Biomedical subjects

Eric Lechevallier

Publications and source records attributed to Eric Lechevallier.

At least 19 recordsLinked to original sources

PubMed2006

Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma.

OBJECTIVES: To analyse the influence of age at diagnosis on tumour characteristics and cancer-specific survival in renal cell carcinoma (RCC). METHODS: Data on age, tumour characteristics, and survival for 4774 patients from 12 European RCC databases were recorded. Patients were divided into four groups according to age at diagnosis: < or =40, >40 and <60, > or =60 and <80, and > or =80 yr. The following variables were analysed: TNM stage, Fuhrman grade, tumour size, symptoms at diagnosis, ECOG performance status (PS), and cancer-specific survival. The groups were compared for usual clinical and pathologic variables, and cancer-specific survival. RESULTS: The four groups accounted for 288 (6%), 1839 (38.5%), 2499 (52.3%), and 148 cases (3.2%), respectively. Differences were found among groups for tumour stage, symptoms at diagnosis, ECOG PS, Fuhrman grade (p<0.001), tumour size, M stage, and histologic subtype (p: 0.02). Patients < or =40 yr were more likely to have papillary or chromophobe RCCs and less likely to have clear-cell RCCs. No significant difference was found among groups for N stage (p: 0.15). The 5-yr cancer-specific survival rates for the four age categories were 85%, 74%, 70%, and 69%, respectively. In multivariate analysis age category remained an independent prognostic parameter (p<0.001). CONCLUSIONS: Renal tumours diagnosed in younger age are characterized by lower tumour stages and grades as well as favourable histologic patterns compared with tumours in older patients. Basic research is required for explaining such a relationship between age, tumour aggressiveness, and therefore tumour biology.

Adult↗

PubMed2006

[Flexible ureteroscopy and holmium-Yag laser: material and technique].

Flexible ureteroscopy combined with Holmium-YAG laser is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique perfectly adapted to diseases of the upper urinary tract. This technology must be part of the therapeutic armamentarium of any centre involved in the management of urinary stones. The technical facilities must be complete and adapted. Flexible ureteroscopy is a technique with a rapid learning curve once the operator is familiar with all of the equipment. This article describes the material and technique of flexible ureteroscopy combined with Holmium-YAG laser.

Equipment Design↗

PubMed2006

[Intravesical BCG instillations for the treatment of superficial bladder tumours in renal transplant recipients].

Superficial urothelial tumours of the bladder are more frequent and more often at higher risk of progression and recurrence in renal transplant recipients. When conservative treatment of these tumours is indicated, BCG instillations are recommended. However, immunosuppression of renal transplant recipients constitutes a classical contraindication to BCG therapy. Some authors have nevertheless used BCG instillations in renal transplant recipients. The authors reviewed the use of BCG in renal transplant recipients by studying the effects of immunosuppression on the mechanisms of action of BCG and the various clinical experiences reported in the international literature.

Adjuvants, Immunologic↗

PubMed2006

[Renal oncocytoma].

Due to its nonspecific clinical and radiological features, renal oncocytoma is usually diagnosed on the operative specimen. Histological confirmation of the diagnosis is based on the distinction between oncocytoma and renal cell carcinoma (RCC), which can be difficult. Description of cases in which RCC and oncocytoma are present in the same tumour and the hypothesis of a link between oncocytoma and RCC further complicate the diagnosis of this tumour by the urologist. The authors reviewed the management of tumours suspected to be oncocytoma based on a review of the international literature concerning the diagnosis, natural history and treatment of renal oncocytoma.

Adenoma, Oxyphilic↗

PubMed2006

[ABO-incompatible renal transplantation].

The growth of living donor kidney transplantation, facilitated by revision of the French Bioethics Law of 6 August 2004, is sometimes fJced with the problem of ABO blood group incompatibility between the recipient and a potential donor. Are the risks of ABO-incompatible organ transplantation sufficiently mastered to allow satisfactory results? The authors conducted a review of ABO-incompatible transplantations in the light of the current state of knowledge on the immunological mechanisms involved and a systematic review of the international literature to define their level of proof.

