Biomedical subjects

J F Hermieu

Publications and source records attributed to J F Hermieu.

At least 37 records · Page 2Linked to original sources

PubMed1996

Early detection of prostate cancer in men with prostatism and intermediate prostate-specific antigen levels.

OBJECTIVES: To determine the prevalence of prostate cancer and the diagnostic ability of prostate-specific antigen density (PSAD) in men with lower urinary tract symptoms and intermediate prostate-specific antigen (PSA) levels of 4 to 10 ng/mL (Hybritech assay) and to assess the clinical significance of prostate cancers in men who subsequently underwent radical prostatectomy. METHODS: Six systematic transrectal ultrasonography (TRUS)-guided biopsies were performed in 153 symptomatic men (mean age, 66 years) with PSA levels between 4 and 10 ng/mL, irrespective of digital rectal examination (DRE) findings. Prostate volume was also determined by TRUS and PSAD was calculated (serum PSA divided by volume of entire prostate). The rate of positive biopsies was compared with PSAD (more than 0.2 versus less than 0.2), DRE (positive versus negative), and patient's age (more than 70 years versus 61 to 70 versus 60 or less). Eligible patients with cancer underwent radical prostatectomy, and specimens were analyzed with regard to clinical significance of tumors. RESULTS: The overall cancer detection rate was 29.4%. PSAD and DRE, but not age, were both statistically significant in differentiating negative from positive biopsies. Independent of DRE findings, mean PSAD was significantly lower in biopsy-negative cases (0.29 +/- 0.17 and 0.25 +/- 0.16) than it was in positive cases (0.34 +/- 0.17 and 0.35 +/- 0.15). Half of the patients who underwent radical prostatectomy had pathologically nonorgan-confined disease (more than pT3), 34% had positive margins, and 47% had a Gleason score of 8 to 10. PSAD, DRE, and age could not predict outcome, probably owing to the small number of patients. However, the number of positive biopsies (1 or 2 versus 3 to 6) was able to predict pathologic stage. CONCLUSIONS: In men with lower urinary tract symptoms and intermediate PSA levels of 4 to 10 ng/mL, PSAD may be useful in the selection of patients for prostate biopsy. Carcinomas found using these criteria are of clinical importance.

Adult↗

PubMed1996

A single positive prostate biopsy in six does not predict a low-volume prostate tumour.

OBJECTIVE: To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)-guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen. PATIENTS AND METHODS: Of 158 patients submitted to RP for T1-T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extra-capsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with postoperative biological progression (P+), having a prostate-specific antigen (PSA) level > 0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively. RESULTS: The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with < 10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow-up of 22 months. CONCLUSION: A single positive needle-biopsy in six systematic TRUS-guided prostate biopsies is not predictive of low-volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.

Aged↗

PubMed1996

Advances in the assessment of clinically localized prostate cancer.

OBJECTIVE: We review the advances in pathology, biology, and radiology which could improve the detection of extracapsular prostate cancer preoperatively. METHOD: The experiences of others are compared to ours to give a topical overview of advances in the assessment of clinically localized prostate cancer. RESULTS: Despite new technologies, such as colour Doppler and endorectal magnetic resonance imaging, radiology does not enhance the ability to detect small invasion through the prostatic capsule. Biopsy features are one of the new fields of investigation. The number of positive sextant biopsies and the analysis of periprostatic spaces on biopsies appear to be major prognosis factors. In our experience, capsular perforation on biopsy is very powerful with respect to the proportion of positive biopsies ( > 66.7%) and serum PSA ( > 25 ng/ml, polyclonal assay) to predict biological progression after radical prostatectomy. The utility of the proportion of invaded tissue on biopsy is still debated. CONCLUSIONS: Despite technical improvements, the staging of clinically confined prostate cancer is still a major issue. The best hope comes from the study of biopsy features in addition to PSA.

Biopsy↗

PubMed1996

Prostate specimen reevaluation in patients with organ confined prostate cancer and postoperative biological recurrence.

PURPOSE: We evaluated whether detectable levels of prostate specific antigen after radical prostatectomy for stage P2 disease are associated with unconfined cancer overlooked at pathological examination. MATERIALS AND METHODS: Among 129 patients with stages T1 and T2 prostate cancer treated with radical prostatectomy 60 had stage P2 disease. The initial slides from the 7 patients with biological failure were carefully reviewed and, if necessary, the embedded blocks were sectioned every 2 mm. RESULTS: The disease was upstaged histologically from P2 to P3 in 6 of 7 patients by reinspecting the initial slides (3) and examining new slides (3). CONCLUSIONS: A postoperative detectable prostate specific antigen level in cases of stage P2 cancer reflects the presence of unconfined disease that may be overlooked by histopathological examination.

