Biomedical subjects

J Cukier

Publications and source records attributed to J Cukier.

At least 19 recordsLinked to original sources

PubMed1992

Extracorporeal lithotripsy of ureteric calculi using the Dornier HM-3 lithotriptor.

Over a 5-year period (November 1984-November 1989), we treated 356 patients with ureteric calculi; 170 were treated by extracorporeal shock wave lithotripsy (ESWL) on a Dornier HM-3 lithotriptor. The calculi (n = 176) were uniformly distributed along the length of the ureter: 44 were just below the pelviureteric junction, 59 were lumbo-iliac, 42 were in the upper bony pelvis and 32 in the lower bony pelvis. The mean diameter of the upper ureteric calculi was 10 mm and for the others it was 8 mm. Thirty-four patients with acute obstructive pyelonephritis required pre-ESWL drainage of the urine. X-ray localisation required intravenous urography during lithotripsy in 52 cases (30%). On plain X-ray the following day 170 stones (96%) were judged to have disintegrated. The 6 patients whose stones were not fragmented received further treatment (ureterotomy (4) and ureteroscopy (2)). Five patients required additional treatment because of pain or fever (catheterisation (3) and ureterotomy (2)) and 2 patients had a second lithotripsy owing to insufficient fragmentation. Four patients were lost to follow-up. In 153 patients (90%) the fragments were eliminated completely, 146 in the first month and the remainder before the sixth month. No serious sequelae were observed. In addition to the 5 patients who required supplementary treatment. 11 patients with pain or fever needed medical treatment. We recommend first intention in situ ESWL for all ureteric calculi.

Adolescent↗

PubMed1992

[Isolated and unilateral malacoplakia of the upper urinary tract. Apropos of a case].

Malakoplakia, strictly unilateral and localised to the upper urinary tract, is a rare presentation of this uncommon inflammatory disease. In this 53 year old woman, the disease presented in the form of a tumour of the left upper urinary tract. Radical nephroureterectomy was performed and histological examination of the resection specimen revealed the diagnosis.

Diagnosis, Differential↗

PubMed1992

[Cutaneous trans-jejunal ureterostomy: an original technique used in 29 patients].

The authors report an original technique of transintestinal cutaneous diversion using the jejunum A 10 to 15 cm segment of jejunum is raised from the second loop and is attached to the skin transperitoneally. The stoma lies below the ureterojejunal anastomosis and the two ureters, sutured according to Wallace's technique, are implanted end-to-end into the proximal and extraperitonealised end at the height of the sacral promontory. 29 patients have been treated by this technique for various indications: 21 bladder tumors, 5 neurogenic bladders, 1 bladder exstrophy, 1 cervical cancer, 1 prostatic cancer. 15 patients (52%) had previously received pelvic irradiation. The mean follow-up was 47 months (2-192 months) and the mortality was zero. 4 patients (13.8% developed early complications: 2 cases of urinary tract obstruction and 2 intestinal obstructions requiring 3 operations. 6 patients developed 7 minor late complications (24.1%): 2 cases of pyelonephritis, 4 cases of renal stones, only one of which required an operation, and 1 case of prolapsed stoma. None of the patients developed any alteration in renal function or dilatation of the upper urinary tract after the operation. The addition of sodium bicarbonate was found to be useless, as none of the patients developed any metabolic disorders. Transjejunal cutaneous ureterostomy achieves excellent drainage by means of a short graft with a stoma situated below the level of the ureteric implantation, as reflected by the absence of any long-term deterioration in renal function despite full lumen ureterojejunal implantation without an antireflux device. This technique is simple to perform and is indicated in all situations, particularly after pelvic irradiation. It is associated with low morbidity, no mortality and ensures an excellent long-term result.

Adolescent↗

PubMed1992

[Posterior urethral valves in newborns and infants. Treatment and clinical course].

Severe forms of posterior urethral valve are essentially seen in neonates and infants. In 6 neonates under the age of 3 months, the predominant presenting features were a deterioration in the general status and renal failure. Transurethral section of the valves, after urinary drainage for an average of one month, restored patency of the lower urinary tract in every case. All children have persistent renal failure, which is moderate or severe in 4 cases. In 6 infants between the ages of 3 and 11 months, the clinical presentation was dominated by signs of infection. Section of the valve was able to be performed earlier, with subsequent urethral stricture in one case. Five infants, initially presenting with renal failure, have persistent moderate renal failure. The degree of obstruction accounts for the severity of the uropathy and its early clinical presentation. The renal prognosis is poor and related to the uretero-renal consequences of the valve as well as associated renal dysplasia.

