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F Guille

Publications and source records attributed to F Guille.

At least 19 recordsLinked to original sources
PubMed2003

[Carcinomatous degeneration on augmentation ileocystoplasty for tuberculous bladder].

The development of cancer on the ileal graft after augmentation ileocystoplasty for benign bladder disease is a little known complication. The authors report a case of squamous cell carcinoma in the ileal bladder occurring 37 years after augmentation ileocystoplasty for tuberculous bladder, in a 68-year old patient. Carcinomatous degeneration is usually occurs more than ten years after cystoplasty. Patients treated by this operation must be submitted to annual cystoscopy combined with guided biopsies at the slightest doubt. This surveillance should be started between the 5th and the 10th postoperative year.

Aged↗
PubMed2003

[Nosocomial infections in urology].

Hospital acquired infections represent a medical priority for surgeons as well as anesthetists and nursing staff. ANAES charged with national hospital accreditation program establishes protocols and objectives to be attained in terms of quality of care and patient satisfaction. According to available pilot studies, prevention of hospital acquired infections relies on surgical environment, preoperative patient preparation, sterilisation techniques, antibiotic prophylaxis and catheter care. Great improvements are under way in this domain and in management of multiresistant bacterial infections with a decrease in multiresistant kelbsiella infections. Our optimism is however tempered by the increase in methicillino-resistant Staphylococcus aureus (MRSA) infections. Many questions on nosocomial infections are still unanswered due to insufficient scientific evidence and difficulty in organising rigorous studies. Further progress will require a full involvement of hospital administrations and funding health organisations to provide the financial support required to implement preventive procedures and related architectural modifications.

Cross Infection↗
PubMed2002

[Spontaneous subcapsular renal hematoma: diagnosis and treatment. Two case reports].

Spontaneous perirenal haematomas essentially raise the problem of the aetiological diagnosis, but can sometimes be inadequate. Arteriography is useful when CT scan is negative or in the case of vascular disease. The therapeutic attitude, nephrectomy or conservative treatment remains controversial, but in view of the frequency of renal neoplastic lesions, the authors recommend nephrectomy at the slightest doubt concerning renal integrity. When no case be found, the assessment must be completed postoperatively with long-term, close surveillance, due to the risk of an undiagnosed neoplastic lesion. The authors report two recent cases and try to propose a diagnostic and therapeutic strategy based on the aetiology.

Female↗
PubMed2002

Solitary contralateral adrenal metastasis after nephrectomy for renal cell carcinoma.

Malignant involvement of the contralateral adrenal gland in cases of renal cell carcinoma is extremely rare. Solitary metachronous metastatic involvement of the contralateral adrenal gland from renal cell carcinoma is rarely diagnosed during life. In fact, clinical signs and symptoms of adrenal insufficiency are rare in these patients. We report a case of renal cell carcinoma with solitary metachronous contralateral adrenal metastasis occurring 9 years after radical nephrectomy.

Adrenal Gland Neoplasms↗
PubMed2001

A conservative approach to major blunt renal lacerations with urinary extravasation and devitalized renal segments.

OBJECTIVES: To determine the feasibility of a conservative (expectant) approach to major blunt renal laceration with urinary extravasation and devitalized renal segments. PATIENTS AND METHODS: All patients treated conservatively who presented between 1990 and 1999 with major renal laceration (grade 4 and 5) were retrospectively reviewed to determine whether urinary extravasation and devitalized segments adversely affected the outcome. For each patient the data collected included the initial emergency department evaluation, findings on computed tomography, associated injuries, duration of hospital stay, transfusion requirements, complications and follow-up imaging. RESULTS: Of 20 patients who sustained blunt trauma resulting in a major renal laceration (five grade 5 and 15 grade 4) with urinary extravasation, 11 had coexisting devitalized segments. There was a statistically significant difference in the length of hospital stay (16.3 vs 7.3 days), blood transfusions (six vs two patients, P < 0.08) and the need for delayed surgical intervention (nine vs two, P < 0.01) between patients with and with no devitalized segments, respectively. Urinary extravasation spontaneously resolved in two of 11 patients with and in seven of nine with no devitalized segment, respectively (P < 0.05) CONCLUSIONS: Urinary extravasation will resolve spontaneously in most patients with blunt renal trauma, and expectant treatment does not adversely affect the outcome or prolong hospitalization. In patients who present with a major renal laceration associated with devascularized segments, conservative management is feasible in those who are clinically stable with blunt trauma. However, the physician must be especially aware of the probable complications within this subset of patients.

