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J Cukier

Publications and source records attributed to J Cukier.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Direct cutaneous ureterostomy: a new technic. Preliminary results].

A current problem in urology involves the search for a method of high urine bypass which combines simplicity of application with therapeutic efficacy. A new technique of direct cutaneous ureterostomy is described which is applicable to both narrow and dilated ureters, and which prevents stenosis without catheterization. The originality of the method resides in the association of two previously described artifices. The first is related to the parietal crossing and involves interlocking of the aponeuroses of the external oblique and transverse abdominal muscles with resulting displacement of the internal oblique muscle fibers outside of the parietal course of the ureter. The second artifice concerns the ureterocutaneous anastomosis, with the formation of a skin flap in V sutured to the terminal portion of the axially incised ureter, the point of the V being attached to the apex of the incision. Ureteral vascularization must be respected and a sufficient length of ureter used to ensure anastomosis without traction. An indwelling ureteral catheter is maintained for one month, followed by urographic and ultrasonographic surveillance at progressively increasing intervals. This operative procedure was used in 23 patients (21 men and 2 women), age 48 to 74 years, with bladder cancer necessitating total enlarged cystoprostatectomy. Bilateral cutaneous ureterostomy was performed in 19 cases, and the unilateral operation (single kidney) in 4 patients. Of the 41 ureters on which a bypass was performed, 31 were initially narrow and 10 dilated. Overall results for 41 ureters showed that 34 (82,9%) were permeable after 18 months, a catheter having to be maintained in 7 cases only (17,1%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Bladder wall urethroplasty in the treatment of urinary incontinence caused by congenital cervico-urethral malformations].

Twelve patients with urinary incontinence from congenital cervico-urethral malformations were treated by bladder wall urethroplasty. Operation was that of Leadbetter (16 times) or Tanagho (twice) type. Results were satisfactory in 5 patients, poor in the other 7 cases: 6 children required endoscopic resection of the neck malformation to improve bladder retention, but this failed to provoke deterioration of the acquired continence. The relevant literature is reviewed, the commonest techniques mentioned, and factors affecting results analyzed. Essential factors appear to be the state of the bladder, the contractility of the bladder tissue used for urethroplasty, and residual bladder capacity which depends on initial capacity. Final evaluation of efficacy of treatment requires long-term follow up, continence sometimes improving at puberty.

Adolescent↗
PubMed1984

[Mortality and morbidity after total cystectomy for cancer].

The authors review mortality and morbidity in 100 consecutive patients who during a six year period underwent total cystectomy for carcinoma of the bladder. The postoperative mortality was 15 (15%), essentially as a result of septic and respiratory complications. In relation to the type of diversion: 6 deaths in 46 cases of cutaneous ureterostomy, 4 deaths amongst 19 cases of trans-intestinal cutaneous ureterostomy, 3 deaths amongst 24 cases of uretero-colic implantation and 2 deaths amongst 11 cases of replacement enterocystoplasty . Amongst factors involved in the cause of postoperative mortality, three appeared to be of essential importance: a very high anaesthetic class (class IV), defective drainage of dissected areas, sources of deep abscesses , and use of the intestine in the method of completing total cystectomy. In the last 40 cases, the use of cutaneous ureterostomy in 82.5% of cases and careful attention to drainage of the operative site led to a reduction in mortality to 5% (2/40) whilst in the first 60 cystectomies of the series, 68.3% of which were completed by ureterocolic implantation, mortality was 21.7% (13/60). Early and late complications were also much more frequent in diversion procedures using the intestine than after direct cutaneous ureterostomy. But after replacement enterocystoplasty , late complications were virtually nonexistent. The authors indicate the following guidelines as conclusions: - in patients who accept a cutaneous implant, direct cutaneous ureterostomy is the best bypass procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Uselessness of systematic bone scintigraphy in the assessment of the spread of bladder cancer, before excision surgery].

