[Prostatic adenoma. Diagnosis, development, prognosis, treatment].
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Humans↗
Biomedical subjects
O Haillot
Publications and source records attributed to O Haillot.
Cell proliferation in dysplasia of the prostate: analysis by PCNA immunostaining.
Patterns of cell proliferation in the prostate were compared between benign epithelium and dysplasia. Proliferating cell nuclear antigen (PCNA) immunostaining was used to quantitate proliferation, and basal cells were tallied separately from secretory cells with the aid of keratin immunostaining. Using a novel technique, absolute cell densities (cells/mm) were determined and used to calculate growth fractions. In benign epithelium, 83% of PCNA+ cells were basal cells, while only 7% of PCNA+ cells in dysplasia were basal cells and there was a clear separation between groups. This dramatic shift of the proliferative compartment to the secretory cells in dysplasia was accompanied only by a moderate increase in overall secretory cell density and moderate reduction in basal cell density, but these ranges overlapped those of benign epithelium. The median PCNA+ secretory cell "growth fraction" was 0.12% in benign epithelium and 1.06% in dysplasia. The findings presented give further support to the concept that dysplasia represents an evolutionary stage in the malignant transformation of prostatic epithelium. The patterns of change in PCNA immunostaining may reflect certain aspects of the biologic nature of malignant transformation.
Adenocarcinoma↗
[Cancer of the prostate: the experiences and opinions of T. A. Stamey (Stanford) on the natural history, positive resection margins and the role of radiotherapy. (I). The conference of 20 November 1993, CNIT, Paris].
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Aged↗
[The frequency of surgery of benign prostatic hypertrophy].
OBJECTIVES: To calculate the incidence of surgical treatment of benign prostatic hyperplasia (BPH) in two French departments, Indre-et-Loire and C her, in order to deduce the incidence in France. METHODS: All patients operated for BPH by transurethral resection or transvesical prostatectomy were counted prospectively over a 6-month period by all surgeons of the Indre-et-Loire and Cher departments. Collection of case files was complete and based on BPH resection specimens sent to pathology. 506 patients were included in this survey. RESULTS: The mean age of the patients was 71.8 years. 78% of patients were operated by a private urologist, and 93% by a specialist urologist. The mean postoperative stay was 7.1 days and varied according to the patient's age, the weight of the prostate and the site of the operation (university hospital, private establishment and general hospital). This study allowed calculation of the annual incidence of surgery for BPH in these 2 departments: 822/100,000 men over the age of 50 years. The maximal incidence was observed during the 7th decade of life: 1,742/100,000. In our study, private urologists operated 76 patients for BPH per year. CONCLUSION: Extrapolation of these results to the French population indicates an annual incidence of surgery for benign prostatic hyperplasia in France of 776/100,000 men over the age of 50 years. On the basis of this incidence, an estimated 55,000 to 65,000 men are operated for BPH per year in France.
Adult↗
[Primary carcinoid tumor of the kidney associated with cystic malformation of the kidney].
We report a case of primary renal carcinoid tumor associated with kidney malformation. The carcinoid tumor contained cells which stained with anti-chromogranin, anti-serotonin and anti-somatostatin antibodies. The carcinoid tumor was developed on a cystic malformation with transitional epithelium. Immunohistochemical studies revealed positive chromogranin and serotonin cells within the epithelium. The 21 other cases of primary renal carcinoid were reviewed with a particular emphasis on the 2 other cases associated with renal lesions containing endocrine cells. These 3 cases could help to explain the development of primary renal carcinoid tumor.
APUD Cells↗
The use of perioperative Doppler ultrasound as a screening test for acute tubular necrosis.
For many years Doppler ultrasound has helped to identify the cause of renal allograft dysfunction. However, Doppler examinations were often performed after the onset of acute renal failure. In the present study we used Doppler ultrasound during grafting to follow changes in renovascular resistance. As early as 30 min after the renal artery had been unclamped, the calculated resistance index (RI) at the hilar part of the renal artery was significantly higher in the group of patients who developed acute tubular necrosis (ATN) than in the group of patients with early normalization of renal function (P = 0.05). This result did not correlate with raised cold and warm ischemia times and serum creatinine level on discharge in patients who presented with ATN. RI higher than 0.730 min after unclamping allows for an identification of those grafts at greater risk for the development of ATN and should be an indication for the early introduction of intensive therapy.
Adult↗
Insufficient dialysis shunts: improved long-term patency rates with close hemodynamic monitoring, repeated percutaneous balloon angioplasty, and stent placement.