Adolescent↗
PubMed2001

Leiomyosarcoma of the renal pelvis.

We report a case of renal leiomyosarcoma arising from the renal pelvis with immunohistochemical confirmation of the diagnosis. In this instance clinical presentation and imaging finding are not helpful in accurately establishing the diagnosis preoperatively. Wide surgical excision would appear to be the treatment of choice.

Adult↗
PubMed2001

Management of major blunt renal lacerations: is a nonoperative approach indicated?

OBJECTIVES: The aim of the study was to determine whether a nonoperative approach is able to reduce renal parenchymal loss after renal trauma. METHODS: Sixty-four consecutive patients with major blunt renal lacerations were treated from 1988 to 1999. Initial management was conservative. In group 1 (35 patients) delayed hemorrhage, persistent urinoma or hemodynamic instability were dealt with by open surgery. In group 2 (29 patients), most complications were dealt with using endoscopic procedures; open surgery was reserved exclusively for major complications. RESULTS: In group 1, 7 patients were not operated and 28 patients were managed surgically. Twenty (57%) patients underwent total (8) or partial (12) nephrectomy. In 8 patients the surgical intervention was open drainage of perinephric collection (6) and/or renorrhaphies (2). Four patients in this group developed urinary fistulae treated successfully with ureteral stents. Length of hospital stay was 9.6 days (3-25 days). In group 2, persistent hemodynamic instability led to nephrectomy in 1 case. The remaining 28 patients were managed conservatively, with endoscopic ureteric stenting in 5 cases. A persistent urinary extravasation with hyperthermia led to open drainage of perinephric urinoma (5) and renorrhaphy (2). No delayed nephrectomy was necessary. Average hospital stay was 12 days (5-21 days). Only 1 patient in this group developed hypertension. CONCLUSION: For most patients and with close follow-up available, conservative treatment represents a real alternative to open surgery in major blunt renal lacerations. In our experience, open surgery usually results in loss of renal parenchyma.

Adolescent↗
PubMed2000

[Intraluminal renal metastasis from a rectal adenocarcinoma: an unusual site].

Primary adenocarcinoma of the urinary tract are uncommon. But secondary involvement of pyelocalyceal system by metastasis of colorectal origin is rare. We report a case of late rectal metastasis with renal pelvis growth presenting as a pyonephrosis. This study emphasizes the relevance of cytokeratin 7 and 20 immunostaining in such differential diagnosis.

Adenocarcinoma↗
PubMed1999

Prostate specific antigen levels in the follow up of localised prostate cancer: how does radiotherapy compare to radical prostatectomy?

This study aimed to evaluate tumor progression as assessed by PSA level of curative treatment for localised prostate cancer by either radiotherapy or prostatectomy. From 1987 to 1993, 180 patients were treated for clinically localised prostate cancer either by radiotherapy or prostatectomy. One hundred and five patients with clinical T1T2N0M0 were eligible for this study. Forty five underwent external beam radiotherapy and 60 had a radical prostatectomy. After radiotherapy PSA slowly decreased to reach a nadir 18 months after treatment. Any subsequent increase from this lowest post treatment level is associated with tumor progression. After radical prostatectomy PSA becomes undetectable and any increase will be regarded as evidence of tumor progression. The median PSA level before treatment and the median length of follow-up were comparable for the two groups. There was no statistically significant difference in overall survival and biological evidence of disease progression at 5 y. Analysis of the evolution of median PSA level shows a progressive decline during the 4 y after radiotherapy. After radical prostatectomy PSA become undetectable, 4 y after treatment PSA levels become comparable in the two groups. The biochemical free survival was 60% for the prostatectomy group and 62% for the radiotherapy group. PSA is an effective marker of tumour progression after surgery or radiotherapy for localised prostate cancer. In our retrospective study recurrence rates at 5 y were not significant but direct comparisons are limited due to the Gleason score of the two groups. PSA levels can take up to 4 y to reach a nadir after radiotherapy.

Journal Article↗
PubMed1998

[Ureteral reimplantation on psoas bladder: long-term results].

