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Biomedical subjects

M Robert

Publications and source records attributed to M Robert.

At least 91 records · Page 5Linked to original sources
PubMed1997

[Management of stage I testicular nonseminomatous germ cell tumors with an embryonic carcinomatous component. 18 cases].

OBJECTIVE: To evaluate the prognosis and therapeutic modalities of stage I nonseminomatous germ cell tumours of the testis (NSGT) with an embryonic carcinomatous component (EC). MATERIAL AND METHODS: 18 patients with stage I nonseminomatous germ cell tumour of the testis with an embryonic carcinomatous component were treated between 1987 and 1995. EC represented more than 50% of the testicular tumour mass in 15 cases. This tumour contingent constituted the only potential prognostic factor in 4 cases, but vascular or lymphatic emboli (n = 3), tumour stage > pT1 (n = 5) or absence of endodermal sinus component (n = 9) were observed in 14 cases. The first 3 patients underwent retroperitoneal lymph node dissection and the following 15 patients were submitted to surveillance (n = 4) or chemotherapy (n = 11) according to the PVB [Cisplatin, Vinblastine, Bleomycin] (n = 7) or BOE [bleomycin, Etoposide, Cisplatin] (n = 4) protocols. RESULTS: With a follow-up of 10 to 110 months (mean: 46), the survival rate is 100% and the recurrence rate is 22%. None of the patients with a local stage exceeding pT1 relapsed after chemotherapy. 2 patients in whom the EC contingent represented less than 50% of the tumour mass and who were simply watched, did not relapse. 4 relapses, detected 3 to 14 months after orchidectomy (mean: 8.5), during surveillance (n = 2) or after chemotherapy (n = 2), required surgical resection or complementary chemotherapy. They occurred in patients in whom EC represented more than 50% of the testicular lesion. The tumour of initially conservatively managed patients did not contain an endodermal sinus component (n = 2) or presented vascular emboli (n = 1). The subjects treated by chemotherapy were characterized by the presence of emboli (n = 1) or the absence of endodermal sinus component (n = 1). The course after recurrence was favourable in 3 cases and the last patient is currently receiving chemotherapy. CONCLUSION: EC is an independent risk factor whose presence justifies proposal of complementary treatment by retroperitoneal lymph node dissection or chemotherapy, possibly limited to 2 courses of BOE. Surveillance can only be considered in the case of a minority of EC in the tumour, in the absence of any associated risk factors.

Adolescent↗
PubMed1996

Type III-IV laryngotracheoesophageal cleft: report of a successfully treated case.

This report presents a case of Stage III laryngotracheoesophageal cleft (LTEC). It is, to our knowledge, the fourth case in which the patient is still alive twenty months after surgery. We herein describe an initial symptomatology dominated by a bubbling hypersalivation, our surgical technique using a pleural shred of interposition and an endoscopic check during the operation and, finally, the clinical development dominated by a food intake refusal which was progressively improved through psychiatric help.

Cleft Palate↗
PubMed1996

Rectal afferent function in patients with inflammatory and functional intestinal disorders.

