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Biomedical subjects

O Bouchot

Publications and source records attributed to O Bouchot.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Wadding of the axilla in the conservative treatment of cancer of the breast. Prevention of lymphocele].

A randomized prospective study was carried out on 53 consecutive female breast cancer cases hospitalized at the Centre René Gauducheau, In Nantes (France), with the intent of investigating whether surgical wadding of the axillary fossa with the use of proximate muscular tissue can prevent lymphocele from occurring, and avoid placement of suction drains usually required in conservative management of breast cancer. Results have been significant regarding the incidence of lymphocele (p less than 0.001), as well as the mean puncture volume and the total number of punctures needed (p less than 0.001), thus reflecting the efficacy of a simple method, which yields satisfactory cosmetic results. Failures with this method were related to the technical procedure per se, and not to its principle. The lapse of time required before additional treatment was initiated as subject to a factor not related to the method, but depended upon the recovery of normal shoulder mobilization.

Adult↗
PubMed1990

[Prevention of complications in inguinal lymphadenectomy].

Inguinal lymphadenectomy, as indicated in the treatment of metastases of carcinoma of the penis and of malignant melanoma in the inguinal lymph nodes, involves considerable mortality and morbidity. From February, 1988, to January, 1990, we performed 15 inguinal lymphadenectomies in 10 patients with an average age 51.9 +/- 5.3 years. The technique used combined a transverse incision parallel to the inguinal fold, complete inguinal lymphadenectomy, transposition of the sartorius muscle and vaporization of a film of fibrin glue. The last 2 operations, besides the effectives protection of the femoral pedicle, aim at suppressing dead spaces that may produce hematomas, subcutaneous infection or lymphoceles, and at avoiding the insertion of an aspiration drain, which causes persistent lymphorrhea. Out of the 15 cases of lymphadenectomy, 5 presented with a small- (48 ml in average) or medium-volume (200 ml) lymphocele, which was treated by a simple evacuating puncture. No necrosis of the skin edges, subcutaneous infection or lymphorrhea were observed. These results are encouraging, since our patients can rapidly resume their social life and have an acceptable quality of survival.

Adult↗
PubMed1990

[Electrocoagulation of the paraurethral glands (Reiser's operation) in women with urethro-cystalgia].

One hundred nineteen cases of women with chronic urethrocystalgia were reviewed. The symptoms were dominated by urethral burning (83%) and pollakiuria (75%). Electrosection of the paraurethral glands according to Rieser's technique and resection of the urethral floor (100% of cases) were combined with hymeneoplasty in 9% of cases. The results concern 67 women with a mean follow-up of 6 years: cure: 36%; marked improvement: 34%; no change: 30%. The authors discuss the presence of paraurethral glands, their role in the urethrocystalgia syndrome and the place of Rieser's operation in their treatment.

Adult↗
PubMed1990

[Post-traumatic stenosis of the membranous urethra].

Secondary urethral stricture is the most serious complication of traumatic rupture of the membranous urethra, directly related to the treatment of the rupture. In a series of 45 patients treated for urethral rupture with a minimal follow-up of 5 years, 30 developed stricture (66%). An urethral guide, inserted in 31 cases, was responsible for the stricture in 26 of these cases (84%). This stricture developed rapidly (average of 7.4 months), whether the initial rupture was complete or incomplete and was longer (average of 35 mm) in the case of complete rupture. End-to-end urethrorraphy performed between the 15th and 35th day in 14 patients was complicated by 4 secondary strictures (28%). The treatment of the stricture depended on the initial treatment of the rupture and the radiological length of the stricture. In the case of stricture secondary to an urethral guide, end-to-end urethrorraphy for a stricture less than or equal to 40 mm (12 cases) and 2 stage urethroplasty for a stricture greater than 40 mm (4 cases) achieved a good result in 68.8% of cases. The strictures secondary to end-to-end urethrorraphy (4 cases) were treated by direct vision urethrotomy (3 cases) with 100% of immediate good results and by urethral telescoping (1 case) complicated stress urinary incontinence.

Adolescent↗
PubMed1989

Interleukin 2 receptor in rat heart allograft rejection.

