Biomedical subjects
Publications and source records attributed to J J Rambeaud.
Piezo-electric shock wave lithotripsy was successfully performed in 20 patients out of 25 presenting with distal ureteral stones. Echographic adjustment of the stone remains the very most important point of the technique. The treatment is non invasive, doesn't require any in-hospital stay and displays good tolerance.
Between 1985 and 1988, 156 organs were harvested using a multiorgan procurement technique (MPO) in the Urology Dept of Grenoble University Hospital (50 MOP). All the organs transplanted either in Grenoble or in other centers have been followed up after transplantation to try to appreciate their value and function. The surgical procedure is described, and results, organ by organ, are given. The conclusion is that the MOP technique is perfectly usable and reliable without jeopardizing any of the transplanted organs.
An 8-center, double-blind, placebo-controlled trial of 39 patients with benign prostatic hypertrophy was conducted to assess the effects of prazosin HCl treatment on functional urologic variables after a treatment period of 4 weeks. The randomized groups were comparable for demographic variables and symptoms, except for the mean residual urinary volume, which was significantly higher in the prazosin HCl group. Prazosin HCl elicited statistically significant improvements in the mean prostatic urethral pressure and prostate area (Mann-Whitney U test: p = 0.001 for both variables as compared with the placebo group). Functional bladder capacity also improved significantly in the group receiving the test drug (Mann-Whitney U test: p = 0.05, as compared with the placebo group). Clinical improvements were also observed in the mean maximum urinary flow, decreased nocturia frequency, and residual urinary volume. Patient preference significantly favored the prazosin HCl treatment (Mann-Whitney U test: p = 0.001). Seven patients on prazosin HCl and 5 receiving placebo reported one or more side effects during the trial phase; these were mild to moderate and disappeared or were tolerated. No statistically significant effects on blood pressure or heart rate were observed.
Three important models can be used in experimental carcinogenesis: Clonogenic assays which can be used to study tumor cells in vitro. This method is particularly useful in order to investigate biochemical markers and chromosomal spreads. Chemically-induced bladder tumors in various animals are used to analyse the mechanisms of induction and development of these cancers. The athymic mice have provided, over the last twenty years, an immunological system suitable for the heterotransplantation of human tumor tissues. These three experimental models, which are complementary, are reviewed and discussed.
We present here four cases of adult prostatic utricules, and discuss the endoscopic or surgical treatment. A brief embryological and clinical summary allows a better understanding of this malformation. Therapeutic indications are reviewed and transtrigonal approach is described. We think that this surgical procedure gives better results and less morbidity.
Precipitation of calcium oxalate was studied in a group of ten patients who underwent transurethral prostatectomy with glycine irrigation. Post operatively all patients showed hyperoxaluria; 60% with oxaluria higher than 10 times the critical concentration of calcium oxalate in urine. Other factors, known to favour crystallogenesis were modified during the same period: low urinary output, relative hypercalciuria and uraturia and hypomagnesuria. Thus, conditions for intraluminal precipitation of calcium oxalate were present post operatively. We suggest the use of a xanthine oxidase inhibitor to prevent hyperoxaluria.
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We report 2 cases of both functional and non functional paragangliomas. Emphasis is put on preoperative localization. CT along with echography is recommended as the initial radiographic procedure. If the tumor is not detected or in case of multiple tumors, a scintigram using MIBG is performed as a second still difficult to define. This feature is of importance in the long term follow up.
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Seventeen cases of anterior urethral injuries are presented. The authors define the management of these lesions: emergency IVP and suprapubic catheter drainage; after three to five days, retrograde and voiding urethrography and surgical repair: end to end anastomosis when the rupture is complete (8 cases with 7 good results, 1 fair result), in case of partial rupture, surgical repair should be preferred (2 cases with 2 good results); the other alternatives, urethral catheter (2 cases), or suprapubic catheter drainage with delayed treatment of stricture (3 cases), appeared to be less comfortable, contusions must be treated conservatively.
A retrospective study of 30 cases of rupture of the urethra treated over a period of 12 years showed that the membranous urethra was involved in 25 patients. Cases of partial rupture of the anterior urethra treated by transient urine bypass were excluded from the study. As a result of the only moderate results obtained before 1977, the following therapy was instituted for ruptures of the posterior urethra after that date: immediate insertion of a suprapubic bladder drain (percutaneous or surgical); visualization of bladder and urethra on the 5th day using the bladder catheter and retrograde urethrography; deferred emergency repair operation towards the 8th or 10th day for cases with a stable pelvis and absent vital lesions; delayed repair during the 3rd month for the other cases. Results were evaluated as good with respect to urethral permeability in 3 of the 6 cases of emergency repair, 10 of 12 patients receiving deferred emergency surgery and 11 of 12 cases of delayed operation. Only two cases of sexual impotency were noted among the last ten cases treated. The obvious procedure to be adopted whenever possible is therefore an end-to-end urethrography as a deferred emergency operation.
The authors present 3 cases where the diagnosis of ectopic insertion of the ureter, responsible for incontinence, had been missed: -- 2 cases of refluxing urethral insertions, including 1 case of single ureter, -- 1 case of vaginal ectopic ureter with duplicity. The authors stress that an ectopic insertion of the ureter can be asymptomatic until adulthood when it may present as simply as urinary stress incontinence. The diagnosis is suggested by a history of incontinence developing since childhood, accompanied by radiological signs of pyeloureteric duplicity or a small atrophic kidney. When the diagnosis is missed, successive surgical treatments are bound to fail, while excision of the renal segment drained by the ectopic ureter results in cure.
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40 tubal sterilisations have been carried out in 5 years. The indications most often are for grand parity. The anatomical criteria for effective sterilisation by the vaginal route should be sought by gynaecological examination under general anaesthetic. The date for the operation, the technique and its difficulties have been described. The operation lasted on an average 30 minutes. The average stay in hospital was 8.2 days. Only one local complication using this techinque was noted. On one occasion the authors had to abandon the vaginal route to reach the tubes. This simple procedure without any aesthetic inconvenience seems to them to be the ideal route for tubal sterilisation.
Thirty six hepatobiliary scintigraphies with 99mTc-Dimethyl IDA were performed in thirty patients with an hepaticojejunostomy one month to ten years after surgery. Twenty patients underwent surgery for biliary disease and ten for duodenal or pancreatic disease. In most cases (twenty three), the radionuclide study has been systematically performed to assess the scintigraphic pattern of a normal hepaticojejunostomy. In seven cases this pattern was abnormal. Four times the biliary enteric anastomosis was involved. Three times it showed an abnormal liver morphology. After an hepaticojejunostomy, hepatobiliary scintigraphy seems to be the only examination providing dynamic information for the biliary enteric anastomosis and the intestinal loop. But it sometimes is difficult to analyse in all cases, it must be the screening test in patients when symptoms occur after hepaticojejunostomy; but a percutaneous transhepatic cholangiogram cannot always be avoided.
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Nephrectomy of a non-functioning renal transplant after renal transplantation is a delicate operation which the authors evaluate on the basis of a retrospective analysis of 62 patients. A review of the literature helps to more clearly define the indications, optimal time of the operation and the operative technique. A subcapsular approach, by simplifying the operation, constitutes an important factor in reducing the operative morbidity in the late forms. "Early" transplantectomies are often more serious because of the recently operated patient's fragile status and immunosuppression, responsible for frequent infectious complications. Transplantectomy should therefore not be delayed once the permanent loss of transplant function has been confirmed.