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Biomedical subjects

M Ayed

Publications and source records attributed to M Ayed.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Diagnostic and therapeutic advantages of rigid ureteroscopy: retrospective study of 304 cases].

Uretroscopy has become a common tool for the diagnosis and management of the upper urinary tract. Between April 1994 and Decembre 1999, 304 ureteroscopy procedures were performed. The most common therapeutic procedure was stone manipulation in 299 cases (distal ureter 259 cases, mid-ureter 23 cases, lumber ureter eight cases and staged in nine cases). Procedure was made by a rigid ureteroscope 8.5 Ch or 11.5 Ch. Dorinia was used in 175 cases (57.5%) with or without fragmentation by ultrasound. Therapeutic ureteroscopy was also used to remove a double-J stent that had migrated into the pelvic ureter in one case and in three cases of ureteral tumor. It was used in one case to confine the extrinsic compression of a ureteral stenosis. Median follow up was 12 months (6-36 months). The overall success rate was 87.6%. Results are comparable in men and women (P = 0.8). Success rate was 90% in single lithiasis and 76.2% in case of numerous stones (P = 0.0094). There was a statistically significant difference in success rate between stones 15 mm or under in size (89% stone-free) and those 15 mm (66% stone-free) or larger. In conclusion, rigid ureteroscopy is a minimally invasive and reliable technique for the management of ureteric calculi and for the diagnosis and treatment of other ureteric lesion.

Adolescent↗
PubMed1999

[Results of the treatment of renal lithiasis by percutaneous nephrolithotomy: apropos of 115 cases].

OBJECTIVES: The objective of this study was to analyse the results of percutaneous nephrolithotomy (PCNL), which was recently introduced into Tunisia, in order to determine its place among the treatment options for renal stones. MATERIAL AND METHODS: Our retrospective study was based on 115 consecutive PCNL procedures performed between April 1994 and November 1997. The stone was a single pelvic stone in 13 cases, lower caliceal in 15 cases, lower pyelocaliceal in 28 cases, partial staghorn in 20 cases, total staghorn in 16 cases and multiple pyelocaliceal in 23 cases. In our series, ultrasound lithotripsy constitutes the procedure of choice for renal stone fragmentation. RESULTS: A good result was obtained immediately in 67% of cases. This figure is lower than that published in the literature because of the complexity of the stones and the high failure rate due to the learning curve, involving 6 members of the team. In the case of failure, the procedure was converted to conventional surgery under the same anaesthetic in 20 patients. Residual stones, observed in 23 patients, were successfully treated by extracorporeal shock-wave lithotripsy (ESWL) in 79% of cases. By combining PCNL and ESWL, the good result rate was 80%. The mortality rate of this series was 0.8% and the morbidity rate was 7.5%. Complications were generally rare and often minor. CONCLUSION: PCNL occupies an important place in the treatment of renal stones. The results depend on the site, size and number of stones and on the operator's experience.

Adolescent↗
PubMed1999

[Leiomyosarcoma of the bladder: apropos of 2 cases].

The authors report two cases of bladder leiomyosarcoma, an extremely rare invasive bladder tumour, with a very poor prognosis due to very early local invasion. The definitive diagnosis can only be established by histological examination. The treatment modalities for this histological type of bladder tumour have not been standardized and remain controversial. However, the treatment of choice appears to be radical prostatocystectomy preceded by neoadjuvant chemotherapy when compatible with the patient's general state.

Adult↗
PubMed1998

[Results of BCG in the treatment of pTa and pT1 bladder tumors. Evaluation of a long protocol using 75 mg of Pasteur strain BCG].