Soluble interleukin 2 receptors (S-R-IL-2) of truncated Tac chain, produced in vitro during T lymphocyte activation, may represent an in vivo marker of an alloimmune reaction. We analyzed serum S-R-IL-2 production during acute heart allograft rejection and compared soluble and membranous Tac chain (blood lymphocytes and graft invading cells) regulation during rejection. Serum S-R-IL-2 was tested in an immunoradiometric assay, with a combination of two mouse IgG1 anti-IL2-R mAbs (ART18 and OX39). Membranous Tac chain was analyzed by immunochemistry in graft tissue, and by immunofluorescence on blood and spleen leukocytes. Four experimental groups were used: untreated allogeneic, untreated syngeneic, CsA-treated (10 mg/kg/day for 15 days) allogeneic and CsA-treated syngeneic graft recipients. In the untreated allogeneic group, S-R-IL-2, tested every day until rejection (9.14 +/- 1.6 days), increased as early as day 3 after transplantation, peaked at day 6, and plateaued thereafter. The allograft was infiltrated at day 5 by Tac chain-positive cells (10% of OX1 cells and 84% of OX19 cells). A small percentage of mononucleated cells was labeled in blood, but not in spleen, by ART18 and OX39 at day 7 only. In contrast, in untreated syngeneic and CsA-treated allogeneic combinations, there was no increase of baseline S-R-IL-2 level (P less than 0.001), and graft infiltrate did not contain IL-2-R positive cells. CsA treatment prolonged heart allograft survival (41.3 +/- 2.8 days). Baseline S-R-IL-2 levels during treatment were lower than those observed in untreated animals. In the CsA-treated allogeneic group, after CsA treatment interruption, S-R-IL-2 levels significantly increased, reaching a plateau at day 37. Results suggest that S-R-IL-2 measurement can be useful for clinical diagnosis of allograft rejection.

Animals↗
PubMed1989

Management of regional lymph nodes in carcinoma of the penis.

In the management of carcinoma of the penis, standard treatment of the primary tumor is by radiotherapy for small lesions (Tis, T1, T2 located in the glans) and by amputation in other cases (T2 with invasion of the shaft). The diagnosis and treatment of regional lymph nodes are thus the essential problems with this cancer. In our series of 45 patients with a minimum 5-year follow-up, clinical assessment was incorrect in 22.5% of cases (22% of the patients with negative bilateral biopsy of the superficial inguinal nodes developed metastases), and many of the complications (flap necrosis, lymphedema) occurring after inguinal lymphadenectomy contributed to a poorer quality of patient survival. A therapeutic approach to the management of regional lymph nodes in order to combat the carcinoma more effectively and improve patient survival quality is suggested.

Adult↗
PubMed1989

[Sterility and tumors of the testis. Study of late exocrine and endocrine functions in stage I or IIA tumors].

Spermatogenesis and plasma hormone levels (testosterone, follicle stimulating hormone and 17 beta estradiol) were studied in patients presenting stage I or IIA testicular tumors. Patients with a previous history of cryptorchidism or varicocele, and those who had received combined chemotherapy, were excluded. In 22 patients (10 seminomas and 12 non-seminoma tumors) a spermogram was obtained at the time of orchidectomy, before the procedure in 9 cases and immediately afterwards in 13. Hormone levels, together with tumor marker assay (alpha feto protein and beta HCG) were determined preoperatively. Exocrine and endocrine function were restudied after 3 years of follow up. There was an initial restudied after 3 years of follow up. There was an initial deterioration in spermatogenesis in 17 patients (77.8%) as shown by a sperm count less than 20 million per cm3, an ejaculate volume less than 1.5 cm3 and a motility after one hour of less than 60%. In this group 11 patients had a sperm count of less than 10 million per cm3. Endocrine anomalies discovered included an increase in serum beta HCG levels (7 cases), combined with a decrease in follicle stimulating hormone and an increase in 17 beta estradiol. After 3 years, only 5 of these 17 patients demonstrated fertile sperm (29.4%). The endocrine anomalies tended to regress after orchidectomy. While these endocrine anomalies were always accompanied by hypofertility, their absence was not synonymous with a normal spermogram. Thus the reestablishment of fertile sperm remains unlikely even in early stage testicular tumors.

Adult↗
PubMed1989

[Emphysematous pyelonephritis and perinephritis].

