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Olivier Bouchot

Publications and source records attributed to Olivier Bouchot.

At least 19 recordsLinked to original sources
PubMed2006

Surgical care, morbidity, mortality and follow-up after nephrectomy for renal cancer with extension of tumor thrombus into the inferior vena cava: retrospective study since 1990s.

OBJECTIVES: The aim of our survey was to evaluate surgical care, morbidity, mortality and follow-up of patients who had undergone surgical exeresis of a renal cancer with extension of tumor thrombus into the inferior vena cava. PATIENTS AND METHODS: Between June 1991 and March 2003, 40 (5.4%) patients were operated on for an enlarged nephrectomy with thrombectomy. The upper limit of the tumor thrombus was below the sus-hepatic veins in 21 (52.5%) patients and above the sus-hepatic veins in 19 (47.5%) patients with six (15%) located in the right atrium. RESULTS: Cardiopulmonary bypass (CPB) was used for 12 patients (30%). A per-operative embolism was noted for three (7.5%) patients: two cases of cruoric embolism and one case of gaseous embolism, systematically occurring in patients operated on without CPB. Early mortality was 7.5% (three patients) attributable to hemorrhagic complications. Overall survival at 2 and 5 years was 45.2% and 38.7%, respectively. Disease-free survival at 2 and 5 years was 28.3% and 8.9% respectively. Only the pN stage had a statistically significant prognosis value for overall survival but not for disease-free survival. At the end of the study, only one (2.5%) patient could be considered free of the disease with sufficient follow-up after the surgery. CONCLUSION: Patients with renal cancer and tumor extension in the inferior vena cava need multidisciplinary cooperation to adapt a good surgical strategy, particularly with the use of CPB. However, the rate of patients free of disease after such surgery was low.

Adult↗
PubMed2006

Temporary coronary artery occlusion during off-pump coronary artery bypass grafting with the new poloxamer P407 does not cause endothelial dysfunction in epicardial coronary arteries.

OBJECTIVE: The aim of this study was to assess the efficacy of the novel reversible thermosensitive gel poloxamer 407 for occlusion of the coronary vessel necessary for minimally invasive operations and its effects on coronary endothelium. METHODS: Domestic swine were submitted to occlusion of the left anterior descending or right coronary artery using the poloxamer. The left and right internal thoracic arteries were used as grafts to perform coronary artery bypasses. Animals were humanely killed after 3 hours of perfusion (acute; n = 8) or 3 days (subacute; n = 6). The vascular reactivity of coronary artery was evaluated in response to serotonin and bradykinin. Histologic studies were performed to analyze cardiomyocyte necrosis and endothelial coverage. RESULTS: The gel led to an occlusion of 7.8 +/- 2.2 minutes. Concentration-response curves of occluded coronary segments showed no difference of endothelium-dependent relaxations in both operated groups (P < .05 vs control). Histologic studies demonstrated the absence of cardiomyocyte necrosis after coronary artery occlusion in the acute group; a small infarct zone was detected in 1 animal in the subacute group, resulting from an occlusion of the first diagonal branch. The endothelial layer coverage was preserved in both groups. CONCLUSION: The poloxamer 407 represents a promising technique for obtaining hemostasis at the site of anastomosis during construction of bypasses during beating heart coronary artery surgery, without damage to the endothelium or ischemic consequence.

Anastomosis, Surgical↗
PubMed2006

Alternative to sternotomy: aortic valve replacement through right thoracotomy.

Many minimally invasive alternatives to aortic valve replacement through full sternotomy have been described. We report an approach through a right thoracotomy that has been planified in 2 patients with contraindication to standard thoracotomy. Exposure was excellent, and valve replacement could be performed safely.

Aortic Valve Stenosis↗
PubMed2006

[Morbidity and mortality of renal cancer with inferior vena cava extention according to various types of surgical management].

