Biomedical subjects

P Glemain

Publications and source records attributed to P Glemain.

30 records · Page 2Linked to original sources

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↗

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

[Clinical, neurophysiologic and therapeutic remarks from anatomic data on the pudendal nerve in some cases of perineal pain].

Clinical observations in patients suffering from positional perineal pain have led us to performing an anatomical study of the pudendal nerve in order to demonstrate compression of this nerve trunk by elements likely to compress it in the sitting position. Thus we observed that the falciform process of the sacrotuberous ligament may act in this way. Besides helping us to understand the clinical symptoms, this anatomical study allowed choosing the technique we found most appropriate for the anatomical conditions observed out of the various neurophysiological examinations described in the literature. Lastly, we describe the surgical technique that allows releasing the trunk of the pudendal nerve under an operating microscope.

Evoked Potentials, Somatosensory↗

PubMed1989

[Does perineal muscle testing provide information on the quality of the urethral sphincter in women?].

A prospective study was carried out on 100 women presenting with urinary incontinence with the intent of determining whether a relationship could be found between the quality of the perineal musculature, as assessed by testing the levatores, and that of the urethral sphincters, as assessed by a study of the urethral pressure profile, thereby defining the respective importance of each of these tests. The mean maximum closing pressure values were compared for three groups whose testing was scored good, fair or nil. Evidence of a positive relationship existing between the levatores testing and the maximum closing pressure against rest (p less than 0.05) and stress (holding-back) (p less than 0.01) urethral pressure profiles was brought forth. However, this relationship does not allow to extrapolate the testing results to the sphinters. In practice, at the individual patient level, one may be satisfied by merely testing the pelvic musculature in case of reeducational treatment of incontinence. Nevertheless, whenever surgery is indicated, objective assessment of the urethral sphincters by ways of an urethral pressure profile study is mandatory.

Adult↗

PubMed1989

[Changes in bladder contractility in spinal cord diseases].

Changes in bladder contractility were studied by repeated cystomanometry in 147 patients suffering from central medullary lesions of sudden onset, including 93 cases of spinal shock. The morphology of contraction was always modified in the same fashion though intermediate stages were apparent, some being quite characteristic of neurological dysfunction. This process, which ends in a phasic contraction reproduces the stages of ontogenesis. When contractions are present, but do not produce complete bladder emptying, spontaneous improvement is unlikely in the presence of a complete lesion; sphincterotomy should therefore be considered at an early stage.

Adolescent↗

PubMed1988

[Urodynamic examination of prostatic adenoma. For what purpose?].

In order to demonstrate that the quality of the functional result after surgery for prostatic adenoma depends on the initial urodynamic equilibrium, the authors performed preoperative cystomanometry and urethral pressure profile, in addition to the standard assessment, in 115 patients. Only vesical acontractility clearly appeared to be a factor of residual dysuria, as it multiplied the risk by a factor of 3. In contrast, the values for the urethral pressure profile did not have any predictive value on incontinence, probably because they were modified by the operation. However, and understanding of the vesico-sphincteric equilibrium can lead to a modification of the therapeutic indications in certain circumstances in which this equilibrium appears to be particularly precarious.

Aged↗

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↗

PubMed1982

[Neonatal gonococcal ophthalmia].

Gonococcal ophthalmia of the newborn still exists in 1981. On the occasion of a case recently observed it is reminded that 1% silver nitrate remains the best prophylactic means.

Ampicillin↗

PubMedDate not supplied

Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors.

