[When should treatment of prostate cancer begin?].
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Humans↗
Biomedical subjects
J Cukier
Publications and source records attributed to J Cukier.
[Does the antireflux operation promote growth of the kidneys? Apropos of 65 surgically treated children with a minimal follow-up of 4 years].
A study in 65 children followed up over at least 4 years after Cohen's operation evaluated renal growth rate using Eklof and Ringertz method. Analysis showed that: small kidneys with corticopapillary lesions were all atrophied; hypertrophic kidneys remained hypertrophic or were within a normal growth rate range; normal size kidneys never hypertrophied but atrophied in 13.5% of cases; the presence of corticopapillary lesions multiplied the risk of degradation of a normal size kidney by a factor of 5.5. These findings are in concordance with documented data, only Willscher et al finding accelerated renal growth rate after surgical relief of reflux.
Atrophy↗
[Ureterosigmoidostomy with antireflux in children. Apropos of a short series].
Ureterosigmoidostomy with anti-reflux technique (Petit-Leadbetter procedure) was performed in 12 children, mainly after failure to repair an exstrophy. After a mean follow up of 45 months, results were assessed as good from clinical and urographic points of view, although there were 3 possible cases of reflux, one of anastomotic stenosis (operated upon with success) and one of moderate continence only. An anastomotic tumor was not detected, but follow up is of moderate duration only. This operation should be reserved for a limited number of cases: those with irreparable exstrophy and those in whom a skin bypass is unacceptable.
Adolescent↗
Genital tract reconstruction in a patient with congenital absence of the vagina and hypoplasia of the cervix.
A 15-year-old female presented with congenital absence of the vagina and a blind ending hypoplastic cervix. The uterine cavity appeared normal by ultrasound examination, and the patient experienced molimina. Cognizant of risks and failures of described attempts at correction, reconstruction was performed using a series of stents covered with skin grafts. At 21 months postoperatively, the patient now has a functioning vagina and menstruates regularly. The desire to avoid a hysterectomy coupled with new alternatives in the management of the infertile patient resulted in the approach described.
Adolescent↗
[Use of the intestinal graft in renal transplantation in children and adults].
Intestinal grafts as a means to external shunting of urine during renal transplant operation were described by W.D. Kelly as early as 1966. Since then 80 cases have been reported in the Anglo-Saxon literature. A total of 68 well-documented cases showed functional kidneys in 52%, complications in 42% and a 13% mortality rate. Between 1973 and 1985, of 400 renal transplant operations in children, an intestinal graft was used in 8 cases (2%) to provide 4 definitive external diversions and 4 enlargements or replacements of bladder. Indications for use were neurological bladder and posterior urethra valves. In all cases the graft was prepared before transplant operation. Enlargement of bladder requires good cervico-urethral function determined by previous study of a generally nonfunctioning bladder distal to an cutaneous ureterostomy. To avoid post-transplant urological effects the graft for enlargement or replacement is opened temporarily on to skin and closed several months after grafting. Follow up for 2 to 8 years showed 6 kidneys functioning normally, and 3 enlarged or replaced bladders out of 4 currently closed functioning satisfactorily. The 2 lost kidneys were rejected 2 weeks and 2 years respectively after the graft operation. There was no mortality or urological complication. The only surgical complications related to the intestinal graft were 3 early-onset occlusions treated successfully. Calculi formed in 2 cases, one being eliminated spontaneously at an early stage and the other, of late onset, requiring two operations. Metabolic or infectious complications were benign.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Anatomical classification of adenocarcinomas of the kidney. Reflections apropos of 270 surgically treated cases].
Prognostic correlation between the pathologic stage and survival was evaluated in 270 patients with renal cancer treated by enlarged nephrectomy and regional lymphadenectomy. Postoperative mortality varied in proportion to the extent of the tumor: 2.8% for intracapsular cancer, 6.4% for cancers invading perirenal fat, 9.4% for those extending into renal vein, 27.2% for those invading inferior vena cava, 17.4% for those with lymph node invasion and 17.6% for the metastatic tumors operated upon. Overall uncorrected survival was 63.5% at 5 years and 30.9% at 10 years, survival depending therefore on the developmental stage of the cancer. Intracapsular tumor: uncorrected survival at 5 years, 79.7% and at 10 years, 48.8%. For tumors invading perirenal fat without other dissemination: uncorrected survival at 5 years, 70.8% and at 10 years, 16.6%. Tumor extending into renal vein without caval or lymphatic invasion or metastases: uncorrected survival at 5 years, 56.2% and at 10 years, 30%, without any statistical difference from the 2 previous stages. Cancer with inferior vena cava invasion: 11 patients operated, 3 postoperative deaths, 4 metastatic recurrences between 11 and 40 months, and 4 survivors without metastases 6 to 55 months after operation. Cancer with lymphatic dissemination: no survivor in complete remission after 5 years. Cancer with bone or visceral metastases: uncorrected survival at 3 years, 8.3% (single peripheral metastasis irradiated). No operated patient with metastases survived for 5 years. A new classification is proposed: Stage I: intracapsular cancer more or less propagated into the renal vein. Stage II: cancer invading the perirenal fat with more or less propagation into renal vein. Stage III: propagation to the inferior vena cava excluding any lymphatic involvement.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
[Pseudotumoral cystitis].