Chronic symptoms of abdominal pain and discomfort are reported by patients with inflammatory bowel disease (IBD) and functional disorders of the gut, such as Irritable Bowel Syndrome (IBS). It has recently been suggested that transient inflammatory mucosal events may result in long-lasting sensitization of visceral afferent pathways. To determine the effect of recurring intestinal tissue irritation on lumbosacral afferent pathways, and to identify a plausible mechanism that could account for the overlap in symptomatology between IBD and IBS, we compared rectal afferent mechanisms in patients with Crohn's disease (inflammation limited to the ileum) with those observed in patients with diarrhea-predominant IBS. Continuous volume ramp and phasic pressure step distension of a rectal balloon were performed in 9 healthy male control subjects, 12 male patients with isolated ileal Crohn's disease and 9 male patients with diarrhea-predominant IBS using an electronic visceral stimulation device. The response of rectal afferents to distension was evaluated by measuring thresholds for the perception of physiological (stool) and aversive (discomfort) sensations, viscerosomatic referral patterns, skin conductance responses, receptive relaxation, and rectoanal reflex responses. In response to slow ramp distension, thresholds for aversive sensations were significantly higher in Crohn's disease patients, but similar between the two other groups. In response to rapid phasic distension, IBS patients reported discomfort at lower distension pressures, while all other thresholds were similar between groups. Skin conductance responses to aversive distension were greatly reduced in Crohn's disease patients while IBS patients had greater responses when compared to normals. Changes in viscerosomatic referral patterns and receptive relaxation rate were similar in Crohn's disease and IBS patients. These findings demonstrate that chronic ileal inflammation is associated with increased thresholds for discomfort and greatly diminished systemic autonomic reflex responses. In contrast, IBS patients show lowered thresholds for discomfort associated with increased autonomic responses. The findings in Crohn's patients may result from descending bulbospinal inhibition of sacral dorsal horn neurons in response to chronic intestinal tissue irritation.

Adult↗
PubMed1996

The gender difference in orienting liquid surfaces and plumb-lines: its robustness, its correlates, and the associated knowledge of simple physics.

In comparison between male and female psychology students, a greater proportion of female students fail to represent liquid surfaces and plumb-line objects as invariably horizontal and vertical, respectively. However, the occurrence of this perplexing gender difference has not been ascertained among young adults enrolled in science programs, who should ostensibly be more fully equipped in terms of academic competence, irrespective of their gender. The present large sample of undergraduates (N = 1412), majoring in natural and applied sciences, and social sciences or humanities and arts, completed water-level and plumb-line items, along with other simple physics problems, indicating how and in reference to which principle they had solved these tasks. They also answered questions pertaining to possible personal proficiency correlates of a biological, experiential, perceptual, and sociocognitive nature. The data revealed not only that women's achievement was consistently poorer than men's across discipline categories, but surprisingly that this was so even within specific fields requiring and providing the most visuo-spatial skills as well as physical knowledge and training. Especially for women, mastery was predicted by success in simple physics problems, and to a lesser degree by perceptual, sociocognitive, and experiential variables. Biological variables did not contribute to proficiency for either gender, though the data fitted a recessive gene model. Responses based on relevant physics principles were more accurate, but men and women generally adopted the same procedural strategies. The present compelling demonstration of a gender gap in achievement that is not compensated by formal science education, extending thus even to future physical scientists, invites further investigation into its perceptual and cognitive determinants, as well as into those more distally connected with early aptitudes, interests, and experiences.

Adolescent↗
PubMed1996

Aorto-colonic fistula as a late complication of colon interposition for oesophageal atresia.

A 22-year-old man developed severe haematemesis 21 years after colon interposition for long-gap oesophageal atresia. A fistula, from an anastomotic ulcer to the descending thoracic aorta, was discovered and treated successfully by surgical resection. This previously unreported complication highlights the need for the prevention of peptic complications following oesophageal replacement in children.

Adult↗
PubMed1996

Purification and characterization of the active precursor of a human sperm motility inhibitor secreted by the seminal vesicles: identity with semenogelin.