Congenital Abnormalities↗

PubMed1992

[Epididymitis disclosing an idiopathic urethroseminal reflux in children].

Idiopathic urethroseminal reflux is exceptional in children. In both of our cases, it presented in the form of epididymitis and was confirmed by suprapubic cystography, which also eliminated an obstructive cause and any associated malformations. Long-term antiseptic treatment prevented recurrent infections.

Child↗

PubMed1991

Tumors of the upper urinary tract: 10 years of experience.

We reviewed 108 patients with upper urinary tract tumors who underwent surgical treatment during a 10-year period (87 men and 21 women with a mean age of 63.5 years). Of the tumors 97% were unilateral and only 3 patients had bilateral tumors. Two-thirds of the patients had a single tumor focus and a third had 2 or more tumor foci. Additionally, there were 31 patients (28.7%) with previous and/or simultaneous bladder tumors. Nephroureterectomy was performed in 92 cases, nephrectomy in 6 and a conservative operation in 13. In 65 cases lymphadenectomy was added. The survival rates at 5 and 10 years were 67 and 65%, respectively. Of the patients 90% with cancer-related deaths had high grade tumors. Of the 15 patients with positive lymph nodes 87% died of metastasis compared to 8% of the 50 patients with negative lymph nodes. Nine patients (8.7%) had relapse in the upper urinary tract, 6 (5.8%) in the ipsilateral ureter and 3 (2.9%) in the contralateral ureter. Of these 3 patients 2 had recurrent multifocal bladder tumors. For patients who present with an upper urinary tract tumor the risk of a bladder cancer was approximately 9% and that of a contralateral urothelial tumor was 1%.

Adult↗

PubMed1991

[Prostate-specific antigen. Interpretation of the results in relation to the sampling method].

The authors compare the two prostate specific antigen assay methods most widely used in France. The first method (RIA Baxter) uses an isotope marker (Iodine 125), the other (EIA Biotrol) uses an enzymatic marker (alkaline phosphatase). Prostate specific antigen was assayed by means of these two techniques in two groups of patients: one group of 49 men considered to be free of any prostatic disease, recruited from blood donors; another group of 89 male patients in whom a prostate specific antigen assay was performed prospectively at the first urology outpatients visit. The two prostate specific antigen assay techniques gave different results, but the values obtained by these two methods were not discordant. It is therefore possible to define a coefficient of proportionality of 1.45 regardless of the prostate specific antigen concentration or the urological disease considered (EIA Biotrol x 1.47 = RIA Baxter).

Adult↗

PubMed1991

[Prostatic specific antigen (PSA). Interpretation of results as a function of the assay method].

The authors compare the two PSA assay methods most widely used in France. The first method (RIA Baxter) uses an isotope marker (Iodine 125), the other (EIA Biotrol) uses an enzymatic marker (alkaline phosphatase). PSA was assayed by means of these two techniques in 2 groups of patients: one group of 49 men considered to be free of any prostatic disease, recruited from blood donors; another group of 87 male patients in whom a PSA assay was performed prospectively at the first urology outpatients visit. The two PSA assay techniques gave different results, but the values obtained by these two methods were not discordant. It is therefore possible to define a coefficient of proportionality of 1.47 regardless of the PSA concentration or the urological disease considered (EIA Biotrol x 1.47 = RIA Baxter).

Adult↗

PubMed1991

[Extracorporeal lithotripsy of ureteral calculi using the Dormier HM3 device. A series of 176 calculi].