ABO Blood-Group System↗

PubMed2006

[Endoscopic management of urothelial tumours of the upper urinary tract].

OBJECTIVE: The reference treatment for filling defects of the upper urinary tract is nephroureterectomy with excision of a perimeatal bladder segment. The authors evaluated the role of endoscopy and laser in the management of filling defects of the upper urinary tract. MATERIAL AND METHODS: Filling defects of the upper urinary tract were evaluated by biopsies performed during ureteroscopy followed by 10 Watt Holmium-YAG laser vaporisation. High-grade or incompletely vaporised tumours or multifocal tumours or tumours more than 2 cm in diameter received complementary treatment. Low-grade and completely vaporised tumours were followed by ureteroscopy at 3 months and then every 6 months. The authors conducted a prospective study from March 2002 to September 2004. Fifteen consecutive patients were managed according to this protocol. The mean age was 70 years (range: 53 to 85 years). Thirty nine tumours were treated. The mean tumour diameter was 1.05 cm (range: 0.3 to 2.5 cm). RESULTS: In this series of 15 patients treated according to this protocol, 39 tumours were diagnosed and treated. The grade was determined by biopsy in 66% of cases. Seven patients have a median recurrence-free survival of 18 months (range: 12 to 34 months). Overall, conservative management was able to be performed in twelve patients, corresponding to a 22-month kidney preservation rate of 80%. Two patients died during follow-up, one from prostatic cancer and the other from invasive urothelial bladder tumour. One patient who had had recurrence ans had been re-treated was lost for report. CONCLUSION: Filling defects of the upper urinary tract can be investigated by ureteroscopy to obtain a histological diagnosis and to perform treatment by laser vaporisation. Complementary treatment is then performed depending on the histological results, either by complementary vaporisation or by nephroureterectomy. Laser treatment ensures a high kidney preservation rate but with a recurrence risk. Conservative endoscopic treatment, which is considered to be acceptable in cases of necessity, may also be useful in the context of small, unifocal, minimally invasive tumours with a normal contralateral kidney.

Aged↗

PubMed2006

[Inferior calyx stone and flexible ureterorenoscopy to mobilize the stone before fragmentation].

Flexible ureterorenoscopy is recommended for the treatment of inferior calyx stones, 10 to 15 mm in diameter, particularly after failure of extracorporeal lithotripsy. It is recommended to mobilize an inferior calyx stone towards the renal pelvis or superior calyx before starting fragmentation. This manoeuvre is essential to preserve the ureterorenoscope. The objective of this technical note is to explain the stone "relocalization" manoeuvre and describe how in situ treatment of an inferior calyx stone can be dangerous for the flexible ureterorenoscope.

Humans↗

PubMed2006

[Study of urothelial bladder tumours in renal transplant recipients].

OBJECTIVE: To study the prevalence, treatment and outcome of urothelial bladder tumours (UBT) in renal transplant recipients. PATIENTS AND METHODS: Multicentre retrospective study performed in 2004 by questionnaire sent to members of the AFU Transplantation Committee. RESULT: Seven centres returned the questionnaire with a total of 32 UBTs in 21 males and 3 females with a mean age of 63.2 +/- 10.1 years, with no history of UBT. The incidence was 255 per 100,000. The median interval between transplantation and UBT was 60 months (range: 5 to 259 months). 72% of UBTs were stage pT > or = 1 and 63% were grade 3. CIS was present in 20% of cases. 25% of patients were N+. In addition to resection of the UBT, 3 patients were also treated with mitomycin C and 1 was treated with BCG. 7 patients underwent cystectomy, with a palliative objective in 42% of cases, associated with radiotherapy-chemotherapy (2/3) or chemotherapy alone (1/3). Immunosuppressive therapy was decreased in 50% of cases. Six patients (25%) died from bladder cancer, 25% relapsed with a tumour progression rate of 50%. 46% of patients were in remission of their UBT 4% died from an intercurrent cause. 76% of survivors have a Junctional graft with no alteration of serum creatinine. CONCLUSION: Renal transplant recipients have an increased incidence of UBT, which are more aggressive and associated with a higher mortality compared to the general population. Increased surveillance and aggressive treatment therefore appear to be justified.

