Biomedical subjects
Publications and source records attributed to O Cussenot.
MRI has only recently been described in the evaluation of traumatic rupture of the corpora cavernosa. Our case report emphasises the perfect correlation between the MRI findings and the anatomical lesion. This examination therefore constitutes a valuable aid in the pretreatment assessment of rupture of the corpora cavernosa.
Metastatic renal cancer has a poor prognosis because of the limited impact of traditional treatment modalities on this tumour. The few long-term survivals obtained after isolated surgical resection of the primary tumour or its metastases can be attributed to the occasionally unpredictable natural history of this tumour and isolated surgical resection generally does not appear to improve the survival of these patients. Among non-surgical treatments, radiotherapy is purely palliative and hormone therapy has been shown to be ineffective. New therapeutic approaches have been recently developed, suggesting a possible improvement in the prognosis of metastatic renal cancer. A better understanding of the mechanisms of chemoresistance of renal cancer should lead, in the near future, to the use of drugs capable of increasing the efficacy of cytotoxic chemotherapy in this tumour. The results obtained with new forms of immunotherapy open up prospects for combined immunosurgical modalities.
Four artificial deformations of the skull (collection of the Laboratoire d'Anthropologie of the Musée de l'Homme) have been analysed in terms of their morphology and osteometry. The study of the endocranial base in the three planes of space was made possible by a computerised three-dimensional reconstruction based on data gathered by CT. These four skulls were paired as regards their shape (2 annular and dolichocephalic and 2 tabular and brachycephalic) and as regards their age (2 skulls of children and 2 of adults). Certain modifications of the base, such as a tendency to platybasia and to an antero-superior tilt of the posterior fossa around an axis passing through the basion, could be observed in the two modalities of deformation studied. The existence of a region little subject to modelling combining the body of the sphenoid and the basilar and lateral portions of the occiput was confirmed as regards the chondrocranium, whereas the peripheral structures of the base were remodelled like the membranous structures of the vault of the neurocranium.
Horseshoe kidney is a renal fusion which combines three anatomic abnormalities: ectopia, malrotation and vascular changes. These anomalies can be recognised separately to varying degrees in unfused kidneys. Necessary modifications of the standard technique for percutaneous nephrolithotomy (PNL) are directly deducible from analysis of the anatomic data of the imaging of horseshoe kidneys. We report our experience with 5 patients (7 kidneys) who underwent PNL for calculi in horseshoe kidneys. The percutaneous approach was performed under ultrasound and fluoroscopic monitoring. In situ disintegration by ultrasonic lithotripsy and nephrostomy drainage were necessary in all cases. Modifications of the standard PNL procedure are related to the anatomic changes. The lower abdominal position of a horseshoe kidney necessitates upper or middle calyceal puncture, while the malrotation necessitates a more posterior puncture. Monitoring of the puncture needle by fluoroscopy as it is advanced postero-anteriorly is more difficult and the risk of the surgeon's hand entering the radiation path is increased. The renal pelvis is deep and a long endoscope may be required. Aberrant segmental vessels may create potential hazards. The majority of problems in location can be avoided by use of an ultrasonically guided needle. Percutaneous nephrolithotomy is the treatment of choice for calculi in horseshoe kidneys for the following reasons: the high incidence of recurrent lithiasis in horseshoe kidney and the complexity of repeated surgical approaches diminish the acceptable results of open surgery; difficulties in focussing on the calculi and drainage problems militate against the success of extracorporeal shock wave lithotripsy (ESWL); PNL has a good success rate and the least morbidity.
The importance of growth factors in prostatic regulation has been demonstrated for several years. These "prostatic" growth factors are ubiquitous polypeptides which are not specific to the prostate. To date, three principal families of growth factors appear to be potentially involved in the development of benign prostatic hypertrophy: Epidermal Growth Factor (EGF), Fibroblast Growth Factor (FGF), Transforming Growth Factor beta (TGF beta). The FGF and TGF beta families probably play a central role in the pathogenesis of benign prostatic hypertrophy. A better definition of the respective roles of growth factors and androgens in the control of prostatic growth opens up prospects for the future in the field of basic treatment of benign prostatic hypertrophy.
The authors report a case of transplantation of a horseshoe kidney in two recipients. Based on this case and a review of the literature, they emphasise the technical precautions required for collection and transplantation of these malformed kidneys.
Bronchial sutures grafts by epiplooplasty is a method used to allow a better vascularisation of the bronchial sutures. The authors purpose an other method using the pericardial fatty fringes (P.F.F.). The vascularisation of P.F.F. was studied on 30 fresh cadavers and 8 patients before surgery. Angiography of the internal thoracic artery was done in the first group and M.R.I. in the second group. M.R.I. is better than angiography because numerous parietal vessels project in the angiogram, and they overlap pericardial fat fringes vessels.
In order to restore anal sphincteric function, artificial AMS sphincter was used with his 3 components: the peri-intestinal cuff giving anal sphincter tone, the pump used for active opening and the pressure regulating balloon. In the same fashion a continent valve may be created on an intestinal segment as a part of a reconstructed bladder. In this case the pump may be replace by a subcutaneous port allowing fluid injection to adjust volume and pressure in the cuff. Two patients with fecal incontinence related to sequela of a high imperforate anus syndrome were implanted. Follow-up is greater than 1 year with normal continence in the day for the first case (degree 2) and continence day and night in the second case. Artificial valve has been implanted in seven cases of neobladder pouch (or related situations), with in 4 cases very good results and in 3 cases a failure (Follow-up 3-36 months).
