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Biomedical subjects

F Guille

Publications and source records attributed to F Guille.

At least 37 records · Page 2Linked to original sources
PubMed1993

Accuracy of ultrasound diagnosis after blunt testicular trauma.

The aim of this study is to determine the value of ultrasound evaluation for the diagnosis of testis rupture due to blunt scrotal trauma. We reviewed 16 operated cases of blunt scrotal trauma with hematocele, which were evaluated by ultrasound preoperatively. In 2 cases a tunica albuginea rupture was correctly diagnosed by ultrasonography but there were 2 false-positive and 5 false-negative diagnoses of rupture. Systematic exploration of the 16 cases revealed testicular rupture in 7, simple hematocele in 7 and hematocele associated with spermatic cord injury in 2. In 2 cases orchiectomy was necessary. From our experience the accuracy rate of ultrasound evaluation of blunt scrotal trauma was 56%, with a 58% negative predictive value. Considering these results, ultrasound examination of blunt scrotal trauma with hematocele is not sufficiently accurate to eliminate surgical exploration and, therefore, we recommended early surgical exploration as primary therapy in these cases.

Adult↗
PubMed1993

[Can we do better than surgery in the treatment of benign prostatic hypertrophy? Results after 10 years in endoscopic resection and adenomectomy in urination and sexual disorders].

Surgery is considered to be the reference treatment for obstructive benign prostatic hypertrophy (NPH). Transurethral resection of the prostate (TURP) and suprapubic prostatectomy are the operations most frequently performed by urologists. However, little information is available concerning the long-term results of this surgery. In order to assess the long-term efficacy, we recalled 618 consecutive patients operated for benign prostatic hypertrophy between 1979 and 1982 (390 by TURP and 228 by suprapubic prostatectomy (SP). 167 patients were reviewed and investigated, 150 had died and 301 were lost to follow-up. Ten years after the operation, 85% of the patients reviewed had good or satisfactory micturition and 72% of them were satisfied, regardless of the technique used. In 80% of patients, no complementary procedure was required to ensure urinary comfort. However, the effects of this surgery on sexual function were considerable, as one half of patients reporting sexual intercourse before the operation reported a deterioration of sexual function after the operation. Lastly, long-term morbidity affected 10 to 41% of patients and 9 to 12% of them were reoperated. Although, overall, surgery gave excellent results at 10 years, 15% of patients did not derive any benefit from the procedure. It is therefore important, in the future, to more clearly define the indications for surgery and the place of noninvasive treatments. At the present time, young subjects wishing to preserve their sex life may benefit from noninvasive first-line treatments, provided their quality of life is sufficiently altered by the severity of the urinary symptoms.

Aged↗
PubMed1993

Variations of intestinal motor activity in bladder replacements and in the intestine.

Urinary reservoirs are made from intestinal segments. The motor activity of the intestinal tract is regulated by hormonal and neurological controls. This study compares the motor activity of intestine in situ with those of a neobladder, following oral intake. The changes in motor activity before and after ingestion of standardized 570 Kcal meal were measured simultaneously in the duodenum and in the neobladder of 4 patients who underwent a Camey tubularized ileocystoplasty. Similar motor movements were produced in the graft and in the duodenum. Modifications due to oral intake were then measured in 14 patients with various types of urinary reservoirs (ilea, ileo-colic or colic; and tubularized or detubularized) by measuring the pressure inside the graft. After oral intake the compliance of the detubularized colic and ileocolic reservoirs was greater than that of ileal reservoirs, even after detubularization, since the motor activity and the basal pressure increased greatly in the tubularized or detubularized ileal bladders and much less in the detubularized colic and ileocolic bladders. It is well known that digestion is maximal in the second half of the night, therefore this link between intestinal and neobladder motor activity might explain one of several mechanisms involved in nocturnal increase in reservoir pressure and urine incontinence.

Eating↗
PubMed1993

Does detubularization improve continence in bladder replacement?