Radio-endoscopic examination in a personal series of 27 patients was suggestive of a tumoral lesion not confirmed by histopathology. Etiology of the inflammatory process was not always clearly apparent, without the guarantee offered by examination of permanent sections of endoscopic or surgical specimens, the presence of a masked cancer remained a possibility: in exceptional cases an inappropriate total cystectomy had been performed.
Adult↗
[Renal scintigraphy under hyperdiuresis in upper urinary tract dilatations].
Emphasis is placed on the existence of two types of dilatation of the upper excretory tract: obstructive and non-obstructive lesions. Renal scintigraphy with technetium-labelled DTPA combined with a Lasilix test was performed in 34 patients (26 operated and 8 treated medically) with a total of 41 dilated renal units. Intra-operative exploration in the 17 reno-ureteral units assessed as being the site of obstruction on scintigraphy confirmed the lesion in the 14 cases of anomalies of the pyelo-ureteral junction and the 3 mega-ureters. For as long as the obstructed zone is not resected the dilated urinary tract fails to empty. In the other 12 units, the scintigraphy diagnosis of non-obstructive hypotony was confirmed by the operation and the subsequent course (notably in the 10 cases of reflux in the wide ureters reimplanted with a good result without resection of end of ureter).
Child↗
[Transurethral resection of prostatic adenoma. Complications and results].
A retrospective study of a homogeneous series of 100 patients who underwent transurethral prostatic resection showed that all ceased to have dysuria, though 6 out of 10 remained with frequency and compelling urge to urinate. Post-operative haemorrhage was not a major risk (1% of the cases) but the septic risk was not negligible (septicaemia 2%, bouts of high fever 8%, epididymitis 6%) despite pre-operative sterilization of the urine. Urethral stenosis developed in 5% of the cases and incontinence in 1 of the 100 patients. This series was conspicuous by the absence of mortality, and systematic anticoagulant therapy proved effective in preventing thromboembolic complications. The difficulties encountered in mastering this surgical technique are illustrated by the need for repeated endoscopic resection on account of a residual lobe in 2 cases. Transurethral prostatic resection therefore entails complications and risks and is not as benign as it would appear.
Aged↗
[Ultrasonic discovery of a latent thyroid adenocarcinoma associated with a parathyroid adenoma].
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Adenocarcinoma↗
Prostatic and membranous urethrorectal fistulas: a new technique of surgical closure.
We report on a quick, safe and simple procedure, the anterior perineal trans-anorectal approach, which was used successfully to treat 2 difficult cases of prostatorectal and membranous urethrorectal fistulas. This method was devised after a review of all techniques to treat these fistulas, which are known to be difficult. Our 2 cases, like others, demonstrate the harmlessness of anterior section of the anal sphincter, provided the sphincter is repaired correctly. This approach should be used in patients with urethroprostatorectal pathological conditions for whom a perineal access is contemplated.
Adult↗
[Cancers of the bladder: new therapeutic orientations].
Based on data obtained from a general review of treatment of infiltrating cancer of bladder, new therapeutic orientations are proposed in which chemotherapy occupies a privileged position as adjuvant treatment of surgical excision. Emphasis is placed on the frequency of bladder cancer and invasive tumors, as well as the high incidence of unsuccessful results due not to local recurrence but to metastases that do not respond to local and regional radiosurgical treatment. Objective results are obtained in approximately 50% of measurable metastases after combined Adriamycin and Cisplatin treatment. The efficacy of this chemotherapy suggests its prophylactic use to eradicate microscopic metastatic lesions remaining after local and regional therapy. If indications are well chosen, and not too heavy chemotherapy administered, then it is probable that as complementary treatment to surgical excision should improve efficacy of treatment of infiltrating cancer of bladder. The observation of necrosis of pulmonary metastases during chemotherapy provides justification for therapeutic orientation of this type.