OBJECTIVE: The objective of this study was to evaluate the mortality and morbidity of patients operated for renal cancer with inferior vena cava extension according to the surgical management and the upper limit of the tumour thrombus. underwent radical nephrectomy with resection of neoplastic venous thrombus extending into the inferior vena cava. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.50%) with invasion of the right atrium in 6 cases (150). RESULTS: Cardiopulmonary bypass (CPB) was used in 12 patients (30%). The transfusion rate was 87.5%. In the group of 19 patients with thrombus extending above the hepatic veins, the transfusion rate was lower in patients operated by CPB (p=0.008). Intraoperative embolism occurred in 3 patients (7.5%): 2 cases of thrombotic embolism and 1 case of gas embolism, always in patients operated without CPB. The early mortality was 7.5% from haemorrhagic complications. The early morbidity was 47.5%. No significant difference was observed between groups of patients operated with or without CPB in terms of morbidity (p=0.836) or mortality (p=0.896). CONCLUSION: The management of patients with renal cancer and inferior vena cava extension is complicated and requires a multidisciplinary approach. Patients operated under CPB for tumours extending above the hepatic veins have a lower transfusion rate and a lower embolic complication rate with no increase of mortality and morbidity.

Adult↗
PubMed2006

[Oncological results of renal cancer with inferior vena cava thrombosis after nephrectomy].

OBJECTIVE: The objective of this study was to evaluate survival and risk of recurrence in patients undergoing nephrectomy with resection of inferior vena cava tumour thrombus in our department. MATERIAL AND METHODS: From June 1991 to March 2003, 40 patients underwent radical nephrectomy with resection of inferior vena cava tumour thrombus. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.5%), with thrombus in the right atrium in 6 cases (15%). Cardiopulmonary bypass (CPB) was used in 12 patients (30%) RESULTS: With a mean follow-up of 28.5 +/- 36.8 months (range: 0-150), 22 patients (55%) have died. The 2- and 5-year overall survival rates were 45.2% and 38. 7%, respectively. Local and/or metastatic recurrence was observed in 28 patients (70%) after a mean interval of 18 +/- 22.9 months (range: 1-104). Patients with tumour thrombus derived from the left kidney had a higher local recurrence rate than patients with thrombus derived from the right kidney (p = 0.0194). The 2- and 5-year recurrence-free survival rates were 28.3% and 8.9%, respectively. Only stage pN had a statistically significant prognostic value on overall survival, but not on recurrence-free survival. At the end of the study, only 1 patient (2.5%) can be considered to be cured with no disease progression with a sufficient follow-up (52 months) after nephrectomy. CONCLUSION: Nephrectomy with resection of tumour thrombus from the inferior vena cava provides a gain in terms of medium-term survival, but the majority of patients are not cured by this major surgery. Only lymph node status has a prognostic value.

Adult↗
PubMed2006

[Practice patterns of general practitioners in the Loire-Atlantique region and their patients' knowledge of prostate cancer screening].

OBJECTIVE: The objective of this study was to analyse the practices of general practitioners in the Loire-Atlantique region and their patients' knowledge about prostate cancer screening. MATERIAL AND METHODS: A "doctor" questionnaire focussing on prostate cancer screening practices was sent by mail to 1,086 general practitioners of the Loire-Atlantique region. "Patient" questionnaires were enclosed to be completed by 5 consecutive male patients over the age of 50. RESULTS: The doctor participation rate was 4.7%. Prostate cancer screening was performed by 98% of doctors. However 63% of doctors performed digital rectal examination and PSA annually, but only 27% in the specific age-group from 50 to 75 years. The "patient" questionnaire was completed in 233 cases. 88% of patients were informed about prostate cancer screening, essentially by their doctor or the media. 33% of patients indicated digital rectal examination and 23% indicated PSA as prostate cancer screening methods. Only 33% of patients declared to know one of the treatments for prostate cancer, reporting surgery in 78% of cases and radiotherapy in 32% of cases. CONCLUSION: General practitioners answering the questionnaire performed prostate cancer screening, but according to AFU guidelines only in 1/3 of cases. The majority of patients considered that they had been informed about prostate cancer screening, but with many imperfections.