Human seminal plasma contains a sperm motility inhibitor that originates from seminal vesicles as a precursor form. This precursor is degraded into smaller peptides by prostatic proteases shortly after ejaculation. The seminal plasma sperm motility inhibitor (SPMI) precursor was purified by a combination of cation-exchange chromatography on S-Sepharose followed by C4 reverse-phase high-performance liquid chromatography directly from seminal vesicle fluid or washed seminal coagulum. The purification procedure yielded a protein of apparent homogeneity, with a molecular mass of 52 kDa by SDS-PAGE. It migrated as a 105-kDa protein by molecular sieving under denaturing conditions. The purified SPMI precursor was digested by the prostatic protease prostate-specific antigen (PSA), causing a 76 +/- 4% drop in biological activity and transformation into low molecular mass SPMI polypeptides (5-20 kDa) similar to those observed in liquefied semen. The N-terminal amino acid sequences of three degradation peptides were obtained by Edman degradation and found to correspond to residues 45-50, 85-90, and 137-143 of semenogelin, a protein characterized as the major structural component of semen coagulum. The amino acid composition of SPMI precursor was found to be almost identical to that of semenogelin. Moreover, the mass of the precursor was estimated at 49,620 daltons by electrospray-ionization mass spectrometry, a value in close agreement with the expected mass of semenogelin according to its cDNA sequence. The SPMI precursor was found to inhibit sperm motility in a dose-dependent manner, with complete immobilization at 500 U/ml of SPMI. The motility of completely immobilized spermatozoa was partially recovered after washing of the cells. The results suggest that SPMI precursor is the major component of the seminal vesicle secretions and seminal coagulum. It can be degraded by PSA in a manner reminiscent of its processing in whole semen. Taken together these results indicate that the SPMI precursor is semenogelin and that intact semenogelin can immobilize spermatozoa.

Amino Acid Sequence↗
PubMed1996

Childhood urolithiasis: urological management of upper tract calculi in the era of extracorporeal shock-wave lithotripsy.

OBJECTIVE: To evaluate the management of urolithiasis in children since the development of extracorporeal shock-wave lithotripsy (ESWL). METHODS: Between 1988 and 1994, 37 children, aged from 2 to 15 years (mean 10), with upper tract urolithiasis were evaluated and treated. Lithogenic metabolic disorders or anomalies of the urinary tract were present in 11 children (30%) Urolithiasis was multiple in 9 cases and bilateral in 2 cases. A total of 47 renal (30) or ureteral (17) stones were managed, of which 5 were partial or complete staghorn calculi. Initial treatment was surgery in 4 cases (1 nephrectomy, partial nephrectomy and 2 pyelolithotomies) and piezoelectric ESWL in 43 cases. RESULTS: The overall ESWL success rate was 82.2%, with auxillary endoscopic procedures in 3 cases. ESWL failures required surgical stone removal in 5 cases, endoscopic ureterolithotripsy in 1 case and electrohydraulic ESWL in 1 case. Residual fragments after pyelolithotomies were also treated by ESWL. CONCLUSION: ESWL is the mainstay of treatment of childhood upper tract urolithiasis, but other therapeutic methods retain specific indications. Its application requires great vigilance and its long-term effects are uncertain. It is therefore important to rule out any underlying pathology and where possible to prevent further stone formation.

Adolescent↗
PubMed1996

Evaluation of the risk of stone formation: study on crystalluria in patients with recurrent calcium oxalate urolithiasis.

OBJECTIVE: The aim of this study was to determine the usefulness of the morning calcium oxalate crystalluria in detecting stone formers particularly prone to recurrence. METHODS: Over a 24-hour period of urine collection, the morning calcium oxalate crystalluria was evaluated as well as the risk of stone formation, established with Tiselius and Parks indices, for 25 recurrent stone formers (group 1) and 25 normal controls (group 2). RESULTS: Morning crystalluria (type, size, number/ml and state of aggregate) and the Tiselius index were comparable in the two groups. Conversely, calciuria as well as the citrate/ calcium ratio and the Parks index varied significantly for stone formers and normal controls. No particular correlation appeared between crystalluria and indices of Tiselius and Parks, calciuria, calcium-oxalate product or calcium/ oxalate and citrate/calcium ratios. CONCLUSIONS: Morning calcium oxalate crystalluria does not enable an efficient characterization of recurrent stone formers. Its discordance with others potential indicators of the risk of stone formation poses the problem of their respective validity and evokes the prevalence of still unknown inhibiting agents in the phenomenon of crystallization.