The authors reviewed bone scans in 55 patients with carcinoma of the bladder. Only 3 patients had a pathological bone scan. In two, an ordinary X-ray of the spine (visible on IVP) showed the existence of bone metastases. Thus amongst the total of 55 cases, bone scan was of specific value only once (1,9%). The authors mention the frequency of bone metastases at autopsy (24 to 37%) and the superiority of bone scan over an ordinary radiological skeletal survey. In the literature, false negative results for bone scan do not exceed 5% whilst the false negative rate for ordinary X-ray is 19%. Despite this reliability, bone scan alone is of basic importance in only a small number of cases. The present series is in line with those in the literature. Thus, other than where there is a special indication, the authors no longer request a bone scan in the assessment of spread of carcinoma of the bladder.

Bone Neoplasms↗
PubMed1983

[Prognostic value of extraembryonic components in testicular dysgerminoma (seminoma excluded)].

In 32 cases of non-seminoma germinal tumours of the testis, correlations were established between the presence in situ of beta HCG and alpha foetoprotein, as demonstrated by the PAP immuno-peroxidase technique, the results of serum radioimmunological assays and the clinical course of the disease. It appeared that beta HCG-secreting mononucleate cells were present side by side with multinucleate syncytiotrophoblastic cells and that the immunohistological technique gave "earlier" results than the radioimmunological assays. The demonstration by this technique, in stage II dysgerminomas, of a cryptocellular trophoblastic carcinoma with beta HCG-secreting mononucleate cells indicates a highly malignant germinal tumour.

Chorionic Gonadotropin↗
PubMed1983

[Trophoblastic cryptocarcinoma with mononucleate cells, secreting beta chorionic gonadotropic hormones in seminoma. Prognostic value].

In 18 cases of seminoma of the testis correlations were established between beta HCG secretion, as demonstrated by the PAP immunoperoxidase technique, serum radioimmunological assays and clinical course of the disease. Mononucleate beta HCG-producing cells were found side by side with multinucleate syncytiotrophoblastic cells. This information was obtained earlier with the immunohistochemical technique than with radioimmunological assays. The immunoperoxidase technique makes it possible to detect mononucleate beta HCG-positive cell cryptocarcinomas which, when present in stage II seminomas, constitute a very dangerous dysgerminal tumour.

Adult↗
PubMed1983

[Modification of the expressivity of blood group antigens in urothelial bladder tumors. Prognostic value].

On the basis of 30 bladder tumours treated neither by radiotherapy nor chemotherapy, the authors undertook a study of changes in the expressivity of blood groups A and B in cases of urothelial bladder tumours. The study was carried out by indirect immunofluorescence by contact between the bladder tumour and immunoglobulins (human IgG anti-A and anti-B antibodies) and a polyvalent anti-immunoglobulin coupled with fluorescein. The conventional microscopy of these tumours uses a classification based upon that of the WHO (4 classes: I, II, III, IV) and 4 stages (0, A, B, C). The authors distinguish four types on the basis of the degree of the presence on tumour cell membranes of blood group antigens. Their findings were as follows: - the study of BGA in the epithelium near to the tumour is as important as the study of the tumour itself; - class II, stage 0 papillomatous bladder tumours retain BGA as well as in the surrounding urothelium; - carcinomatous tumours (class IV) lose in great part (type C) or completely (type D) their BGA. Tendency to recurrence or the immediate gravity of the tumour is all the greater when the expressivity of BGA is less in the surrounding epithelium; - in intermediate bladder tumours (class III), recurrences seem all the less frequent when the expressivity of BGA in the tumour and surface urothelium is better. Convinced as to the importance of this immunological study, the authors feel that it would be appropriate to continue these studies and extend labelling to H antigen and carcino-embryonic antigenic.

ABO Blood-Group System↗
PubMed1983

[Prognosis of venous and lymphatic invasion in cancers of the renal parenchyma treated with enlarged nephrectomy].