Aged↗
PubMed2005

Molecular cloning and characterization of FBXO47, a novel gene containing an F-box domain, located in the 17q12 band deleted in papillary renal cell carcinoma.

Genetic alterations of chromosome arm 17q occur in numerous tumor types, including breast and ovarian tumors, suggesting the presence of a tumor-suppressor gene on the long arm of chromosome 17 that is critical for carcinogenesis. Previous studies have shown an allelic imbalance (70% gain or loss) of 17q in papillary renal cell carcinoma (pRCC). In this study, we analyzed 15 cases of pRCC for loss of heterozygosity with the use of 7 microsatellite markers between 17q11 and 17q23. We identified a minimal deleted region in which the D17S250 marker (17q12) was deleted in 50% (7 of 14) of informative cases. We isolated the cDNA of a novel gene named FBXO47, which is near D17S250. Human FBXO47 is composed of 11 exons and spans approximately 30 kb of genomic DNA. FBXO47 cDNA consists of 2,269 bp with a 1,359-bp open-reading frame. Of note is that FBXO47 is preferentially expressed in normal tissue relative to the corresponding tumor tissue, particularly in the kidney, liver, and pancreas and to a lesser extent in the thyroid gland, stomach, and small intestine. The putative protein encoded by this gene is made up of 453 amino acids and belongs to the F-box family, most of whose members, such as SKP2 and FBW7, have been implicated in carcinogenesis. Together, these results indicate that FBX047 has a potential role as a tumor-suppressor gene.

Amino Acid Sequence↗
PubMed2005

[Retrospective study of laparoscopic retroperitoneal radical nephrectomy].

OBJECTIVE: To analyse the results of laparoscopic retroperitoneal radical nephrectomy in terms of feasibility, morbidity and disease control. PATIENTS AND METHODS: Between October 1997 and May 2004, 42 laparoscopic retroperitoneal radical nephrectomies were performed in 33 men and 9 women for renal tumour. Three or four trocars were used depending on the operative findings in order to achieve oncological imperatives: primary control of the renal pedicle before mobilization of the kidney (the artery was clipped and the vein was sectioned by Endo-GIA), passage in the plane of radical nephrectomy and absence of direct contact with the tumour The operative specimen was extracted whole in an impermeable endoscopic bag by enlarging a trocar orifice to avoid any parietal contact. RESULTS: 21 right radical nephrectomies and 21 left radical nephrectomies were performed in patients with a mean age of 61.8 years (range: 36 to 83 years). The mean size of the kidney was 120 mm (range: 60 to 170 mm), for a mean weight of 430 g (range: 55 to 870 g). The mean tumour size was 46.4 mm (range: 15 to 90 mm). The mean operating time was 132 min (range: 70 to 240 mm) for an estimated mean blood loss of 120 cc (range: 0 to 1000 cc). The mean hospital stay was 8.3 days (range: 4 to 26 days). Conversion was necessary for technical difficulties in 7 cases (16.7%), venous injuries in 5 cases, arterial injury in 1 case, and difficult dissection of the perirenal fat due to a history of high-grade diffuse lymphoma in remission. The final histological stage showed 31 pT1 tumours, one pT2 tumour and 10 pT3 tumours. Four patients died in a context of metastatic diseases with a mean follow-up for our series of 15 months (range: 1 to 64 months). CONCLUSION: Laparoscopic retroperitoneal radical nephrectomy is a feasible technique, which strictly complies with the principles of cancer surgery. The main complication observed in our series was bleeding, which appears to depend on the surgeon's experience.

Adult↗
PubMed2005

[Complications of Bricker ileal conduit urinary diversion: analysis of a series of 246 patients].