Over 54 months, 70 short stenoses of 63 shunts (32 Brescia-Cimino fistulas, 31 grafts) in 59 patients necessitated a first percutaneous transluminal angioplasty (PTA). Restenosis led to 63 redilations in 38 lesions. Nine stents were inserted in seven grafts and two proximal veins in seven patients, the indication being that stenosis had recurred twice in 6 months. In three of these stenoses, five delayed intrastent redilations were necessary. Three previously dilated occluded grafts were recovered with local thrombolysis. Morbidity was 4.08%, with one immediate rupture, four delayed pseudoaneurysms (1-28 months), and two periprocedural bacteremias. Half (15 of 29) of graft stenoses and only 14% (four of 27) of Brescia-Cimino fistula stenoses had a mean restenosis interval of less than 6 months. The mean restenosis interval increased from 3.6 months +/- 0.5 (standard deviation) before stent placement to 15.2 months +/- 0.4 after stent placement (P < .001). Insertion of a stent can be advised when stenoses of graft venous anastomoses have recurred twice in less than 6 months. The combination of all interventional radiologic procedures allowed a significant improvement in secondary patency rates after PTA, with 82% at 1 year, 79% at 2 years, and 71% at 3 years.
Adult↗
[Epidemiology and detection of renal cancer in adults].
The incidence of renal carcinoma in France is 7 for 100,000 men and 3 for 100,000 women. Most cases are found in patients in their sixties or seventies. With the exception of the rare Von Hippel-Lindau disease, the only risk factor is tobacco smoking. The circumstances in which renal carcinoma is discovered have changed during the last few years: 1 out of 2 renal carcinomas are still diagnosed on their classical signs (essentially haematuria), but almost as many other cases are incidentally and unexpectedly detected by abdominal ultrasonography when the carcinoma is totally asymptomatic. The conventional attitude towards these fortuitously discovered renal tumours is the same as for asymptomatic tumours, i.e. widened nephrectomy. In case of small tumours a few centimetres wide, 20% of which are benign, it may be useful to wait a few months and reevaluate the situation prior to considering surgery. In elderly and asymptomatic patients the immediate surgical risk/long-term benefit ratio must be carefully weighed.
Adult↗
Simultaneous occurrence of acute myelogenous leukemia and seminoma of the testis.
Simultaneous tumors are rarely encountered during the course of acute leukemias. We report on a case of seminoma of the testis that occurred during the evolution of acute myelogenous leukemia. To our knowledge, this simultaneous association has not previously been described, but a causal relationship was not apparent in the present case. The likelihood of a common carcinogenesis existed, but direct exposure to carcinogens could not be established. Although the results of a physical examination and echography were normal at the time of diagnosis, we cannot exclude the presence of microscopic cancer of the testis. Since the dissemination pattern of seminoma is usually slower than that observed in this case and the disease remains limited to the lymph nodes for long periods following dissemination, the rapid development of the present case might have been attributable to the immunosuppression and the scrotal sepsis that occurred during the induction therapy. Immunosuppression might have stimulated the progression of a primary microscopic seminoma and the development of metastasis, whereas the scrotal sepsis and inflammation might have favored the occurrence of metastasis through bypass of the lymphatic barrier.
Adult↗
[What is new in the diagnosis of tumors of the testis?].
The major new developments in the diagnosis of testicular tumours over the last 11 years consist of imaging techniques and tumour markers. Doubtful clinical diagnoses of testicular tumours can now be clarified as a result of progress and diffusion of ultrasonography. Ultrasonography, a reliable (90%) and non-invasive examination, is more of a diagnostic aid than a decisive element, except in a few special cases. At the present time, magnetic resonance imaging is of no value in the diagnosis of testicular tumours. Alpha-foetoprotein and human chorionic gonadotrophin are the two essential markers for the follow-up, rather than for the diagnosis, of a testicular tumour. Lactate dehydrogenase and placental alkaline phosphatase are useful, especially in the seminomas, but are much less specific. The other markers studied have either not proven to be of any clinical value or are still in the field of research. Computed tomography appears to be gradually replacing lymphography for lymph node staging. The combination of the two examinations reduces the number of false negatives (10%) at the price of a higher number of false positives (38%). The diagnosis of testicular cancer can sometimes be made at the stage of carcinoma in situ, a precancerous lesion which progresses towards an invasive tumour in one half of cases. The practical indications for screening for carcinoma in situ are still controversial.
Biomarkers, Tumor↗
[Huriet law--practical guide].
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Clinical Protocols↗
Cutaneous toxicity of autologous bone marrow transplantation in nonseminomatous germ cell tumors.
High doses of carboplatin or cisplatin combined with cyclophosphamide and etoposide followed by autologous bone marrow transplantation (ABMT) rescue have been used in the treatment of testicular tumors that have had a bad prognosis. Unusual cutaneous complications, evoking radiation-induced dermatitis, have been seen in two of eight patients with the same regimen. This new type of toxicity seems to be related to high-dose combination chemotherapies. Good results in the treatment of patients with testicular tumors on relapse who continue to respond to chemotherapy lead to the extension of this type of schedule and cutaneous toxicity will probably develop.
Adult↗
Papillary tumour of the vagina resembling transitional cell carcinoma.