Aged↗

PubMed1996

[A single positive prostatic biopsy out of six systematic biopsies is not correlated with the intracapsular nature of the tumor on an individual level].

OBJECTIVE: To evaluate whether or not a single positive prostatic biopsy out of six systematic ultrasound-guided biopsies, is reliably correlated manner with favourable histopathological features of the tumour on the radical prostatectomy (RP) specimen. MATERIALS AND METHODS: In a series of 158 patients undergoing RP for clinically localized prostatic cancer, 15.2% had only one positive biopsy out of 6 systematic biopsies. We compared the rates of capsular effraction (C+) and positive resection margins (RM+), assessed on the operative specimen, in this group of patients with a single positive biopsy (group 1) and in the group (group 2) diagnosed by more than one positive biopsy. The postoperative biological progression rate (P+), defined as an immediate or secondary postoperative elevation of PSA beyond 0.1 ng/ml by polyclonal assay, was also evaluated in the two groups. The Gleason score was evaluated and compared on biopsies and on RP specimens. RESULTS: 29.2 of cases were C+, 16.7% were RM+ and 26% were P+ in group 1, versus 70%, 46.5% and 49.5%, respectively, in group 2. All differences were statistically significant. All patients in group 1 with less than 10% of prostatic tissue invaded on the positive biopsy had stage P2, while all patients with 100% of the length of the biopsy invaded by tumour had stage P3. The Gleason score was accurately predicted by the positive biopsy in 39% of cases and was underestimated in 39% of cases. CONCLUSION: A single positive prostatic biopsy out of six systematic biopsies is a useful predictive factor of local extension, but, in the individual patient, does not guarantee favourable histopathological characteristics of the tumour, nor a favourable course of the disease.

Aged↗

PubMed1996

Micturition disturbances and human immunodeficiency virus infection.

PURPOSE: Human immunodeficiency virus (HIV) infections often lead to urological disorders, including tumors, infections and micturitional disturbances. It often is difficult to identify the origin of voiding disorders but the most frequent causes are infections (prostatitis and so forth), obstruction (cervico-prostatic or urethral) and neurological (encephalitis, myelitis, polyradiculoneuritis and so forth). We determined the etiologies, therapy and clinical outcome of micturitional disturbances in the acquired immunodeficiency syndrome. MATERIALS AND METHODS: Between February 1989 and September 1992 we studied prospectively 39 HIV positive patients with voiding symptoms, such as straining, urinary retention, frequency and urgency. Each patient underwent a thorough neurological and urological examination, along with radiological evaluation of the urogenital tract and nervous system. Urodynamic evaluation was performed to specify the etiology and type of disturbance before treatment. The patients were followed for 2 to 24 months (mean 9) and 34 (87%) had urodynamic abnormalities, including a hyperactive bladder, bladder sphincter dyssynergia and a hypoactive bladder. RESULTS: The cause of the voiding disorder was neurological in 61.5% of the cases, and the 2 most frequent disorders were cerebral toxoplasmosis and HIV encephalitis. Treatment was usually given to relieve symptoms with drugs acting on the detrusor-sphincter complex. A total of 22 patients (57%) had lasting improvement, while 17 (43%) died 2 to 24 months (mean 8) after onset of the voiding symptoms. CONCLUSIONS: A micturition problem is an unfavorable event since it usually indicates a neurological cause.

Acquired Immunodeficiency Syndrome↗

PubMed1996

[Does the proportion of tumor tissue in biopsies reflect the extent of localized prostate cancer?].

OBJECTIVES: To evaluate whether the percentage of biopsy tissue invaded by tumour provides any supplementary information to laboratory and/or biopsy data (Gleason, number...) in the preoperative staging of patients with localized prostatic cancer (T1-T2). MATERIALS AND METHODS: 170 patients with a mean age of 65.05 +/- 6.12 years and a mean PSA of 22.5 +/- 21.4 ng/mL were submitted to radical prostatectomy (RP) for T1-T2 prostatic cancer. 110 patients were submitted to a series of 6 transrectal prostatic biopsies to establish the diagnosis. We evaluated the percentage of biopsy tissue invaded. This parameter, as well as the Gleason score and the preoperative PSA, were studied in comparison with pathological criteria of the operative specimen (capsule status, resection margins) and postoperative PSA. RESULTS: The cut-off value of 10% of invaded biopsy tissue was calculated as being the most discriminant for the prediction of resection margins, capsule status and progression of laboratory parameters. When less than 10% of biopsy tissue was invaded, there were 31.2% positive margins (RM+). 28% of invaded capsules (pT3), and 21.7% of laboratory progression (P+) versus 44.1%, 71.4% and 47%, respectively, when more than 10% of tissue was invaded. The Gleason score of the biopsy did not improve this prognostic evaluation. The mean quantities of invaded biopsy tissue were statistically different between pT3 and pT2, RM+ and RM-and P+ and P-. When only one positive biopsy was invaded by less than 10%, 87.5% of these operated patients remained stable, RM- and pT2. CONCLUSIONS: On an individual level, the percentage of invaded tissue does not reflect the degree of extension or progression of localized prostatic cancer. Only a single positive biopsy invaded over less than 10% of its length is statistically correlated with a good prognosis.

