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Biomedical subjects

F Richard

Publications and source records attributed to F Richard.

At least 109 records · Page 6Linked to original sources
PubMed1998

[Renal tumor with thrombus involving all of the lumen of the inferior vena cava: surgical indication, technique and results].

OBJECTIVES: Almost 5% of renal tumours are associated with thrombus of the renal vein or inferior vena cava at the time of diagnosis. Radical nephrectomy with complete resection of the tumour nodule is the reference first-line treatment in this situation. This retrospective series was designed to analyse the surgical strategy according to the extent of the tumour nodule and the morbidity and mortality as a function of the prognostic factors of these renal tumours. MATERIALS AND METHODS: From 1982 to 1995, 51 patients (out of a series of 724 nephrectomies) presented with renal vein invasion involving all of the lumen of the inferior vena cava. The choice of medical imaging varied over time (cavography, Doppler ultrasound, CT, MRI and transoesophageal ultrasonography). Control of the inferior vena cava was always performed below the renal veins and above the thrombus. RESULTS: MRI and transoesophageal ultrasonography were found to be the most reliable diagnostic examinations. The incision and vessel control technique must be selected as a function of the type of thrombus and the emboligenic risk. With a follow-up of 4.3 years, the overall 2-year survival was 46% and the 5-year survival was 31%. All recurrences at 1 year occurred in N+ patients. CONCLUSION: Lymph node status and invasion of the perirenal fat are the most important prognostic factors, while the presence and length of the thrombus do not appear to influence survival. Radical nephrectomy of these tumours, invading all of the lumen of the inferior vena cava, requires complete resection of the thrombus. Adhesion of the thrombus constitutes a major technical problem that must be envisaged before the incision in order to correctly control the vessels.

Adenocarcinoma↗
PubMed1998

[Secondary prevention of coronary disease in France. Result of the EUROASPIRE study: the Lille register of ischemic cardiopathies].

The EUROASPIRE study was initiated to assess the impact of recommendations concerning secondary prevention of coronary artery disease in Europe published in 1994 by the European Societies of Cardiology, Hypertension and Atherosclerosis. France and eight other countries are involved in this project. The authors report the French data. A total of 546 men and women, aged less than 71, divided into 4 diagnostic groups (coronary bypass, angioplasty, myocardial infarction, acute ischaemia) were selected in different departments of cardiology. Data concerning their main risk factors and management were noted from the hospital files. At least 6 months after their hospital admission, 396 patients were systematically interrogated and examined. The availability of information on the risk factors in the hospital files varied according to the risk factor and diagnostic group from 61 to 97%. At the time of hospital admission, 42% of patients were considered to be smokers and 23% to be obese. Six months after hospital admission, 28% of patients were still smoking, 34% were obese, 49% had total cholesterol levels greater than 5.5 mmol/L (2.10 g/L) and 48% had blood pressure readings of over 140/90 mmHg. In France, as in other European countries, the prevalence of modulable risk factors of coronary artery disease is high at least 6 months after hospital admission. Systematic application of the recommendations of scientific societies should result in a significant decrease in recurrences and in mortality after an initial coronary event.

Coronary Disease↗
PubMed1998

[Review on the use of CO2 in laparoscopy surgery].

Laparoscopic surgery is one of the treatment modalities available to urologists, who must be familiar with the concepts of the physiology of CO2 and its clinical consequences. CO2 is absorbed during insufflation, leading to hypercapnia, reaching a steady-state from the 20th minute. The insufflation pressure must be between 10 and 14 mmHg. Intraoperative surveillance is based on oxygen saturation (pulse oximeter) and capnography, which measures the CO2 concentration of expired air. The causes of hypercapnia must be prevented: untimely recovery, retroperitoneal dissection, excessive intra-abdominal pressure. If hypercapnia occurs, the patient must be exsufflated and the operation should be resumed after a certain interval. The specific complications of laparoscopy (gas embolism, arrhythmias, pneumothorax) can be avoided by respecting the rules of security and by maintaining surveillance during recovery. The pain due to diaphragmatic peritoneal irritation can also be decreased by complete exsufflation.

Carbon Dioxide↗
PubMed1998

[Spontaneous intraperitoneal rupture of the ureter].

