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P Grise

Publications and source records attributed to P Grise.

At least 37 records · Page 2Linked to original sources
PubMed2000

Initial experience of an objective structured clinical examination in evaluating urology residents.

OBJECTIVES: Objective Structured Clinical Examination (OSCE) is now generally considered as the new gold standard for evaluating clinical competence. The objective of this study was to assess the feasibility of OSCE in evaluating urology residents. MATERIAL AND METHODS: 20 urology residents rotated through a circuit of five standardized patient-based OSCE stations of 10 min duration. The selection of problems was based on educational objectives of urology residency programs. Written questionnaires based on Likert-type scales were used to measure OSCE feasibility. The mean score was arbitrarily used as a passing score. Student t test was only used to compare the performance between junior and senior residents. RESULTS: Senior residents performed globally better, but without significant differences (51.3+/-7.8 vs. 45.03+/-5.1, p>0.05). Senior resident scores regarding outpatient problems were significantly higher (p = 0.04), more senior residents reached the passing score (75 vs. 16% junior residents). All the participants agreed that the clinical situations were realistic and that the simulated patients were believable. Most participants agreed that the sampling of cases were representative of urology practice. CONCLUSIONS: This is the first reported OSCE applied to urology residency. The results of this pilot study support the feasibility of an OSCE in assessing the performance of urology residents. Our data raises questions regarding the training of outpatient consultation skills to residents. This experiment warrants further series to explore the study's psychometrics features.

Clinical Competence↗
PubMed2000

Total bilateral ureteral replacement for stenosing ureteritis in Henoch-Schönlein purpura.

Stenosing and calcified ureteritis occurring in Henoch-Schönlein purpura remains a rare urological complication. The authors describe their own experience of the diagnosis and treatment of this rare pathology along with a review of the literature. Recognition and early surgical management may prevent serious renal outcome. In cases of ureteral replacement, different procedures using ileal segment have been proposed. We report the results of the Cockett and Goodwin procedure with a follow-up of more than 25 years.

Child↗
PubMed2000

[Contribution of lumboscopy in the treatment of pyeloureteral junction syndromes. Report of 25 cases].

OBJECTIVE: Evaluation of the results of lumboscopic repair of ureteropelvic junction syndromes. MATERIAL AND METHOD: Retrospective study of 25 consecutive lumboscopic retroperitoneal pyeloplasties performed over 3 years in 14 women and 11 men with symptomatic ureteropelvic junction syndrome. RESULTS: The mean operating time was 200 minutes (range: 120-360 minutes) and mean blood loss was 60 ml. Surgical conversion was necessary in three cases due to the difficulty of dissection and in one case because of rupture of the ureter. Analgesic prescription was generally only necessary for the first 2 postoperative days. The mean hospital stay was six days (range: 2-16 days). Patients were able to return to work an average of 10 days after the operation. With a mean follow-up of 9 months (range: 6 to 18 months), all patients were asymptomatic except for one patient who reported pain at a trocar site. Follow-up urography at 3 months showed marked improvement in 18 patients (85.7%), moderate pyelocaliceal dilatation in 2 cases and one failure. CONCLUSION: Lumboscopic pyeloplasty is an alternative to endopyelotomy. It provides a comparable success rate to that of conventional surgery, while reducing the morbidity, length of hospital stay and convalescence. However, it requires mastery of intracorporeal suture techniques.

Adult↗
PubMed2000

Results of concomitant radio-chemotherapy for invasive bladder tumors.

INTRODUCTION: The aim of this study was to evaluate combined radiation and chemotherapy for invasive bladder tumors and to define possible biological prognostic factors. MATERIALS AND METHODS: Forty-five patients (mean age 75 years, range 68 to 86) were treated by deep bladder resection with combined radiation (5 courses of 10 Grays [Gys]) and chemotherapy (2 cycles of 100 mg of cisplatin over 7 weeks). Subsequent to the treatment, evaluations at 10 weeks, then 3 months, 6 months, and 12 months, and every year, included a clinical examination, Karnofsky evaluation, a cystoscopy with urinary cytology, and systematic deep bladder pathology biopsies after a computer tomography (CT) scan. In our series, DNA analysis and an immuno-histochemistry study of MiB1, p53, and MdR were also performed in the last 20 patients. RESULTS: At 6 months, progression of the disease was evaluated in 26% of cases; at 12 months, satisfactory local control was evaluated in 60% of cases. However, only 15 patients were in complete remission after a period of 2 years. Of these, only eight patients were in remission with more than 42 months follow-up. We observed aneuploid tumors in 30% of cases; these patients died after 6 months despite concomitant radio-chemotherapy. In our experience, the results of associated immuno-histochemistry markers was not really contributive. CONCLUSION: This therapeutic alternative may be useful in patients where a cystectomy cannot be performed. It not only permits bladder conservation, but also offers satisfactory, significant quality of life, even if survival rates remain uncertain.