Adult↗

PubMed1996

[Problems raised by representation of activities in urology. Cooperative study by the urology services of the AP - HP (Public Services - Paris Hospitals)].

Paris public hospital urology departments conducted a study which had three objectives: - to test the indicators of activity to determine whether they were well adapted to measurement of the surgical activity performed, - to determine the contribution of the PMSI to the measurement of this activity, - to propose actions designed to improve the representation of the surgical activity actually performed by urology departments. The results of this study show that one half of the operations performed do not correspond to the field of PMSI (day-only admissions, outpatients department). The indicators currently used for budget allocation or interdepartment comparisons of activity are inadequate and, most importantly, induce deformities, variable from one department to another, which severely affect the image of the activity produced by these indicators. Two main reasons can explain these deformities: - the use of the NGAP and the score to measure activity: there is a marked variation of the score for the same operation, from one department to another. - the very poor census of activity performed in outpatient surgery. These two reasons are not related to the medical activity. Definition of a unique nomenclature for surgical procedures would constitute a great progress, provided that this nomenclature allows us to accurately describe our activity and can be modified according to our needs. Although the PMSI is a marked improvement of the information system, its application, in its current state, will not radically change the situation. The PMSI must be enlarged in one way or another, to outpatient activity including procedures performed in the outpatients department. For these measuring tools of activity, which determine the calculation of our budgets, to be adapted to our practice, we must be able to analyse their relevance and introduce changes. We need to develop this field of medico-economic research in urology.

Paris↗

PubMed1996

[Post-treatment PSA, indicator of radical treatment effectiveness of localized cancer of the prostate].

Prostate specific antigen (PSA) has become essential to the follow-up of radical treatment for T1-T2 tumours. Various assays are available, but require a correlation coefficient to homogenize their results. PSA is probably the most reliable marker for the follow-up of radical prostatectomy (RP), as this operation should make PSA undetectable after 3 weeks. Highly sensitive tests, with a limit of detection of 0.1 ng/ml, allow the earlier laboratory detection of tumour escape (20 to 45%). Anastomotic biopsies are positive in 35 to 50% of cases. Seminal vesicle invasion and positive resection margins are more frequently associated with recurrence. The doubling time and rate of progression of PSA after RP can be used to distinguish local recurrence from metastasis. Urinary PSA is not useful in the follow-up of RP, as it is secreted by the periurethral glands. The use of the PSA after radical radiotherapy is less clearly established, as this treatment is not designed to eliminate all prostatic tissue or render PSA undetectable. Therapeutic efficacy is situated between 1 and 1.5 ng/ml according to the tests and is achieved in approximately 40% of cases after 4 years. A PSA level greater than 3 ng/ml at 3 months is indicative of a poor prognosis. Prospects for the future include the use of highly sensitive assays and reverse transcriptase polymerase chain reaction (RT-PCR) to detect circulating prostatic cells. The use of PSA has led to a re-evaluation of the efficacy of radical treatments and could influence the indications for adjuvant treatments.

Forecasting↗

PubMed1995

[Urination disorders in HIV infected patients].