The ureteral duplication is a relatively common malformation and usually has no pathologic consequences. On the contrary, congenital diverticula of the ureter are rare and often give rise to urinary complications. A double malformation combining left ureteral duplication and a congenital diverticulum of the right ureter is reported and discussed. This rare case illustrates one and the same malformational process arrested at different stages of development.
Simian virus SV40 has been widely used to immortalize epithelial cells of mammalian origin. We report here, for the first time to our knowledge, the immortalization of normal adult prostatic epithelial cells in culture by transfection of a plasmid containing SV40 genome with a defective replication origin (SV40 ori-) encapsulated into liposomes. These cells (PNT1) have now been cultured for more than 12 months, and shown to contain the SV40 genome. They express large T protein, present the phenotype of differentiated luminal prostatic cells (positive with antibodies to cytokeratin 18, 19, weakly positive for prostatic acid phosphatase and prostatic specific antigen, negative with anticytokeratin 14 and KL2 antibody). PNT1 cells contain high affinity receptors for dihydrotestosterone. These cells provide a useful tool to study the biology and the pathology of adult prostatic epithelial cells, specially to understand the steps leading to prostatic transformation.
From 93 skulls and 23 foeto-skeletals we give a glimpse of the rhythme of the human foetuse's facial bones growth and the main variations for facial measurements rating during foetal period. The best correlation between foetal age and facial measurements was obtained with facial height (correlation coefficient: 0.96). Evolution of cranio-facial rating, during foetal stages shows essentially: the increase of the height/width facial rating, the same rhythme of growth for frontal and facial width, the rapidly growth of biparietal diameter up to 30 amenorrhea weeks comparatively to the facial and frontal growth in width.
Three hundred and eighty children underwent 434 angioaccesses. Of these angioaccesses, 113 were constructed in 74 children weighing under 10 kg. Most accesses (n = 340) were distal arteriovenous fistulae (AVF). After microsurgery there was a 96% immediate patency. Seventy percent of AVF, excluding distal ulnarbasilic AVF, were functional, sometimes after secondary superficialization of the vein. Eighty-five per cent of the distal radial-cephalic AVF are still patent after 2 years, 60% are still patent after 4 years. These radial-cephalic AVF required 65 repeat anastomoses, and 12 ligations of the proximal-radial artery in order to reduce to 50% the high blood flow (pre-reduction average index = 900 ml/min per m2. The patency rate of arteriovenous-bridge grafts was not encouraging. The severity of stenoses in the proximal-venous trunks, sometimes related to previous catheterization, is emphasized. Advantages of the radial-cephalic wrist AVF in children are highlighted.
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A free screening consultation for carcinoma of the prostate was proposed to men over the age of 50 years working in different companies in the areas of Paris. This consultation included a digital rectal examination, a blood test for determination of serum acid phosphatase and prostatic specific antigen, and two dimensional trans-rectal ultrasonography of the prostate. 600 patients were seen. 575 were evaluable. Prostate biopsy was recommended in 152 men. Ninety-three prostate biopsies were performed. Eighteen prostatic cancers and 1 urothelial cancer invading the prostate were detected with an overall incidence of prostate cancer of 3.1%. Radical prostatectomies were performed in 10 of the 18 patients with a prostate cancer. Sensitivity of digital rectal examination ultrasonography and PSA were respectively 42.8%, 47.3% and 68.4% with an abnormal serum PSA level defined as being greater than 5 ng/ml. The predictive value of a positive ultrasonography (18.7%) contrasts with the predictive value of a positive digital rectal examination (30.7%) and serum PSA (30%). Digital rectal examination and determination of serum prostatic specific antigen seem to be the most useful tests for mass screening of prostate cancer. Transrectal ultrasonography is very useful for guided prostatic biopsy and for a better topographic evaluation of the tumor.
Cell lines of neoplastic human prostate gland tissue are uncommon. We studied the condition of long term prostatic cell culture; 18 primary cultures of epithelial prostatic cells and 15 subcultures were maintained for several months. The optimum medium for primary prostatic cell cultures contains: little calcium, epithelial growth factor (EGF), phosphoethanolamine, spermine and cholera toxin, the cell characterisation for cultivation of normal, hyperplastic and neoplastic prostate gland tissue in subcultures uses monoclonal antibody against cytokeratin, prostatic acid phosphatase and prostatic specific antigen.
Four cases of central vein stenosis occurred after the use of Hickman's catheter in 32 children at the beginning of chronic hemodialysis. The seriousness for future angioaccesses is emphasized.
Four cases of leiomyoma of the urinary tract are presented: 3 locations in the bladder and one location in the ureter. Leiomyomas of the urinary tract are rare. These benign mesothelial tumors require conservative resection. Small lesions can be managed with endoscopic techniques.
Xanthogranulomatous pyelonephritis is a rare disease which frequently has a pseudotumoral appearance. Preoperative diagnosis is hazardous in spite of ultrasonography and CT scan correlation. Recently developed magnetic resonance imaging (MRI) identifies fatty tissue which is specific for XGP. The frequency of invasive investigations has decreased because of this new data and partial nephrectomy has become possible in localized forms of XGP. Magnetic resonance imaging provides an accurate reproduction of the lesions in three dimensions which allows detection of complications (abscess and fistulae) and a study of resection difficulties.