Biomedical subjects

E Lechevallier

Publications and source records attributed to E Lechevallier.

58 records · Page 4Linked to original sources

PubMed1993

[Transverse transcolonic cutaneous ureterostomy after pelvic irradiation].

The late urological sequelae of pelvic radiotherapy for cancer sometimes require cutaneous urinary diversion. The local conditions often exclude the use of direct or transileal ureterostomy. Three cases of cutaneous ureterostomy using the transverse colon are presented. There was no operative mortality. A single ureterocolonic stenosis was observed at 12 months and was treated endoscopically. The choice of the transverse colon was based on its position away from the field of irradiation and, consequently, teh absence of radiation lesions, its blood supply which can be used to form pedicles and the possibility of resecting irradiated ureteric segments allowing anastomoses with the proximal ureters. The results reported in the literature show an operative mortality of 0 to 4% and a low morbidity. This technique can be considered to be a technique of choice for cutaneous urinary diversions in urological complications of pelvic radiotherapy.

Adenocarcinoma↗

PubMed1992

[New uretero-cystoneostomy in cystocecoplasties. Technique and results].

Ureteric reimplantations into an intestinal segment are frequently followed by early, secondary or late stenoses. In UCN, it is essential to perform atraumatic ureteric dissection followed by reimplantation of a short ureter well vascularized by a single superior pedicle, i.e. the simplest UCN, putting the least strain on the ureter both during creation of the diversion and during subsequent healing. The ileal segment of an ileocaecocystoplasty must extend above the right iliac vessels. It is open on the antimesenteric border and its distal border is stripped of a 3 mm band of mucosa. To reach its homologue, the left ureter passes underneath the common root of the sigmoid mesocolon. Each optimally shortened ureter is placed in and fixed to the start and the end of a longitudinal mucosal tunnel, about 3 cm long. The ileum is sutured as a cuff around the orifice of each ureter. A ureteric stent is left in place for a fortnight. The ileum is sutured to the right laterocaval retroperitoneal tissue. This UCN is simple and rapid to perform.

Cecum↗

PubMedDate not supplied

[Treatment of stage Ta,T1 and Tis bladder tumors using Calmette-Guérin bacillus vaccine].

The authors report a series of 71 patients (sex ratio: 1F/4M, mean age: 68 years) with stage Ta (n = 20), T1a (n = 32), T1b (n = 14) and Tis (n = 5) bladder tumours treated by endoscopic resection followed by a course of intravesical BCG instillation (120 mg/week for 6 weeks). The mean follow-up was 15 months (3-36 months). The overall recurrence rate was 42%. A recurrence occurred in 50% of Ta (median time to recurrence: 10.1 months), 32% of T1a (median: 5.8 months), 65% of T1b (median: 7.3 months) and 20% of isolated Tis (median: 7 months). Disease progression was observed in 9% of stage T1 tumours. The following risk factors for recurrence were identified: stage T1b (p = 0.05), multifocal tumours (p = 0.05), resistance to previous chemotherapy (mitomycin C) (p = 0.001) and association with Tis for stages T1 (p < 0.02). The following risk factors for disease progression were identified: stage T1b (p < 0.001), grade III for stage T1 (p = 0.05) and association with Tis (p < 0.05). Ten patients (14%) developed transient BCGitis. BCG was found to be effective in the prophylaxis of recurrence of stage Ta, T1 and Tis bladder tumours. This treatment is proposed for recurrent stage Ta grade II and III tumours and stage T1 tumours in the presence of recognised risk factors. The high risk of progression for stage T1b grade III tumours associated with Tis demands rigorous surveillance.

Administration, Intravesical↗

PubMedDate not supplied

[Puncture biopsy of the prostate].

At the present time, the diagnosis of prostatic cancer is based on prostatic needle biopsy in 90% of cases. Prostatic needle biopsy is classically indicated in the presence of a clinical suspicion of prostatic cancer (digital rectal examination, PSA, ultrasonography, but it can also be indicated for re-evaluation of a first negative biopsy or for stages T1a-b, in the case of prostatic intra-epithelial neoplasia, or in the case of detectable PSA after radical prostatectomy. It must be ultrasound-guided with a sextant, biopsying the suspicious zone. It is associated with a low incidence of minor morbidity. Analysis of the biopsy cores should provide information allowing estimation of the tumour volume and stage. However, despite all of these advantages, the detection rate of prostatic needle biopsy does not ensure detection of all prostatic cancers and cannot distinguish non-significant carcinomas.

Biopsy, Needle↗