Humans↗
[Vesico-ureteral reflux in adults. Apropos of 103 cases].
Case reports of 103 adult patients operated upon for vesicorenal reflux are reviewed. The majority of the patients (94%) were women, and clinical signs appeared initially after puberty in half of these, mainly as fever, abdominal pains and pyuria. Twelve of the 25 women known to have children had had serious septic accidents during pregnancy. Only 11% had two normal kidneys, 50% having bilateral and 39% unilateral kidney lesions. Of the total studied, 70% of kidneys had corticopapillary lesions, while 35% were smaller than normal. The average length of the submucous trajectory of a refluxing ureter was 3.5 mm, 95.5% of kidneys with corticopapillary lesions having a ureter ending in a short submucous trajectory (average: 3.7 mm). Of the 156 ureters operated upon by antireflux advancement, stenosis developed in 2 and residual reflux in 9, 7 of these latter corresponding to exclusively transvesical ureteral dissections. Global efficacy was 73% for this type of surgery, with 7.5% poor and 19.5% doubtful results. Conclusions drawn from this analysis were: the adverse effects of reflux during pregnancy (one out of 2 cases), the frequency of renal lesions in adults (35% of small kidneys and 70.4% of kidneys with corticopapillary lesions), the short submucous portion of these ureters--its length did not exceed that found in children with reflux--perhaps there had not been intramural ureteral growth, and the efficacy of the antireflux operation if a wide extravesical dissection is performed before the antireflux advancement procedure itself.
Adolescent↗
[Adjuvant chemotherapy of infiltrating bladder cancer. A feasibility trial].
From January 1981 until December 1983, 51 patients have been submitted to total cystectomy for infiltrative bladder cancer, stages B2 C and D1 of the Marshall classification. They have be proposed in a trial of feasibility with adjuvant chemotherapy using Adriamycin and Cis Platinum. 24 patients have been excluded, 17 because medical contraindications, 5 because they were foreigners, 3 because they refused the therapy. 27 patients have received the chemotherapy. In 5 patients the treatment has been interrupted before the completion of 6 cycles. The results show the feasibility of a trial with adjuvant chemotherapy. The theorical rationale and the methodology are discussed.
Adult↗
[Extracorporeal shockwave lithotripsy. Its application in pyelocaliceal and upper ureteral calculi].
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Adult↗
[Treatment aimed at a cure of a metastasized bladder cancer].
A bladder cancer with pulmonary metastasis is treated by chemotherapy (adriamycin-cis platinum) with a regression of pulmonary metastasis, then by cystectomy with enterocystoplasty, new courses of chemotherapy, then a pulmonary metastasectomy, histologically completely necrotic. Twenty four months after surgery the patient is recurrence free.
Cisplatin↗
[Cancer of the prostate: subcapsular orchiectomy].
More than 80% of prostatic cancers are detected at stage C or D., so that barely 10% are "curable". The positive effect of hormonal palliative treatment depends on the hormono-dependence of the tumor. Of all types of hormonal treatment, sub-albugineal castration remains one of the best. The authors report a series of 42 patients: 33 previously treated by hormones (estrogens or antiandrogens) and 9 never treated before. All were metastatic. Bone metastatic pain disappeared in 68% of the cases after castration. After failure of hormonal treatment castration relieved pain in 62% of the cases and controlled local tumoral spread in 56%. Hormone manipulation does not prolong the patients survival. Castration is as efficient as drugs and has no side effects. It should be undertaken when clinical discomfort or ureteral obstruction appears and not before. Hormonal drug therapy does not help when the effects of castration have worn off.
Aged↗
[Renal cancers with venous extension: surgical problems].
Renal cell carcinoma with a thrombus limited to the trunk of the renal vein is quite different from renal cell carcinoma extending into the inferior vena cava. In the first case, the operative mortality is low, and the five year survival rate is about 53%. In the second case, surgery is difficult and the mortality is high; the gravity is directly related to the level of tumour thrombus involvement in the inferior vena cava; the proportion of cases with metastatic dissemination at the time of surgery is higher; the two year survival rate is 38.5% only. However, the long term survival rate of patients without metastasis and alive after surgical management, is equal in the two groups, about 60%. The prognosis of surgical treatment of renal cell carcinoma with massive extension high in the inferior vena cava would be improved by the optimal patient selection (patients without metastasis) and by the use of cardio-vascular surgical procedures (CEC).
Carcinoma, Renal Cell↗