Biomedical subjects
Publications and source records attributed to M Zerbib.
Twenty five patients with symptomatic BPH and normal PSA underwent electrovaporization. The mean IPSS was 21.5 before and 7.8 three months after treatment while the mean peakflow was 7.1 ml/s and became 16.9. With a short hospital stay (3 days) and a very low morbidity, electrovaporization seems to be a good alternative to TURP. A longer follow-up is necessary.
We report two cases of grade 1 papillary transitional cell carcinoma which have a distinct pathological. The tumor was infiltrating the lamina propria in the first case (pT1) and the superficial muscle in the second case (pT2). These tumors were composed by nests and tubules with few cytological atypias, making the diagnosis of cancer difficult. The prognosis of these tumors is not well defined.
INTRODUCTION: Electrohydraulic lithotripters use a R-wave triggering system as episodes of cardiac arrhythmia were observed during early clinical experiments. This study was designed to assess the safety of non triggered shock wave treatments using an external fixed rate device (120/min) on the Sonolith 4000 Plus (*), a non bathtub electroconductive lithotripter. METHODS: Our study is the first prospective evaluation of non-EKG-gated lithotripsy where the patient under continuous Holter monitoring served as his own control during a randomized alternation of periods with or without R-wave triggering. This design allowed for a direct comparison of the effect of EKG-gated and non-EKG-gated lithotripsy respectively. The sequence of the different periods was randomly assigned. The recordings were compared to a pre-treatment recording, the cardiologist ignoring the randomization. RESULTS: 25 consecutive patients without cardiac history have been treated for urinary stones. Ventricular and supraventricular excitability disorders have been noted in 7 patients, always during a non-EKG-triggered period. There was no correlation with stone location. No cardiac rhythm disturbances have been observed during triggered periods in the 25 patients. Auricular extrasystoles (0.1-0.5/min) were observed in 6 patients, and auricular couplets (0.5/min) in one. Ventricular extrasystoles were noted in 4 patients, and ventricular couplets in one. One patient had an asymptomatic non sustained ventricular tachycardia which resolved spontaneously. No clinically significant disorder occurred. Treatment time and analgesics requirements were reduced by non-EKG-triggering. CONCLUSIONS: Non-EKG-triggering lithotripsy has a definite potential for cardiac disturbances, but appeared to be clinically safe in these patients with no cardiac history.
Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation. 13 patients were continent (68.4%) in the sling procedure group and 5 in the sphincter group. Continence remained stable with a mean follow-up of 77 months (range: 39-110 months). 2 patients had urgency and none had dysuria. The sling procedure gave us the same results as sphincter with less morbidity.
The authors report 1 case of particularly severe reflex neurovascular dystrophy whose clinical course was marked by the discovery of a carcinoma of the prostate. There was improvement in the reflex neurovascular dystrophy despite hormonal therapy of the cancer. Reflex neurovascular dystrophy cannot be considered as a form of a paraneoplastic syndrome.
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Male urinary incontinence needs usually a surgical treatment. Over-flow incontinence is due to bladder neck, prostatic or urethral obstruction and is treated by transurethral resection of the prostate or uretrotomy. Intrinsic sphincter deficiency needs an artificial sphincter implantation or an endoscopic periurethral injection of teflon particles or collagen. Incontinence due to detrusor over-activity is rarely treated by subtrigonal phenol injection or ileal detubularized cystoplasty augmentation.
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Based on a series of 150 total hysterectomies carried out via laparoscopy between January 1993 and December 1994, we observed 2 bladder complications: 1 bladder injury and 1 vesicovaginal fistula. These two accidents form the basis of discussion on the risk factors for these complications, their diagnosis, treatment, and prevention.
OBJECTIVE: To evaluate the efficacy and toxicity of subcutaneous immunotherapy using a combination of recombinant interleukin-2 (r-IL2) and interferon-alpha (IFN-alpha) for the treatment of patients with metastatic renal cell carcinoma (RCC). PATIENTS AND METHODS: Initially a maximum of 45 patients with advanced RCC were to be included in the study, according to a Fleming three-stage procedure. To be included patients had to have measurable metastasis. Of a potential 45 patients with advanced RCC, 15 patients were included in the study (10 men and five women, mean age 51 years, range 25-69). From the first week of treatment r-IL2 was given subcutaneously on day 1 to 5, at 18 x 10(6) units once a day and then 9 x 10(6) units once a day for the following 5 weeks. IFN-alpha was given three times a week for the last 5 weeks. Minimum follow-up was 6 months. RESULTS: All patients initially underwent radical nephrectomy. Seven patients were found to have metastases at the time of diagnosis. All patients received ambulatory therapy, except for the first 5 days of treatment. Overall, 80% of the patients received more than 75% of the complete dose of r-IL2. One patient suffered toxicity greater than the World Health Organization (WHO) grade 2 (neutropenia). No patient had a complete or partial response, two patients had a minor response, two patients had stable disease and 11 patients had disease progression. CONCLUSIONS: Subcutaneous r-IL2 and IFN-alpha had no beneficial effect on the first 15 patients and the study was discontinued, in accordance with the Fleming rules. The dose, administration and combination of r-IL2 and IFN-alpha may explain the lack of efficacy. Other studies have shown that low doses of r-IL2 are not effective and the superiority of the combination of r-IL2 and IFN-alpha has not been proven. Therefore, a high dose of r-IL2, in association with other cytokines, chemotherapy and adoptive immunotherapy, may be the only way to improve the response rate of metastatic RCC.