Fifty-three (22 p. 100) of 247 cases of renal parenchyma cancer seen between 1963 and 1978 were Robson's stage III cancers. Of the 211 patients treated by enlarged nephrectomy 18 (8.5 p. 100) had lymph node invasion, 35 venous extension without lymph node involvement, and 8 simultaneous spread into the large renal vessels or inferior vena cava and lymph nodes. Of the 10 patients N+ V0 operated upon, one died postoperatively and 7 from cancer, including 6 with a less than 5-year survival. There are only two survivors. Only one of the 8 patients with both lymph node and vein involvement operated upon is still alive. Ten (58.8 p. 100) of the 17 patients undergoing surgery with renal vein extension but no invasion of the inferior vena cava or lymph nodes, and truly exposed to a 5-year postoperative follow-up period, lived for 5 years and 9 of these are still alive. Invasion of the inferior vena cava in the absence of lymph node involvement (11 cases operated) produced no recurrence of the tumor in 5 patients after a prolonged follow-up period. These findings, together with those published in the literature, suggest the need for modifying Robson's classification.

Aged↗
PubMed1983

[Results of reconstructive surgery of renal artery stenosis in children].

The authors report their experience of 20 cases of renal artery stenosis in children, seen over the last ten years. The stenosis was latent in 8 of the 20 cases and was usually discovered during investigation for headaches or a complication of hypertension. The search for a renal cause involved the use of urography (which shows the classical signs of asymmetrical kidney size, delayed excretion, very sharp image, asymmetry on the fluid load test) (19 of the 20 cases) and arteriography which, in 5 cases, showed a bilateral lesion. Almost all of the anatomical lesions were situated in the arterial trunk (20 out of 25), 4 lesions were at the bifurcation of the trunk and only one lesion involved a branch. The most common lesions were dysplasia and hyperplasia of the arterial wall. These lesions were treated by aorto-renal by-pass grafting (without any synthetic prosthesis) in 8 cases, by direct re-implantation into the aorta in 5 cases, by spleno-renal anastomosis in 5 cases, by resection and anastomosis in 4 cases, by enlargement venous angioplasty in 1 case and by auto-transplantation in 1 case. The following results were obtained: 9 cures (45%), 3 moderate results (15%) and 8 failures (40%), including 7 cases of early thrombosis and 1 delayed stenosis. The cases treated by direct aorto-renal re-implantation or by resection and end-to-end anastomosis were always successful. The failures occurred in children operated by one of the other techniques of arterial repair. Surgery provided these authors with excellent or satisfactory results in 60% of cases.

Adolescent↗
PubMed1983

[Lymphography and lymph node excision in bladder cancer. Apropos of a series].

The authors reviewed a series of 100 consecutive total cystectomies for carcinoma of the bladder, 78 with bilateral pelvic lymph node dissection and 43 with preoperative lymphography, attempting to determine the reliability of lymphography, to quantify the risk of lymphadenectomy and to assess the usefulness of lymphadenectomy when the nodes are involved. Routine reading of lymphography was associated with a level of accuracy of 68.7% an error rate of 10.8% and a level of uncertainty of 20.5%. Evaluating the results by number of patients rather than by the number of sides opacified by lymphography, the score was even lower: accuracy 60.5%, error 13.2%, doubt 26.3%. Strictly reviewing those cases where all necessary information was present in the record, initial routine reading of lymphographies gave 58% accuracy, 14% error, and 28% doubtful. Retrospective reading by one radiologist only gave much better results, but these did not correspond with the results obtained in everyday routine work. The number of complications related to lymphadenectomy appeared slight: amongst 78 operations, one lymphocoele, two cases of prolonged lymphatic discharge and three cases of oedema of the lower limbs. Of 14 patients with involved nodes, only three are living without recurrence and with follow-up periods which are as yet too short. All patients with involvement extending above the common iliac bifurcation died within a short time, as did all those with prostatic involvement. Comparing the data from their own series and the literature, the authors came to the following conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

[Bladder accommodation disorders in children with posterior urethral valves].