OBJECTIVE: To evaluate indications and long-term results of ureteral reimplantation with psoas hitch bladder. MATERIALS AND METHODS: Between January 1985 and December 1997, we performed psoas-hitch ureteral reimplantation in 18 patients (13 females and 5 males). Mean age was 48 years old. All ureteral injuries involved a pelvic portion of the ureter. The indication was: ureteral injury during gynecological procedures in 5 cases, stricture following open uretero-lithotomy in 3 cases, avulsion of the ureter during ureteroscopy in 1 case, stricture following prior ureteral reimplantation in 3 cases, prostate cancer involving the distal ureter in 1 case, megaureter in 1 case, radiation therapy in 1 case, pelvic and ureteral endometriosis in 3 cases. Treatment consisted to adequate mobilization of the bladder, fixation of the posterolateral corner of the bladder to psoas and ureteral reimplantation with anti-reflux system. In all cases, psoas-hitch ureteral reimplantation has been performed because of an inability to perform end-to-end uretero-ureterostomy or direct uretero-neocystostomy. RESULTS: No complications were observed. At follow-up of 7 months to 12 years (mean 5.7 years) we noticed 13 success (72.4%), 4 improvements (22.2%) and one patient (5.4%) was lost at follow-up. No nephrectomy was done. CONCLUSION: Psoas-hitch bladder ureteral reimplantation is simple, effective and a first-line procedure for the replacement of the long defects of the lower ureter.

Adult↗
PubMed1998

[Conservative treatment of stage III kidney injuries].

OBJECTIVE: The aim of this study is to evaluate the safety and effectiveness of conservative management in stage III renal trauma. MATERIAL AND METHODS: We reviewed the records of 150 patients who presented in our institution with renal trauma between 1986 and 1995. RESULTS: Minor injuries (stage I and II: 100 cases) were treated with expectant management. Only 3 patients required nephrectomy in this group. Stage III injuries were seen in 40 patients. The great majority (85%) were treated conservatively with renal sparing procedures such as endourologic techniques (14 cases), nephrorraphy or partial nephrectomy (20 cases). Total nephrectomy was performed in 15% of the cases and only for severely injured kidney or major associated intraabdominal injuries. In this group, none of the patients suffered from hypertension at follow-up. All patients (10 cases) with pedicle injury (stage IV) required total nephrectomy. CONCLUSION: Stage III renal trauma with urinary extravasation can safely be treated conservatively.

Adolescent↗
PubMed1997

Autogenous skin graft in the treatment of large incisional lumbar hernias and bulges.

OBJECTIVE: Repair of large incisional lumbar hernias or muscular bulges is a challenge to the surgeon as reflected by the high recurrence rate. We evaluated a surgical procedure using a running strip of autogenous skin graft as a retention suture. METHODS: Eight patients with large incisional lumbar hernias (> or = 20 cm, n = 6) or muscular bulges (n = 2) underwent a parietal reconstruction with this procedure. Two patients had previously been treated with synthetic meshes without success, and one had a colocutaneous fistula. RESULTS: No recurrence was observed in 6 patients (75%) with a mean follow-up of 14 months. After significant weight gain, 2 repairs failed at 6 months and 1 year (partially in 1 case). No recurrence was noted for muscular bulges. CONCLUSION: The use of a running strip of autogenous skin graft is a simple and reliable procedure for the repair of large lumbar hernias or muscular bulges for patients with stable weight conditions.

Hernia↗
PubMed1995

Is ipsilateral adrenalectomy a necessary component of radical nephrectomy?

Due to the increased use of modern imaging systems during the last few years, kidney tumors are often diagnosed at an earlier and less advanced stage. This fact implies a reevaluation of the operative technique of radical nephrectomy that was recommended 30 years ago. The ipsilateral adrenal involvement during radical nephrectomy for renal cell carcinoma is assessed and the necessity of its extirpation is discussed. Between September 1987 and September 1993, we performed 299 radical nephrectomies for renal cell carcinoma and removed 285 ipsilateral adrenal glands. Eleven adrenal glands (3.8%) were involved with the kidney tumor and 274 (96.2%) were free of disease. In 7 of the adrenal gland involved cases (63.6%) the tumor invaded the gland by direct extension from the superior pole of the kidney. In the other 4 cases the ipsilateral adrenal gland was affected by a metastatic lesion. In all 11 adrenal gland involved cases the tumors were at an advanced stage (the lowest was stage pT3N1). Our results led us to recommend adrenalectomy during radical nephrectomy only when direct extension of the kidney tumor into the gland is suspected (upper pole or large tumors) or when the adrenal is the site of a single metastasis. Macroscopically normal adrenal glands at radical nephrectomy should not be routinely extirpated. Metastatic renal cell carcinoma (not by contiguity) in the ipsilateral adrenal gland should be regarded as a stage M+ (distant metastasis) tumor.

