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P Plante

Publications and source records attributed to P Plante.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Leiomyosarcoma of the renal vein].

The authors report a new case of leiomyosarcoma of the right renal vein, marked by a rapidly fatal course within 9 months, despite the initial absence of metastasis. This exceptional vascular tumour (only about thirty cases have been published) must be distinguished from primary renal leiomyosarcoma and retroperitoneal leiomyosarcomas involving adjacent structures. This difficult diagnosis was suggested by preoperative CT and angiography. Leiomyosarcomas of the renal vein generally have an unfavourable outcome in the medium term. The prognosis is related to the localized nature of the tumour and the risk of local and distant recurrence. Limited tumour resection is rarely sufficient and radical nephrectomy is usually necessary, possibly associated with a vascular procedure on the inferior vena cava in the case of contiguous extension.

Adult↗
PubMed2001

[Retroperitoneoscopic pyeloplasty for primary hydronephrosis: preliminary results of the first 30 procedures].

OBJECTIVE: To evaluate the preliminary results of retroperitoneoscopic pyeloplasty (RP) for the treatment of primary ureteropelvic junction syndrome (PUPJS) in terms of operating time, operative and postoperative complications, clinical functional and radiographic results, length of hospital stay and resumption of physical activity. MATERIAL AND METHODS: From November 1997 to June 2000, from a consecutive series of 59 patients treated for an anomaly of the ureteropelvic junction (UPJ), the 29 patients (18 females and 11 males, mean age: 35.6 years [range: 17-68]) operated by RP for PUPJS (bilateral in one case) were reviewed. Twelve patients presented a lower pole vascular pedicle and 24 patients had an extrasinusal renal pelvis. The RP technique was identical for all patients (4 ports) and the UPJ repair was performed according to the technique described by Anderson-Hynes and Küss (28 cases) or Y-V plasty (2 cases). RESULTS: The mean operating time was 150 minutes (range: 120-240) and the mean hospital stay was 4.2 days (range: 3-10). There were no intraoperative complications, but one conversion (3.3%) was necessary because of major adhesions. postoperative complications (23.3%) consisted of: four urinary tract infections with one case of acute pyelonephritis, perirenal haematoma, urine leak in the Redon drain due to obstructed double J stent, migration of the double J stent underneath the anastomosis leading to unstentable cicatricial stricture (treated by open pyeloplasty 3 weeks later). With a mean follow-up of 19.7 months (range: 7-40), 28 patients were asymptomatic and one patient presented persistent lumbar pain at 9 months with no signs of recurrence. The 3-month IVU, performed in 27 patients, showed reduction of hydronephrosis in 85.7% of cases and a patent ureteropelvic junction in 96.3% of cases. Complete resumption of physical activity and return to work were possible an average of 1 month postoperatively (a fortnight for the population under the age of 40 years). CONCLUSION: PUPJS can be treated by RP according to the same principles as conventional surgery. RP pyeloplasty can be performed with an acceptable operating time and morbidity. The functional and radiological results in terms of patency of the UPJ need to be assessed in the longer term.

Adolescent↗
PubMed2000

Retroperitoneal laparoscopic adrenalectomy: clinical experience in 52 procedures.

OBJECTIVES: Laparoscopic adrenalectomy has become an effective option for removal of small adrenal tumors. The aim of this prospective study was to evaluate the retroperitoneal approach with regard to intraoperative complications, morbidity, and length of hospital stay. METHODS: Between September 1996 and October 1999, we performed 52 laparoscopic adrenalectomies (31 left, 21 right) for benign lesions by a retroperitoneal approach in 44 patients (27 women, 17 men) with a mean age of 46.9 years (range 17 to 74). The average adrenal tumor size was 32 mm (range 10 to 63). All procedures required four trocars and a mean operative time of 135 minutes (range 75 to 240). RESULTS: There was no mortality, conversion rate to open surgery was 1.9%, and estimated blood loss was 80 mL (range 30 to 200). With a mean follow-up of 16 months, morbidity was 17.2%, which included intraoperative complications (5. 7%) with two vascular injuries, and postoperative complications (11. 5%) with wound infections, deep hematoma, and parietal dehiscence. Average length of hospital stay was 5 days with a mean analgesic consumption of 2 days (range 1 to 5). CONCLUSIONS: The retroperitoneal approach in laparoscopic adrenalectomy appears to be a minimally invasive and safe therapeutic option that may become the standard for unilateral or bilateral adrenal tumors not larger than 7 cm. However, a learning curve in laparoscopy is indispensable before starting this type of procedure.

Adolescent↗
PubMed2000

Role of preoperative positive apical biopsies in the prediction of specimen-confined prostate cancer after radical retropubic prostatectomy: a multi-institutional study.