The authors report an eighth case of emphysematous perinephritis and a new case of emphysematous pyelonephritis. The general features of these two diseases and their similarities are described: middle aged diabetic women, clinical picture of sepsis, gas images projected over the renal area with delayed excretion on intravenous pyelography, computed tomography reveals the exact site of the emphysematous images (perinephritic and or intraparenchymal). Emphysematous perinephritis may be an early form of emphysematous pyelonephritis. Surgical drainage of the renal compartment allows conservative management at this early stage.

Diabetes Mellitus, Type 2↗
PubMed1989

[Varicocele in children and adolescents. Is surgery justified?].

Varicocele, a disease essentially observed in adults, is under-estimated in children and adolescents, in whom, for the majority of authors, the therapeutic management is surgical although the benefits in terms of fertility are unknown. Forty-eight children and adolescents, seen between 1978 and 1983, were followed by clinical examination and subsequent sperm count with a mean follow-up of 5.20 years. The presence at the first examination of the subsequent development of testicular atrophy is a pejorative element in the disease: 12% of children managed expectantly developed left testicular atrophy at puberty associated with severe anomalies of the sperm count. Persistent testicular atrophy after surgery was synonymous with anomalies of the sperm count in all of these children. Regression of moderate atrophy was observed in three children after surgical cure, but the pre and post-treatment sperm counts were normal.

Adolescent↗
PubMed1989

[The Whitaker test. Its reliability and place in the study of congenital malformative uropathies].

47 children with hydronephrosis or megaureter under went urodynamic assessment by Whitaker's test. The reliability of this test, evaluated on a long-term follow-up (3.20 years in average) by clinical, radiographic and diuretic renogram test, was excellent in 86.6 per cent. This reliability was better in hydronephrosis (90.5%) than in megaureter (83.3%). The comparison between diuretic renogram and Whitaker's test showed a discordance in 43 per cent. But the diuretic renogram was still a good urodynamic assessment when the curve was not equivocal. In others cases, Whitaker's test was essential for the diagnosis of obstruction.

Adolescent↗
PubMed1989

[Varicocele in children and adolescents. Is surgical treatment justified?].

Varicocele , a disease essentially observed in adults, is underestimated der-estimated in children and adolescents, in whom, for the majority of authors, , the therapeutic management is surgical although the benefits in terms of fertility are unknown. Forty-eight children and adolescents, seen between 1978 and 1983, were followed by clinical examination and subsequent sperm count with a mean follow-up of 5.20 years. The presence at the first examination of the subsequent development of testicular atrophy is a pejorative element in the disease: 12% of children simply followed developed left testicular atrophy at puberty associated with severe anomalies of the sperm count. Persistent testicular atrophy after surgery was synonymous with anomalies of the sperm count in all of these children. Regression of moderate atrophy was observed in three children after surgical cure, but the pre- and post-treatment sperm counts were normal.

Adolescent↗
PubMed1989

[Injuries of the posterior urethra. Apropos of 57 patients excluding iatrogenic injuries].

Between 1973 and 1986, 57 patients presented with a fracture of the pelvis with rupture of the posterior urethra. All of these patients were treated as an emergency and were then followed periodically with a minimal follow-up of 2 years. There were 4 cases of rupture of the prostatic urethra and 53 cases of rupture of the membranous urethra, including 32 complete ruptures and 21 partial ruptures. In the case of rupture of the membranous urethra, initial treatment, in 34 cases, was realignment by guiding catheter either immediately (25 cases) or deferred emergency (9 cases) and, in the other 19 cases, end-to-end urethrorrhaphy or urethroplasty (2 cases) as a deferred emergency (15th to 32nd day). The results were evaluated on the maximal flow/second and the flowmetry curve, intravenous pyelography with micturating and post-micturating films and the need for dilatations or reoperations. In the cases treated by realignment by guiding catheter, 28 of our 34 patients (82%) developed secondary stenosis which is difficult to treat because of the large amount of granulation tissue and fibrosis, although the best results were obtained by end-to-end urethrorrhaphy (75%). In contrast, repeated dilatations and optical urethrotomies were failures. Deferred emergency end-to-end urethorrhaphy, in 17 cases, ensured a good immediate result in 60% of our patients. Secondary stenosis (7 cases) was always short and easily accessible to optical urethrotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Linitis plastica extending through the entire digestive tract. A case report].

A 43-year-old man who presented a perplexing diagnostic challenge, had diffuse linitis plastica involving the entire gastrointestinal tract (autopsy). Although the usual primary site is the stomach in case of linitis plastica, invasion of the large and small bowel is rarely seen, but must be searched with proctoscopic exam and barium enema. We review the literature and discuss the pathogeny of this disorder.

