Biomedical subjects
Publications and source records attributed to P Grise.
A patient presented with a reno-cutaneous fistula revealing a xanthogranulomatous pyelonephritis secondary to staghorn calculus. Total nephrectomy was necessary because of renal destruction. This treatment allowed closure of the fistula and a good clinical result.
Serum and prostatic tissue concentrations of lomefloxacin were measured in 12 elderly patients who underwent transurethral resection of the prostate after receiving a single oral dose of 400 mg. The peak serum concentration of lomefloxacin was 2.5-10.0 micrograms/mL (mean, 5.2 +/- 1.9 micrograms/mL). During surgery, serum and tissue concentrations averaged 4.6 +/- 2.2 micrograms/mL and 6.5 +/- 2.7 micrograms/g, respectively. The ratio of tissue to serum concentrations was 1.53 +/- 0.54. The levels of lomefloxacin in serum and prostatic tissue were found to be higher than the minimum inhibitory concentration (MIC) values for most urinary tract pathogens.
The occurrence of serotonin in the human adrenal gland was demonstrated both by immuno-histochemical and biochemical approaches. Using specific polyclonal antibodies to serotonin, the presence of numerous immunoreactive cells was revealed by means of the peroxidase-antiperoxidase technique. These cells exhibited the morphological characteristics of mast cells. Combination of high performance liquid chromatography and electrochemical detection showed the presence of substantial amounts of both serotonin and its metabolite 5-hydroxyindolacetic acid in adrenocortical extracts. The role of serotonin in the regulation of steroidogenesis from human adrenocortical slices was studied in vitro using a perifusion system technique coupled to a specific radioimmunoassay for cortisol. Graded doses of serotonin (from 10(-8) M to 3 x 10(-7) M) increased cortisol production in a dose-dependent manner. Prolonged exposure of adrenal fragments to serotonin (10(-7) M) induced a biphasic response, i.e. a rapid and transient increase in cortisol secretion followed by a plateau phase, suggesting the existence of a desensitization phenomenon. The stimulatory effect of serotonin (10(-7) M) was not altered during infusion of the serotonin1 and/or serotonin2 receptor antagonists methysergide (10(-6) M) and ketanserin (10(-6) M), respectively. In contrast, ICS 205 930 (10(-6) M), a non-selective serotonin3/serotonin4 antagonist, totally abolished the response of adrenal slices to serotonin (10(-7) M). The benzamide derivative zacopride, considered as a serotonin4 agonist, induced a robust stimulation of cortisol secretion. In addition, the corticotropic effects of serotonin (10(-7) M) and zacopride (10(-6) M) were not additive. Incubation of adrenocortical fragments with zacopride (10(-6) M) or serotonin (10(-6) M) caused a significant increase in cAMP formation. Taken together, these data suggest that serotonin, locally released by intra-adrenal mast-like cells, may act as a paracrine factor to stimulate cortisol secretion in man. Our results also indicate that serotonin-induced corticosteroid production is mediated through activation of a serotonin4 receptor subtype positively coupled to adenylate cyclase.
We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra-prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure-regulating balloon is implanted within the area of abdominal pressure, retroperitoneally. After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow-up of 20 months. These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir. Although long-term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary diversion.
Haemangiopericytoma is an uncommon tumour of vascular origin. The authors report a case of one of the rarer sites of this tumour in man: paravesical pelvic haemangiopericytoma. Although modern imaging techniques have provided useful information concerning the hypervascular and clearly demarcated appearance of this tumour which displaces but does not invade adjacent organs, its diagnosis can only be established by histology. Its degree of malignancy and its invasive potential are unclear. The risk of local recurrence and metastases in more than one half of cases justifies wide surgical excision, possibly combined with adjuvant radiotherapy, and long-term follow-up.
The authors report a case of pyeloureteric adenocarcinoma in a urinary diversion inserted for bladder exstrophy and in a context of chronic pyelonephritis secondary to renal stones. The various aetiopathogenic hypotheses are discussed. Renal stones and chronic inflammation very probably played an important role in the development of this type of adenocarcinoma in the urothelium.