BACKGROUND/AIMS: To report the clinical presentation, diagnosis and results of aggressive surgical management in patients with metastatic ampullary and pancreatic tumors. METHODOLOGY: Twelve patients underwent pancreaticoduodenectomy for ampullary or pancreatic metastases from January 1, 1987, to June 30, 1998, in 2 institutions. The primary cancer was renal cell carcinoma (n = 5), melanoma (n = 2), venous leiomyosarcoma (n = 1), carcinoid tumor (n = 1), colon carcinoma (n = 1), breast carcinoma (n = 1) and small-cell lung carcinoma (n = 1). The mean interval between primary treatment and metachronous pancreatic metastasis was 88 months. In 3 cases, pancreatic metastases were synchronous with the primary tumor. The main symptoms were jaundice (n = 8) and upper gastrointestinal tract bleeding (n = 2). The principal investigations were computed tomography scan (n = 9), arteriography (n = 7), duodenoscopy (n = 6) and fine-needle aspiration (n = 4). A correct preoperative diagnosis was made for 8 patients. RESULTS: In all cases, the pancreatic tumor was resected with intention to cure or provide useful palliation, using pancreaticoduodenectomy for isolated tumors (n = 11) or total pancreatectomy for multiple lesions (n = 1). Three out of 12 patents had positive lymph nodes, and the resection margin was free of disease in all cases. There was no postoperative mortality. Survival after pancreaticoduodenectomy averaged 26 months. Overall survival of patients undergoing pancreaticoduodenectomy was 35% at 2 years and 17% at 5 years. One patient is still alive more than 10 years after pancreaticoduodenectomy. CONCLUSIONS: Pancreaticoduodenectomy can be performed safely, representing a suitable option for resection in patients with symptomatic or late isolated pancreatic metastases in the absence of widely metastatic disease. The best indications are solitary metastases from renal cell carcinoma, sarcoma and neuroendocrine tumors. However, there is no evidence of survival benefit after pancreaticoduodenectomy for synchronous tumors or metachronous tumors from melanoma or colon carcinoma.

Adult↗

PubMedDate not supplied

[The prevention of the recurrence of stage pTa bladder tumors using intravesical instillation of BCG].

45 patients were included in a retrospective study designed to assess the long-term efficacy and tolerance of immunotherapy by intravesical BCG instillation in the treatment of stage pTa bladder tumours (mean follow-up 52.7 months, range: 12-87 months). 41 patients (91% responded to immunotherapy: 24 (53%) did not develop anu recurrences with a mean follow-up of 49.4 months (range: 19-87 months) and 17 (37.7%) were improved by treatment as the interval between recurrences was significantly increased. 4 patients (8.8%) failed to respond to BCG therapy with progression to stage pTa G3 vesical papillomatosis in one patient. The local tolerance was poor for twelve patients (26.6%), requiring discontinuation or spacing of the instillations. Other complications such as prostatitis and intense fever were observed. Three patients had persistent disturbances of micturition following treatment in the form of urinary frequency due to the decreased bladder volume. Neither the grade, nor the frequency of recurrences prior to treatment, nor the solitary or multifocal nature, nor the site of the initial tumour appeared to influence the response to BCG therapy and did not constitute independent individual prognostic indicators.

Administration, Intravesical↗

PubMedDate not supplied

[Instantaneous pressure-flow relations in a continuous flow in a collapsible tube: impact on the evaluation of urethral resistance].

The urethra is a collapsed tube in the absence of micturition. Consequently, the evaluation of instantaneous urethral resistance by the pressure/flow relation (R = P/Q2) derived from Bernoulli's equation has been criticised for not taking into account the opening pressure or at least the fact that flow must maintain patency of the urethra during voiding. The objective of this study was to determine whether such a criticism is justified in terms of fluid mechanics. A study of the pressure/flow relation was performed in a soft tube, collapsed by various peritubular pressures, which subsequently opened in response to flow. Experiments demonstrated that the pressure/flow relation, the instantaneous resistance to flow and the pressure drop were identical when the tube reached the same calibre, despite different peritubular pressures. The same pressure therefore propels the flow and maintains the patency of the tube. Consequently, it would be unreasonable to expect to improve the evaluation of instantaneous urethral resistance by subtracting an opening pressure from the maximal bladder pressure. The formula R = P/Q2 is valid, experimentally, and complies with the principles of fluid mechanics. In theory and in practice, it constitutes a good method of evaluation of instantaneous resistance.

Humans↗