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J Guiter

Publications and source records attributed to J Guiter.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Coronary ischemia after kidney transplantation in patients over 60 years of age].

Many elderly patients (aged over 60) are waiting for renal allograft but are considered a risk population for myocardial infarction or sudden cardiac death. Between 1987 and January 1st, 1990, 22 elderly patients (16 men and 6 women; mean age 63.4 +/- 0.7 years; range 60-69 years) underwent cadaveric kidney transplantation. Twenty patients had been on haemodialysis for 4.8 +/- 1 years (range: 1-16.3), one had been on peritoneal dialysis for 5 years and one had developed chronic rejection of a previous cadaveric allograft. Among these 22 patients, 6 (27 percent) developed antibodies directed against the random lymphocyte panel and one had a second transplant. Cardiovascular risk factors were systematically estimated, including medical history, cervical arterial Doppler, echocardiography and stress thallium testing (STT). Coronary angiography was performed if there was evidence of myocardial ischaemia. STT did not show any coronary disease in 16 patients and was not maximal (less than 60 percent of maximal theoretical stress) in 4 patients. In 2 patients, STT showed myocardial ischaemia: one, with a history of angina, underwent coronary angiography and angioplasty; the other had silent ischaemia and refused coronary angiography. Two patients died of myocardial infarction. One of them was the patient with silent ischaemia and positive STT test. The patient with angioplasty had a successful transplantation 20 months later, without any cardiovascular complication. After 9 to 32 months of follow-up, 19 patients have functioning allografts (mean serum creatinine level 151 +/- 6 mumol/l). One patient lost his kidney from urinary fistula. Eight patients (36 percent) developed acute rejection and all responded to intravenous corticosteroids. No immunological transplant loss was observed. After 18 months, the graft actuarial survival rate was 85 percent. We conclude that elderly patients free of clinical or silent myocardial ischaemia are good transplant recipients. The cardiovascular risk could be prevented by using STT during the pretransplant screening. If the STT is not maximal or shows coronary ischaemia, coronary angiography is mandatory.

Actuarial Analysis↗
PubMed1991

[Urination control during sleep].

The authors present their approach to the sleep factor in children with enuresis, based on a still on-going exploration of manometric changes in bladder activity. Twenty patients have already been examined by cystomanometry in day time and polygraphic sleep recording at night, combined with continuous measurement of bladder pressure. This method derives from the studies of Gastaut and Broughton, in 1963, but takes into account the concept of bladder immaturity. The patients studied fell into two homogeneous groups, depending on whether enuresis was obviously due to bladder immaturity (Group I) or was strictly isolated (Group II). No disorder of sleep organization has been found in none of these two groups, but both had apparently nonspecific irritant factors. The enuresis episode is described. It tends to occur frequently at the beginning of the night, is prepared by an increase in bladder pressure which is always very pronounced in Group I subjects, and is associated with insufficient awakening reaction due to an apparently exceedingly high awakening threshold. The physiopathological and therapeutic implications of these findings are discussed.

Adolescent↗
PubMed1989

[Early surgery of obstructive uropathies discovered antenatally. First results apropos of 56 cases].

Between September 1984 and April 1988, 56 children underwent surgery for an obstructive uropathy discovered on antenatal ultrasound examination. These included 31 cases of stenosis of the pyelo-ureteral junction (PUJ), 9 cases of vesicorenal reflux, 6 mega-ureters (MU), 6 ureteroceles, 3 posterior urethral valves and 1 ectopic ureteral orifice. Major reflux (type III and IV) was included within the obstructive uropathy classification in that it opposes the normal pressure gradient which ensures progression of urine towards the bladder. The nature of the obstruction, morphological study of the kidneys and the renal function itself were very precisely studied and monitored (IVU, ultrasound, isotope tests, DTPA with frusemide and DMSA). In 46 children reconstructive and conservative surgery was possible. Analysis of the various groups of uropathy showed that: 1. Stenosis of the JPU had a very favorable or sometimes spectacular outcome both functionally and morphologically. 2. Cases of reflux showed excellent results, except in the presence of preexisting major renal dysplasia. 3. Mega-ureters had a less good prognosis. Renal growth depended above all on the degree of renal dysplasia which was often associated. 4. This was also true for sever forms of posterior urethral valves. A discussion follows which tries to reply to the following questions: 1. Why does early surgery for stenosis of the JPU give better results? 2. On the other hand, why is the same benefit not obtained in the other obstructive uropathies?

Female↗
PubMed1987

[Natural history of cancer of the prostate].