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The authors have developed a new model of flewible metal prosthesis to maintain the urethral calibre throughout the period of healing and epithelial restoration following internal urethrotomy. It consists of a large intravesical spiral, a shaft within the prostatic and sphincteric urethra and a spiral in the bulbar and anterior urethra. This prosthesis, implanted in 7 patients for periods ranging from 2 to 5 months, provides additional calibration following internal urethrotomy, but a longer follow-up is necessary to assess its real efficacy.
Based on two cases of correction of vesicoureteric reflux by endoscopic Teflon injection associated with a marked foreign body reaction, the authors analyse the tolerance of this substance for this type of treatment. On reviewing 29 cases of reflux, they found 3 failures (10%) of the method with 2 foreign body granulomas (7%). These complications, related to the use of Teflon, have been rarely reported in the literature, which essentially refers to the risks of migration of Teflon.
This study evaluates, 1) the pain induced by extracorporeal shock wave lithotripsy for renal stones using a piezo-electric shock wave lithotriptor (EDAP LT 01) and 2) the predictive factors for severe pain leading to an indication for analgesia. The relationship between extracorporeal shock wave lithotripsy intensity and pain intensity is evaluated by a numerical scale at the beginning of the session (T0), after 15 min (T15) and after 30 min (T30). At the end of the session, patients are categorized by one of us using a three-point scale which integrates the pain and the maximum tolerable intensity. These two types of evaluation are well correlated. Successive levels of stimulation are well discriminated by patients. Habituation is observed during the session for patients with low-level pain. In 28% of the patients, the intensity of pain required analgesia. Pain cannot be predicted by age, anxiety state, side of the stones and size, diameter of the contact between patient and convergence dome. In contrast, three parameters are correlated with the pain level: The L1 distance of renal parenchyma and the L2 distance skin-stone crossed by the piezoelectric waves, the size of the stone. The superior caliceal, middle caliceal and pelvic stones are significantly the most painful. These predictive variables can be easily measured before extracorporeal shock wave lithotripsy.
A double-blind, placebo-controlled, randomized, multicenter study was undertaken to investigate the effects of Zoladex plus flutamide vs. Zoladex plus placebo in patients with advanced prostatic cancer. Interim analysis has revealed no differences between the 2 groups in objective or subjective responses at 6 months' follow-up or in overall survival and time to disease progression at 15 months' follow-up.
Although urethrotomy alone gives poor results at 5 years, these results are greatly improved by repeated urethrotomy. This treatment is particularly useful in patients at risk, especially as it can be easily performed under local anaesthesia. The authors confirm the reliability of resection-anastomoses, the superiority of one-stage urethroplasty over two-stage urethroplasty and the poor prognosis associated with a history of repeated dilatations and infectious aetiology.
Gonadotropin-releasing hormone (GnRH) analogues administered for the treatment of advanced prostatic cancer induce a transient increase in plasma testosterone levels during the first week of treatment, often with a secondary rise in plasma levels of prostatic acid phosphatase and a flareup of disease. To determine whether the antiandrogen nilutamide (Anandron) blocks these effects, we carried out a multicenter, placebo-controlled study of nilutamide in men with prostatic cancer treated with the GnRH analogue buserelin. Thirty-six men with disseminated prostatic cancer and elevated plasma levels of prostatic acid phosphatase were randomly assigned to two groups. Group 1 included 17 men who received buserelin (500 micrograms daily subcutaneously) and nilutamide (300 mg daily by mouth); group 2 included 19 men treated with buserelin and placebo. Symptoms were assessed, and plasma was collected before treatment, daily for 14 days, and on days 18, 22, and 29 after the initiation of treatment. Bone pain appeared or worsened in 5 of the 17 men in group 1 and in 12 of the 19 men in group 2 (P less than 0.05). Acute urinary obstruction occurred in one man in group 2. Despite similar changes in the plasma testosterone levels in both groups, the median concentration of plasma prostatic acid phosphatase decreased almost immediately in group 1, but increased transiently, then decreased on day 14 in group 2. Median levels of prostate-specific antigen decreased immediately in group 1 and decreased on day 8 in group 2. We conclude that nilutamide can prevent the adverse consequences of the buserelin-induced transient rise in plasma testosterone levels in men with advanced prostate cancer treated with a GnRH analogue.