Adenocarcinoma, Scirrhous↗
PubMed1988

[Long-term efficacy of anticholinergic and alpha-blockader drugs on the detrusor muscle in children with myelomeningocele].

Pharmacological agents, essentially anticholinergic and alpha-blocking drugs, occupy an important place in the stabilization of congenital neurogenic bladders. In actual fact, the functional characteristics of the detrusor, contractility, compliance and functional capacity, are important factors in the prognosis of these neurogenic bladders, both for the future of the upper urinary tract and for the possibilities of continence. This behaviour of the detrusor may be pharmacologically modified not only by anticholinergic drugs, but also by alpha-blockers due to the adrenergic innervation of foetal bladders by short neurones. This study compared the activity of these 2 drugs prescribed separately over a minimal period of 2 years to 54 children with congenital neurogenic bladder. The amplitude of vesical contraction was reduced in about 75% of cases with both drugs, but this result was obtained more rapidly with anticholinergic drugs than with alpha-blockers. No escape phenomenon over time was observed. Anticholinergic drugs were more effective on phasic contractions while alpha-blockers were more effective on rhythmic contractions. In contrast, they had an insignificant action on hypertonia. The increase in functional vesical capacity was 4 times greater with anticholinergic drugs than with alpha-blockers, possibly because of a simultaneous reduction in peripheral resistance with alpha-blockers.

Adolescent↗
PubMed1988

[Dysuria in women and bladder hypocontractibility].

Urodynamic tests used to analyze 120 cases of non-neurogenic and non-iatrogenic dysuria in women provided data to which the following criteria were applied: maximum output less than 15 ml/s and/or residue greater than 100 ml. Clinical examination, including endoscopy, established a possible obstructive cause in 60 cases (36 patients with prolapse, 12 with urethral stenosis and 12 with cervical disease) the 60 other cases remaining unexplained. The frequency of reduced or absent contractility, 68% in the total population, is still 58% when a cervico-urethral obstruction exists.

Adolescent↗
PubMed1988

[Factors of the urinary prognosis of myelomeningoceles].

Based on a retrospective series of 200 patients with myelomeningocele followed over a period of 3 to 17 years (mean = 9.02 years), the authors define the prognostic elements of the radiographic and urodynamic assessment. Their aim was to define a population at risk presenting a possibility of deterioration of the upper urinary tract. The mean age at the time of the first assessment by the authors was 12 years (range: 2 to 38 years), at which time the upper urinary tract was not dilated in 73% of cases and dilated in 27% of cases. Evaluation of the clinical course revealed that 7% of the upper tracts were dilated at the first consultation and only 1% of them remained so, 26% became dilated secondarily and 67% were never dilated throughout the observation period. The last cystometric assessment provided the following mean values: --for the overall population (200 patients): a premicturating pressure (P2) of 32 cm of water and a compliance (CPL) of 20 ml/cm of water; --for the population in which the upper tract was dilated at the last consultation (54 patients): a P2 of 45 cm of water and a CPL of 7 ml/cm of water; --for the population in which the upper tract was not dilated at the last consultation (146 patients): the P2 was 27 cm of water and the CPL was 24 ml/cm of water. These 2 parameters therefore appeared to be essential and their prognostic value should be evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[How to examine an non-contractile bladder].

Bladder contractility is dependent on the quality of the detrusor muscle and its innervation, and acontractility can therefore result from muscular or neurologic dysfunction. Etiologic factors involved in this functional disorder include collagen overload of the bladder wall and/or denervation or inhibition phenomena. Cystometric conditions necessary and sufficient for recognition of the disorder are indicated, the stop-test being an indispensable exploration to establish diagnosis. The Lapidès test is reliable when peripheral neurologic lesions are involved but the lesion must be complete; for incomplete lesions greater sensitivity is obtained with electrophysiologic tests such as analytic electromyography, sacral evoked potentials or rapid cystometry. Tests using an alpha-blocker allow recognition and lifting of reflex inhibition, particularly in neurologic patients with high level lesions. Proof of the psychogenic nature of the retention in hysterical patients is more difficult to obtain, and a specific test is not available, apart from histology, for diagnosis of bladder collagenosis.

Electrophysiology↗