OBJECTIVES: A multi-institutional study of 280 radical prostatectomy specimens obtained from three independent academic hospitals was undertaken to validate a nomogram developed for the prediction of specimenconfined protstate cancer after prostatectomy. METHODS: Three preoperative factors - the Gleason score, prostatespecific antigen (PSA) and apical location of positive biopsies - that were identified with a previous logistic regression formula were collected. Links between margin status and preoperative criteria were confirmed by univariate methods. Subsequently, the predictive indexes of positive margins were calculated and compared to the actual margin status in terms of predictive characteristics. RESULTS: This control series, independent of the initial series that was used to identify the relevant preoperative factors, confirmed that positive apical biopsies(p<0.001), PSA (p<0.005) and the Gleason score (p<0.005) were strongly linked to the occurrence of positive margins. Different cutoff values for the predictive index were compared in a receiver operating characteristic curve. A value of 0.5, similar to the one described in the original series, gave an adequate compromise between sensitivity and specificity with respective values of 68 and 73% and a test accuracy of 72%. In practical terms, it was possible to predict 85% of negative margins, and to delineate two groups with different rates of positive margins (14.5 vs. 50%). CONCLUSIONS: We demonstrated that PSA, the Gleason score and apical biopsy status are cumulative risk factors for positive margins. Risk of positive margins increases when it is not possible to obtain a wide excision of periprostatic fascia, as at the apex. This study substantiates the independent prognostic value of positive preoperative apical biopsies for predicting positive surgical margins.

Aged↗
PubMed2000

[Kock's pouch: experience and clinical course in 31 patients].

OBJECTIVES: To analyse the morbidity and functional results of Kock's continent urinary diversion performed since 1992 in cystectomized patients in whom the urethra could not be used. MATERIAL AND METHODS: From March 1992 to June 1998, 31 Kock's pouches were performed by 2 surgeons on a group of patients with a mean age of 54 years. Henriet's technique was used in 23 patients until 1996, and was then modified the last 8 patients in order to create a continent valve. The diversion was performed after cystectomy for bladder or gynaecological tumour in 23 cases and 1 urinary tract reconstruction in 8 cases (neurogenic bladder, destroyed urethra, conversion of Bricker diversion). RESULTS: With a mean follow-up of 42 months (12 to 84), the perioperative mortality was 3.4% and immediate complications were 26%, justifying reoperation in 6.4%. Late complications predominantly consisted of disinvagination of the valve with a reoperation rate of 13%. No surgical revision for newly modified antireflux valves has been performed since 1996. The continence rate of the system, evaluated between 3 and 6 months, was 90%. CONCLUSION: Kock's pouch is a delicate operation, clearly associated with a high morbidity in this series, as in the literature, although the results improved with experience. Indications must be confined to patients in good general condition, motivated for self-catheterization (ATS) and in whom the urethra cannot be used for bladder replacement.

Adult↗
PubMed2000

[Urethral instability].

Urethral instability is an abnormal behaviour of the urethra associated with sudden reduction of urethral pressures. This disease is rarely described in view of its nonspecific clinical features and the abnormalities only detected on continuous urethral recording. Alteration of the voiding reflex is the most likely aetiopathogenic basis, although other urethral and neurological diseases have been observed. The numerous treatment options reflect the limited knowledge concerning aetiological factors.

Humans↗
PubMed2000

[Assessment of urinary continence in Hautmann neobladder].

OBJECTIVE: The Hautmann neobladder is a bladder replacement technique frequently proposed after total cystectomy for bladder cancer. The objective of this prospective study was to evaluate the patients' urinary continence after this operation, based on clinical and urodynamic data. MATERIALS AND METHODS: The functional assessment was based on 26 patients from a series of 45 consecutive Hautmann bladder replacements performed between February 1994 and May 1999. These 26 nonselected patients (21 men and 5 women) with a mean age of 56 years (range: 38-68) accepted the principle of functional assessment of continence at visits held 1, 3, 6 and 12 months postoperatively including clinical interview, urodynamic studies and fibroscopy. Only one patient presented with preoperative stress incontinence. The mean follow-up of these 26 patients was 22 months (range: 10-60). Three patients, including two women, died from progression of their bladder tumour at the 12th, 20th and 32nd postoperative months. RESULTS: Urodynamic studies showed a mean maximum capacity of the ileal reservoir of 420 ml (range: 316-571), a maximum filling pressure of 15 cmH2O (range: 2-24) and a maximum urethral closure pressure of 49 cmH2O (range: 31-74). According to the evaluation criteria used, the satisfactory continence rates, as assessed by the patients were 62%, 77%, 84.6% during the day and 42%, 615%, 77% at night, at 3, 6 and 12 months, respectively. CONCLUSION: The Hautmann neobladder ensures satisfactory diurnal and nocturnal urinary continence in more than 75% of cases after the 6th postoperative month. Continence is an evolving parameter especially during the first postoperative year. The selection of patients in good general condition and motivated for management of their new urinary situation remains an essential prerequisite to obtain a good functional result.