Based on a literature review, the natural history of cancer of prostate is analyzed stage by stage. Included in the study were only untreated patients or those in whom treatment had not affected the course of this neoplasm. Clinico-pathologic correlations, conversion rate of localized to metastatic forms and 5 and 10 year survival rates were determined for each stage. For stage A (25%) the criteria of size and tumoral grade should be analyzed relative to their incidence on the neoplastic course and patient survival rate. The problem of stage A1 prostate cancer in a young patient is analyzed. For stage B (25%) the determining factor for local extension and the presence of metastatic pelvic glands is the grade. Emphasis in stage C (20%) is placed on the importance of the distinction between penetration and extension through the capsule, on which the possible need for adjuvant radiotherapy is based. For stage D (30%) a more detailed analysis is made of the problems raised by elevated plasma acid phosphatases levels in the presence of a negative finding for extension of tumor and the significance of pelvic gland metastases.

Adenocarcinoma↗
PubMed1987

[Trans-intestinal cutaneous ureterostomy].

On the basis of a personal series of 243 cases of transintestinal cutaneous ureterostomy, including 216 cases following total cystectomy, the authors initially review the technical factors determining success, stressing in particular the quality of the uretero-intestinal anastomoses and the careful formation of the parietal tract and the cutaneous stoma. They then analyse their results, defining successively the operative mortality attributable to the diversion (reduced by 2% once the technique has been mastered) the early non-fatal complications (14.8% of intestinal obstructions, only requiring re-operation in 4.5% of cases; 11% of urinary fistula, most of which resolved spontaneously; 8% of faecal fistulae, requiring re-operation in 2/3 of cases; 3.7% of ischaemic necroses of the cutaneous stoma) and finally the late complications affecting the uretero-intestinal anastomoses (17% of stenoses, mostly unilateral), the intestinal graft (0.8% of calculi on non-absorbable sutures: 5.3% of stenoses of the cutaneous stoma; 6% of mucosal prolapses) and the equipment, which has made enormous progress in recent years. Renal function is only preserved when renal failure was not present pre-operatively. The authors conclude on the unquestionable value of transintestinal cutaneous ureterostomy as a high urinary diversion procedure, while recognising that it does not constitute either the ideal solution nor the exclusive solution, particularly after total cystectomy.

Colon, Sigmoid↗
PubMed1986

[Cancer of the prostate. Results and causes of failure after exclusive radiotherapy in 131 cases treated at in locoregional stage between 1972 and 1981].

A retrospective study was carried out to evaluate results of exclusively physical treatment by external radiotherapy of 131 cases of cancer of prostate treated between 1972 and 1981. Median follow up has been for 8 years in 19 cases (stage A), 61 cases (stage B) and 51 cases (stage C). Patients were treated exclusively by external irradiation after histopathologic diagnosis and assessment of possible extension of tumor. High energy photons were developed by a linear accelerator and irradiation carried out through four portals, two anteroposterior, two lateral, with precise guidance by rectal and bladder opacification. Irradiation delivered to a pelvic volume over 5 weeks was subsequently reduced to the prostate bed until a total dose of about 65 to 70 Gy has been given. Primary glandular chains received 60 to 65 Gy, and critical organs, bladder, rectum, small intestine a smaller dose of less than the tolerance levels for these organs. Clinical, biologic and scintiscan examinations were repeated every three months. Results are presented as actuarial survival, as survival without local recurrence and a detailed analysis of failure of treatment. The 8-year survival rate was 60% for stage A, 47% for stage B and 33% for stage C. Unsuccessful cases were evaluated in terms of isolated metastases, metastases associated with local recurrence and isolated local recurrence. The highest incidence of ineffectiveness of therapy was noted in patients with distant metastases (26%), the rate being higher (41%) in stage C cases than in stage B cases (19%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1986

[Nuclear magnetic resonance imaging in the urologic study of the male pelvis. Apropos of 60 examinations].

Theoretical concepts underlying the principle of nuclear magnetic resonance imaging are defined and the technical basis for its use in medical imaging described (sequences, accumulations, contrast media). Results are presented of a spectrometric study of 23 operative specimens from the bladder, prostate and seminal vesicles with analysis in vitro of relaxation time of the various tissues. Findings confirmed the value of NMR imaging for evaluation of macroscopic extension of tumors within the affected organs, as well as the interrelations of the organs, but the impossibility of identifying histologic structure of tumors and organs explored by this technique. Two groups of subjects were studied: a first group of 20 healthy volunteers to define NMR semeiology of male pelvis and a second group of 40 patients with mainly tumoral lesions of vesicles or prostate. Details are provided of the diagnostic value of NMR imaging with respect to the tumor, local and regional invasion and bone metastases. Excellent images of the tumor were obtained, with the possibility of determining its macroscopic stage, but its histologic nature could not be ascertained. Multiplane examination allowed better assessment of local and regional spread than by a CT scan, particularly for prostatic tumors (bladder, prostate bed or seminal vesicle extension). A negative feature of major importance exists, however, in that early glandular involvement is not detected by NMR imaging, which also fails to identify one case in two with bone metastases. Current research should allow progressive correction of present NMR imaging insufficiencies, notably in the field of tissue characterization.

Humans↗
PubMed1985

[Re-establishment of urinary continuity by uretero-ureterostomy in renal transplantation. Apropos of 135 cases].