OBJECTIVE: The objective of this retrospective study was to evaluate the mortality and early and late morbidities of Bricker ileal conduit urinary diversion. PATIENTS AND METHODS: Between January 1990 and December 2002, 246 Bricker ileal conduit urinary diversion was performed in our centre in 164 males (67%) and 82 females (33%) with a mean age of 64 years (range: 9 to 90 years). Bricker diversion was performed in 73.6% of cases for underlying tumour (prostate, bladder, cervical, colon cancer), and in 26.4% of cases for benign disease (neurogenic bladder radiation bladder bladder exstrophy, incrusting cystitis). Cystectomy was associated with Bricker diversion in 62.2% of cases. The mean follow-up was 24 months (range: 1 to 151 months). The following parameters were studied: mortality and early and late medical or surgical, urological and gastrointestinal complications. RESULTS: The postoperative mortality was 6.9% (17 deaths, 16 in patients in whom Bricker diversion was performed for cancer). The early morbidity was marked by gastrointestinal complications (ileus, fistula, evisceration) in 46 cases (1.7%), 25 of which required re-operation. A medical complication was observed in 41 patients (16.7% of the series), responsible for 60% of the postoperative mortality (10 of the 17 deaths). A urinary fistula was observed in 7 patients (2.8%). The late morbidity consisted of parietal complications (incisional hernia, peristomal hernia, stricture of the stoma) in 18.3% of cases. Urological complications consisted of acute pyelonephritis (11%), ureteroileal stricture (4.9%) and urinary stones (4.9%). CONCLUSION: Bricker ileal conduit urinary diversion is associated with considerable mortality, especially in cancer patients. Early complications are essentially gastrointestinal, while late complications tend to be parietal or urological.

Adolescent↗
PubMed2005

[Small round cell desmoplastic tumour presenting as a testicular mass].

The authors report a case of small round cell desmoplastic tumour presenting as a testicular mass. This is a rare tumour arising from serosal tissues, especially the tunica vaginalis. It is characterized by a specific reciprocal translocation t(11;22) (p13;q12) inducing fusion of the EWS and WT1 genes. Treatment of this tumour consists of a combination of surgical resection, as complete as possible, and intensive chemotherapy (P6 protocol or Institut Gustave Roussy protocol) and possibly radiotherapy. However, the prognosis remains very poor.

Adult↗
PubMed2005

[Predisposing factors for ureteric strictures in renal transplantation].

OBJECTIVE: Renal transplantation is a well defined surgical procedure, but it nevertheless remains associated with a risk of medical and surgical complications. Ureteric strictures, with an incidence ranging from 2% to 7.5% according to the series, are the most frequent urological complication. The objective of this study was to determine the incidence of ureteric strictures and the existence of risk factors predisposing to the development of ureteric strictures and to evaluate their consequences on patient and graft survival, based on a single-centre retrospective series of renal transplantations. PATIENTS AND METHODS: From January 1990 to December 2002, 1787 renal transplantations were performed consecutively in our centre. Graft, donor and recipient characteristics were extracted from a computerized database and validated by an independent observer. The parameters studied included donor's age and recipient's age, donor's haemodynamic status and serum creatinine at the time of harvesting, cause of death, graft weight and number of graft arteries, cold ischaemia and reperfusion times, number of HLA incompatibilities and percentage anti-HLA immunization, time to return of graft function, acute rejection, presence or absence of a double J stent, episodes of acute pyelonephritis, CMV infection and patient and graft survival according to the Kaplan-Meier method. RESULTS: Ureteric stricture was observed in 74 patients (4.1% of cases) and a donor age greater than 65 years (p < 0.0001), the presence of more than 2 arteries on the graft (p = 0.03) and recipients with an anti-HLA immunization less than 25% (p = 0.037) were identified as independent risk factors. Furthermore, grafts complicated by ureteric stricture resumed function later (p = 0.001). The development of ureteric stricture did not have an unfavourable impact on the 10-year recipient and graft survival rates.

