Percutaneous antegrade dilatation of ureteral strictures in kidney transplants.
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Biomedical subjects
Publications and source records attributed to L Alexandre.
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Transplant ureteral stricture can be treated by either incisional surgery or percutaneous endoluminal dilation. We present 17 cases of percutaneous antegrade endoluminal dilation. The results of this procedure were satisfactory, with a 70% success rate that seems to be maintained during long-term followup. The results were better if dilation was done on a short and recent juxta-anastomotic stricture stented with a 10F Double-J* catheter for 2 months.
In 119 patients with pelvic urogenital tumours the diagnosis of lymph node metastasis was made by lymphography-guided fine needle biopsy. The results of this technique, performed without anaesthesia and devoid of morbidity, could be interpreted in 88 percent of the cases. In the search for micro- and macroscopically invaded lymph nodes fine needle biopsy had a sensitivity of 66 percent, a specificity of 100 percent, a positive predictive value of 100 percent and a negative predictive value of 92.3 percent. In cases with macroscopically invaded nodes its sensitivity was 82.3 percent.
Thirty-two patients with transitional cell cancer of the bladder infiltrating the lamina propria were treated with intravesical BCG. Seventy-five percent of these patients could keep their bladder at the cost of regular BCG treatment and strict endoscopic monitoring. A better evaluation of prognostic criteria, including malignancy grade, total amount of vesical muscle removed during the initial resection and investigation for lymphatic system emboli, should help in a better selection of patients, separating those who might have recurrent infiltrative tumours from those who would benefit from a conservative treatment and offering the former a more aggressive therapy.
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1. In a four period, double-blind, placebo-controlled study, apomorphine (0.009 mg kg-1 subcutaneous route) and yohimbine (0.30 mg kg-1 i.v. route) were administered to 10 male healthy volunteers. Penile circumference was monitored using plethysmography and subjective sexual arousal was self-assessed. Data were collected before, during and after a stimulation session during which 50 erotic slides were projected to the subjects. 2. Apomorphine induced an erection starting from the fourth minute post-injection, and potentiated the visually-induced response. Self assessment showed increased tumescence and rigidity without modifications of sexual arousal. 3. Yohimbine did not modify penile diameter without stimulation and did not affect the physiological response to erotic stimuli. 'Sexual excitement' was decreased by yohimbine during the post-stimulation phase. One subject experienced severe anxiety while he was infused with yohimbine. 4. These results are discussed with reference to animal data and to recent studies carried out in impotent patients.
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The effects of the current revolution in the organisation and financing of medical care are important for physicians. In all major countries, physicians are increasingly concerned about the controls being placed on their practices.
Community hospitals is undergoing rapid consolidation into network of private corporations providing health care services. So, the industrialization of health care lead to mega corporate health care. The multi-nationalization of U.S. multi-health care systems as HCA or Humana, has began at the end of the 70. The impact of this phenomena on the French health care system will be important. In order to protect technological independence and to integrate physicians into medical industrial complex, we have to create european multi-health systems.
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The aim of this study is to assess the economic impact of neuroleptic strategies in the long-term treatment of schizophrenic patients. In this respect a new neuroleptic strategy (amisulpride) was compared to a reference drug (haloperidol) using a cost minimization method. Clinical, demographic and economic (direct medical costs) data were obtained retrospectively from patients' charts. Patients (n = 160) were randomly selected according to diagnosis (schizophrenia, DSM III-R), treatment (outpatient, amisulpride or haloperidol) and follow up period (at least 6 months). The health insurance point of view was selected for the economic analysis. We found a significant reduction of the annual number of days of relapse when patients were treated with amisulpride compared to haloperidol. This reduction was associated with a significant reduction of direct costs mainly related to shorter length of hospitalization. This result was only partly explained by demographic and clinical variables such as the severity of the disease. The differences remained significant when populations were matched. This finding illustrates the validity of the concept of efficiency in psychiatry.