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J M Ferriere

Publications and source records attributed to J M Ferriere.

At least 19 recordsLinked to original sources
PubMed2006

[Role of embolization in renal angiomyolipomas].

OBJECTIVE: The purpose of this study is to present the role of embolization in the treatment of renal angiomyolipoma (AML) in cases of hemorrhage and to prevent bleeding. METHODS: Over a period of 10 years, 35 AMLs in 34 patients, recruited in two medical centers, were treated with embolization: 16/35 AML were treated urgently to stop bleeding, and 19/35 AML had preventive embolization. Six patients were completely asymptomatic and 13 had a history of previous hematoma or flank pain. Catheterization was highly selective in all cases (coaxial microcatheter in 19 cases), and for embolization we used nonresorbable microparticles, coils, and alcohol. RESULTS: When patients presented with acute bleeding, embolization was efficient in 80% of cases; another embolization was necessary in two cases, and surgery in two others. In six of these cases, surgery was planned and done at a later date. When treatment was preventive, one embolization was necessary in 17 cases, and two embolizations per case were necessary in the other two. Over a period of 18 months of follow-up, we observed a 28% decrease in tumor volume; four patients were treated by surgery at a later date. CONCLUSION: Embolization is the technique of choice to treat a bleeding AML urgently. When preventive treatment is considered, in symptomatic or asymptomatic AML, embolization can be an alternative for surgery, but more data is needed to specify its proper place in the management of these tumors.

Adult↗
PubMed2001

Biochemical screening for subclinical cortisol-secreting adenomas amongst adrenal incidentalomas.

OBJECTIVE: Biochemistry and I-6beta-iodomethyl norcholesterol scintigraphy (IMS) have both been used to assess cortisol secretion by adrenocortical incidentalomas. However, which biochemical abnormalities indicate subclinical corticoid excess is still debatable whilst IMS is expensive and cumbersome. The aim of the study was to evaluate prospectively patients with adrenal incidentalomas using both IMS and biochemical methods to examine whether the IMS pattern is associated with biochemical abnormalities and, if this is so, to find a biochemical parameter that could be used as a screening test to identify a subset of patients on whom IMS could subsequently be performed. METHODS: Thirty-one patients with benign cortical adenomas were recruited from 43 consecutive patients with adrenal incidentalomas. All 31 patients underwent IMS and measurement of (i) 0800 h serum cortisol, ACTH, dehydroepiandrosterone and 17-hydroxyprogesterone; (ii) midnight serum cortisol; (iii) 2400 h excretion of urinary free cortisol; (iv) cortisol after the overnight 1 mg dexamethasone (DEX) suppression test; (v) cortisol after an i.v. 4 mg DEX test; (vi) determination of the diurnal variation in serum cortisol. RESULTS: Sixty-one per cent of patients displayed unilateral uptake during IMS and 39% showed bilateral uptake. Patients with unilateral uptake exhibited significantly lower ACTH concentrations (P=0.0005), higher midnight cortisol concentrations (P=0.02), disrupted diurnal variation of serum cortisol (P=0.02) and higher cortisol concentrations after DEX suppression tests (P=0.01). Cortisol concentrations following the two DEX suppression tests correlated closely (r=0.80, P=0.0001). The i.v. 4 mg DEX test was clearly more sensitive for the diagnosis of unilateral uptake than the overnight 1 mg DEX test (76 vs 52%). Using various thresholds of cortisol concentration following the overnight 1 mg DEX test, it was found that the sensitivity of the test could be improved to 100% if the threshold was set at 60 nmol/l rather than the classical value of 138 nmol/l. All patients but one with post-test serum cortisol concentrations above 60 nmol/l as against none of patients with cortisol below 60 nmol/l exhibited at least one associated biochemical abnormality indicating subclinical glucocorticoid excess. CONCLUSION: In adrenocortical incidentalomas, unilateral uptake during IMS suggests subclinically excessive and/or autonomous cortisol secretion. A cortisol concentration above 60 nmol/l following the overnight 1 mg DEX test is highly correlated with unilateral uptake and is associated with biochemical abnormalities indicating subclinical glucocorticoid excess. Our results favour the use of the 1 mg overnight DEX test with revised criteria of interpretation as a screening test for subclinical hypercortisolism among patients with adrenocortical incidentalomas.

Adenoma↗
PubMed2000

Analytical and prospective evaluation of urinary cytokeratin 19 fragment in bladder cancer.

PURPOSE: We evaluated CYFRA 21-1, an immunoradiometric assay, developed to detect soluble cytokaratin 19 fragment, for its diagnostic performance in bladder transitional cell carcinoma as well as its analytical performance. MATERIALS AND METHODS: We assessed CYFRA 21-1 in the serum and urine of 182 patients, including 66 with bladder transitional cell carcinoma (group 1), 66 with another urological pathology (group 2) and 50 free of urothelial disease (group 3). The power of urinary CYFRA as a diagnostic test for bladder transitional cell carcinoma was evaluated by receiver operating characteristics curve analysis. Analytical performance was assessed by determining intra-assay and interassay precision, and accuracy by dilution testing and recovery of supplemented analyte. RESULTS: Mean urinary CYFRA plus or minus standard deviation was 154.39+/-49.00, 22.6+/-8.9 and 2.40+/-0.14 ng./ml. in groups 1 to 3, respectively (significantly different). Receiver operating characteristics curve analysis revealed optimal 96.9% sensitivity and 67.2% specificity for a threshold value of 4 ng./ml. Analytical determination showed that intra-assay and interassay precision provides a satisfactory coefficient of variation. The assay for accuracy had acceptable recovery in diluted samples as well as in those with supplemented analyte. CONCLUSIONS: The urinary immunoradiometric CYFRA 21-1 assay performs well analytically. Urinary CYFRA 21-1 is a useful marker for diagnosing transitional cell carcinoma and provides sensitivity in low grade disease.