Aged↗
PubMed2000

[Unusual tumor: liposarcoma of the spermatic cord].

Spermatic cord liposarcoma is a rare tumour, as only 60 cases have been reported in the literature. They represent 7% of all malignant spermatic cord tumours. The authors report a new case of spermatic cord liposarcoma unusual by its inflammatory and fibrotic features, occurring in an 83-year-old man in poor general health. Treatment consists of surgical resection as widely as possible. Adjuvant radiotherapy is sometimes effective on local recurrences. Despite the slow rate of progression of this tumour, prolonged surveillance is required due to the high risk of late recurrence.

Aged↗
PubMed1999

Adenocarcinoma on renal allograft as a complication at 5 years.

We report a new case of renal carcinoma in allograft kidney, 5 years after transplantation, which presented as a suspect allograft abscess in a complex history of recurrent urinary infection. Only surgical management with peroperative histological evaluation permitted us to confirm the diagnosis of malignancy.

Adenocarcinoma↗
PubMed1999

Semen cryopreservation after orchidectomy in men with testicular cancer.

OBJECTIVE: To assess the feasibility of semen cryopreservation after orchidectomy in patients with testicular tumour. PATIENTS AND METHODS: The quality of semen samples was investigated in 36 men with testicular tumour (mean age 31.7 years, range 20-49) who were referred to our infertility centre for semen cryopreservation. For each patient, the number of straws, semen volume, number of spermatozoa, and sperm motility before and after freezing were evaluated. RESULTS: Fifteen patients (42%) banked sperm before and 21 (58%) after orchidectomy; the delay was >7 days in 19 patients (53%). The mean age, histological diagnosis and tumour stage did not differ significantly whatever the time of cryopreservation. Semen quality did not differ significantly in patients who cryopreserved sperm before or after orchidectomy and there were no significant differences in sperm values whatever the delay before preservation. Semen quality was the same in patients with seminoma or nonseminoma tumour. CONCLUSION: These findings indicate that spermatogenesis of the contralateral testis is sufficient for successful semen cryopreservation after orchidectomy. Urologists should be encouraged to increase the awareness among oncology teams and patients about the new developments in preserving fertility for patients with cancer.

Adult↗
PubMed1999

The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction.

OBJECTIVE: To report our experience of assessing children with chronic voiding dysfunction (>6 months' duration) using a minimal urodynamic evaluation, and the management of detrusor-sphincter dyscoordination (DSdc) using pelvic floor biofeedback. PATIENTS AND METHODS: From 1994 to 1997, 120 children (mean age 7.5 years) with three predominant and associated symptoms were referred to one urologist; they had nocturnal enuresis (28 children), urge incontinence (42) or urinary tract infection (50). All patients were assessed by urinary culture, renal ultrasonography and a minimal urodynamic evaluation, i.e. urinary flowmetry with sphincter electromyography (EMG) using perineal surface electrodes. If they had urinary tract infection and/or renal dilatation, they underwent voiding cysto-urethrography. In children with DSdc, urinary training with frequent voiding was instituted initially, with subsequent pelvic floor biofeedback exercises if the improvement was deemed unsatisfactory. RESULTS: DSdc was diagnosed in 33 children (28%), none of whom had isolated nocturnal enuresis. Pelvic floor biofeedback was undertaken by 15 children (12 girls and three boys); it was well accepted because it was administered as a computer game. In all affected patients the DSdc resolved on EMG and there was a significant clinical improvement. Vesico-ureteric reflux was detected in 24 patients, associated with DSdc in 10. The reflux resolved spontaneously on antibiotic prophylaxis in six children and after urinary re-education in four. CONCLUSION: A minimal urodynamic evaluation seems to be useful in the diagnosis of DSdc which caused urinary tract infection and/or bladder overactivity. The results with pelvic floor biofeedback were excellent in these children.

Biofeedback, Psychology↗
PubMed1999

p53 mutations in bladder tumors inactivate the transactivation of the p21 and Bax genes, and have a predictive value for the clinical outcome after bacillus Calmette-Guerin therapy.

