) with retro-hepatic involvement and C (2 patients) with supra-hepatic involvement. The surgical tactics and results are analysed for each of these 3 sub-groups. The prognosis is relatively good in sub-group A, but is increasingly less favourable in groups B and C.

Aged↗
PubMed1982

[Course of primary nonoperated vesicorenal reflux in children. Apropos of 44 cases].

From a series of 600 cases of reflux seen over 12 years, the authors chose a group of 44 children aged between 3 and 11 who had not been operated for their reflux. The period of follow-up ranged from 1 to 10 years. Treatment consisted of massive antibiotic therapy for the severe episodes of infection and maintenance treatments for more than six months in a great many cases. For this group of 44 children with 60 refluxing ureters, the results were: --a disappearance of infection in 82% of cases, --a disappearance of the reflux in 70% of cases, even including type III reflux. 4 children were lost to follow-up, and 5 had to be operated secondarily. The authors reserve this trial of medical treatment to reflux in the small child, intermittent reflux, reflux with no or only minor involvement of the upper urinary tract on I.V.P. and finally, reflux which causes infections particularly sensitive to medical treatment in the presence of a cooperative family. With the aim of reducing the irradiation to a minimum, the authors performed follow-up urography with a single 15 min film every two years and annual isotope cystography. The authors discuss the possibilities of extending this medical approach for the future.

Anti-Infective Agents, Urinary↗