An unusual case of spontaneous intraperitoneal rupture of the ureter was observed in adult with acute renal pain. Diagnosis was best established with CT rather than intravenous urography. CT demonstrated ureteral leakage with the contrast medium extravasating into the peritoneal cavity. The patient was initially managed successfully by endourology. Secondary stenosis of the ureter required surgery for partial resection of the distal ureter.

Adult↗
PubMed1997

D allele of the angiotensin I-converting enzyme is a major risk factor for restenosis after coronary stenting.

BACKGROUND: Although intracoronary stent implantation significantly reduces restenosis compared with balloon angioplasty, a minority of patients still develop restenosis predominantly due to neointimal hyperplasia. Experimental studies suggest that the renin-angiotensin system is involved in neointimal hyperplasia after arterial injury. In humans, the plasma and cellular levels of ACE are associated with an I/D genetic polymorphism in the ACE gene, DD patients having higher levels. METHODS AND RESULTS: We investigated a possible relation between the ACE I/D polymorphism and restenosis in 146 patients who underwent successful implantation of a Palmaz-Schatz stent and had 6-month follow-up angiography. The minimal lumen diameter (MLD) before and after the procedure did not differ significantly among the three groups of genotypes (DD, ID, and II). At follow-up, MLD had a significant inverse relationship to the number of D alleles present (DD, 1.65 +/- 0.71 mm; ID, 1.84 +/- 0.60 mm; II, 2.05 +/- 0.61 mm; P < .007). Late luminal loss during the follow-up period was significantly related to the number of D alleles (DD, 0.89 +/- 0.61 mm; ID, 0.60 +/- 0.52 mm; II, 0.40 +/- 0.53 mm; P < .0001). The relative risk of restenosis (defined as a > 50% diameter stenosis at follow-up) approximated by the adjusted odds ratio was 2.00 per number of D alleles (95% confidence interval, 1.03 to 3.88, P < .04). CONCLUSIONS: The ACE I/D polymorphism influences the level of late luminal loss after coronary stent implantation. These results suggest that the renin-angiotensin system may be implicated in the pathogenesis of restenosis after coronary stenting.

Aged↗
PubMed1997

The angiotensin II type 1 receptor gene polymorphism is associated with coronary artery vasoconstriction.

OBJECTIVES: This study sought to assess the potential association of the angiotensin-converting enzyme (ACE) and angiotensin II type 1 (AT1) receptor gene polymorphisms on coronary vasomotion in humans. BACKGROUND: Abnormal coronary vasomotion plays a role in the clinical expression of coronary atherosclerosis. The components of the renin-angiotensin system are important determinants of vasomotor tone. Furthermore, epidemiologic evidence suggests that these components are involved in the pathogenesis of coronary artery disease. Indeed, two genetic polymorphisms of the ACE and AT1 receptor genes were synergistically associated with the occurrence of myocardial infarction. The influence of these genetic polymorphisms on the risk of myocardial infarction may be related, at least in part, to a deleterious effect on coronary vasomotion. METHODS: We studied the response of angiographically normal human coronary arteries after intravenous injection of methylergonovine maleate, a potent vasoconstrictor whose effects have been previously explored in various aspects of coronary artery disease. We characterized the ACE and AT1 receptor genotypes in a consecutive series of 140 patients with normal coronary arteries. Coronary vasomotion was assessed with quantitative coronary angiography. RESULTS: No effect of the ACE gene polymorphism was detected. Conversely, the patients carrying the AT1 receptor CC genotype (n = 13) had significantly greater vasoconstriction in distal coronary vessels (p < 0.009). CONCLUSIONS: The AT1 receptor gene polymorphism is associated with coronary vasomotion in humans.

Adult↗
PubMed1997

Optimizing the absorption of valspodar, a P-glycoprotein modulator, Part II: Quantifying its pharmacokinetic variability and refining the bioavailability estimate.