Calcium Oxalate↗
PubMed1996

Management of major blunt renal lacerations: surgical or nonoperative approach?

OBJECTIVE: To evaluate changes in the management of major blunt renal trauma since the introduction of computerized tomographic diagnosis and follow-up. MATERIAL AND METHODS: Twenty-three consecutive patients with deep blunt renal lacerations without major pedicle injury or shattered kidney were treated from 1986 to 1995. In group 1 (1986-1989, 12 patients), initial management was conservative, but with open surgery in cases of hemodynamic instability or persistent urinary extravasation. In group 2 (1990-1995, 11 patients), a plain conservative approach was followed and open surgery was reserved for major complications only. RESULTS: In group 1, 6 patients required early renal exploration (4 nephrectomies, 2 renorrhaphies). A persistent urinary fistula led to late nephrectomy in 1 of the renorrhaphy patients. Retroperitoneal hematoma and urinary extravasation spontaneously resolved in 6 cases. Length of hospital stay was significantly lower (p = 0.02) for nonoperated patients. None suffered from hypertension at long-term follow-up (5-8 years, mean 7.2). In groups 2, all 11 patients were treated conservatively, with endoscopic ureteric stenting in 4 cases. Urinary extravasation always resolved, but 9 patients had residual perirenal hematoma at the time of discharge. Length of hospital stay was significantly higher (p = 0.0005) with ureteric stenting. Nine months after trauma, 1 patient suffered from recurrent pyelonephritis. Radiographic follow-up (1-30 months, mean 10.2) revealed minor sequelae in all evaluated patients. CONCLUSION: In most patients with major blunt renal lacerations, a conservative approach is safe. Most extravasation spontaneously resolves and minimally invasive techniques will deal with nearly all complications. In our experience, open surgery usually results in nephrectomy.

Adolescent↗
PubMed1996

[Metabolic investigation of calcium oxalate urinary lithiasis. Indicators of lithogenic risk: modalities, applications and perspectives].

Despite exhaustive metabolic investigations, calcium oxalate urinary stones often remain idiopathic and, in the absence of any objective aetiopathogenic parameter, the prevention of recurrences and follow-up are particularly problematical. Various indicators have been elaborated to quantify, the lithogenic risk, based on various parameters potentially involved in the crystallization process. Their disparity illustrates the difficulty of achieving such an objective as well as the progress in fundamental concepts and their frequent technical complexity penalizes their practical application. The performances of these indices, except in the hands of the team which has proposed them, often lack reproducibility and paradoxical or even contradictory findings are frequent. They may simply reflect the variability of the lithogenic process or may reflect the predominant role of potent inhibitors, especially macromolecules. The metabolic investigation of calcium oxalate urinary stones is initially limited to detection of lithogenic diseases amenable to specific treatment. After repeating the basic laboratory tests, recurrences, especially when they are unexplained, require more complex investigations. At the present time, applications of lithogenic risk indices are essentially confined to the field of clinical and basic research. Among the various indicators available, the urinary citrate/urinary calcium ratio and Parks' index appear to be particularly promising.

Calcium↗
PubMed1996

[Need for multidisciplinary care management in the treatment of type III laryngo-tracheo-esophageal cleft].

We report a case of type III laryngotracheoesophageal cletf. To our knowledge, this case represents the fourth case repaired. Survival was 22 months. The surgical repair we describe here is the first condition to survival. Close collaboration initially with anesthesiologists, then with the intensive careteam unit is required for post-operative management. Moreover, in addition to the surgical trauma, post-operative management is often long with tracheotomy and gastrostomy leading to a corporeal schema disorder in swallowing and respiration. Early psychologic assistance is indispensable to a good functioning of the aero-digestive region.

Abnormalities, Multiple↗
PubMed1996

[Indicators of the risk of calcium oxalate urinary calculi: comparative study of the Parks' and Tiselius' indices, urinary citrate/calciuria ratio, and morning crystalluria].

