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H Bensadoun

Publications and source records attributed to H Bensadoun.

At least 19 recordsLinked to original sources
PubMed1998

[Distal vascular access for chronic hemodialysis in patients over 65 years of age. Surgical results].

OBJECTIVE: To evaluate the results of vascular accesses for chronic haemodialysis in elderly patients. MATERIAL AND METHODS: 56 consecutive vascular accesses for haemodialysis were performed from November 1993 to December 1995 in patients over the age of 65 years. The policy adopted was to prefer distal accesses: only forearm accesses, primary arteriovenous fistula (AVF) or radio-M venous bioprosthesis shunt (AVS) were performed. Surgical or interventional radiological reoperation rates and abandonment rates were evaluated. RESULTS: 13 AVF (mean age: 74.5 years) and 43 AVS (mean age: 73.8 years) were analysed. The mean number of reoperations was significantly higher in the shunt group. 1 out of 13 AVF was abandoned versus 9 out of 43 AVS (no significant difference). DISCUSSION: AVS gave poor results in terms of reoperation rate, inducing a high cost and impairment of the quality of life of these patients. Their survival in this population was comparable to that of AVF. Several teams prefer to perform first-line humero-cephalic or humero-basilic arteriovenous fistulas whenever a simple fistula in the forearm cannot be performed. They appear to give better results, but their use in the elderly is poorly evaluated. Peritoneal dialysis may be preferable to haemodialysis in the elderly. As vascular accesses are increasingly performed in elderly subjects with a reduced life expectancy, protection of the proximal venous capital does not appear to be a sufficient argument to justify the use of AVS in this population. CONCLUSION: This study encouraged us to abandon the use of prostheses in the forearm in favour of direct accesses in the arms.

Age Factors↗
PubMed1998

[Carcinoma of Bellini's collecting tubules. Apropos of a case].

Carcinoma of the papillary ducts of Bellini is a rare malignant tumour of the kidney, with a generally unfavourable prognosis because of late diagnosis, often at the state of metastases. The diagnosis is based on pathological examination of the nephrectomy specimen with immunohistochemical study. The role of adjuvant chemotherapy needs to be evaluated.

Adult↗
PubMed1998

[Primitive renal neuroectodermal tumor (PNET). Apropos of a case].

Renal primary neuroectodermal tumours (PNET) are exceptional and belong to the vast group of peripheral malignant primary neuroectodermal tumours (MPNT), the best known forms of which are Ewing's sarcoma of bone and Askin's thoracopulmonary tumour. In the light of a case, the authors discuss the clinical features, course, treatment and pathological characteristics, particularly the value of immunohistochemistry and cytogenetics, which demonstrate a specific chromosomal abnormality, the t (11;22) (q24;q12) translocation.

Adolescent↗
PubMed1996

[Double kidney-total pancreas transplantation with bladder reimplantation. 25 cases].

Twenty five double kidney-pancreas transplantations were performed according to the total pancreas transplantation technique with drainage of exocrine secretions into the bladder via a vesicoduodenostomy. 72% of kidney-pancreas grafts were functional at one year and 59% were functional at four years. The authors observed a slightly higher rejection rate (0.56 versus 0.34) and a higher incidence of urinary tract infection (60% versus 35%) following double pancreas and renal transplantation than after isolated renal transplantation. Complications were rare: two venous thromboses and two cases of urethritis requiring of rediversion of the duodenum into the intestine. These good results, comparable to those reported in the international registry, reflect the value of the pancreatic and renal transplantation technique using a total pancreas drained into the bladder. It would probably be preferable to transplant patients earlier, when chronic renal failure secondary to insulin-dependent diabetes induces end-stage renal failure and the need for haemodialysis.

Adolescent↗
PubMed1996

Insertion of a double pigtail ureteral stent for the prevention of urological complications in renal transplantation: a prospective randomized study.

