Biomedical subjects

P Glémain

Publications and source records attributed to P Glémain.

7 recordsLinked to original sources

PubMed2005

[Methodological analysis of an article].

Methodological analysis, in particular of an article on a clinical trial, first comprises a check of the quality of the study design: description of the primary objective and assumptions leading to the conduct of the study; description of patients; description and justification of the treatments compared and primary end-point; justification for the number of included patients; description of randomization; suitable statistical tests selected a priori; respect of legal and ethical framework. Then, in the results, the comparability of the randomly assigned groups must be checked. The primary end-point must be assessed by intention to treat analysis, then per protocol where necessary. Lastly, it is necessary to seek bias liable to reduce the quality of the demonstration.

Clinical Trials as Topic↗

PubMed1997

[Outcome of nephrogenic metaplasia of the bladder in kidney transplant recipients].

OBJECTIVES: To evaluate the risk of recurrence and malignant degeneration of vesical nephrogenic metaplasia in renal transplant recipients. MATERIAL AND METHODS: Fourteen patients with known nephrogenic metaplasia were systematically followed. Vesical biopsies were performed with a resector, stained with eosin haemalun saffron, analysed and compared to initial results. Labelling by anti-EBV and anti-CMV monoclonal antibodies was performed in 5 cases of intense inflammatory reactions. RESULTS: All patients were males, with a median age of 39 years. Nephrogenic metaplasia had been diagnosed 7 to 80 months after renal transplantation (median = 37.8). Twelve patients were reviewed 5 to 116 months after the initial diagnosis (median = 52). Relapse was observed in 83% of cases, but without any malignant degeneration. CONCLUSION: Nephrogenic metaplasia is therefore a benign recurrent disease. The importance of the initial blood supply and fibrosis in the case of recurrence suggest a disorder of the blood supply, probably traumatic in origin. Only symptomatic patients are currently followed.

Adolescent↗

PubMed1993

[Incidence of the form and caliber of urethral resistance. Evaluation for a normal masculine urethra and in cases of obstruction due to prostatic hypertrophy].

Certain forms of benign prostatic hypertrophy are associated with a reduction of the calibre of the prostatic urethra of the median lobe, a defect of infundibulisation of the bladder neck and a dilated appearance of the bulbar urethra. The objective of this study was to verify whether hydrodynamic arguments could be used to confirm the concept that defective infundibulisation of the bladder neck is directly responsible for an obstructive syndrome or via a reduction in the calibre of the bladder neck orifice. More generally, this study was designed to quantify the distribution of resistance to flow along the normal urethra and to define the role of cervicoprostatic and urethral deformities in the obstruction associated with benign prostatic hypertrophy. Urodynamic studies are unable to answer this question, as the instantaneous urethral resistance is evaluated globally by the Pressure-Flow relation. The authors performed morphological analysis to divide the urethra into simple hydraulic segments for which the corresponding pressure drop coefficients were calculated. These coefficients constitute an approach to segmental resistance to flow and can be used to quantify changes in shape observed on voiding urethrography or ultrasonography. Digital analysis of voiding urethrographies showed that, under normal conditions, urethral resistance was regularly distributed along the urethra and essentially depended on friction of the urethral wall. In the case of benign prostatic hypertrophy, even with a median lobe, the increase in the pressure drop coefficients was due to a reduction in the calibre of the bladder neck orifice and prostatic urethra. Cervical deformities appeared to be minimally obstructive, according to urodynamic parameters, if they were not associated with a reduction in the calibre of the bladder neck orifice.

Evaluation Studies as Topic↗

PubMed1992

[Multifactorial urodynamic study of 115 patients with dysuria and benign prostatic hypertrophy].

Discriminant analyses based on preoperative urodynamic parameters have proved inaccurate in predicting functional results after prostatectomy. To investigate the cause of this failure, we studied a group of 115 patients consecutively referred for prostatism and selected for prostatic surgery only on clinical criteria and flow rate. A preoperative urodynamic work-up was performed, including cystometry and urethrometry. The patients were reexamined 2 months postoperatively and underwent control uroflowmetry. All preoperative urodynamic data were computed simultaneously using principal component analysis and canonical discriminant analysis. The significance of the diagrams obtained with these multifactorial analyses was more closely examined than in previous studies. The results of classification by the discriminant function demonstrating the best combination of preoperative urodynamic variables resulted in 44% of patients being correctly rated. Examination of the diagrams showed that the major cause of failure in previous studies was the great variety of urodynamic conditions in men with prostatism, which indicates a need for multifactorial interpretation of the results of urodynamic explorations.

Aged↗

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↗

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↗

PubMed1987

[Primary megabladder in adults. Comments apropos of 21 cases].

Based on a review of 21 cases, clinical, urodynamic and therapeutic a of primary megalocystis in adults are discussed. This rare entity is defined as an abnormally large bladder capacity in the absence of any obstruction or neurologic lesion, and without effects on the upper urinary tract. The residue is constant whereas, paradoxically, dysuria may be absent and mictional output normal (8 of the 21 cases). Urodynamic tests distinguished two groups of patients: one in which bladder contractility was still present but decreased rapidly as a function of volume to be excreted, while flow was good; the other in which bladder contractility and flow were altered. Therapeutic possibilities are discussed as a function of results obtained. Depending upon the structural alterations of the bladder wall, medical treatment (cholinergic drugs) are usually ineffective. An interesting solution is the use of abdominal pushes in cases with hypo- or acontractile bladder. Aleatory results of surgery to reduce bladder capacity and/or reinforce bladder contraction suggest its use only as first intention surgery for bladders with retained contractile possibilities. Operations on bladder neck in women carry the risk of incontinence and should be considered only as function of results of other methods, and with the reservation that closure pressure should be at least 80 cm initially. Finally, abstention under surveillance is also an alternative in this context.

Adult↗