OBJECTIVES: Evaluation of a protocol of intravesical BCG therapy using 75 mg of Pasteur strain BCG with 2 years of maintenance treatment, and a follow-up of up to 60 months. MATERIAL AND METHODS: 189 patients treated by transurethral resection (TUR) for a pTa (N = 80) or pT1 (N = 109) bladder tumour were included in the study. The local and general safety was excellent. We retrospectively compared this series to a group of patients treated by TUR alone (N = 42) another group treated with TUR and Mitomycin C (MMC) (N = 81). The 3 groups were statistically comparable. RESULTS: At 48 months, 62% of patients treated with BCG were recurrence-free, versus only 18% for patients treated with TUR alone and 38% for patients treated with TUR and MMC (p = 0.001). At 42 months, 11% of pT1 tumours treated with BCG had progressed to invasive carcinoma, and this progression occurred during the first 18 months in every case. In comparison, this progression was observed in 25% of pT1 tumours treated by TUR alone and 21% of tumours treated with TUR and MMC. CONCLUSIONS: Our study confirms the efficacy of our BCG protocol ro reduce the potential for recurrence and progression of superficial bladder tumours, despite reduction of the dose to 75 mg. It also suggests the superiority of BCG compared to MMC in terms of recurrence and progression.

Actuarial Analysis↗
PubMed1998

[Aspects of evolving urogenital tuberculosis. 60 cases].

Based on the results of a retrospective study of 60 patients treated between January 1984 and December 1994, the authors review the current clinical features of urogenital tuberculosis. The sex-ratio shows a male predominance of 65%. The mean age is 48 years. Cystitis and low back pain are the main symptoms of the disease. IVU, performed in all patients, showed pathological images in 98.3% of cases. Urine culture was positive in 23 out of the 50 cases in which it was performed. Serious forms were relatively frequent, with bilateral lesions in 12 cases, associated with renal failure in 4 of them, or unilateral renal destruction in 43 cases. All patients were treated with triple- or quadruple-agent tuberculostatic therapy. 54 patients required one or several surgical procedures: 43 nephrectomies, 7 ureterovesical reimplantations, 11 augmentation enterocystoplasties, 1 Bricker ureteroileostomy, 3 ureterostomies, 1 ureteric resection and 4 epididymectomies. Two patients admitted in a context of deterioration of the general state died during the days following admission. 56 patients were reviewed with a minimum follow-up of 6 months. Two were cured by medical treatment alone. Among the 54 operated patients, clinical improvement was obtained in 43 patients (91%) and radiological improvement was obtained in 33 of the 36 cases in which IVU was performed (91%). In conclusion, despite the various anti-tuberculosis campaigns, urogenital tuberculosis remains a serious disease, essentially because of the delayed diagnosis.

Adolescent↗
PubMed1997

[Emphysematous cystitis: apropos of 2 cases].

Emphysematous cystitis is a rare infectious disease of the lower urinary tract. Its reputedly serious prognosis is related to treatment failures revealing ignorance concerning its pathophysiological mechanisms. Two cases of this disease were seen in our department, both in diabetic men over the age of 70 years with a history of prostatism. They presented to the emergency department with complete urinary retention and alteration of the general state and fever. Urine culture isolated Klebsiella pneumoniae in both cases. Treatment consisted of bladder drainage associated with adapted antibiotic therapy and control of diabetes. A suprapubic prostatectomy was subsequently performed in one case and transurethral prostatic resection was performed in the other case. The prognosis of this disease depends on early diagnosis and rapid introduction of effective treatment.

Aged↗
PubMed1997

[Urinary fistula after transplantation: eleven cases].

OBJECTIVES: To specify the anatomical features of urinary fistulas and to evaluate the results of percutaneous and surgical treatment of post-transplantation urinary fistulas. PATIENTS AND METHODS: 11 urinary fistulas were observed after 160 renal transplantations, corresponding to an incidence of this complication of 6.8%. Urinary fistulas were treated percutaneously in three cases and surgically in eight cases. THE FOLLOWING COMPLICATIONS WERE OBSERVED DURING SURGICAL TREATMENT: extensive necrosis of the urethra in four cases, rupture of the sutures in two cases, a punctate pelvic fistula in one case. RESULTS: The incidence of fistula was 5.8% for Leadbetter reimplantation and 8.1% for Lich-Gregoir extravesical reimplantation. We obtained one success in three patients treated percutaneously and one death and seven successes out of eight patients treated surgically. We performed ureteropelvic anastomosis with the native ureter in the case of extensive necrosis of the ureter (4 cases), a new reimplantation in three cases and suture of the pelvic fistula in one case. CONCLUSION: More than one half of post-transplantation urinary fistulas observed in our department are secondary to ischaemic necrosis of the ureter. We emphasize the value of preservation of the ureteric blood supply during organ harvesting. Post-transplantation urinary fistulas must be treated surgically, as soon as possible, to avoid infectious complications.