OBJECTIVES: Manifestations of urological involvement, including tumour development, infection and impaired micturition are frequent in patients with acquired immunodeficiency syndrome. The frequency and consequences of dysuria itself are difficult to evaluate due to the concomitant effects of underlying infections, obstructive or neurological pathologies. METHODS: Thirty-nine HIV-positive patients presenting impaired micturition including isolated dysuria, urine retention pollakiuria or urge incontinence were followed prospectively from February 1989 to September 1992. Each patient underwent a complete neurological and urological examination. Imaging included CT-scan or magnetic resonance imaging of the brain or spinal cord, echography of the bladder and prostate, intravenous pyelography or ascending and micturition urethrocystography as required. Urinary function tests were used to determine the cause and exact type of impairment to establish therapeutic protocols. RESULTS: A neurological origin was found in 61.5% of the cases. Cerebral toxoplasmosis and HIV encephalitis were the most commonly found causes. Symptomatic relief was obtained in most patients with bladder- sphincter active drugs. After a mean follow-up of 9 months (range 2-24 months), long-term improvement was achieved in 57.9%. Seventeen patients (44%) died within a delay of 2 to 24 months (mean 8 months) after onset of dysuria. CONCLUSION: Signs of impaired micturition are frequently encountered in HIV-infected patients. A full work-up is needed for diagnosis and treatment adaptation. Neurological disease is the most frequent underlying cause and would appear to be a sign of poor prognosis.

AIDS-Related Opportunistic Infections↗

PubMed1995

[Priapism in the adult: report of 15 cases].

OBJECTIVES: The practical approach to the treatment of priapism is complicated by the rarity of this disease. Treatments for impotence by intracavernous injection of vasodilators have considerably increased the incidence of prolonged erections, although "antidote" protocols, when instituted rapidly, ensure detumescence in most cases. The objective of this study was to define a practical and rigorous approach based on comparison of our results with those reported in the literature concerning the management of priapism. METHODS: This series consists of fifteen consecutive cases observed in adults over a ten-year period. The pathophysiology and aetiologies are recalled. The authors evaluate the percentage of detumescence after primary treatment and after retreatment and discuss the incidence of secondary impotence. This information is compared with the data of the literature in order to define a practical approach. RESULTS: After a trial intracavernous injection of vasoconstrictors, creation of a cavernospongiosa fistula provided the best results with a 60% detumescence rate after primary treatment and 80% after retreatment. All treatments combined, 53.3% of good results were obtained after primary treatment and 66.7% after retreatment. In the long-term, 50% of patients with a sufficient follow-up are impotent. CONCLUSIONS: As a result of systematic surveillance of patients treated by an intracavernous injection protocol, the number of priapisms induced in our institution has remained stable over recent years. Patients treated for priapism within 36 hours have a better short-term and long-term prognosis.

Adult↗

PubMed1994

[Endoscopic retropubic colpopexy for stress urinary incontinence in women (Stamey's operation). 55 cases].

Fifty five women with a mean age of 59 years, suffering from urinary stress incontinence (U.S.I.), were treated by endoscopic percutaneous cervicocystopexy (Stamey's operation), 39 patients (71%) suffered from pure U.S.I. and 16 (29%) presented a combination of stress and urge incontinence. Bonney's manoeuvre was positive in every case. With a mean follow-up of 21.5 months, 30 patients (58.8%) were completely continent, 9 (17.6%) presented occasional incontinence with intense effort, 12 (23.5%) were failures and 4 patients were lost to follow-up. The complications were minimal. The results were less favourable in patients with a history of pelvic surgery, particularly for correction of U.S.I., associated urge incontinence, detrusor hyperactivity or low urethral closure pressure, although one half of the patients in this group were nevertheless cured. Stamey's operation is a simple, reliable, easily reproducible technique which gives good results at the cost of low morbidity, short hospital stay and a low cost.

Adult↗

PubMed1993

[Sub-urethral diverticulum in women. Apropos of 6 cases].

Six female patients with a mean age of 40 years presenting with a suburethral diverticulum were treated between August 1990 and October 1992. The commonest functional symptoms were recurrent urinary tract infections (2/3 of cases) and post-voiding urethral discharge (1/2 of cases). Clinical examination revealed a tender anterior vaginal mass in only one half of cases. Only retrograde and voiding cystourethrography and transvaginal ultrasonography always demonstrated a direct or indirect image of the diverticulum. The suburethral diverticulum was resected via a transvaginal approach in the ventral supine position after sterilisation of the urine by prolonged antibiotic therapy. Urine drainage was generally ensured by a suprapubic catheter allowing antegrade cystography on the 15th day, prior to clamping then removal of the catheter. All but one of the patients immediately regained satisfactory micturition without dysuria or stress incontinence. Restoration of micturition was delayed in one patient with feelings of incomplete bladder emptying, but she urinated normally at three months. Postoperative imaging (retrograde and voiding cystourethrography, transvaginal ultrasonography) demonstrated resolution of the diverticulum in 5 cases. One patient had persistent signs of a small, residual diverticulum on antegrade cystography on the 15th day. Suburethral diverticulum is a rare disease of middle-aged women for which transvaginal surgical excision in the ventral supine position gives very good results.

Adult↗

PubMed1993

[Urinary lithiasis and pregnancy].

