Biomedical subjects

Georges Karam

Publications and source records attributed to Georges Karam.

39 records · Page 3Linked to original sources

PubMed2002

Acute graft pyelonephritis and long-term kidney allograft outcome.

BACKGROUND: Long-term graft function is the result of multiple parameters, including both immune and non-immune components, which have a beneficial or detrimental potential. Among these, despite its frequency and theoretical interest (expression of "danger signals" in the graft itself), the effects of acute graft pyelonephritis (AGPN) on immediate and long-term outcome have not been studied in a large series. This article reviews a cohort of 1387 consecutive primary renal transplant recipients. METHODS: The objective of the study was to define the risk factor for AGPN, the risk profile for recurrence, and the impact of AGPN on long-term graft survival. According to a higher risk for AGPN in females during their follow-up, statistical analyses (Cox model, and multiple regression analysis) were performed by recipient sex strata. RESULTS: Multivariate analysis showed that CMV infection was the only risk factor for AGPN occurrence. AGPN occurred in 13% of the graft recipients during their follow-up. Taken as a whole, AGPN was not associated with a significantly poor long-term outcome. However, when assessed in more detail, the outcome of this population was found to be more complex and to depend on several factors. Early AGPN (during the first 3 months) was significantly detrimental for graft outcome, independently of acute rejection episodes. Moreover, E. coli involvement in a first episode was linked to an increased AGPN recurrence. CONCLUSION: This analysis did not support the concept that with current immunosuppression, strong "danger signals" such as those derived from bacteria within an allograft, are instrumental in initiating acute or chronic rejection.

Acute Disease↗

PubMed2002

[T1 bladder tumors: value of a second endoscopic resection].

OBJECTIVE: To quantify the percentage of residual tumour following systematic second endoscopic resection of pT1 bladder tumours before starting treatment with intravesical instillations and to definitively exclude muscle invasion. MATERIAL AND METHODS: From January 1995 to December 1999, 52 patients with a first diagnosis of pT1 bladder tumour underwent a second endoscopic resection 3 to 5 weeks later. Nine surgeons, 5 seniors and 4 juniors, managed these patients and the initial resection was considered to be complete in every case. The second resection consisted of resection of the initial tumour bed and distant biopsies either directed to zones of suspicious CIS zones or quadrant biopsies in the case of optically healthy mucosa. RESULTS: Of the 52 included patients, 19 (36.5%) had residual disease on the second endoscopic resection. Pathological staging was: pT0 = 63.5% (33 patients), pTa = 11.5% (6 patients), pTis = 3.85% (2 patients), pT1 = 17.3% (9 patients), > or = pT2 = 3.85% (2 patients). Residual tumour tissue was revealed at the resection site in 84.2% of cases and in another site in 15.8% of cases. Residual tumour was significantly more frequent in the case of multifocal tumour than in the case of solitary tumour (57.9% vs 24.23%), and when managed by a junior surgeon compared to a senior surgeon (53.8% vs 30.8%). CONCLUSION: This second endoscopic procedure appears to be essential to ensure the absence of residual tumour before starting conservative treatment for pT1 bladder tumours.

Cystoscopy↗

PubMed2002

[Prognostic factors of prostate cancer treated with first-line hormone therapy].

OBJECTIVE: Endocrine therapy of prostate cancer is designed to eliminate the action of androgens to prevent the growth of hormone-sensitive cancer cells. The duration and quality of the response to this treatment vary from one patient to another. The objective of this study was to evaluate the prognostic factors of patients treated by first-line endocrine therapy for prostate cancer. MATERIAL AND METHODS: From September 1988 to September 1999, 170 patients receiving first-line endocrine therapy for prostate cancer were included. Endocrine therapy consisted of LHRH analogues alone in 59.4% of cases, complete androgen suppression in 21.2% of cases, antiandrogens alone in 17.6% of cases and oestrogens in 1.8% of cases. Clinical, laboratory, scintigraphic and histological data were collected. The overall survival was studied by univariate analysis as a function of pretreatment criteria using Kaplan-Meier survival curves. RESULTS: The mean survival of the population was 33 +/- 26 months (range: 2-126 months). The following parameters were associated with a significant reduction of overall survival: age greater than 70 years, high ECOG score, mode of presentation of the cancer by alteration of general state, presence of bone pain, presence of bone metastases particularly in the appendicular skeleton, dilatation of renal cavities, Gleason score > 5, PSA level > 100 ng/ml, haemoglobin < 13.5 g/dl, serum creatinine > 105 mumol/l, low plasma testosterone, high alkaline phosphatase, poor response to treatment assessed by PSA greater than 4 ng/ml at 3, 6 and 12 months. CONCLUSION: Determination of these prognostic factors can be used to predict the patient's response to endocrine therapy and survival. These factors can also be used to stratify patients in comparable groups for clinical trials.

Adult↗