Female↗

PubMed2006

[Outcome of oncocytomas diagnosed by percutaneous renal biopsy].

OBJECTIVE: Renal oncocytoma is a benign tumour that is usually diagnosed postoperatively. Its natural history is poorly defined. We studied the outcome of patients with renal oncocytoma diagnosed by percutaneous biopsy and not operated. MATERIAL: From January 1998 to April 2004, on a series of 148 renal tumour biopsies performed in our centre, 15 showed oncocytoma. The initial treatment was non-surgical. We report the follow-up of these patients and the course of these oncocytomas. The mean follow-up was 404 +/- 20.9 months. RESULTS: The mean age of these patients at diagnosis was 57.6 +/- 14.4 years and the mean tumour diameter was 3.49 +/- 2.43 cm with a mean volume of 62.3 +/- 135.4 cm3. Six of these 15 patients were operated: 4 total nephrectomies and 2 partial nephrectomies. The indications for surgery were the initial tumour volume (n = 1), tumour growth > 0.5 cm/year (n = 4) and the patient's preference (n = 1). Operated patients were younger (45.5 +/- 11.1 years vs 65.6 +/- 10.3 years) and had larger tumours at diagnosis (50 +/- 30.1 mm vs 27.3 +/- 10.5 mm). All 9 patients treated by watchful waiting were asymptomatic. CONCLUSION: The natural history of oncocytomas appears to be a more or less rapid increase in size. Treatment can be conservative. The initial tumour volume or rapid tumour growth are indications for resection. Partial nephrectomy, when allowed by the size and site of the tumour is currently the technique of choice.

Adenoma, Oxyphilic↗

PubMed2006

[Treatment of precalyceal stones of Cacchi-Ricci disease by flexible ureterorenoscopy and Holmium-YAG laser].

Flexible ureterorenoscopy combined with Holmium-YAG laser is an effective and reliable technique for the management of renal stones. Cacchi-Ricci disease is a frequent urological malformation characterized by precalyceal stone formation, for which no preventive treatment is available at the present time. Some complicated forms are difficult to manage because of the technical impossibility of treating these precalyceal stones. The objective of this article is to describe a technique allowing management of these precalyceal stones by flexible ureterorenoscopy combined with Holmium-YAG laser.

Combined Modality Therapy↗

PubMed2005

De novo renal cell carcinoma of native kidney in renal transplant recipients.

BACKGROUND: The 10-year risk of developing a solid malignancy is 20% for kidney transplant recipients. The goal of the current study was to investigate the epidemiology and the diagnostic and prognostic parameters associated with de novo malignancies of the native kidney among transplant recipients at the authors' institution (Department of Urology and Renal Transplantation, Hôpital Salvator, Marseille, France). METHODS: The authors reexamined the follow-up of 933 consecutive transplant recipients at their institution between 1987 and 2003. Immunossupressive therapy was not modified in the event of malignant disease, nor was systematic radiologic monitoring of native kidneys performed. All de novo malignancies of the native kidney were included in the current analysis. RESULTS: Among the 933 patients examined, a combined total of 12 malignancies of the native kidney were diagnosed in 11 individuals. For these 11 individuals, the average ages at transplantation and diagnosis were 42.5 and 49.1 years, respectively. Ten malignancies were discovered fortuitously, whereas two were symptomatic. Among the 10 renal echographies performed, there was 1 false-negative result. Tomodensitometry was performed in 11 cases and yielded no false-negative results. The average tumor size was 37 mm. Nephrectomy was performed in 10 cases, and biopsy was performed in 1. Among the 12 kidney malignancies encountered in the current study, there were 7 conventional cell carcinomas, 3 basophilic papillary carcinomas, and 2 chromophobic renal cell carcinomas. Half of all tumors were Furhman Grade 3 lesions, and pT1aN0M0 tumors (2003 TNM staging system) also accounted for half of all malignancies in the current cohort. Two affected transplant recipients died (one due to disease), and the remaining nine are alive without recurrence and with normal renal functioning (median follow-up, 39 months). CONCLUSIONS: There appears to be an increased risk of malignancy of the native kidney in renal transplant recipients, with high-grade and papillary tumors being particularly common. Consequently, systematic radiologic follow-up of native kidneys must be performed for individuals who undergo kidney transplantation.