PURPOSE: Urologists successfully use ureteral stents to protect the ureterovesical anastomosis in nontransplant patients. MATERIALS AND METHODS: We determined the value of ureteral stents in transplant patients. The frequency of urological complications (leaks, obstructions and urinary tract infections) was compared in a prospective randomized series of 194 kidney transplantations (97 with and 97 without a double pigtail ureteral stent). RESULTS: In the stent group 1 patient had a urinary leak and 35 had urinary tract infections (including 2 cases of Corynebacterium cystitis). In the no stent group 6 patients had urinary leaks, 4 had obstructions and 32 had urinary tract infections. The 1-year patient and graft survival rates were similar in both groups, and renal function at 1 year was also similar (229 versus 208 mumol./l. creatinine in the stent and no stent groups, respectively). A small number of stent related complications occurred (2 stent breakages and 1 stent migration). No stones formed in any case. CONCLUSIONS: Ureteral stent insertion significantly decreases the rate of vesicoureteral leakage and obstruction in renal transplantation.

Adult↗
PubMed1995

[Medical treatment of benign hypertrophy of the prostate].

Surgery is obviously indicated in a patient with benign prostatic hypertrophy and severe signs of urine retention, infection, and a bladder with diverticles and calculi. Inversely the patient with minor dysuria and a normal upper urinary tract usually needs simple counselling. The major question is how to manage patients with intermediary symptomatology. Much emphasis has been placed on measurement of quality of life, but cannot be used to determine a therapeutic strategy. Indeed, there is no precise criteria for indicating medical treatment of benign prostatic hypertrophy. Randomized, controlled and well conducted studies have shown however that the beneficial effect of certain drugs is greater than the placebo effect, but there is no common criteria to determine what degree of improvement justifies prescription. In addition, the cost of medical treatment, in terms of overall health care cost for the society, must be taken into consideration. Despite these drawbacks, several drug classes--plant extracts, alpha-blockers, 5-alpha-reductase inhibitors--have been used with confirmed effectiveness. The spectacular advances in pharmacology in the field of benign prostatic hypertrophy will undoubtedly have an impact on other areas of research, but the medical, economic and ethic justification of prescribing "comfort" drugs is one of the major challenges facing urologists today.

5-alpha Reductase Inhibitors↗
PubMed1995

Combined liver and kidney transplantation in patients with chronic nephritis associated with end-stage liver disease.

A variety of renal diseases can be associated with end-stage liver diseases requiring orthotopic liver transplantation (OLT), including cirrhosis-associated glomerulonephritis (GN), and nephropathy unrelated to the liver disease. A retrospective survey showed that nine patients undergoing liver transplantation in our centre had histologically proven GN or interstitial nephritis with renal failure and/or nephrotic-range proteinuria, and experienced severe complications post-OLT since nephrotoxic immunosuppressive drugs (CsA and FK506) could not be adequately given. Four of the nine patients died. Therefore, combined liver-kidney transplantation has been suggested as first choice treatment in such patients. From January 1990 to February 1994, in patients with end-stage liver disease referred for OLT, and who presented with unexplained renal function impairment and/or significant proteinuria, severe nephropathy was confirmed by renal biopsy in nine: four mesangiocapillary GN with immune deposits, one membranous nephropathy, two diabetic glomerulosclerosis and two interstitial nephritis. All underwent liver transplantation immediately followed by kidney transplantation. The postoperative period was uneventful, and neither death nor renal failure were recorded. Combined transplantation resulted in all patients in the normalization of renal function, and in the disappearance of proteinuria within the first postoperative month. From 6 months to 4 years post-transplant, the renal function remained within normal ranges in all patients. Routine renal transplant biopsy was performed in two patients with pre-transplant cirrhosis-associated GN, and showed no evidence of recurrence of the original nephropathy. We conclude that combined liver-kidney transplantation is an adequate therapeutic option in patients with end-stage liver disease associated with advanced kidney disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Cancer of the kidney, prognostic value of nuclear grading for the early diagnosis of metastasis].