Despite the progress in basic research, the precise assessment of the risk of calcium oxalate urinary stones and the detection of patients at particular risk of recurrent stones are often problematical. A population of 55 renal stone patients and 50 controls served as a basis for various comparative studies of Parks' index, Tiselius' index, the urinary citrate/urinary calcium ratio and the morning calcium oxalate crystalluria. Parks' index and the urinary citrate/urinary calcium ratio were highly discriminant, in contrast with Tiselius' index and crystalluria, which were statistically comparable in the 2 groups. A close correlation was observed for the 3 versions of Tiselius' index, which estimates diuresis, but no particular correlation was detected between crystalluria and the other parameters studied. Parks' index and the urinary citrate/urinary calcium ratio are potentially adapted to the detection and monitoring of renal stone patients at risk of recurrence. On the other hand, the various Tiselius' indices can be essentially used to evaluate urinary calcium oxalate oversaturation and possibly to control treatments interfering with this parameter. The formula simply based on diuresis, and the 24-hour urinary calcium and oxalate excretion (CaO.71.Ox.V-1.2) appears to be sufficient for this purpose. The absence of correlation between crystalluria and the other potential indicators of lithogenic risk raises the problem of their respective validity as well as the possible prevalence in the crystallization process of the powerful inhibitors which are currently unidentified, but probably macromolecular.

Calcium↗
PubMed1996

[Fibroepithelial polyps of the ureter and the kidney pelvis. Report of 3 cases].

The authors report 3 cases of fibroepithelial polyps, one of which was an incidental finding and 2 were symptomatic, presenting in the form of macroscopic haematuria and chronic back pain, respectively. These lesions required 2 nephroureterectomies because of their renal repercussions or their multifocal nature, combined with segmental resection of the ureter, including the base of the tumour. In the light of these cases, the authors review the literature and analyse the current management of this rare disease, in particular the indications for endourological techniques which appear to have a major diagnostic contribution as a complement to IVU and retrograde urography, but whose therapeutic value has yet to be defined.

Adult↗
PubMed1996

[Diagnosis and treatment of cystic tumors of the adrenal gland. Report of 2 cases].

Two cases of cystic tumour are reported. The first consisted of a pseudohaemorrhagic cyst of the right adrenal gland discovered during aetiological assessment of HT refractory to medical treatment. Plasma and urinary assays did not reveal any abnormality suggestive of secreting adrenal tumour. Imaging (ultrasonography. CT and MRI) was in favour of a necrotic malignant tumour and a normal isotope scan (MIBG iodine 131) eliminated phaechromocytoma. Adrenalectomy was easily performed via a subcostal laparotomy and the postoperative course was uneventful. The second case consisted of a right adrenal cyst detected incidentally on ultrasonography. The laboratory assessment demonstrated only a slight elevation of urinary metanephrine and imaging (CT and MRI) was not suggestive of a malignant lesion. Simple annual CT follow-up was decided in this case. The various pathological types of rare cystic lesion of the adrenal gland are described with particular emphasis on their diagnostic and therapeutic modalities.

Adrenal Gland Diseases↗
PubMed1996

[Lymph node eosinophilic granuloma. Apropos of 2 cases of Langerhans-cell histiocytosis with isolated lymph node involvement].

The authors report two cases of isolated lymph node involvement by Langerhans' cell histiocytosis which affected two young children. The histologic aspect reveals that lymph nodes have been modified by a proliferation of large histiocyte-like cells, associated with eosinophils. An immunohistochemical study on paraffin sections and for one case on frozen sections, reveals the usual phenotype of Langerhans' cells: these cells stain positively with S 100 protein and CD1 and are negative for both lysozyme and al antichymotrypsine. After a period of two years for one child and four years for the other, these children are in total remission, one spontaneously, the other after chemotherapy.

Child, Preschool↗