Follow-Up Studies↗
PubMed1995

[Value of extracorporeal shockwave lithotripsy in primary hyperoxaluria type I].

BACKGROUND: Application of extracoporal shock wave lithotripsy (ESWL) has revolutionized the management of many types of urolithiasis, including that observed in primary hyperoxaluria where surgical attempts to remove calculi sometimes result in worsening of renal function. CASE REPORTS: Three unrelated patients aged 8, 10 and 11 years, respectively, with type I primary hyperoxaluria, suffered from recurrent bouts of abdominal pain (two patients) or anemia (one patient). Two patients had chronic renal failure. Plain abdominal films and ultrasonography showed several large bilateral stones. ESWL was applied to the three patients permitting complete removal of stones following three sessions in one patient and partial removal following four sessions in the second patient who developed infection after the first session with transitory increase in creatinemia. Several sessions of ESWL failed to fragment stones in the third patient. CONCLUSION: ESWL may represent a safe procedure for attempting stone removal in patients with primary hyperoxaluria.

Child↗
PubMed1995

[Ureteral stenoses and fistulas after kidney transplantation].

We report a retrospective study of 100 renal transplants, the majority using kidneys from related live donors. We saw 6 ureteric stenoses and four fistulas. Three relatively small stenoses and two limited fistulas were treated percutaneously, all of them successfully. The transplant had to be removed in two patients with a ureteric fistula. Four stenoses and one fistula were treated successfully by open surgery. Actuarial survival of grafts with a urological complication was significantly shorter than that of transplants free of such lesions.

Actuarial Analysis↗
PubMed1995

[Renal transplantation from related live donors. Results and survival].

We report a retrospective study of 91 renal transplants from related live donors carried out at the Charles Nicolle Hospital, Tunis, between 1986 and 1993. There were 27 HLA-identical and 64 semi-identical. Classical immunosuppression based upon corticosteroids and azathioprine was used in the majority of cases. Surgical complications occurred in 15.4% of cases. 56% of patients had at least one acute rejection attack. There were 4 deaths, 3 related to infection and one to septic arterial rupture. Return to hemodialysis was related to chronic rejection in 5 cases and to recurrence of the initial nephropathy in one case. 5-year actuarial survival was 94% for recipients and 81% for grafts. In this series, acute rejection had no negative influence on graft survival and the difference between graft survival between HLA-identical and semi-identical patients was not statistically significant.

Actuarial Analysis↗
PubMed1995

[Adrenal myelolipoma. Apropos of 3 cases].

The authors report 3 cases of adrenal myelolipoma arising in 3 women who were respectively 36, 47 and 48 year old. The diagnosis was made on the surgical specimen in 3 cases, and the clinical symptomatology was dominated pain seen in all 3 cases. 2 patients have presented hypertensive access. After surgery, the evolution was favourable in all 3 cases.

Adrenal Gland Neoplasms↗
PubMed1995

[Vascular complications of kidney transplantation].

We report a retrospective analysis of 100 renal transplantations, mainly from related living donors. The rate of vascular complications was 9%: one arterial hemorrhage due to partial suture failure; one lymphocele; two arterial thrombi, one in the inferior artery leading to fistulization by ureteral necrosis and death following septic rupture of the artery, and one in the renal artery requiring graft removal; and five arterial stenoses, one which regressed spontaneously, one treated by endoluminal angioplasy, one treated surgically, one controlled by medical treatment and one which could not be treated due to secondary hemodialysis after graft rejection. In this series of 100 transplantations, vascular complications were the cause of 16.5% of deaths and 12.5% of post-graft hemodialysis.

Adolescent↗