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To better determine the role of endovesical BCG treatment for superficial tumours of the bladder, it is necessary to understand the natural history of these tumours and the prognostic factors; The goal is to better manage BCG as a preventive measure for relapse of superficial tumours of the bladder and to prevent possible progression by infiltration. It is also important to emphasize the possible complications of this therapy and the currently recommended precautions in order to carefully use this very effective method with the least possible morbidity.
Urinary fistulization to the skin is a rare complication of cystoprostatectomy with replacement enterocystoplasty. In two cases, fistulization did not respond to continuous drainage of the urine and was treated with a muscle flap using the abdominus rectus. This method offers rapid parietal repair giving a reliable rapid cicatrization since the interpositioned flap is well vascularized in an area of poor tissue quality.
Seventeen cases of urinary calculi analyzed by infrared spectrophotometry were found to be composed entirely or nearly entirely of bihydrated calcium hydrophosphate. The observations are summarized here. This type of stone occurs with a frequency of about 1% (0.85% in our experience) of all urinary calculi, predominantly in men (14 of our 17 cases). Diagnosis is based on the physical and chemical analysis of the stone and on infrared spectrophotometry. Most of these stones are pure or nearly pure compounds. The macroscopic aspect of the stones or fragments of stones can guide diagnosis. These stones are cream coloured stones with a smooth regular outer surface. Broken fragments show the same cream colour, sometimes with strips radiating from the centre of the fracture surface. Radiologically, these stones are homogeneously radio-opaque, often oval-shaped with a regular outline. Blood tests can demonstrate suspected or proven hyperparathyroidism (4 out of 10 cases in our 17 observations) with hypercalcemia, hypophosphatemia and hypercalciuria. Complementary examinations may be needed to search for a parathyroid adenoma. With or without hyperparathyroidism, 24-h urinalysis usually shows hypercalciuria up to ro over 500 to 600 mg/24 h. Crystallization usually occurs in the upper urinary tract, in the bladder or in indwelling catheters. These stones are extremely hard and are difficult to break in vitro. To be successful, lithotripsy requires prolonged treatment: up to 3000 to 6000 shockwaves at 22-23 kv with the Dornier apparatus. Despite the notion of hypercalciuria, the pathogenesis of bihydrated calcium hydrophosphate calculi remains to be elucidated.
A Sertoli cell mesenchymal tumour was observed in a 19-year-old male. The prognosis of this rare tumour is good.
Renal ultrasound seems to be more difficult on the left than on the right side. In a retrospective analysis of 343 patients in whom a radical nephrectomy for renal tumor diagnosed by abdominal ultrasonography had been carried out, we analyzed the characteristics of these tumors. TNM classification was used. Right kidney tumors (n = 170) were smaller than the left ones (n = 172), 58 +/- 31.7 mm and 66.8 +/- 31.5 mm respectively, the difference being statistically significant (p = 0.01). Right kidney tumors of a less advanced stage (p < 0.05). Asymptomatic renal tumors were found more frequently on the right side (58.7%) than on the left (41.3%) (p = 0.03) and were smaller on the right (44 mm +/- 19.6 vs 54.5 mm +/- 27.2) (p = 0.04). In conclusion, Ultrasound exploration of the left kidney seems to be more difficult, mostly because the exploration of the right kidney is facilitated by the acoustic window of the liver.
Stress urinary incontinence may be treated by different techniques. This study is based on a retrospective analysis of 59 patients treated between 1985 and 1993, by the Goebell-Stoeckel technique. 48 patients were questionned by phone in March 1995 to estimate the long term results. Two groups were defined; group A: follow-up between 15-60 months and group B: follow-up between 72-120 months (Total average follow-up: 68 months). The majority of patients were elderly, menopaused (88%) and had had one or more surgical procedure for incontinence (60%). Among 59 patients, 8 developped minor early complications. The mean length of hospital stay was 14 days and the mean duration of indwelling catheterization was 6.5 days. 60% of patients have had urinary retention after catheter ablation and have required intermittent catheterization at home for a mean duration of 14 days. Continence was achieved in 84% of cases at 3 months and had persisted in 96% of cases for group A and 91.5% of cases for group B. With a mean follow-up of 68 months, 37.5% of cases had irritative symptoms, 12.5% had minor urethral obstruction. 52% of patients obtained a very excellent result (normal continence, no urgency, no dysuria), 9% obtained an excellent result (normal continence, urgency with no leaked, and/or minor dysuria); 12 obtained a moderate result (normal continence, urgency with minor leakage without toilet set, and/or minor dysuria) and 27% obtained a poor result (incontinence, urgency with leakage necessitating toilet set, and/or dysuria).
The electroconductive lithotripter (ECL) is a new concept for shockwave generation in which a highly conductive solution channels the discharge between the anode and cathode. In vitro experiments showed a linear relation between the voltage setting and the pressure at F2. In vitro stone disintegration studies showed a considerable reduction in shockwave pressure variability, improved energy transfer to the stone, and a unique linear relation between fragmentation and electrode voltage without a saturation effect. This new concept has been used clinically in the Sonolith 4000 lithotripter. In 142 evaluable treatments with a 3-month follow-up, the overall stone-free rate was 82%, and the retreatment rate in stone-free patients was 10%. For stones equal or less than 10 mm, the 3-month stone-free rate, retreatment rate, and secondary procedure rate were 85%, 5%, and 0%, respectively. For stones between 11 and 20 mm, these figures were 83%, 4%, and 2%, respectively. The efficiency quotient was found to be 81% for stones equal or less than 10 mm and 78% for stones between 11 and 20 mm. These clinical results confirm the improvements in efficacy observed in vitro with very satisfactory tolerance.