In a series gathered over 5 years (November 1984 to November 1989), we have treated 356 patients with ureteral lithiasis. Out of these, 170 (134 men and 36 women) were treated with extracorporeal shock-wave lithotrity with a Dornier HM3 system, in situ and as a first intention. The calculi (176 stones) were regularly distributed along the ureter: their location was subpyelic in 44 cases, lumboiliac in 59, upper pelvic in 42 and lower pelvic in 32. The average diameter of the calculi was 10 mm for subpyelic stones and 8 mm for the others. A preliminary urine drainage was required for 24 calculi causing acute obstructive pyelonephritis (32 ureteral drains surrounding the stone, and 2 percutaneous nephrostomies). Radioscopic localization required intravenous pyelography during lithotrity in 52 cases (30%). On radiographs without preparation taken the next day, 170 stones were regarded as fragmented (96%). After some time the 6 patients whose calculus had not been fragmented underwent another treatment (4 ureterotomies and 2 ureteroscopies). Five patients had an additional treatment because of a painful and/or febrile episode (3 drain insertions and 2 ureterotomies) and 2 patients required a second session of lithotrity because fragmentation was not sufficient; 4 patients were lost to follow-up. A total of 153 patients (90%) got rid of their fragments, 146 during the first months and the remaining 7 before the sixth month. No severe complication was noted. Besides the 5 patients who had required additional treatment, 11 patients suffering from pain and/or fever had a medical treatment. These treatments lead us to proposing first-intention "in situ" extracorporeal shock wave lithotrity for all ureteral lithiases requiring a treatment.

Adolescent↗

PubMed1991

[Do posterior urethral valves alter the results of renal transplantation in children?].

The authors conducted a retrospective study based on a series of 715 renal transplantations in children performed between January 1973 and December 1989 at the Hôpital Necker-Enfants Malades in order to determine whether the long-term result of renal transplantation was as good in children with posterior urethral valves (PUV) as in children with a normal lower urinary tract. Group 1 consisted of 50 renal transplantations performed in 41 children in whom the primary urological disease was PUV. The bladder was able to be used without modification in 36 cases and had to be enlarged in 5 cases. A permanent cutaneous urinary diversion was not required in any of these transplanted patients. Group 2 consisted of 665 renal transplantations performed in children without PUV. There was no significant difference between the two groups in terms of the distribution of cadaver kidney and living related donor transplantations. Immunosuppressive treatment consisted of various combinations of prednisone, azathioprine, ALS for the earlier patients in the series, OKT 3 and cyclosporin for the more recent patients. In group 1, we observed a urological complication rate of 20% and a vascular complication rate of 14%, while, in group 2, the urological complication rate was 16.9% and the vascular complication rate was 9.5%. The actuarial 5-year and 10-year graft survival rates were 63% and 49% in group 1 and 63% and 49% in group 2, respectively. The actuarial graft survival rates were therefore identical in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed1990

A multicenter, double-blind, placebo-controlled trial of the efficacy of prazosin in the treatment of dysuria associated with benign prostatic hypertrophy.

An 8-center, double-blind, placebo-controlled trial of 39 patients with benign prostatic hypertrophy was conducted to assess the effects of prazosin HCl treatment on functional urologic variables after a treatment period of 4 weeks. The randomized groups were comparable for demographic variables and symptoms, except for the mean residual urinary volume, which was significantly higher in the prazosin HCl group. Prazosin HCl elicited statistically significant improvements in the mean prostatic urethral pressure and prostate area (Mann-Whitney U test: p = 0.001 for both variables as compared with the placebo group). Functional bladder capacity also improved significantly in the group receiving the test drug (Mann-Whitney U test: p = 0.05, as compared with the placebo group). Clinical improvements were also observed in the mean maximum urinary flow, decreased nocturia frequency, and residual urinary volume. Patient preference significantly favored the prazosin HCl treatment (Mann-Whitney U test: p = 0.001). Seven patients on prazosin HCl and 5 receiving placebo reported one or more side effects during the trial phase; these were mild to moderate and disappeared or were tolerated. No statistically significant effects on blood pressure or heart rate were observed.

Double-Blind Method↗

PubMed1990

[Urethral stricture in children. Long term results of surgical treatments].

Thirty-six urethral strictures were treated between 1977 and 1984. Three strictures were considered to be congenital, eleven were traumatic and twenty-two were iatrogenic. The authors performed twenty five internal urethrotomies, twelve resection-sutures of the urethra and eleven urethroplasties including eight patch grafts with a pedicle derived from scrotal or penile skin, a tubed pedicle scrotal skin flap, one Jurascek urethroplasty and one Leveuf urethroplasty. Internal urethrotomy only gave 50% of good results and is now reserved for short strictures less than one centimetre in length. Resection-suture is an excellent operation which should be reserved for strictures less than two centimetres in length: it gave 84% of good results. One of the various types of pedicle cutaneous urethroplasty is certainly the best operation for long strictures: it gave more than 90% of good results in the present series.