A randomized, sequential, bioreplication study was performed with 24 healthy volunteers to assess the pharmacokinetic variability of oral and intravenous administrations of valspodar, a multidrug resistance modulator for use as a chemotherapy adjunct. Subjects received 200 mg as a 2-hour intravenous infusion and 400 mg orally as microemulsion soft gelatin capsules each given on two separate occasions. Following replicate intravenous administrations, reproducibility in peak concentration and area-under-the-curve was demonstrated by interoccasion equivalence testing. Low to moderate inter- and intra-subject pharmacokinetic variability were observed with coefficients of variation ranged from 9% to 19%. Absolute bioavailability from the microemulsion formulation was 60%. Replicate oral administrations demonstrated uniform and repeatable absorption with interoccasion equivalence in peak concentration, time to reach the peak concentration, and area-under-the-curve. Coefficients of inter- and intra-subject variation for these parameters ranged from 10% to 20% indicating low to moderate pharmacokinetic variability. When variabilities were compared between the two routes of administration, the absence of differences indicated that the rate and extent of drug absorption from the microemulsion formulation was as uniform and repeatable as by intravenous infusion.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1997

Effect of smoking cessation on lipoprotein A-I and lipoprotein A-I:A-II levels.

Cigarette smoking is associated with low plasma high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-I levels, which may explain, in part, its deleterious effects on coronary heart disease (CHD). In a group of ex-smokers, we assessed the influence of smoking cessation on apo A-I particle levels. Plasma lipid, apolipoprotein, and lipoparticle concentrations of 58 subjects who had completely stopped smoking (ex-smokers) were compared with those of 37 subjects who had continued smoking (smokers) before and after a smoking cessation counseling program. Nutritional intake was recorded before and after the program to adjust for potential interaction with plasma lipid variables. Smokers and ex-smokers were similar in gender distribution, age, body mass index (BMI), social status, and nutrient intake. There were significantly greater increases in total cholesterol (P < .04), HDL-C (P < .005), HDL2-C (P < .008), and lipoprotein (Lp) A-I:A-II (P < .04) in ex-smokers than in smokers. After smoking cessation, ex-smokers consumed more vegetable protein (P < .02) and polysaccharides (P < .04) and had higher plasma levels of HDL-C (P < .0004), apo A-I (P < .001), Lp A-I (P < .007), and Lp A-I:A-II (P < .01) than smokers. Adjustments on nutritional variables did not show any additional difference between ex-smokers and smokers, suggesting that smoking per se effects Lp A-I and Lp A-I:A-II levels. In conclusion, HDL particles including Lp A-I and Lp A-I:A-II are higher in ex-smokers than in smokers.

Adult↗
PubMed1997

Long-term effects of localized spinal radiation therapy on vertebral fractures and focal lesions appearance in patients with multiple myeloma.

The occurrence of new vertebral fractures and focal marrow lesions was determined and compared in irradiated and nonirradiated vertebrae of 12 patients with multiple myeloma (MM), prospectively followed using magnetic resonance imaging (MRI) of the thoraco-lumbar spine after localized spinal radiation therapy. During follow-up (mean 35 months), fractures appeared in 5% of irradiated vertebrae and in 20% of nonirradiated vertebrae: new focal lesions appeared in 4% of irradiated vertebrae and in 27% of nonirradiated vertebrae. This study demonstrates a beneficial long-term effect of localized radiation therapy, consisting of a reduced incidence of vertebral fractures and focal marrow lesions in irradiated vertebrae.

Aged↗
PubMed1997

Emergence and scattering of multiple neurofibromatosis (NF1)-related sequences during hominoid evolution suggest a process of pericentromeric interchromosomal transposition.

Type 1 neurofibromatosis (NF1) gene encodes for a member of the GTPase activating protein family and is considered to be a tumor suppressor gene. Its very high rate of de novo mutation in humans led us to study a specific feature of this gene: the presence of numerous NF1-related sequences. According to our results, the human genome contains at least 11 NF1-related sequences, nine of which are scattered near centromeric sequences of seven different chromosomes. These NF1-related sequences, whose extent is quite varied according to loci, are unprocessed copies of the NF1 gene, and bear numerous mutations. A phylogenetic analysis of the six largest sequences indicates that they are all derived from a common ancestor, which would have appeared 22-33 million years ago, and was subsequently duplicated several times during hominoid evolution. The most recent duplication and interchromosomal transposition occurred in the last million years suggesting that the process could still be ongoing. Intriguing similarities between the evolution of alpha-satellite DNA and NF1-related sequences suggest the involvement of a common genetic mechanism for the generation and pericentric spreading of these NF1 partial copies.

