Biomedical subjects

J D Doublet

Publications and source records attributed to J D Doublet.

27 records · Page 2Linked to original sources

PubMed1995

[Kidney surgery using lumbar endoscopy: initial experiences].

OBJECTIVES: To evaluate the feasibility, safety and clinical value of lumboscopy for the treatment of upper urinary tract diseases. METHODS: Six nephrectomies, one renal biopsy and one renal cystectomy were performed by retroperitoneoscopy (lumboscopy) in 7 patients. These cases represent the beginning of our experience. The operating time, incidence of intraoperative or postoperative complications and length of hospital stay were studied. RESULTS: The mean operating time was 134 min for nephrectomy, 180 min for cystectomy and 30 min for renal biopsy. No complications were observed. No conversion into laparotomy was required. The mean postoperative hospital stay was 3 days in the patients who were submitted to a single operation. CONCLUSION: Lumboscopy is a relatively easy, safe and reliable technique, and its use in urology warrants further study and development. Dissection of the retroperitoneal space with low pressure CO2 is possible and simplifies the procedure, without increasing the risks for the patient. The indications, especially for nephrectomy, are currently under evaluation.

Adult↗

PubMed1994

The loss of E-cadherin mRNA transcripts in rat prostatic tumors is accompanied by increased expression of mRNA transcripts encoding fibronectin and its receptor.

We compared the levels of mRNA transcripts encoding E-cadherin, N-cadherin, beta 1 integrin subunit, alpha 5 integrin subunit and fibronectin in the normal rat prostate gland, as well as in tumors derived from three invasive sublines (G, MatLyLu, AT-2) of the Dunning R-3227 rat prostatic adenocarcinoma. E-cadherin mRNA transcripts were only detectable in total RNA extracts prepared from normal rat prostates, whereas N-cadherin mRNA transcripts were only found in normal rat brains. In contrast, the mRNA transcripts encoding the beta 1 integrin subunit, alpha 5 integrin subunit and fibronectin were all elevated in the tumors, as compared to the levels of these transcripts in normal tissues. Our results suggest that there is an inverse correlation between cadherin and integrin mRNA levels in rat prostatic tumors.

Adenocarcinoma↗

PubMed1994

Laparoscopic pelvic lymph node dissection for staging of prostatic cancer.

Assessment of the pelvic lymph node status is a major concern in prostatic cancer staging. In spite of a normal abdominopelvic CT scan examination in patients with organ-confined disease, 7-30% will have lymph node metastases at pathological examination and will not benefit from radical prostatectomy. Laparoscopy enables pelvic lymph node dissection via a minimally invasive approach. Twenty-nine patients underwent laparoscopic pelvic lymph node dissection (LPLND) for prostatic cancer staging. The average duration of the bilateral dissection was 90 +/- 40 min (range 35-180 min). One patient died of a stroke on postoperative day 1, without local complication. The peroperative complications were 1 injury of the external iliac vein, 1 ileal injury, 1 ureteral injury, all 3 (11%) requiring immediate or delayed laparotomy. One patient had a self-resolving bilateral obturator nerve paresis. A previously irradiated patient had perineal lymphedema for 4 weeks. The average number of lymph nodes removed was 8.4 +/- 3.4 (range 4-17) for bilateral LPLND. Five patients had lymph node metastases. The median length of stay for patients undergoing LPLND as a single procedure was 2 days (range 2-11 days). After an operational period, during which the complication rate was relatively high, we now consider LPLND as a safe and effective procedure for the staging of patients with organ-confined prostatic cancer, but considering the increased risk of complications during the application period, we do not encourage the generalization of this technique which should remain restricted to some particular strategies, as in combination with perineal radical prostatectomy.

Aged↗

PubMed1994

[Urethro-vesical stenosis after radical prostatectomy].

Stricture of the urethrovesical anastomosis is an uncommon complication of radical prostatectomy, but it can affect the patient's quality of life. From January 1991 to December 1993, 50 patients underwent radical prostatectomy for clinically localised prostatic cancer (41 via a retropubic incision and 9 via a perineal incision). We retrospectively studied the influence of several factors on the incidence of anastomotic stricture: history of prostatic surgery, surgical incision, blood loss, pathological stage, presence of a contrast agent leak during follow-up urethrocystography, postoperative adjuvant treatment, oncological status at the time of the stricture. Seven patients developed clinically significant anastomotic stricture (14%). The time to onset was 1.5 to 10 months (median: 3 months). We were unable to demonstrate any pre-, intra- or postoperative or histological factors able to predict the development of anastomotic stricture. The transperineal approach appears to be associated with a lower incidence, but this finding must be confirmed in a larger series of patients. The seven patients with an anastomotic stricture were treated by endoscopic scalpel incision of the stricture, followed by insertion of a 22 F Foley catheter for 48 hours. No patient has developed a recurrent stricture with a mean follow-up of 8 months (0 to 13 months). Postoperative continence was normal in every case.

Aged↗

PubMed1994

[Radical prostatectomy: comparison of the perineal and retropubic route (40 patients). Preliminary results].