PURPOSE: We analyze the relationship among p53 mutations, p21 and Bax activation as well as their clinical implication in clinical response to intravesical bacillus Calmette-Guerin (BCG) therapy in high grade bladder tumors. MATERIALS AND METHODS: We analyzed a prospective series of 60 superficial bladder tumors using functional assays in yeast which test the transcriptional competence of p53 and can be used to identify p21 and Bax status. BCG instillations were given after initial tumor resection to 26 patients with a high risk of bladder invasive disease (pT1G3 tumors in 24 and carcinoma in situ in 2). RESULTS: No p53 alteration was detected in cases of pTa tumors. In contrast, p53 mutations were detected in 16 of 24 patients (66%) with pT1 G3 tumors and in 2 with primary carcinoma in situ. These 18 mutant samples scored also mutant for transactivation of p21 and Bax reporter strain. In 26 bladder tumors treated with BCG instillations there was a statistical difference (p = 0.0075) in the response to BCG therapy between 18 tumors with and 8 without alterations using functional assays in yeast. CONCLUSIONS: The p53 mutations, using functional assay in yeast, inactivate the transcription of p21 and Bax genes, and based on these preliminary results could have a useful predictive value for BCG therapy response in bladder cancer.

Adjuvants, Immunologic↗
PubMed1999

[Malignant neuroendocrine tumor of the bladder: an entity not to be unrecognized].

The authors report a case of primary malignant neuroendocrine bladder tumour. This rare bladder tumour presents the morphological and immunohistochemical characteristic common to all neuroendocrine tumours observed in other organs. The urologist must recognise this histological entity, which requires multidisciplinary management.

Cystectomy↗
PubMed1999

[Dysuria and prostatic adenoma: information provided by uroflowmetry].

Uroflowmetry is a non invasive objective criterion for the evaluation of micturition. The values depend on resistance to voiding, but also detrusor pressure. Correct interpretation must take into account the limits of the examination, related to voiding volume, number of micturitions, age, individual factors, and circadian variations. Some artefacts, such as the initial peak or abdominal straining, induce a difference between automatic reading and manual reading, justifying comparison of the result displayed with the appearance of the curve. Uroflowmetry can detect dysuria, which may be poorly perceived or even unknown to the subjects themselves. It also completes the data of symptom scores. It is a good criterion for assessment of the results of treatment, but is insufficient, on its own, to define surgical indications. There is no strict correlation between flow rate and residual volume.

Adult↗
PubMed1999

Selective detection of inactivating mutations of the tumor suppressor gene p53 in bladder tumors.

OBJECTIVE: Mutations in the p53 gene are implicated in the pathogenesis of half of all human tumors. In bladder tumors they are usually detected by immunohistochemistry. The assumption underlying protein analysis is that high level p53 expression is a consequence of mutations, but numerous exceptions have been reported. We describe the detection of p53 mutations in bladder cancer using a functional assay in yeast. MATERIALS AND METHODS: The prospective study consisted of 60 consecutive patients with bladder tumors (7 pT0, 2 CIS, 23 pTa, 24 pT1 and 4 pT2). High grade 3 was observed in primary carcinoma in situ, in 75% of pT1 tumors and in all pT2 tumors. The p53 mRNA extracted from endoscopic resection tissue was reverse transcribed and PCR-amplified. The transcriptional competence of the p53 cDNA was then tested in a yeast reporter strain. A simple functional assay was developed for p53 mutation in which human p53 is expressed in Saccharomyces cerevisiae which activates transcription of the ADE2 gene. Colonies containing wild type p53 are white and colonies containing mutant p53 are red. RESULTS: As this assay evaluates the critical biological function of p53, it can distinguish inactivating mutations from functionally silent mutations. In pTo and pTa bladder tumors, no p53 mutations were detected. In contrast, the functional assay permitted us to detect p53 mutations in 66% of patients with stage T1 tumors (72% of case of high grade 3) and in all cases with primary carcinoma in situ and in 4 cases of stage T2 tumors. CONCLUSION: This preliminary study demonstrates that this functional assay method is a simple and efficient procedure to detect p53 mutations in bladder cancers and suggests that p53 mutations seem to be associated with invasive bladder tumors.

Chromosomes, Artificial, Yeast↗
PubMed1999

[Intraurethral Macroplastic injections in the treatment of urinary incontinence after prostatic surgery].