Aged↗
PubMed1999

Renal angiomyolipoma: a clinicopathologic, immunohistochemical, and follow-up study of 46 cases.

We reviewed 46 cases of renal angiomyolipoma covering the period from 1977 to 1997. Eight cases were associated with tuberous sclerosis and one with lymphangiomyomatosis. Histologically, the lesions were most often classic with the three usual components, i.e., mature adipose tissue, thick-walled blood vessels, and smooth muscle. Seven cases were particularly misleading: three cases were entirely adipose mimicking liposarcoma: two cases had an exclusively smooth-muscle component, one mimicking lymphangiomyomatosis and one with epithelioid cells; another case had a monophasic epithelioid pleomorphic component ("REON": renal epithelioid oxyphilic neoplasm) and proved to be fatal; and another case was associated with collecting duct carcinoma. The immunohistochemical profile showed the coexpression of alpha-smooth-muscle actin and HMB45. Our study is the first to show positivity of estrogen and progesteron receptors or both in more than 25% of cases. Of 35 cases with follow-up information, only one patient died of malignant spread of angiomyolipoma.

Actins↗
PubMed1999

[Gynecomastia].

Gynaecomastia is the least rare manifestation of the male breast disease. Urologists must therefore be able to distinguish the various forms of gynaecomastia, eliminate a testicular tumour and identify the main causes by performing a simple but complete assessment. Medical treatment is fairly disappointing. Surgical treatment is required in patients presenting with complications or when persistent gynaecomastia is aesthetically bothersome.

Gynecomastia↗
PubMed1996

[Therapeutic strategy apropos of 122 cases of early disclosed traumatic rupture of the urethra].

When ureteral rupture is suspected after trauma with fracture of the pelvis, insertion of a suprapubic catheter is required as an emergency measure. Ureteral lesions must be repaired early by the 5th to 10th day after trauma. Pyelography or retrograde ureterography is required to determine whether there is total or partial rupture and the degree of damage is identified endoscopically. We operated 73 total ruptures in deferred emergency situations (58 transpubic, 14 perineal approaches) and achieved good results in 80%. There were also 41 partial ruptures treated with an indwelling catheter in which 21 developed strictures requiring secondary uretrotomy. In three particular situations (anorectal damage, infected perineal wound, polytrauma with head trauma), in 8 patients were managed with suprapubic drainage alone before repair 3 months later. Different complications, including stricture and impotency were observed.

Adolescent↗
PubMed1991

[Functional and metabolic results of 24 Bordeaux-type bladder replacements following total prostato-cystectomy with a more than 2 years follow-up].

In March 1985, we realised the first Bordeaux neo-bladder, with detubularized ileo-colic segment (15 cm of ascending colon and 20 to 25 cm of ileum). The urethra is anastomosed at the lowest point of the caecum. 61 male patients underwent total replacement of the bladder, and we analyse the results in 24 of them, with a follow up more than 2 years. The following results were noted: the sensation of voiding is always physiological, daytime continence is quite perfect, while nighttime continence is good for 71% of patients, the filling pressure of the neobladder is low with a maximum of 20 cm H 0 (range 5-20 cm H20), and its capacity ranged from 300 ml to 400 ml, the mean flow rate is 21 ml/s. We encountered no complication, nothing but 2 gall-stones and two patients with low vitamin B 12. We didn't note neither diarrhea, nor hyperchloremic acidosis. All patients maintained normal renal function. Initially, the indication of Bordeaux ileo-colic neobladder was limited to bladder replacement after cysto-prostatectomy for bladder cancer. Now, the good results obtained, and their durability without any major complication allow us to extend our indications to bladder enlargements in neurogenic bladders.

Cystectomy↗
PubMed1984

[Surgical indications for primary vesico-ureteral reflux in adult candidates for renal transplantation].

Eight out of thirty five candidates for renal transplantation at the Bordeaux transplantation center, between 1975 and 1983, all presenting with primary vesico-ureteric reflux, underwent nephro-ureterectomy. The remaining twenty seven were not treated surgically. The authors consider that no operation is required when the ureter is narrow and uninfected, but that dilated refluant and infected ureters should be treated by nephro-ureterectomy, at least unilaterally. In that event, the operation is performed in two stages, with the second stage being performed at the same time as the transplantation.

Adult↗
PubMed1984

[Primary vesico-ureteral reflux in adults. 1977-1982. Department experience of 6-years].

The study of a series of 182 ureters (in 102 patients) treated in the Tripode Hospital, Bordeaux, highlights the following facts: as a diagnostic tool, cystography, if performed only once, is not reliable; on the other hand, isotopic cystography and endoscopic data are important adjuncts. As regards the management of these cases, 109 vesico-ureteric reimplantations were performed, 83 using Cohen's technique and 26 using Leadbetter's associated in some cases with a unicornous bladder. The results were excellent except in patients presenting with a severe renal insufficiency. Radical surgery was required in twenty cases. Fifty three patients were not treated surgically, but, when renal function is satisfactory, this attitude seems to offer more drawbacks than benefits.

Adolescent↗
PubMed1982

[Chronic renal failure and lithiasis].

After analyzing 39 cases, the authors go on to describe the virtues of surgical treatment of non-uric lithiasis after correct evaluation (lateral urography, CT scanning, retrograde ureteropyelography). The operative techniques draw considerable benefits from intraoperative radiography and, when necessary, the clamping of the renal pedicle under pharmacological protection. Surgical management offers the only possible means of preventing aggravation of the renal failure.

Humans↗