Adenoma↗

PubMed2005

Follow-up of renal oncocytoma diagnosed by percutaneous tumor biopsy.

OBJECTIVES: To evaluate the outcome of patients with oncocytoma of the kidney diagnosed in our center by percutaneous biopsy and treated with watchful waiting. METHODS: From January 1998 to April 2004, of 148 solid renal tumors biopsied in our center, 15 were renal oncocytomas. The mean (+/- standard deviation) follow-up was 30 +/- 19.8 months. We report on the outcome of these patients. RESULTS: The mean age at diagnosis was 57.6 +/- 14.4 years, and mean tumor size was 3.49 +/- 2.43 cm, corresponding to a mean tumor volume of 62.3 +/- 135.4 cm3. During follow-up, 6 of 15 patients needed surgery: two partial and four total nephrectomies. Indications for surgery were initial tumor burden, greater than 0.5 cm/yr tumor growth, and patient's preference in 1 case, 4 cases, and 1 case, respectively. The patients who received surgical treatment were significantly younger (45.5 +/- 11.1 years versus 65.6 +/- 10.3 years) and had more bulky tumors at diagnosis (50 +/- 30.1 mm versus 27.3 +/- 10.5 mm). In 1 patient, a chromophobic renal cell carcinoma was associated with the oncocytoma. All 9 patients who did not receive surgical treatment remained asymptomatic. CONCLUSIONS: The evolution of renal oncocytoma seems to be increase of tumor size with variable velocity. Treatment must be conservative. Initial management might be nonsurgical with close follow-up. Monitoring should not miss the time of conservative surgery. Initial tumor volume or fast tumor growth are indications for surgery. Partial nephrectomy, if the tumor size and localization are reasonable, is currently the technique of choice.

Adenoma, Oxyphilic↗

PubMed2005

[Urological problems encountered during pregnancy].

The many anatomical and physiological changes occurring during pregnancy affect the entire urinary tract. These changes can induce various urological diseases, alter renalfunction and can be life-threatening to the foetus and the mother Some changes can persist post partum. Asymptomatic bacteriuria must be investigated and treated to prevent about 40% of pyelonephritis and a twofold higher premature delivery rate. Duplex ultrasound is the reference examination to diagnose renal colic due to stones and a low-dose IVU can be proposed whenever there is a doubt about the diagnosis. Treatment is conservative. Lower urinary tract symptoms are very frequent and some disorders, such as stress incontinence, can persist after delivery. This review article describes the anatomical and physiological changes observed during pregnancy and their pathological consequences on the urinary tract in order to detect, prevent and treat these disorders.

Female↗

PubMed2005

[Prostate cancer at high risk of recurrence: results of 12 months of radiotherapy-hormone therapy].