OBJECTIVES: To evaluate the results and the place of a minimally invasive intraurethral injection technique designed to improve the efficacy of the urethral sphincter in urinary incontinence after prostatic surgery. MATERIALS AND METHODS: A prospective study of 26 Macroplastique injections performed in 15 patients with a mean age of 66.4 years (range: 54 to 78 years) was conducted over an 18-month period. Eleven patients received 2 injections. Prostatic surgery consisted of retropubic radical prostatectomy (9 cases), transurethral resection (4 cases) or open prostatectomy (2 cases). Three patients received pelvic irradiation. Evaluation at 1, 3 and 12 months consisted of clinical questionnaire and urodynamic assessment. RESULTS: Rapid deterioration of the initial improvement was observed (40% success at 1 month; 71% at 3 months; 33% at 6 months; 26% at 12 months). No significant influence was demonstrated for post-prostatectomy radiotherapy, the patient's age, more proximal bladder dysfunction, severity of incontinence or preoperative status. However, better results were observed when the resting urethral closure pressure remained higher than 30 cm H2O. CONCLUSION: We believe that intraurethral injections still have a place in the therapeutic armamentarium for incontinence after prostatic surgery with satisfactory initial results, which unfortunately deteriorate after 3 months. Our study confirms the value of Macroplastique compared to other substances. It is difficult to define the predictive factors of failure, but a closure pressure greater than 30 cm H2O remains essential. Finally, an interval of at least 3 months should be observed before repeating this procedure in the case of an insufficient result.

Aged↗
PubMed1998

[Kidney procurement from a heart-arrest donor].

Brain death occurred in a 47-year-old head trauma patient following 5 days of intensive care. The procedure for multiple organ procurement was initiated. Irreversible cardiac arrest had occurred during the period in the surgical intensive therapy unit. External cardiac massage and mechanical ventilation were maintained until in situ cooling of the kidneys was achieved. The patient was taken to the operating room for nephrectomy. Both kidneys were transplanted with a favorable outcome. Procurement of kidneys from non-heart-beating donors could increase the number of available grafts for transplantation.

Craniocerebral Trauma↗
PubMed1998

[ST52 treatment of cancer of the prostate during the hormonal resistance phase].

OBJECTIVE: Stilboestrol phosphate (ST 52) was evaluated on pain, general status, life expectancy and PSA, in a retrospective study of patients with prostatic carcinoma and relapse to hormonal treatment. MATERIAL AND METHODS: 32 patients were treated by infusion of Stilboestrol phosphate at a daily escalating dose from 1.2 to 3 g over a period of 10 days, then subsequently oral administration. RESULTS: Minor complications, especially nausea were observed in 12 cases but no major complication or interruption of treatment. Improvement for pain alone or with general status was obtained in 50% (16 cases) at 3 months, but at one year only 10% were still improved. Median survival was 8 months, with 19.4 months for responders at the end of infusions and 4.2 months for non-responders-respectively. CONCLUSION: Stilboestrol phosphate can obtain a clinical response with low morbidity when relapse to hormonal treatment occurs. Infusion responders have a better life expectancy.

Administration, Oral↗
PubMed1998

[Percutaneous colposuspension with fixation to the suprapubic fibrous tissues].

OBJECTIVES: The authors conducted a long-term evaluation of a modification of the Peyrera-Raz procedure by creation of a fixed point in the suprapubic fibrous tissue. MATERIAL AND METHODS: The authors report a series of 38 patients who, despite pelvi-perineal rehabilitation, presented urinary stress incontinence corrected by Bonney's manoeuvre. Treatment consisted of Peyrera-Raz percutaneous colposuspension modified by superior anchoring of the sutures to the suprapubic fibrous plane. Preoperative assessment consisted of clinical and urodynamic examination. Postoperatively, patients were regularly reviewed in the outpatients department and long-term evaluation of the results was performed by means of a telephone questionnaire. RESULTS: The technical modification did not introduce any particular practical difficulty or any specific infectious or painful morbidity. Postoperative self-catheterizations, for an average of 14 days, were required in 6 patients. 9/38 (24%) presented recurrence of their incontinence within the first 6 months; reoperation by a suburethral sling allowed definitive correction of the disorders. 29/38 (76%) were satisfied or very satisfied with the result of their operation with a mean follow-up of 3.2 years, although 6 of them presented minimal incontinence on very intense, unusual efforts. CONCLUSION: Percutaneous colposuspension, modified by superior anchoring of the sutures to the suprapubic fibrous tissue, allows effective treatment of urinary stress incontinence with limited morbidity in 3/4 of cases, with a mean follow-up of more than 3 years.

Adult↗