Search PubMed⌕ Search

Biomedical subjects

E Lechevallier

Publications and source records attributed to E Lechevallier.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Prostatic ultrasonography in routine radiological practice: a survey of 122 radiologists].

OBJECTIVE: To evaluate the indications and practical modalities of prostatic ultrasonography in routine radiological practice. METHODS: An anonymous questionnaire composed of 18 multiple choice questions was sent to 122 radiologists. RESULTS: Among the 76 responses, 90% were men, 90% were in private practice and 94% regularly performed prostatic ultrasonography without clinical information (81%). The prostatic examination was performed by transrectal ultrasonography (60%) combined with vesical and renal ultrasonography. The indications were: urinary functional disorders (56%) and abnormal PSA (40%). Prostatic ultrasonography was considered to be useful to calculate prostatic volumes by 59% of radiologists and in the staging of prostatic cancer (81%). 80% of radiologists did not start by performing digital rectal examination. 59% of patients were informed. CONCLUSION: The observed indications did not correspond to urological consensus recommendations, but ultrasonography was performed according to classical recommendations. This study could justify a more precise definition of the role of ultrasonography in prostatic disease.

Adult↗
PubMed1999

[Renal malakoplakia: prognostic aspects].

We report the changes in imaging findings over a 5 year period of a patient with unilateral malakoplakia involving renal parenchyma and pelvis. The imaging findings of malakoplakia will be reviewed.

Adult↗
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

[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↗
PubMed1997

[5 alpha-reductase and prostate].

The human prostate is a complex organ composed of four glandular zones that differ in their histology and biology. In addition to this anatomical organization, the prostate is mainly composed of epithelial and mesenchymal tissues. Two pathologies affect the growth of the prostate: cancer and benign prostatic hyperplasia. Anatomical and pathological studies have shown that stromal enlargement is the first step in the process of BPH and that both transition and periurethral regions are the exclusive sites of origin. Because the first step of androgen action is the reduction of testosterone into dihydrotestosterone by the 5 alpha-reductase, it have been postulated that modification of this enzymatic activity may play an important role in BPH development. However DHT production alone cannot explain the hyperplastic development of the gland. Thus it has also been postulated that androgen-growth factor interaction may be an important feature of this growth: these growth factors include the IGF axis. An interaction between androgen pathway and sympathethic system, via alpha-adrenoreceptor may also be suspected.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
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

Secretion of insulin-like growth factors and their binding proteins by human normal and hyperplastic prostatic cells in primary culture.

Benign prostatic hyperplasia (BPH) is the most common benign proliferative disorder of unknown etiology found in men. Because insulin-like growth factors (IGFs) with their binding proteins (IGFBPs) are involved in the control of cellular proliferation, differentiation, and metabolism, we compared their secretion by prostatic epithelial and stromal cells in primary culture from the four different zones of normal prostate and from hyperplastic tissue to assess their contributions to the hyperplastic development. IGF-I could not be detected in the conditioned medium from either epithelial or stromal cells from normal and BPH tissues. IGF-II concentrations were the same in the conditioned medium from the epithelial cells of the different zones of the normal prostate and that of BPH cells. IGF-II concentrations secreted in stromal cell culture medium, however, were higher in the periurethral zone than in the peripheral and central zones. Moreover, in the periurethral zone, stromal cells secreted higher concentrations of IGF-II than did epithelial cells. Also, BPH stromal cells secreted more IGF-II than did BPH epithelial cells. IGFBP-3, IGFBP-2, and IGFBP-4 were all secreted by both epithelial and stromal cells. In contrast, IGFBP-5 was only produced by stromal cells of the periurethral zone of the normal prostate and BPH tissue. IGFBP-3 was predominantly secreted by normal stromal cells of the transitional zone. We observed that BPH stromal cells presented the same pattern of IGF-II and IGFBP production as normal stromal cells of the periurethral zone. These data support the hypothesis that the periurethral zone is the main region of the prostate implicated in the development of BPH. They also suggest that the variability in both IGF-II secretion and the secreted forms of IGFBPs, depending on anatomical location within the organ, may be important for the autocrine regulation of normal and hyperplastic prostate growth.

Cells, Cultured↗