Animals↗
PubMed1997

Association of angiotensin converting enzyme and angiotensin II type 1 receptor genotypes with left ventricular function and mass in patients with angiographically normal coronary arteries.

OBJECTIVE: To analyse the potential association of the angiotensin converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) gene polymorphisms on left ventricular function and mass in patients with normal coronary arteries. DESIGN: Consecutive sample. SETTING: University hospital. SUBJECTS: 141 consecutive white patients referred for coronary angiography and with angiographically normal coronary arteries. Patients with valvar diseases, cardiomyopathies, or a history of myocardial infarction were excluded. MAIN OUTCOME MEASURES: Left ventricular variables were measured for all patients. The ACE and AT1R genotypes were determined with a polymerase chain reaction based protocol using DNA prepared from white blood cells. A general linear model was used to compare data according to the ACE and to the AT1R genotypes. RESULTS: A strong association was observed between left ventricular mass and systemic hypertension (mean (SD) hypertension: 114 (31) g/m2; no hypertension 98 (23) g/m2; P < 0.003). However, no influence of ACE and AT1R polymorphisms on left ventricular mass was found, regardless of systemic hypertension. The subjects homozygous for the AT1R CC mutation had a significantly lower ejection fraction than those with allele A (AC+AA) (mean (SD) 62(12)% and 68(10)%, respectively, P < 0.05). No synergistic interaction of ACE and AT1R gene polymorphisms on left ventricular function and mass was found. CONCLUSIONS: These data do not support an association of the ACE and AT1R genotypes on left ventricular hypertrophy in white patients with normal coronary arteries.

Angiotensin II↗
PubMed1997

Cloning, sequencing and in vitro functional expression of recombinant donkey follicle-stimulating hormone receptor: a new insight into the binding specificity of gonadotrophin receptors.

Among all mammalian FSH receptors (FSH-R; including donkey (dk) FSH-R), only horse (hs) FSH-R does not bind hsLH/chorionic gonadotrophin (CG). In order to delineate the structural origin of hsFSH-R specificity precisely, we have cloned dkFSH-R cDNA from donkey testis mRNA by RT-PCR. Transiently expressed dkFSH-R endowed COS-7 cells with both hsLH/CG- and FSH-binding activity, as well as FSH-induced cAMP production. The deduced dkFSH-R amino acid sequence shares 96% identity with the hsFSH-R: notably, in the hormone-binding domain, the specificity of hsFSH-R may be ascribed to only four divergent amino acids: Thr 173, Asp 202, Asn 268 and Pro 322. Interestingly, hsAsn 268 could bear an additional N-glycosylation. According to receptor negative specificity, these amino acids could be implicated in preventing LH/CG binding to FSH-R.

Amino Acid Sequence↗
PubMed1997

[Elaboration and validation of a specific quality of life questionnaire for urination urgency in women].

Urgent micturition interferes with the quality of life (QoL) of women suffering from this symptom. In order to evaluate this disturbance of quality of life and the benefits of treatment, a self-administered questionnaire, specific to the disorders of urgent micturition in women, was developed from a pre-existing scale (Measurement of Urinary Handicap, MUH). The following developmental methodology was adopted: Generation of a first instrument from the patient's descriptions collected by a multidisciplinary group of clinicians: formulation of questions, regrouping of questions into dimensions, choice of reference period and modalities of response. Content validation and test of comprehension in 20 patients. Transverse pilot study (98 patients) designed to reduce the number of questions and analyse the internal reliability and clinical validity. Reproducibility study. The final questionnaire comprises 24 items grouped into 5 dimensions: activities (8 items), emotional repercussions (5), self-image (5), sleep (3), well-being (3). The relevance of regrouping of the questions in their dimension and of calculation of a global score was confirmed by a principal component analysis and multifactorial analysis. The internal reliability and reproducibility of the scores were satisfactory, with a Cronbach alpha of > 0.70 and an intraclass correlation coefficient > 0.80, respectively. The clinical validity of the questionnaire was verified: the QoL scores of patients became significantly lower as the symptoms became more severe. A specific, reliable and clinically valid questionnaire, expressed in the form of a global score and a profile, was able to be developed. The profile of patients suffering from urgent micturition reflects the repercussions of the disease on the major and specific domains of their QoL. This questionnaire presents the required properties to be used in clinical trials designed to evaluate the effects of treatments on the patients' QoL, as a complement to classical clinical evaluations.