Rectal strictures are rare complications of prostatic cancer and are considered to be a sign of poor prognosis. The authors report 9 cases. In 5 cases, the cancer was already diagnosed and had been treated by endocrine therapy. All patients died during the months following onset of the intestinal symptoms despite diversion colostomy (4 cases) and high dose oestrogen therapy. Rectal strictures therefore have the same poor prognosis as escape from endocrine therapy. In 3 cases, the stricture was the presenting sign of the cancer in one case, the cancer was already known and treated by radiotherapy; in this case, survival depends on the hormone sensitivity of the cancer and one patient survived for 7 years with subsequent closure of the colostomy.
The DNA index was measured by flow cytometry on paraffin-embedded tissue blocks, from a series of 50 renal tumours studied retrospectively. These tumours consisted of 48 renal cell carcinomas and 1 oncocytoma. The mean follow-up was 3 years. TNM classification and Syrjanen's combined histological grading were used. There was a significant correlation between ploidy and nuclear grading (P = 0.02); between ploidy and TNM classification (72% of diploid tumours were T1 and T2, M0, N0, P = 0.01); between ploidy and development of metastases during the follow-up (71% of aneuploid tumours developed metastases, P = 0.04). In contrast, ploidy was not related with tumour differentiation (P = 0.052), and did not influence the overall long-term survival (P = 0.2). The small number of patients studied did not allow a significant survival rate to be established for each stage according to ploidy. The measurement of the DNA index by flow cytometry is prognostically useful for renal tumours, but must be compared with other prognostic parameters. Its therapeutic value will only be able to be assessed in the future; especially in conservative surgery indications, possibly in the choice of complementary therapeutic associations and even in the approach to treatment of metastases.
From April 1984 to May 1986, 129 patients with prostate cancer entered a prospective trial with a new LH-RH agonist, Zoladex. Mean age was 72 years (range of 45-94 years) and, in most cases, patients had metastatic disease, not previously treated by chemotherapy or hormone therapy. Patients received a monthly injection of 3.6 mg. Serum testosterone was lowered into the range of castrate levels after 4 weeks of treatment. In 105 evaluable patients at 3 months, a 65% partial response (PR) rate was observed, with 11% stable and 24% progressive disease. Median time to progression was 37 weeks. Analysis of objective criteria revealed 30% PR for prostate volume and 51% CR-PR for prostatic acid phosphatases. Seventeen percent of lytic metastases had recalcified. One hundred twenty-nine patients were evaluable for toxicity. Endocrinological side effects were common: decrease in libido, 92%; impotence, 86%; hot flushes, 48%; and breast swelling or tenderness, 9%. Nonendocrinologic side effects were rare. The treatment is generally well accepted by patients owing to the convenient depot formulation and to the minor side effects.
Many methods have been reported to prevent the development of stomal stenosis following direct cutaneous ureterostomy, thus avoiding catheterizations with their attendant complications, and improving patient tolerance. Nevertheless, although lessened, the risk of stenosis persists in narrow ureters. In order to improve local trophicity and help maintain a wide, flexible intraparietal segment, the authors have developed a technique of cutaneous ureterostomy using a muscle flap from the rectus abdominis muscle and a V-shaped skin flap. This procedure was used on 20 ureters, including 12 dilated ureters and 8 narrow ureters. Follow-up was 3 months to 2 years. In 18 cases, no catheterization was needed, and no stenoses or complications were observed. In one case, stomal stenosis developed on a dilated, irradiated ureter from a non-functioning kidney. An indwelling catheter was used in one narrow ureter with a stenosis proximal to the abdominal wall. These preliminary results suggest that this technique is beneficial. Further studies with a larger number of patients and longer follow ups are needed.
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