OBJECTIVES: Since immunotherapy or surgery can sometimes lead to remission of metastatic renal cell carcinoma, it is important to recognize factors predicting metastasis. We therefore evaluated the usefulness of nuclear grading in predicting metastasis of renal cell carcinoma. METHODS: We retrospectively reviewed 95 patients (69 males, 26 females; mean age 63.9 years) who successively underwent surgical exeresis of a renal cell carcinoma. The TNM classification was established on the basis of preoperative work-up (thoraco-abdominal computed tomography, bone scintigraphy) and pathology examination of the surgical specimen. Nuclear grading was performed by a pathologist who was unaware of the histology results. Outcome was evaluated on the basis of physical examination and computed tomography results 6 months after surgery. RESULTS: There were 34 cases of clear cell carcinoma, 10 granulosus tumours, 2 oncocyte tumours and 16 renal cell carcinomas of undetermined type. Mean tumour diameter was 70.3 +/- 37.8 cm. Tumour classification gave (< 5 cm, n = 23; > 5 cm, n = 26; local invasion, n = 28; invasion of neighbouring organs, n = 2). Metastases had been identified in 11 patients before surgery. Nuclear grading according to the Führman scale gave F1 (n = 3), F2 (n = 28), F3 (n = 34) and F4 (n = 24). Tumour size and the TNM classification were correlated with the observed nuclear grading scores. Within one year of surgery, metastasis was observed in 6 patients whose Führman grades were F3 (n = 1) and F4 (n = 5). Metastasis occurred in 26% of the patients with a Führman grade 4. CONCLUSION: Nuclear grading can be used to identify patients who should be closely followed after surgical removal of renal cell carcinoma in order to improve early diagnose of metastasis.

Adenocarcinoma↗
PubMed1994

Long-term treatment of benign prostatic hyperplasia with alfuzosin: a 24-30 month survey. BPHALF Group.

OBJECTIVE: To address the long-term results of alfuzosin, an alpha 1-antagonist, in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: A 6-month, placebo-controlled study involving 518 patients was followed by two successive one-year, open extensions. Only centres who wished to continue the trial participated in the extensions; 131 patients entered the first extension, with 50 continuing into the second year extension. The results of the second year follow-up are presented here. RESULTS: Depending on their initial randomization to either the placebo or alfuzosin arm, patients were treated with alfuzosin for 24 (n = 50) or 30 months (n = 22). The data collected on those 50 patients in comparison to baseline confirmed that the clinical efficacy observed in short/medium-term studies was maintained. A clinically significant improvement in urinary symptoms was observed; the Boyarsky score decreased from 8.7 (+/- 0.3) at baseline to 5.2 (+/- 0.3) at 24 months, with no deterioration in the objective parameters. In patients treated for 30 months (n = 22), symptomatic assessment and urodynamic parameters remained stable, indicating the sustained effectiveness of therapy. No serious or unexpected side-effect related to long-term exposure to alfuzosin was observed. No complications associated with BPH occurred. Two patients (4%) reported dizziness, neither of whom withdrew from the study. In this population, where 40% of patients were receiving concomitant cardiovascular therapy, no clinically significant change in standing systolic blood pressure, diastolic blood pressure or heart rate was apparent between baseline data and those at 24 months. CONCLUSION: These data demonstrate the usefulness of long-term treatment with alfuzosin in patients with uncomplicated, moderate BPH.

Adrenergic alpha-Antagonists↗
PubMed1994

[Cytopuncture: an alternative to pelviscopy in the diagnosis of lymphatic metastases of urologic pelvic tumors].

119 patients with prostatic or vesical tumours without metastases were studied by lymphography-aspiration cytology to detect lymph node metastases. 12% of aspiration cytologies were uninterpretable, corresponding to N-patients. 12% of the 105 interpretable cases were positive. Some of the patients with negative biopsies were treated nonsurgically. 28 bladder tumours were treated intravesically. 11 prostatic cancers were treated by radiotherapy and 63 patients underwent surgical resection. These 63 patients had an interpretable aspiration cytology and surgical control. Aspiration cytology was falsely negative in 7 cases: 4 microscopic metastases and 3 macroscopic metastases. The sensitivity of aspiration cytology after lymphography is 66% and its specificity is 100%. The positive predictive value is 100% and the negative predictive value is 92.3%. These 7 false-negative results included 3 macroscopic metastases already identified on CT scan and 4 micrometastases in which surgical resection was legitimate.

Adenocarcinoma↗
PubMed1994

Incidence of vascular complications in kidney transplantation: is there any interference with the nature of the perfusion solution?

Two non-randomized groups of 100 kidney transplants each were compared in relation to the flush-out solution used. The two groups were similar with the exceptions of the number of multiple artery kidneys and the proportion of kidneys procured in our center. The rate of vascular complications such as arterial venous thrombosis and renal artery stenosis was higher in the Eurocollins (19) group than in the UW group (4) p < 0.01, even if the multiple artery kidneys are excluded. These results need to be confirmed by a randomized study but it is clear that the use of the UW solution leads to a better arterial flow with fewer vascular complications.

Adenosine↗