The incidence of renal stones in pregnant women is 1 in 1500. The diagnosis may be made more difficult by the particular anatomo-physiological conditions of pregnancy. Ultrasonography is not always sufficient to localise the stone and can be completed by intravenous urography, which is not contraindicated in pregnant women. In more than one half of cases, the stones are eliminated spontaneously during conservative treatment. The urologist may need to intervene in the case of complicated stones: internal or external urinary diversion is generally sufficient to palliate the problem until term. As extracorporeal lithotripsy is contraindicated in pregnant women, some authors recommend ureteroscopy or percutaneous nephrolithotomy when radical treatment is required. Surgical treatment is very rarely indicated.

Cystoscopy↗

PubMed1991

["Clam" enteroplasty in the treatment of unstable or low compliance bladders].

The treatment of urinary incontinence due to unstable bladder remains difficult. In the case of failure of medical or physiotherapeutic treatments, clam enterocystoplasty represents a major and important therapeutic possibility. The operation consists of frontal section of the bladder to form a bivalve followed by interposition, between the two valves, of a detubed ileal graft in order to increase the functional vesical capacity and to interrupt the transmission of detrusor contraction waves from one valve to the other. 10 patients (7 men and 3 women) suffering from urinary incontinence due to neurogenic unstable bladder (4 cases: 3 meningoceles, 1 operated cauda equina neuroma) or to another cause (6 cases, including one sequela of radiotherapy for prostatic cancer and 5 cases of apparently primary urinary incontinence) underwent enterocystoplasty combined, in the case of neurogenic incontinence (2 cases simultaneously and 2 cases previously), with the insertion of an AMS 800 sphincter. No major complication was observed. 9 patients are continent and 1 had to be reoperated to undergo an augmentation enterocystoplasty (failure of the initial operation due to radiation changes of the bladder), 3 retain a post-voiding residual of about 200 ml but not requiring self catheterisation due to the absence of any repercussions on the upper urinary tract. Lastly, urodynamic studies demonstrated a spectacular increase in compliance and functional capacity of the bladder together with a reduction of the amplitude of intravesical pressure peaks.

Adolescent↗

PubMed1991

[Treatment of male urinary incontinence with the AMS 800 sphincter prosthesis: 45 cases].

Urinary incontinence due to sphincter incompetence constitutes a major source of disability. The AMS 800 artificial urinary sphincter allows durable restoration of satisfactory continence in patients who are often unresponsive to any other forms of treatment. 45 men underwent implantation of a peribulbar urethral (40) or pericervical (5) artificial sphincter over a 5-year period. Incontinence was secondary to prostatic surgery in the majority of cases (33). The technique, which is now well defined, consisted of urinary drainage via a bladder catheter for 8 days and activation of the sphincter after 1 month. The mean follow-up is 30 months. 36 (80%) of the patients are continent, including 27 (60%) without revision and 9 (20%) underwent unsuccessful revision resulting in partial or complete removal or permanent inactivation of the prosthesis (sepsis, urethral erosion, defective prosthesis). Strict patient selection, a rigorous implantation technique and standardised management of any incidents are key elements in the success of this procedure.

Adolescent↗

PubMed1989

[Colonic cancer. Indications and results apropos of a continuous series of 223 patients].

The authors report a retrospective study of 223 surgical colonic carcinoma (1978-1987), the rectal carcinoma left out of them because of disparity in technical aspects. The total post-operative mortality rate was 9.4 per cent, made of great mortality in emergency (31 per cent) and in palliative surgery (17 per cent). Out of emergency, the mortality of curative surgery is 3.7 per cent. Surgical procedure was mechanical in 96 per cent with incidence of leakage in 3.9 per cent. The total survival rate is 53 per cent after 5 year follow-up, 70 per cent after curative surgery and 89 per cent for the first level (A) in DUKE'S classification. There is only a problem for the choice in size of resection for the sigmoid side (50 per cent of the cases). Contrary to recent studies, in our experience the post-operative mortality rate and survival rate are different with sigmoidectomy or left colectomy. Then the authors think that every model of resection has to be choice according age of patient and classification of carcinoma.

Adenocarcinoma↗

PubMed1989

[A pre-wirsungal portal vein. Apropos of a case].

Portal vein anomalies are rare. One of the more frequent is pre-duodenal portal vein (50 cases). The case report is describing a pre-pancreatic but retroduodenal portal vein discovered in an operation for chronic pancreatitis. No case report has been found in the literature. This paper presents embryological discussion and surgical consequences in pancreatic surgery.

Humans↗