Activities of Daily Living↗
PubMed1997

[Isolated Burch type indirect colposuspension of the bladder neck in the treatment of stress urinary incontinence in women. Long-term results].

OBJECTIVES: Burch indirect colposuspension remains the reference surgical operation in the treatment of female urinary stress incontinence. The stability of the results is highly controversial and the causes of failure remain hypothetical. The objective of this study was to analyse the long-term results of this technique. METHODS: 100 women suffering from pure urinary stress incontinence, in whom a Burch indirect colposuspension was performed, were included in this study. These patients were reviewed with a mean follow-up of 5.2 years and a questionnaire designed to assess the results was sent to their homes. RESULTS: 64% of patients no longer suffered from incontinence. Deterioration of the results was observed up to 5 years after the operation, but subsequently remained stable. The results were operator-independent. Low sphincter pressure (< 30 cm H2O), preoperative detrusor instability, insufficient hormonal impregnation and a history of pelvic surgery were the main factors predictive of failure of this technique. CONCLUSION: This study confirms the benefit provided by this technique in almost two-thirds of patients and indicates the risk factors of failure which must be taken into account before proposing Burch indirect colposuspension to a woman suffering from urinary stress incontinence.

Adult↗
PubMed1997

[Imaging of small renal tumors].

The increased incidence of detection of small renal tumours, less than or equal to 3 cm in diameter, is related to the generalization and improvement of radiological techniques. Many asymptomatic renal tumours are discovered by ultrasonography and computed tomography. Medical imaging is now able to identify simple cysts (morphological characters, absence of blood supply), angiomyolipomas (demonstration of the fatty contingent) and other solid renal tumours (tumour enhancement on computed tomography). Plain, followed by postcontrast CT looking for contrast enhancement of the lesions is the examination of choice in this context. MRI with Gadolinium injection looking for neoplastic enhancement can be useful in doubtful cases. Medical imaging is able to reliably demonstrate the vascular nature of solid lesions, but cannot distinguish between renal cancer, oncocytoma or another benign solid tumour. Medical imaging allows precise preoperative mapping when partial nephrectomy is envisaged.

Adenoma, Oxyphilic↗
PubMed1997

[Diagnosis of cancer of the prostate (I): Advancements in knowledge and practice since the consensus conference of 1989. The "Cancer of the Prostate" subcommittee of the Committee of Oncology of the French Association of Urology].

The prostatic cancer screening policy in France is defined by recommendations established at the 1989 consensus conference. Mass or individual screening by serum specific prostatic antigen (PSA) assay is not recommended. The Oncology Committee of the Association Française d'Urologie has up-dated the knowledge concerning prostatic cancer screening since 1989. The results are published in the form of a series of articles referring to the criteria used as prerequisites for cancer screening programmes. This article describes: 1) Current screening and treatment recommendations in France and in other countries. 2) The progress in our understanding of the prognosis, diagnosis and treatment of prostatic cancer, justifying revision of the screening policy. 3) The methodology and results of prospective screening studies and the projections of these results on the basis of the French population. Despite the 1989 recommendations, individual screening by serum PSA assay is widely performed both due to the characteristics of the test (simple blood test, low cost, high positive predictive value) and information of the public by the media concerning the morbidity and mortality related to prostatic cancer. The current data of the literature are unable to define the impact of PSA screening on the morbidity and mortality of prostatic cancer. Randomized prospective studies are currently underway. The absence of proof of a favourable impact of PSA screening is only one of the causes of the controversy concerning this screening technique, as another source of controversy is the magnitude of iatrogenic disorders induced by screening. In patients with raised PSA, the diagnostic examinations (biopsy) and curative treatments (surgery or radiotherapy) proposed are invasive, responsible for considerable morbidity and non-negligible mortality. Finally, the cost of screening remains unknown. Future recommendations must adapt their conclusions to changes in the current situation, in which prostatic cancer is simultaneously considered to be a non-serious disease which does not justify screening and a serious disease, as soon as the diagnosis is made, justifying, for 95% of urologists, an invasive and mutilating treatment in men with a life expectancy of more than 10 years.

Attitude to Health↗