On the basis of 8 special cases, the authors draw attention to the role of pathology of the bladder itself in the aetiogenesis of residual dilatations of the upper urinary tract after endoscopic treatment of posterior urethral valves. This pathology is dominated by impaired accommodation of the bladder with hypertonicity during filling. It is a second bladder disease, residual after section of the valve. The diagnosis may be made on the basis of two arguments: --narrowing of the upper tract when the bladder is kept permanently drained (in the absence of any vesico-ureteral reflux); --data from urodynamic examination (confirming the absence of any residual obstructive pathology in the cervico-urethral canal). The effects upon the upper urinary tract of this impaired vesical accommodation may be demonstrated by simultaneous urodynamic studies of the upper and lower urinary tract, but in practice urography findings (comparison between full bladder and empty bladder) and those of urodynamics are sufficient to make the diagnosis. It is thus possible to avoid an erroneous diagnosis of primary obstruction of the terminal ureter or of residual cervico-urethral obstructive pathology. This in turn avoids useless and dangerous ureterovesical reimplantations, endoscopic procedures involving the bladder neck or so-called residual valve tissue which no longer exists. Therapeutic approaches are reviewed. The respective roles of urinary bypass and of enterocystoplasty have not yet been clearly defined.

Adolescent↗
PubMed1983

[Obstructive posterior urethral valves. A series of 82 cases].

The authors report their experience gained from a series of 82 cases of severe posterior urethral valves with distension of the upper urinary tract. From analysis of their own series and from a study of the literature, they propose a therapeutic approach to these severe forms. Vesico-ureteral reflux was present in 45% of cases. Once the patency of the bladder neck and urethra was restored, 41% of these cases of reflux disappeared spontaneously and 25% persisted but were well tolerated. Only 13 ureters (29.5%) had to be re-implanted. The cases of ureteral distension without reflux had a similar favourable course after removal of the obstruction of the lower urinary tract. 57% of the dilated ureters resolved or were greatly improved and 11% persisted but were well tolerated. Simple treatment of the valves meant that ureterovesical re-implantation was avoided in 68% of cases. The overall results of uretero-vesical re-implantation were mediocre: out of 32 re-implanted ureters, there were only 15 successes (46.9%), 13 cases (40.6%) were unchanged and there were 4 failures (12.5%). The authors recommend the simple treatment of the posterior valves and suggest careful consideration of the indications for ureterovesical re-implantations in children with abnormal bladder and ureters proximal to the posterior urethral valves.

Adolescent↗
PubMed1983

[Role of radiotherapy in the treatment of bladder cancer. Comments apropos of 178 cases].

In the light of their experience involving 178 patients suffering from carcinoma of the bladder and a study of the literature, the authors attempt to determine the role of radiotherapy in the treatment of carcinoma of the bladder. A number of points emerge: --the possibility of stopping the progression of a recurrent multifocal superficial malignant tumour by 2 flashes of 6.5 Gy; --the efficacy of curative doses of radiotherapy associated with transurethral resection of the tumour in 20% of cases. These figures rise to 50% in anaplastic carcinomas. 20% efficacy of radiotherapy alone without surgery is a high figure. It tends to restore the radiotherapy sensitivity test suggested by R. Couvelaire to its true value; --when combined with excision surgery (partial cystectomy or total prostato-cystectomy), high doses of radiation do not give a better result than limited radiation. In view of the gravity of radiotherapy complications which may occur in up to 20% of cases where high doses of radiation have been administered, the authors would be inclined to limit radiotherapy when treatment of the tumour must be mixed, with surgery. A preoperative flash of 6.5 Gy followed by postoperative radiotherapy up to a total of 45 Gy when partial cystectomy is used. When a decision is made to perform cutaneous implantation of the ureters, the technique should consist of concentrated radiotherapy of 20 Gy in one week followed by excision by total prostato-cystectomy the next week. When urinary bypass is to involve uretero-colonic implantation or bladder replacement, flash radiotherapy of 6.5 Gy once or twice. No additional postoperative radiotherapy. Sandwich radiotherapy is too dangerous.

Aged↗