Adolescent↗

PubMed1990

[Endoscopic section of the band for urinary retention following aponeurotic supporting of the neck of the bladder].

The authors report on 15 cases of severe dysuria following the formation of an aponeurotic support for the neck of the bladder leading to more or less complete vesicle retention. An endoscopic section through the entire thickness of the band was performed in all patients via an incision in the neck of the bladder. The band was identified in all cases. Vesical retention disappeared in 13 of 15 cases and was noticeably reduced in the other two. Perfect continence was maintained in 11 of these patients. The 4 others presented with slight problems of continence consisting in discrete leaks at night in three cases and in a few leaks when standing up or changing position in one. No vesicovaginal fistula was noted. The authors review the literature on the occasion of their work.

Adult↗

PubMed1990

[Chemotherapy in advanced transitional cell carcinoma of the urinary tract. Phase II trial of a combination of doxorubicin and cisplatin].

Between January 1, 1983 and December 31, 1984, 18 patients with advanced transitional cell carcinoma of the urothelium were treated in a Phase II trial with doxorubicin 45 mg/sqm plus cisplatin 90/mg/sqm/day every four weeks. 17 patients were evaluable for response. There were: 4 partial responses (24% of response objective effects, 95% confidence limits are 15% and 33%) and 13 failures. The median survival was 18.5 months for responders and 10 months for non responders.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

[5-year treatment results of urethral stenosis using internal urethrotomy in adults].

The authors reviewed the records of 69 patients with a mean age of 51 years treated for single (81%) or multiple (19%) urethral strictures, in whom the first operation to be performed was endoscopic internal urethrotomy with a follow-up of at least 5 years. The mean follow-up was 71 months. The actuarial rate of good results was 27.2 +/- 11% at 5 years. The success rate of repeated internal urethrotomy was satisfactory, but was not evaluated with the same follow-up (62.5% after the first repeat urethrotomy with a mean follow-up of 13 months).

Adolescent↗

PubMed1990

[Stenosis of the urethra in children. Long-term results of surgical treatment].

Thirty-six urethral strictures were treated between 1977 and 1984. Three strictures were considered to be congenital, eleven were traumatic and twenty-two were iatrogenic. The authors performed twenty five internal urethrotomies, twelve resection-sutures of the urethra and eleven urethroplasties including eight patch grafts with a pedicle derived from scrotal or penile skin, a tubed pedicle scrotal skin flap, one Jurascek urethroplasty and one Leveuf urethroplasty. Internal urethrotomy only gave 50% good results and is now reserved for short strictures less than one centimetre. Of resection-suture is an excellent operation which should be reserved for strictures less than two centimetres: it gave 84% of good results. One of the various types of pedicle cutaneous urethroplasty is certainly the best operation to treat long strictures: it gave more than 90% of good results in the present series.

Adolescent↗

PubMed1990

[Relationships between posterior urethral valves, vesico-renal reflux and renal dysplasia].

Children with valves of the posterior urethra show asymmetric involvement of the upper urinary system with a nonfunctional kidney in 10 to 15% of cases. In a study of 12 nephrectomy patients and 14 reflux patients, the authors reached the conclusion that valvular obstruction, vesico-renal reflux and dysplasia are coexisting anomalies with little relationship between each other.

Humans↗

PubMed1989

Suction lipoplasty: biohazardous aerosols and exhaust mist--the clouded issue.

With the increased popularity of suction lipoplasty procedures, attention has been focused on their safety. One significant concern involves the rotary vane aspirators used to provide the suction required for the procedure. A series of experiments was carried out to determine whether aerosols are produced during the use of a rotary vane aspirator, since aerosols are known to be hazardous under appropriate conditions. Using a viable strain of Pseudomonas aeruginosa, we challenged the system through the suction port, and the exhaust from the aspirator was then cultured in a particle sampler. Results indicate that viable pathogens are released from the exhaust in physiologically significant particles capable of penetrating to the level of the alveolus in the normal human lung. These infectious particles were produced for 3 hours after the initial challenge. When an appropriate filtration device was attached to the aspirator outflow, the aspirator pump and environment were protected. In the absence of an appropriate filtration device, the aerosolized particles may constitute a hazard to patients or medical workers in the vicinity of the aspirator.

Aerosols↗