A case of a peculiar papillary neoplasia of the vagina resembling a urothelial tumour is presented. Four vaginal tumours were excised from a 76-year-old woman. Five years before this patient had undergone a uretero-nephrectomy for a non-invasive papillary transitional cell carcinoma of the renal pelvis. The four vaginal tumours demonstrated gross and microscopic similarities to low-grade papillary transitional cell carcinoma of the urinary tract. This observation indicates that multicentric, non-invasive, papillary tumours may affect the whole uro-genital area. The vaginal wall was not overlaid by a normal squamous epithelium, but by a peculiar "transitional-like" epithelium. Variegated endocrine cells were documented within this lining, using immunohistochemical and ultrastructural techniques. The eventuality of a histogenetic link between the tumour and the adjacent epithelial lining remains unresolved.
Aged↗
[Cytokeratins and transitional epithelium of the bladder. Particular distribution of cytokeratins].
The purpose of this study was to determine the tissue distribution of certain cytokeratins in the urothelium. A series of ten cystectomy specimens containing normal tissues was investigated by immunocytochemical labeling with specific antibodies against cytokeratins 19, 18, 8, 7, 10. Monoclonal antibodies were used on frozen sections. Distribution of keratin was correlated with morphologic changes. All specimens were lined by a normal transitional epithelium. Low molecular weight cytokeratins (polypeptides 19, 18, 8, 7) were detected in all cell layers. Anticytokeratin 19 stained epithelium in a rather uniform way. Different antibodies specific for cytokeratin 18 reacted differently on the same tissue. With certain anticytokeratins 18 and 8, a higher staining intensity was found in superficial layers as compared with intermediate cell layers. So-called "umbrella" cells were strongly stained. Anticytokeratin 10 revealed very rare endocrine-like cells. This normal urothelial pattern is in agreement with previous reports. This pattern of expression of cytokeratin polypeptides differs from that of nonkeratinizing squamous epithelium. Therefore, histological differentiation of epithelia is accompanied by pronounced changes in the expression of cytokeratin polypeptides.
Carcinoma, Transitional Cell↗
[Wilms' tumors in adults].
Two cases of Wilms' tumors in adults are reported according to the criteria defined by Kilton. The study of the literature allows defining the pathogenetic hypothesis for these embryonic tumors, as well as their peculiarities in comparison with those occurring in childhood. The prognosis seems to be improved by an aggressive treatment. A schedule of treatment including initial surgery, radiation therapy and chemotherapy varying according to the tumoral group (NWTS 2 staging) is proposed.
Adult↗
[Descriptive epidemiology of tumors of the renal parenchyma in adults, in Indre-et Loire from 1980 to 1987].
296 solid renal tumors were studied retrospectively, i.e. the total number of renal tumours diagnosed in the Indre-et-Loire region between 1980 and 1987 inclusive. The crude incidence rate increased from 5.4 per 100,000 in 1980 to 8 per 100,000 in 1987. The standardised rates were 6.7 per 100,000 for men and 3.2 per 100,000 for women. These figures being quite high for France. The mean age at the time of diagnosis, 67 years for women and 65 years for men, decreased during the study, especially for women. Patients in whom the renal cancer was discovered accidentally, tended to be older than those in whom the tumour was symptomatic. The percentage of tumours discovered at stage I rose from 29 to 49% the percentage of tumours at stage IV fell from 45 to 23.5%. In parallel, the percentage of nephrectomies rose from 40 to 70%. The overall 5 year survival rate was 43.5%, rising to 71% for stage I tumours. It appeared that patients who consulted in the private sector tended to be younger and were therefore at an earlier stage in the natural history of the disease. From an epidemiological viewpoint, the introduction of ultrasonography in the Indre-et-Loire region and its more widespread use did not produce any change in the means of diagnosis of renal cancer.
Adenocarcinoma↗
[Ureteral stenosis in pancreatitis. Role and value of the double J tube].
One case of right ureteral stenosis due to a flow of necrosis from an acute lithiasic pancreatitis, treated with the insertion of a double J tube, is reported. 14 cases of ureteral stenosis following pancreatitis have been found in the literature. They occur whatever the severity of pancreatitis and can either reveal it or, on the contrary, be asymptomatic. The ureteral lesions are of three kinds: compression by a pseudocyst of the pancreas, sheathing of the ureter and "ureteritis" in the flows of necrosis, necrosis of the ureteral wall. The management of these ureteral stenoses involves treating both the pancreatitis and the obstruction, according to its type. In cases of compression or sheathing of the ureter, ureteral endoprostheses inserted in an early stage allow maintaining the patency of the ureter during the healing phase. In case of ureteral necrosis, nephrostomy, then ureteral resection prove to be necessary.
Aged↗
[ The law, indispensible images and superfluous images in cancer of the kidney].
In France, a physician is considered liable for a medical error only if the appropriate diagnostic and therapeutic means were not used. The urologist who evaluates a patient is responsible for the diagnosis of renal carcinoma and for assessing the spread of the disease and deciding whether surgery is indicated. The urologist coordinates the various investigations and interprets results in the light of each individual patient's characteristics. In most renal carcinomas, only simple imaging techniques are needed: renal ultrasonography and an intravenous urogram or a CT scan. Further techniques may be required to assess disease spread according to the French Urology Association's Oncology Committee, only abdominal ultrasonography and a chest film are "absolutely required", the other imaging techniques being "desirable" or "optional".
Diagnosis, Differential↗