Adolescent↗
PubMed2005

[Therapeutic management of ureteric strictures in renal transplantation].

OBJECTIVE: Ureteric strictures, with a reported incidence ranging from 2% to 7.5%, are the most frequent urological complication of renal transplantation. This article reports the results of open surgery and percutaneous or endoscopic techniques used to treat these strictures, based on a single-centre retrospective series of renal transplantations. PATIENTS AND METHODS: From January 1990 to December 2002, in a series of 1787 consecutive renal transplantations performed in our centre, 74 were complicated by ureteric stricture (4.1% of cases). Strictures occurred at the ureterovesical implantation in 82.4% of cases and during the first year in 88% of cases. The mean time to management of the stricture after transplantation was 9 months (range: 6 days-120 months). Criteria of success were defined by regression or even resolution of ultrasound signs of dilatation associated with stabilization of serum creatinine obtained by the external urinary diversion. Surgical or percutaneous revisions (particularly repeated changes of double J stents) were considered to be treatment failures. RESULTS: 44 strictures (59.5% of cases) were treated by open surgery and 30 (40.5%) were treated by a first-line endoscopic or percutaneous technique. In our hands, open surgical techniques (ureteropelvic anastomosis: 80% of success (n=5), ureterovesical reimplantation: 82% of success (n=11), ureteroureteric anastomosis: 100% of success (n=4)) gave better results than endourological techniques (endoscopic electrical incision: 61.5% of success (n=13), double J stent: 61.5% of success (n=13), balloon catheter dilatation: no success (n=4)). CONCLUSION: Classical open surgical revision remains the reference treatment for ureteric strictures in renal transplantation for our team.

Adolescent↗
PubMed2005

[Unusual metastatic spread after converted laparoscopic radical nephrectomy: natural history of the tumour or role of laparoscopy?].

Retroperitoneal or transperitoneal laparoscopic radical nephrectomy is currently proposed by an increasing number of urologists as an alternative to conventional open surgery to treat renal tumours. The authors report a case of metastasis to unusual sites (sigmoid colon, small intestine, root of the nose) after converted retroperitoneal laparoscopic radical nephrectomy for a T3 renal tumour, which raises the problem of the possible role of the laparoscopic approach in this unusual metastatic progression of the disease.

Adenocarcinoma↗
PubMed2004

Pharmacodynamic equivalence of a decapeptyl 3-month SR formulation with the 28-day SR formulation in patients with advanced prostate cancer.

AIMS: The objective of the study was to assess the pharmacodynamic equivalence of LHRH analogue triptorelin 3-month and 28-day SR formulations. METHODS: Patients with documented locally advanced or metastatic prostate cancer were randomized to receive one injection of the 3-month formulation (n = 63) or three injections at 28-day intervals of the 28-day formulation (n = 68). Group-chemical castration rates defined as the percentage of patients reaching a testosterone plasma level </=0.5 ng/ml were compared at D84 (i.e., 3 x 28 days). Testosterone, LH and triptorelin plasma profiles, and change from baseline in plasma PSA were assessed over 3 months (from baseline to D91). RESULTS: Chemical castration rates were 98 and 96% in the 3-month and 28-day formulation groups, respectively, with confidence interval (two-sided 94.2% CI) of [-8.1%; 9.6%]. Median times to reach chemical castration were 18.8 and 18.5 days (p = 0.86, log rank), respectively. Ratios for mean peak plasma levels and AUC(91) of the two formulations for both testosterone and LH fell within the [0.80; 1.25] equivalence interval. Mean PSA decreases from baseline at D91 were 91.0 and 91.7%, respectively (p = 0.73). CONCLUSION: Treatments with the two triptorelin formulations over 3 months are pharmacologically equivalent.

Aged↗