Biomedical subjects
F Debruyne
Publications and source records attributed to F Debruyne.
Basic research.
Basic research is currently investigating the molecular cascade associated with bladder cancer development. Many new findings are potential leads towards the improvement of the diagnosis and prognosis of this disease. Special care, however, should be taken in the design of protocols for clinical evaluation of the value of these markers. Some initial guidelines have been put forward in this report.
A randomised comparison of monotherapy with Casodex 50 mg daily and castration in the treatment of metastatic prostate carcinoma. Casodex Study Group.
Casodex (Bicalutamide, ICI 176,334) is a potent, non-steroidal, selective anti-androgen with a long half-life allowing once-daily oral administration. In this randomised, open, multicentre study, Casodex 50 mg monotherapy was compared with castration (medical, using goserelin acetate, [Zoladex], or surgical) in 245 patients with advanced prostate cancer. Primary end-points were time to treatment failure, time to objective progression and survival. Subjective responses, quality of life and tolerability were also evaluated. There was no significant difference between the groups in terms of objective progression or subjective responses. Treatment failed in 59 of 119 patients (50%) randomised to Casodex and in 61 of 126 patients (48%) randomised to castration (no statistically significant difference). An updated analysis showed that survival was similar in the two groups. Casodex was well tolerated with a low incidence of diarrhoea and sexual dysfunction. On the basis of this study, Casodex monotherapy is an effective alternative to castration in the treatment of metastatic prostate cancer.
The prediction of clinical outcome from transurethral microwave thermotherapy by pressure-flow analysis: a European multicenter study.
A total of 100 patients treated with a single session of microwave thermotherapy at 4 European centers was stratified according to 2 different types of obstruction (constrictive and compressive) and compared to clinical outcome at 6 months. Patients had a Madsen-Iversen score of 8 or more, maximum flow rate of 15 ml. per second or less and residual urine volume of 300 ml. or less at entry. The change in Madsen-Iversen score was the same in the 2 groups. Maximum flow rate increased from 8.71 +/- 2.62 to 14.73 +/- 4.04 ml. per second in the constrictive group, and from 8.54 +/- 2.26 to 10.41 +/- 4.52 in the compressive group (p < or = 0.0001). Residual urine decreased from 96.00 +/- 72.85 to 40.34 +/- 56.33 ml. in the constrictive group and from 109.86 +/- 67.09 to 84.65 +/- 81.45 ml. in the compressive group (p < or = 0.0001). Success, as defined by an increase of 50% or more in maximum flow rate and Madsen-Iversen score, was noted in 68% of the constrictive but only 15% of the compressive groups (p < or = 0.0001 chi-square test for trend). Selection by pressure-flow criteria for patients being considered for thermotherapy should improve the overall clinical results.
Bracken fern-induced bladder tumors in guinea pigs. A model for human neoplasia.
We have induced tumors by feeding guinea pigs with a diet containing 25 or 30% dried bracken fern for 100 or 150 days. A high incidence of bladder tumors was obtained. All but one animal had preneoplastic or neoplastic lesions after 4 months; after one year, 24 or 25 exposed animals had carcinoma. Bladder tumors obtained were essentially pure transitional cell carcinomas, although 4 cases (7% of the exposed animals and 10% of the 39 transitional cell carcinoma observed) showed areas of focal squamous metaplasia. Immunohistological detection of cytokeratins 10, 13, and 18 confirmed the transitional nature of these tumors. Tumor development can be followed by ultrasonography and cytology. Bladder tumors arose through several steps. Dysplasia and preneoplastic hyperplasia were seen after 4 months and papillary carcinomas appeared after 6 months, whereas muscle-invasive carcinomas required 1 year. Thus this model reproduces the full spectrum of preneoplastic and neoplastic bladder lesions observed in humans. Interestingly, when tumors were induced in older guinea pigs, none of them progressed to a muscle-invasive stage. This phenomenon should provide the opportunity to study the molecular mechanisms associated with these two different growth patterns, a major issue in understanding human bladder tumor progression.
[The contribution of proton spin resonance tomography in the diagnosis of petrous bone anomalies].
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Acoustic analysis of tracheo-oesophageal versus oesophageal speech.
In order to evaluate the vocal quality of tracheo-oesophageal and oesophageal speech, several objective acoustic parameters were measured in the acoustic waveform (fundamental frequency, waveform perturbation) and in the frequency spectrum (harmonic prominence, spectral slope). Twelve patients using tracheo-oesophageal speech (with the Provox valve) and 12 patients using oesophageal speech for at least two months, participated. The main results were that tracheo-oesophageal voices more often showed a detectable fundamental frequency, and that this fundamental frequency was fairly stable; there was also a tendency to more clearly defined harmonics in tracheo-oesophageal speech. This suggests a more regular vibratory pattern in the pharyngo-oesophageal segment, due to the more efficient respiratory drive in tracheo-oesophageal speech. So, a better quality of the voice can be expected, in addition to the longer phonation time and higher maximal intensity.