OBJECTIVE: To evaluate the risk of progression after conformal radiotherapy combined with 12 months of adjuvant hormone therapy in a series of patients with prostate cancer considered to be at high risk of progression. MATERIAL AND METHODS: Between January 1997 and December 2001, 63 consecutive patients classified at high-risk according to Amico's classification were treated by combined radiotherapy-hormone therapy. All patients presented at least one factor of the high-risk group of Amico's classification: TNM 92 stage T2c, T3 or T4, or Gleason score > or = 8 or baseline PSA > 20 ng/ml. All patients were treated by combined radiotherapy-hormone therapy with concomitant hormone therapy for 2 months and adjuvant hormone therapy for 10 months. Biochemical progression was defined according to the ASTRO criteria. The median follow-up was 36 months. RESULTS: The 3-year and 5-year biochemical recurrence-free survival was 78%. No local recurrence was observed in 94% of cases and no metastases were observed in 93% of patients. On univariate analysis, only a baseline PSA greater than 22 ng/ml was identified as a predictive factor of early biochemical recurrence. The 3-year biochemical recurrence-free survival was 96% for patients with baseline PSA < 22 ng/ml and 56% for patients with baseline PSA > or = 22 ng/ml (p=0.0017). CONCLUSION: The early results of 12 months of radiotherapy-hormone therapy in high-risk patients in our series were comparable to those reported in the literature. Only a high baseline PSA was predictive of early biochemical recurrence. Adjuvant hormone therapy (long-term, intermittent hormone therapy) could therefore be modulated as a function of the baseline PSA.

Adenocarcinoma↗

PubMed2005

[Renal oncocytoma associated with renal cell carcinoma].

Renal oncocytoma is a benign tumour that can be associated with renal cell carcinoma in rare genetic syndromes. The authors report the case of a 62-year-old patient with no medical history, in whom assessment of low back pain in 1999 demonstrated a 40 mm tumour of the lower pole of the left kidney. Percutaneous needle biopsy of the tumour demonstrated oncocytoma confirmed by Hale's stain. Follow-up ultrasound demonstrated an increase in size (88 mm) and a nine-fold increase in volume over four years (210 cm3 in April 2003). Surgery was indicated in view of the rapid increase of the tumour volume. Histological examination of the operative specimen demonstrated a combination of oncocytoma and Fuhrman grade III renal cell carcinoma.

Adenoma, Oxyphilic↗

PubMed2005

[Current place of chemotherapy in the treatment of hormone-refractory metastatic prostate cancer].

The current management of hormone-refractory metastatic prostate cancer is purely palliative. The use of chemotherapy in this indication was revised in 1996, based on the results of studies with a combination of mitoxantrone and prednisone. This combination demonstrated a significant improvement of quality of life (+48%) and pain (+30%), but without any overall survival benefit. Two studies using taxols, TAX_327 and SWOG_9916, were published in the New England Journal of Medicine on 7 October 2004, with, for the first time, a median overall survival benefit of 2 months. However, the encouraging results of these 2 studies, which will probably modify the management of hormone-refractory prostate cancer, need to be interpreted cautiously. First of all, they were conducted in selected study populations (mean age less than 70 years, Kamofsky index greater than 80% in more than 85% of cases, local disease control in more than 70% of cases). They also comprise many methodological imprecisions and biases with especially, in the TAX 327 study, a change of treatment arm in 1/3 of patients without exclusion of these patients from the final analysis. The results obtained are also at the limit of statistical significance. The target improvement of overall survival, +25% and +33%, respectively, was not achieved at the end of these studies. Finally, from a palliative point of view, only one of these 2 studies (TAX_327) demonstrated a palliative benefit compared to mitoxantrone: 9% for pain, for a sixfold higher cost. Adverse effects were significantly more frequent than with mitoxantrone. Patient selection and details about the indications are necessary. Taxols should not be used systematically in this indication. Furthermore, although several studies are underway, the benefit of taxols at earlier stages of the disease are unknown. Urologists must be aware of the place of chemotherapy in the treatment of prostate cancer in order to remain at the centre of the treatment decision.

Adrenal Cortex Hormones↗

PubMed2005

[Reduction of the renal transplantation cold ischaemia time by the use of a timesheet].