Adrenal Gland Neoplasms↗
PubMed1995

Treatment of the intraoperative penile erection with intracavernous phenylephrine.

A total of 23 patients who had an intraoperative penile erection during endoscopic or penile surgery underwent intracavernous injection of 200 micrograms phenylephrine. Detumescence occurred rapidly in all patients with a single injection. Hemodynamic changes consisted of a transient increase in systolic and diastolic blood pressures (+9%, p < 0.05) without significant change in pulse rate (-5%, p > 0.05). No marked side effect was reported even in elderly patients. Intraoperative penile erection, which seems to be more frequent in patients younger than 50 years, during general anesthesia with propofol or epidural anesthesia, can be treated safely with intracavernous injection of phenylephrine.

Adult↗
PubMed1994

Erythrocyte polyamines and prognosis in stage D2 prostatic carcinoma patients.

We studied 43 patients with newly diagnosed, untreated, stage D2 prostatic carcinoma, and correlated the initial performance status, hemoglobin, prostate specific antigen levels, tumor Gleason grade, extent of disease on the bone scan, and erythrocyte spermidine and spermine levels with progression. Three patients died of unrelated causes and were excluded from the study, 16 remained in remission with a mean 28 +/- 11 months of followup and 24 had progression (18, or 75%, of whom died of the cancer) with a mean 12 +/- 9 months of followup (p < 0.05 for followup) after initiation of hormonal therapy. Pretreatment performance status, hemoglobin, and erythrocyte spermidine and spermine levels were correlated with progression, hemoglobin and spermine being the most significant independent variables (p = 0.006 and p = 0.001, respectively). Concerning cause-specific survival, only hemoglobin and spermine erythrocyte levels were significant independent variables (p = 0.02 and p = 0.0025, respectively). If confirmed, polyamine erythrocyte levels obtained by a simple blood sample could discriminate at diagnosis patients with a high risk of rapid hormonal relapse who may benefit from a more aggressive primary management.

Aged↗
PubMed1994

[Acquired experience in anesthesia and perioperative intensive care in percutaneous nephrolithotomy. Current approach in the endoscopic treatment of lithiasis and pyelo-ureteral junction anomalies].

Percutaneous endoscopic treatment of the kidney retains a place in the treatment of renal stones (percutaneous nephrolithotomy--PCNL) and ureteropelvic junction abnormalities (endopyeloplasty). It requires anaesthesia ensuring surgical comfort and safety for the patients despite changes in position and the prolonged ventral supine position. The operation carries certain iatrogenic risks related to caliceal irrigation in patients with more or less documented episodes of infection and carries risks of haemorrhage and effraction of adjacent organs. 282 patients treated by PCNL between 1984 and 1991 were reviewed in order to define the respective indications for general anaesthesia and peridural anaesthesia and to determine the modalities, to evaluate the risk and severity of absorption of irrigation fluid and to assess the risk of infection by defining the indications for prophylactic antibiotics. General anaesthesia, using etomidate and propofol via an infusion pump, ensures surgical comfort, anaesthetic safety and better control of intraoperative complications. The renewed interest in this technique must be counterbalanced by the growing incidence of anaphylactic reactions related to anaesthetic drugs. Operations lasting more than 2 hours, raised intracaliceal pressure, the initially exclusive use of glycine for irrigation induce haemodilution complications, possibly aggravated by glycine intoxication. Repeated surgery is preferable with the use of an Amplatz tube as often as possible and physiological saline, except when required by the operation. Patients with a history of urinary tract infection or infected stones should receive prolonged and effective antibiotics before, during and after the operation. Prophylactic antibiotics are reserved for those patients with no history of infection. These principles equally apply to percutaneous nephrolithotomy and endopyeloplasty.

Adolescent↗