Camey in the seventies promoted bladder replacement. In 1987, the French Association of Urology gave us the opportunity to review 729 Tubularized Ileocystoplasty (Camey operation) [1]. The day time continence was excellent or acceptable (mild stress incontinence) on 91% of the patients, the night time continence was excellent (no pads, no leakage) or acceptable (one pad or less than 3 wakes at night) for 44% of the patients (56% had to use a device). Since 1985, the detubularization attempted to improve the continence rate. Today, the review of the literature shows that day time continence has not changed and the night time continence improved less than 20% arising from 44% to 60%. Bladder replacement after prostatocystectomy has been proved to be superior to continent urinary diversion in patients whose urethral and external sphincter can be preserved. Day time continence is excellent in tubularized and detubularized bowel reservoirs. Night time continence, in 30 to 50% of patients, remains an unresolved problem also in detubularized low pressure reservoirs, even if they are of great capacity. The literature is therefore too optimistic when describing night time continence in 85% of the patients. These results are stated in spite of the absence of sensitivity in the neobladder, the loss of reflexic increase in sphincteric activity during bladder filling, and the low sphincteric tonus during sleeping. These optimistic results are due to lack of unanimous criteria for evaluating continence after bladder replacement and not taking into consideration as continence failure the abundant although not frequent nighttime incontinence. In order to improve continence, muscle reeducation and artificial sphincter implantation are the most adequate solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1992

[The diagnostic value of erythrocyte polyamines (EPA) in prostatic adenocarcinoma (PA): apropos of 100 patients].

Spermidine and spermine are ubiquitous polyamines which are intensely metabolised in the prostate. Polyamines are involved in the processes of proliferation and differentiation of normal and neoplastic cells. As the erythrocyte levels of these polyamines are correlated with the intratumoral levels, we assayed EPA in 45 controls, 66 patients with benign prostatic hypertrophy and 100 patients with prostatic cancer. Erythrocytic polyamines are markers of proliferation and prostatic metastases and can be used to distinguish between hormone-sensitive and hormone-resistant patients. Although non-specific, polyamines constitute circulating markers of the state of tumour proliferation of a given patient and definitely have a prognostic value which needs to be evaluated by further studies.

Adenocarcinoma↗
PubMed1991

Early endoscopic realignment of complete traumatic rupture of the posterior urethra.

Early primary endoscopic realignment of complete traumatic rupture of the posterior urethra is a simple, rapid and non-traumatic technique. We have recently treated 5 patients in this manner. All are continent and 4 are potent. Four patients were followed up for 1 year. One patient required no further management and had excellent urinary flow rates. The other 3 developed short secondary strictures which were managed successfully by 1 or 2 internal urethrotomies.

Adult↗
PubMed1991

[Radical prostatectomy and biologic glue].

Fibrin glue (reconstituted fibrin glue-Tissu-col-Immuno-France) was used in 24 patients following radical prostatectomy with ilio-obturator lymphadenectomy (Group II) to improve haemostasis of the operative field, to decrease or eliminate lymphatic oozing and to promote healing of the urethrovesical anastomosis. The results in terms of duration of drainage, quantity of fluid evacuated by these drains, operative complications and length of hospital stay were compared to those obtained in 24 clinically identical patients operated previously without the use of fibrin glue (Group I). Although fibrin glue is easy to use, ensures a particularly dry operative field at the end of the operation and does not induce any infectious complications (abscess, hepatitis), it increases the cost of the operation (5 ml vial = 2,500 FF) and the use of this product does not reduce the drainage time (Group I: 7 +/- 4.6 days; Group II: 8.5 +/- 5.4 days) the volume of blood or lymphatic discharge (Group I: 500 +/- 570 ml; Group II: 660 +/- 825 ml) or the length of hospital stay (Group I: 16.5 +/- 4.8 days; Group II: 17.4 +/- 5.5 days). These results argue against the routine use of fibrin glue in radical prostatectomy.

Aged↗
PubMed1991

[Bladder replacement and continent diversion: what about metabolic complications?].