OBJECTIVE: Reduction of the cold ischaemia time is one of the major objectives designed to improve the quality and cost of renal transplantation. Based on the experience of other centres, we report the impact of using a renal transplantation timesheet on the cold ischaemia time in our centre. MATERIAL AND METHOD: Since March 2004, we have used a renal transplantation timesheet with the collaboration of all personnel involved in transplantation (coordination, nephrologists, clinical pathologists). For each kidney harvested, the name of the personnel and the start and end times of their interventions were recorded. The authors report the results for the first 7 months. Cold ischaemia times and the incidence of delayed graft function were studied. RESULTS: 47 kidneys were harvested between 01/03/2004 and 30/9/2004 in our centre and 46 transplantations were performed. The mean cold ischaemia time was 14 h 51 min, i.e. a reduction of 8 hours 58 minutes compared to that observed in 2003 (23 h 50 min) (p < 0.01). Delayed graft function (DGF) was observed in 10/46 (21.74%) recipients. This DGF rate was significantly lower than that observed in 2003 (DGF 2003 = 30%), while the mean donor serum creatinine was higher (155 +/- 177 micromol/l vs 98 +/- 71 micromol/l in 2003, p < 0.05). The longest delays were those related to availability of an operating room (n=2: 10 h and 14 h). CONCLUSION: The use of a renal transplantation timesheet allowed a significant reduction of the cold ischaemia time and DGF rate. It requires the collaboration of all renal transplantation personnel and is an indicator of motivation. This timesheet allowed the correction of certain habits that can still be improved. These results should lead to an improvement of the results and cost of renal transplantation.

Creatinine↗

PubMed2005

[Tubulopapillary tumours of the kidney: prognostic value and therapeutic implications of the distinction between type 1 and type 2 based on a series of 58 cases].

OBJECTIVE: The purpose of this study was to demonstrate the prognostic value of subdivision of tubulopapillary tumours into 2 histological subtypes and to discuss the therapeutic implications. MATERIALS AND METHODS: This was a single-centre retrospective study of 58 cases from a series of 414 patients operated for renal cancer between 1988 and 2001 based on review of histology slides (biopsies and operative specimens). The radiological assessment was based on ultrasound reports and review of CT scans. Karyotypes were described by cytogenetic analysis. RESULTS AND DISCUSSION: Tubulopapillary tumours represented 14% of all kidney tumours with a male prevalence of 77% and a mean age of 56.5 years. The overall mean follow-up was 62.6 months. Treatment consisted of 25 right radical nephrectomies, 29 left radical nephrectomies and 4 partial nephrectomies. 84% of tumours were low-grade and 80% were low stage T1 or T2. Multifocal lesions were observed in 31% of cases. Synchronous bilateral lesions were observed in 12% of cases. The 5-year survival was 95% and the 10-year survival was 87%, correlated with stage, grade, tumour diameter, presence of necrosis and low enhancement. According to the data reported by Delahunt, 2 subtypes can be distinguished: Type I tumours (75%) with low grade and low stage were correlated with a high rate of multifocal lesions (30%) with a genetic predisposition. Type 2 tumours (25%), usually unifocal, were correlated with a higher grade and stage, confirmed by their poorer prognosis. Biopsy allows a distinction of the type and grade of the tumour. CONCLUSIONS: In our series, for equivalent mean tumour diameters (55 mm), tubulopapillary tumours treated by radical nephrectomy had a good prognosis regardless of their subtype. Classification of the tumour by biopsy prior to surgery could have implications for therapeutic management. For type 1 tubulopapillary tumours identified on preoperative biopsy, we propose radical nephrectomy due to the high risk of multifocal lesions (30%). Although partial nephrectomy may be indicated for type 1 tubulopapillary tumours less than 4 cm, the patient must be informed about the risk of recurrence and the importance of long-term follow-up. Studies including a larger number of patients must be conducted to compare the survival associated with type 2 tumours compared to that of the classical histological subtype.

Carcinoma, Papillary↗