Uretero-ureteral anastomosis was performed in 135 patients (40 women and 95 men) during kidney transplantation using either cadaver (120 cases) or living donor (15 cases) organs. The ureter of the retained kidney was linked proximal to the transplantation, whether or not there had been previous contemporary nephrectomy. Results were highly interesting: no mortality, no need to remove graft for urinary complications and no ureteral anastomotic stenosis. Urological complications were absent in 108 cases (80%) while 17 cases (12.6%) developed a urinary fistula, only 5 of which required surgical intervention Hematoma related to the nephrostomy occurred in 6 cases (4.4%) but operation was necessary in only 2 of these cases. Overall need for repeat surgery involved only 7 patients (5.2%) during the month following transplantation. One of 2 cases of hematoma operated upon required partial excision of the transplantation kidney due to the presence of an intraparenchymatous arteriovenous fistula. A curious finding was that of the 17 cases developing fistulae most of them had received live donor kidneys (5/15) whereas only 12 occurred in the 120 cadaver kidney transplants. Prevention of fistulae appears to be assisted by spatulation of the ureter rather than by its bevelled section, and the maintenance of a long ureteral loop to avoid traction. It is suggested that certain postoperative urine losses may be the result of a hyper-diuresis, without actual dehiscence of the anastomosis. In 4 patients with a urine output of more than 1.5 litres at the time of transplantation, the kidney proximal to the ureteral ligature became infected, and a second nephrectomy was necessary in 4 cases.

Adolescent↗
PubMed1985

[Adenocarcinoma of the kidney with invasion of the inferior vena cava. Apropos of 32 cases].

The authors present 32 cases of renal cell carcinoma with inferior vena cava involvement. Three sub-groups of patients can be distinguished on the basis of the level of this involvement: A (24 patients) with infra-hepatic involvement, B (6 patients) with retro-hepatic involvement and C (2 patients) with supra-hepatic involvement. The surgical tactics and results are analysed for each of these 3 sub-groups. The prognosis is relatively good in sub-group A, but is increasingly less favourable in groups B and C.

Aged↗
PubMed1982

[Course of primary nonoperated vesicorenal reflux in children. Apropos of 44 cases].

From a series of 600 cases of reflux seen over 12 years, the authors chose a group of 44 children aged between 3 and 11 who had not been operated for their reflux. The period of follow-up ranged from 1 to 10 years. Treatment consisted of massive antibiotic therapy for the severe episodes of infection and maintenance treatments for more than six months in a great many cases. For this group of 44 children with 60 refluxing ureters, the results were: --a disappearance of infection in 82% of cases, --a disappearance of the reflux in 70% of cases, even including type III reflux. 4 children were lost to follow-up, and 5 had to be operated secondarily. The authors reserve this trial of medical treatment to reflux in the small child, intermittent reflux, reflux with no or only minor involvement of the upper urinary tract on I.V.P. and finally, reflux which causes infections particularly sensitive to medical treatment in the presence of a cooperative family. With the aim of reducing the irradiation to a minimum, the authors performed follow-up urography with a single 15 min film every two years and annual isotope cystography. The authors discuss the possibilities of extending this medical approach for the future.

Anti-Infective Agents, Urinary↗
PubMed1981

[Urethral stenosis in the young girl, myth or reality? Comparison of clinical, radiological, instrumental and urodynamic data (author's transl)].

In 240 girls aged between three and fifteen years with mictional problems or urological infectious complications, 58 had radiological appearances of urethral stenosis. A complete clinical, urographic, urodynamic, endoscopic and instrumental study was performed in these 58 children. The majority of these young girls suffered from frequency with urgency, enuresis, pyuria and radiological and endoscopic appearances of trabeculated bladder. Thirteen showed signs of vesico-ureteric reflux. A basic fact: only two of the children had meatal stenosis. All the others had a urethral calibre larger than normal. Almost all the children had an unstable bladder, but with the exception of the two girls with a tight meatal stenosis, none had urodynamic data compatible with poor stream or vesico-sphincter dysinergism. The author concluded in the existence and the exceptional nature of true stenosis of the terminal urethra in the young girl. Most often, in the absence of true stenosis, there is nevertheless a functional stenosis related to contraction of the striate sphincter intended to overcome contraction of the unstable bladder. Such non-inhibited bladders are the site of marked disinhibition contractions without any element of outlet obstruction no increase in urethral resistance and no increase in micturation pressures. Disturbances of day and night continence are essential. Vesical trabeculations are a logical consequence, easy to understand, but the episodes of recurrent infection and the development of vesico-ureteric reflux (present in 13 of the girls) are rather more complicated to explain. This pathological state is most often reversible as the bladder matures. Nevertheless, bladder education, pharmacological treatment, dilatations and urethrotomy may help such children. Such treatment has given favourable results in 50% of cases.

Adolescent↗