Computed tomographic imaging of repaired fistulas of the lateral semicircular canal.
Computed tomographic images, made about 6 months after the repair of fistulas of the lateral semicircular canal with a mixture of bone dust and physiologic adhesive, show the bony density of the reconstructed part of the canal.
The effect of sustained phonation at high and low pitch on vocal jitter and shimmer.
Looking for possible signs of vocal fatigue, acoustic waveform perturbation was measured in normal female subjects during sustained phonation at various fundamental frequencies (Fo). At none of the pitch levels a rise of the jitter or the shimmer was found after 25 min of vocalization. On the other hand, an effect of Fo was seen from the start: above the habitual speaking Fo of our subjects' voices there was a tendency for the jitter to be higher and for the shimmer to be lower.
[High-frequency hearing thresholds prior to and following middle ear surgery].
Middle ear surgery may affect the cochlea. On 80 patients, the mean HF thresholds before and after middle ear surgery including stapediotomy, combined approach tympanoplasty and myringoplasty are compared. A small deterioration of the mean HF thresholds up to 10 dB is observed.
Locoregional disease.
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Clinical observations on the on-off effect of the acoustic stapedius reflex.
The on-off effect of the acoustic stapedius reflex was found in association with several kinds of ear disease: otosclerotic stapes fixation, incudostapedial dislocation and sensorineural hearing loss. One fifth (8/40) of the patient group with an on-off effect and sensorineural hearing loss showed the typical symptoms of Ménière's syndrome.
Postoperative imaging of labyrinthine fistulae in cholesteatomas.
We evaluated the morphology of three operatively closed labyrinthine fistulae which were due to acquired middle ear cholesteatoma in three patients. In all three cases the fistula location was in the horizontal semicircular canal. The fistulae were closed by a mixture of bone powder and Tissucol. The layer closing the fistula was in all cases indistinguishable from the bony otic capsule on the postoperative CT.
Congenital arterial anomaly in the middle ear presenting as a glomus tumor.
A case of congenital agenesis of the cervical internal carotid artery with rerouting via the inferior tympanic artery and the embryonic hyoid artery to the horizontal internal carotid artery is presented. At otoscopy the anomaly simulated a glomus tumor. CT scan, by demonstration of the absence of the vertical portion of the carotid canal, the enlargement of the inferior tympanic canaliculus, and the soft tissue mass within the middle ear in continuity with the horizontal internal carotid artery, diagnosed the anomaly very accurately.
Cholesteatomas of the temporal bone: a comparison of CT and operative findings.
In a series of 45 consecutive cases with proven cholesteatoma, the correlation between the preoperative CT findings and observations made at surgery was evaluated. On the preoperative CT protocol 11 parameters of the anatomical and pathological features of the temporal bone were correlated with the operation report. Except for the ossicles, a high degree of correlation was noted between CT findings and those at the operation.
[Microperturbation of vocal cord vibrations, jitter and shimmer].
The cycle-to-cycle variability of the period duration (jitter) and the period amplitude (shimmer) are measures for the micro-instability of vocal fold vibrations. A short survey is presented of the definition of jitter and shimmer, a number of calculation methods, the normal values, and the effects of age and voice pathology.
Some limitations of the radioisotope bone scan in patients with metastatic prostatic cancer. A subanalysis of EORTC trial 30853. The EORTC Urological Group.
This article reviews the serial bone scans of 149 of 327 patients entered into a randomized prospective trial comparing orchidectomy versus zoladex and flutamide in patients with metastatic prostatic cancer. Attention is drawn to the difficulty of evaluating the response rate and of the importance of tumor load in determining survival. The use of sequential bone scans once the diagnosis of metastatic disease has been confirmed is of questionable value as the scans are expensive and contribute little to the further management of the patient in the absence of symptoms requiring relief.
[The ototoxicity of cisplatin: a clinical study].
The ototoxic side effects of cisplatin are evaluated in 23 patients by a conventional and high-frequency audiogram. The ototoxicity of cisplatin consists of a high frequency loss which was found to be dose and frequency related. The hearing loss started predominantly in the higher frequencies (12-16 kHz) and the ototoxicity increased with increasing dose of cisplatin. The ototoxicity of cisplatin appears to be inversely related with the patient's age, although it is difficult to draw definite conclusions because age and dose are closely related to each other in our study.