Transperineal radical prostatectomy, described at the beginning of the century for the treatment of prostatic cancer, is currently being reappraised following the development of surgical techniques allowing the dissection of subvenous external iliac nodes via a limited incision. Twenty four patients (group 1) underwent transperineal prostatectomy and 16 (group 2) underwent retropubic prostatectomy. The choice of surgical approach was left to the operator. We retrospectively compared the two groups. All patients had histologically proven prostatic cancer, clinically confined to the prostate. The operating time, the development of complications. the preoperative-postoperative haemoglobin difference, the number of patients transfused and the number of units transfused, urinary continence at three months and the histological results were studied. Three patients operated via the perineal approach and one patient operated via the retropubic approach suffered an operative rectal injury. The number of transfused patients (12.5% in group 1 and 37.5% in group 2) and the preoperative-postoperative haemoglobin difference for non-transfused patients (mean of 2.9 g/100 ml in group 1 vs 4.6 g/100 ml in group 2) were significantly different. No significant difference was observed between the two groups in terms of invasion of the prostatic capsule or seminal vesicles. Overall, only 106 out of 40 patients had a truly intraprostatic tumour, corresponding to understaging of the cancer in 60% of cases. Although the number of patients with imperfect continence was higher in group 1, the difference observed was not significant. The transperineal approach allows prostatectomy to be performed under similar oncological conditions to those of retropubic prostatectomy, while decreasing the operative blood loss.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

[The results of a 1993 AFU survey on laparoscopy in urology].

The development of laparoscopy in the field of urology has been considerable since 1991. In order to evaluate the use of this technique in the French urology community and the need to develop evaluating and teaching structures for this technique, a postal questionnaire was sent to 714 members of the Association Française d'Urologie (AFU) on June 23, 1993. The reply rate was 22% and 72 of the responders (46%) performed urological laparoscopy. A total of 684 laparoscopic urological procedures were reported, corresponding to an average of 9.5 procedures per operator. 45 operators had performed fewer than 16 laparoscopic procedures. The complication rate was 5% with a perioperative mortality of 0.3%. These figures should be considered to be minimal values. Eighty six responders (54%) did not perform laparoscopy. Forty seven of them (57%) were waiting for these techniques to demonstrate their practical value. Eighty two urologists thought that laparoscopic lymph node dissection had a role to play in the diagnostic and therapeutic strategy of prostatic cancer. One hundred and thirteen urologists (85%) considered that the development of urological laparoscopy would be moderate. Eighty nine urologists answer the question concerning possible training in these techniques and 77 of them intended to learn laparoscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗

PubMed1992

[Sub-venous iliac lymphatic dissection with celioscopy for the staging of prostatic cancer (16 patients)].

Subvenous external iliac lymph node dissection is an essential element for the staging of prostatic cancer. 7 to 30% of patients with intracapsular prostatic cancer have lymph node metastases despite normal imaging examinations. Laparoscopic surgery allows lymph node dissection through a limited incision. Sixteen patients underwent laparoscopic lymph node dissection (LLND) for prostatic cancer. The mean duration of the operation was 100 +/- 50 minutes (35-180 min: 130 minutes for the first nine operations, then 60 minutes for the last seven operations). One patient died on the second day from a cerebral vascular accident. There was one technical failure (pneumoperitoneum leak), one vascular injury, one ureteric injury, one transient paresis of the obturator nerves and one case of perineal lymphoedema. The mean number of lymph nodes removed in bilateral lymph node dissection was 7.5 +/- 2 (14-20) per patient. Three patients had lymph node metastases. The mean hospital stay related to laparoscopy was 4 +/- 2 days with a median of 2 days. Laparoscopic surgery, like any conventional or innovative surgical technique, requires specific training to become safe and effective. It allows complete histological examination of the lymph nodes removed and planning of prostatectomy, which may be subsequently performed through a perineal approach.

Abdomen↗

PubMed1987

[Polycystic renal dysplasia in children].

Ultrasonography has profoundly modified the diagnostic conditions of polycystic renal dysplasia in children. Non-palpable forms, which were previously most frequently missed, can now be detected during the antenatal period. In infants, ultrasonography generally provides a definite diagnosis, which can be confirmed by aspiration-opacification of the cysts. On the basis of a series of 40 cases and a review of the literature, the authors discuss the therapeutic implications of these new data. Surgery remains essential in cases of palpable polycystic renal dysplasia, especially when it is complicated. However, in the sub-clinical forms, as the risks of malignant degeneration and the incidence of post-operative complications are minimal in the one case and undefinable in the other, surgical excision is possible but not essential.

Child↗

PubMedDate not supplied

Retroperitoneal nephrectomy: comparison of laparoscopy with open surgery.

Retroperitoneal laparoscopic nephrectomy (RLN) is a relatively recent technique whose performance needs to be firmly established. The aim of this study was to compare the results of RLNs in 19 patients with retrospective results for 10 cases of open surgery. Ten of the RLN patients had transplanted kidneys. We used a slightly modified, already published technique with only three trocars that did not require balloon dilatation of the retroperitoneal space. It was successful in patients with and without transplants. The average operative times of RLN and open surgery were 115 and 110 minutes, respectively. In no instance did the laparoscopic procedure need to be converted to open surgery. There were no peri- or postoperative complications that could be related to the RLN technique. The average length of hospitalization after RLN was considerably shorter (3.8 days) than after open surgery (7.9 days). In conclusion, our experience shows that RLN is a safe, reproducible technique that reduces recovery time. It has become our first-line approach for simple nephrectomy, nephroureterectomy for ureteral tumors, and removal of the native kidney in transplant recipients.

Adolescent↗