During the past several years there has been increasing interest in refunctionalizing patients who have undergone radical extirpative surgery for pelvic malignancies and patients with dysfunctional bladders. To accomplish this, intestinal segments have been successfully employed in a variety of configurations. Independent of their optimal urosurgical implementation these procedures are not without potential complications, a significant portion of which involve metabolic derangements. Besides first follow-up results of patients with bladder substitution or continent urinary diversion, analysis of experimental investigations and functionally comparable clinical conditions enables an insight into potential following physiopathological interrelationships. These concern, besides the problem of chronic metabolic acidosis, disorders of bile acid and vitamin B12 metabolism as well as the potential induction of a secondary hyperoxaluria with subsequent oxalate concrement diathesis. Furthermore, there may be a malabsorption of calcium and vitamin D with development of intestinal osteopathy due to the reduction of absorptive surface. Apart from these problems of enteral loss and deficiency manifestations, several case reports and investigations suggest that bone demineralization can occur as a consequence of chronic metabolic acidosis and patients are at risk of skeletal demineralization. The pathogenesis of this association has yet to be clarified. These physiopathological interrelationships must be considered in medical attendance of patients with intestinal substitute bladders and continent supravesical pouch systems over many years. As these procedures become more popular, it becomes important to identify any metabolic changes that may occur as their consequence.

Animals↗
PubMed1991

[Intestinal motility and its variations in replacement bladder and intestine].

Urinary reservoirs replacing the bladder are made of intestine. The digestive tract motor activity is regulated by hormonal and neurologic mechanisms. The purpose of this work is the comparison of the motor activity in intact bowel with that of the new urinary reservoir during and after an oral intake. The modifications of pre- and post-prandial motor activities are recorded simultaneously in duodenum and neobladder by 4 patients with a tubular entero-cystoplasty (Camey I); standard meal (570 Kcal) triggers a similar activity in both segments. The modifications induced by an oral intake are then recorded by 14 patients with various reservoirs (ileum, ileum-cecum, cecum) and with different shapes (tubular or non-tubular). The compliance of non-tubular colic or ileocolic reservoirs appears greater than that of ileal reservoirs, even after detubularization. After oral intake, basal pressure and motor activity increase clearly in ileal bladders and much less in colic or ileocolic bladders. Nocturnal leak observed in many urinary reservoirs may be linked to the persistence of an intense motor activity in the neobladder with a marked increasing during the second part of the night.

Circadian Rhythm↗
PubMed1990

[Substitute bladders].

Following prostato-cystectomy in men or total cystectomy in women the bladder can be replaced by constructing an intestinal pouch to be connected to the urethra. This bladder replacement reservoir should possess the specific qualities of the natural bladder: it should collect and retain the urine at low pressure, protect the upper urinary tract against reflux and distension, control voluntary micturition at a socially acceptable rhythm and avoid the metabolic disorders due to the reabsorption of urine by the intestinal mucosa. Low pressure reservoirs are the ones most commonly used. They are obtained by opening the ileal or ileocaecal graft along its antimesenteric border and rearranging the intestinal tissue to form a pouch connected to the urethra. Detubulated reservoirs have a capacity and a compliance that are close to those of the urinary bladder. Daytime continence is acquired in the immediate postoperative period, and night-time continence is possible in 60 to 70 per cent of the patients. These are the main advantages of bladder replacement by tubular small intestine. The reservoirs thus constructed have few contractions, but they have not yet proved to be capable of full evacuation in the long term. Intermittent bladder catheterization might well be the price to be paid in the future for an immediate improvement in night-time continence.

Cystectomy↗
PubMed1990

Erythrocyte polyamine levels in human prostatic carcinoma.

Abnormally high red blood cell polyamine levels were found in benign prostatic hyperplasia and in prostatic adenocarcinoma patients. In prostatic adenocarcinoma patients a relationship was noted between the importance of red blood cell spermidine and spermine concentrations, and the clinical stage of the disease (Whitmore classification). Considering prostatic adenocarcinoma patient populations, patients with metastases (groups 3 and 4) statistically differed from those without metastases (group 2). Furthermore, red blood cell polyamine level determination discriminated patients in the hormonal escape group (group 4) from those usually considered as hormone responsive (groups 2 and 3). No statistically significant correlation was observed between red blood cell polyamine levels and usual tumor markers (prostatic acid phosphatase and prostate specific antigen). These results confirmed that red blood cell polyamine levels must be considered as a circulating index of cell proliferation that might be of clinical importance during the long-term followup and treatment of prostatic adenocarcinoma patients.

Adenocarcinoma↗
PubMed1990

[Urologic complications after 333 kidney transplantations].

26 urological complications were observed in 25 patients following 333 kidney transplantations. The low incidence of these complications (7.8%) is largely due to the systematic resort to the Leadbetter-Politano ureterovesical anastomosis, except in one case (uretero-ureterostomy due to the shortness of the graft). We recorded 9 urinary fistulae and 17 cases of ureteral obstruction. Urinary lithiasis was excluded from this work. Urinary fistulae occur almost only between the second week and the end of the first month. Ureteral obstructions occur relatively early (within 30 days in 14 cases and within the first 48 hours in 9 cases). Two grafts were lost (8% of complications, but 0.6% of the entire series), and one patient died following transplantectomy. In 10 of 26 cases (38.5%), the etiology of the urological complication was related to the harvesting technique (2 short ureters, 8 ischemic ureters).

Adolescent↗
PubMed1989

[Microscopic hematuria. Semiologic value in urology. Management of microscopic hematuria].

Microscopic hematuria, a frequent cause for consultation, poses a problem regarding its significance. It is essential that a curable pathology is not neglected. In the absence of associated clinical data, nephrological orientation of investigations depends on the study of urinary sediments and phase contrast microscopy. Where there is a urological orientation, half the lesions involve the lower urinary tract; the use of flexible urethrocystoscopy has been a true advance in terms of its simplicity and reliability. When a lesion is demonstrated the question still remains as to whether it is in fact responsible for the microscopic hematuria. It is best to remain prudent when a poorly significant lesion is discovered. Since 20% of microscopic hematurias remain unexplained, how far should one go in the paraclinical investigation and follow up of involved patients?

Adult↗
PubMed1989

Contraception in men: efficacy and immediate toxicity. A study of 18 cases.

Ten years ago research into a reversible method of male contraception proved unsuccessful, not for any objective reasons but because volunteers failed to comply with treatment. A change in social attitudes towards contraception, a constant demand for a reversible method of male contraception and the current interest in protecting germinal cell lines by blockage of spermatogenesis during chemotherapy led the authors to reactivate the study. Eighteen volunteers received a synthetic progestogen (Norluten) and a percutaneous testosterone gel. Clinical, biological, hormonal and seminal tests were performed each month. One patient, however, had to withdraw from the trial on medical grounds (hyperlipidaemia). Ten patients achieved azoospermia which is the only guarantee of efficacy. Immediate tolerance was good but protocol compliance was poor since 8 of the 17 volunteers abandoned the trial within a year. Treatment reversibility was evaluated in 15 patients whose F.S.H. level and spermatogenesis returned to normal when contraception was ended. This additional study demonstrates that hormone contraception in males is effective and well-tolerated, but the protocol placed too great a demand on the patients and 50% withdrew from the trial within a year.

Administration, Cutaneous↗
PubMed1989

Hypofertility in males due to a secretion anomaly of the seminal vesicles and its treatment.

Between 1981 and 1986, 5,000 males with infertility were treated. Eight (0.16%) of them had hypospermia, a decrease in seminal fructose, asthenospermia without oligospermia considered as a secretion anomaly of the seminal vesicles. Artificial Insemination with the Husband's sperm (AIH) combined with vesiculo-prostatic plasma from a vasectomized donor was performed successfully in 3 couples. In this series, failures were associated with an important fertility factor in the female. AIH combined with vesiculo-prostatic plasma from a vasectomized donor is considered as an effective treatment of male hypofertility caused by vesicular dysfunction.

Female↗
PubMed1988

[Renal hemangiopericytoma. Review of the literature apropos of a case].

Regard to a new case of renal hemangiopericytoma, the authors have reviewed the literature, in order to specify the main features of this uncommon entity. Because of the lack of correlation between the clinical behavior and the histologic pattern, hemangiopericytomas should be treated as potential low grade malignancies and followed carefully. Surgery seems to be actually the only form of treatment to propose.

Adult↗
PubMed1985

[Pregnancy and purulent retention of urine in the upper urinary tract. Apropos of 4 cases].

The authors report their diagnostic and therapeutic approach to four recent cases. While ultrasound is an excellent diagnostic aid, only simplified intravenous urography can establish the nature and localization of the obstacle. As regards management, surgery, when it is possible, allows removal of the obstacle and the repair of the excretory tract. In pregnant women, as in other cases when surgery is not feasable, the drainage of the infected and retained urine is achieved endoscopically. The J ureteral catheter offers a sure and comfortable method. When retrograde catheterization is unsuccessful, percutaneous nephrostomy can be used as a temporary measure to tide over the pregnancy.

Adult↗