Adult↗
PubMed2000

[Repair of female urinary incontinence with prolene "TVT": preliminary results of a multicenter and prospective survey].

OBJECTIVES: A multicentre, prospective study (6 private centres, 1 general hospital and 1 teaching hospital) was conducted to evaluate the perioperative morbidity and short-term functional results of the TVT procedure in the treatment of the female urinary stress incontinence. PATIENTS AND METHODS: From November 1996 to September 1999, 120 patients with a mean age of 65.2 years (range: 37-91) were operated according to the tension-free vaginal tape (TVT) technique for isolated urinary stress incontinence (stage 2 or 3) in 94 cases and associated with pelvic tone disorder in 26 cases. 59 patients (49.2%) presented recurrence of urinary incontinence that had already been operated between 1 and 4 times. Physical examination demonstrated hypermobility of the urethra in 73 cases (60.8%), isolated clinical sphincter incompetence in 47 cases (39.2%) and pelvic tone disorders in 31 cases. Urodynamic studies, performed in 113 patients, demonstrated sphincter incompetence in 65 cases (57.5%) with a mean maximum urethral closure pressure of 18 cmH2O (range: 5-29). RESULTS: The operation, performed under spinal anaesthesia in 97 cases (80.8%), general anaesthesia in 16 cases (13.3%) and local anaesthesia in 7 cases (5.8%) lasted an average of 28.7 min (range: 15-60) for insertion of the TVT. Perioperative complications consisted of twelve bladder injuries (10%) and two pelvic haematomas (1.7%). No cases of infection, erosion or migration of the tape were reported. In the group of 94 patients operated exclusively by TVT, the mean hospital stay was 2.6 days (range: 1-7). Twelve patients (10%) required self-catheterization for 2 to 30 days. With a mean follow-up of 15.2 months (range: 36-6), continence was restored in 104 patients, corresponding to a cure rate of 86.7%. A marked improvement was obtained in 11 cases (9.2%) and five cases (4.2%) were considered to be failures. CONCLUSION: The TVT procedure is a new approach to the treatment of female urinary stress incontinence. Its advantages are its simplicity, the rapidity of the technical procedure and the short-term efficacy on continence. A longer follow-up is essential to assess to the functional outcome and the long-term urethral tolerance.

Adult↗
PubMed2000

[Pfannenstiel short horizontal laparotomy in retropubic radical prostatectomy].

OBJECTIVE: To evaluate the feasibility of the Pfannenstiel short horizontal laparotomy to perform retropubic radical prostatectomy and its consequences on postoperative analgesic consumption. MATERIALS AND METHODS: From December 1998 to February 2000, 62 radical prostatectomies were performed via a short horizontal suprapubic incision. The mean length of the incision in the lower abdominal fold was 10.2 cm (range: 8 to 14 cm). The mean duration of radical prostatectomy was 130 minutes (range: 90 to 210 min). Double drainage (retropubic and subaponeurotic) was systematically maintained for an average of 48 hours. Postoperative narcotic analgesic consumption, and the modalities and duration of prescription were compared between 30 patients operated by this technique and 30 patients previously operated via a midline infraumbilical incision. RESULTS: The abdominal wall opening and closing time was about 20 minutes. The operation was always performed via this incision, allowing excellent exposure of lymph node areas and the prostate. Postoperative complications related to this incision consisted of a single subaponeurotic haematoma, which was not drained. The mean dosage and duration of postoperative analgesic consumption decreased by 44% compared to the reference group. Postoperative assessment of the abdominal wall showed almost complete disappearance of the scar at 3 months and no secondary wound dehiscence. CONCLUSION: The Pfannenstiel short horizontal laparotomy is a simple and reproducible technique for retropubic radical prostatectomy. This feasibility study was accompanied by a reduction of postoperative analgesic consumption in the study group.

Aged↗
PubMed1999

Second non-germ cell malignancies in patients treated for stage I-II testicular seminoma.

PURPOSE: To measure the incidence of second non-germ cell malignancies (SNGCM) in patients treated for a stage I-II testicular seminoma. MATERIALS AND METHODS: From 1970 to 1992, 131 evaluable patients received in the Institut Claudius Regaud a post-orchiectomy treatment for a stage I-II testicular seminoma. The therapeutic modalities, including salvage treatment for six recurrences, were as follows: infradiaphragmatic radiotherapy (IDRT) (n = 55); infra- and supradiaphragmatic radiotherapy (IDRT + SDRT) (n = 64); IDRT + SDRT with chemotherapy (n = 12). The mean follow-up was 11 years. The cumulative incidence of SNGCM was compared to the overall cancer incidence in the general male population on the basis of the Tarn Cancer Registry; the relative risk was expressed as a standardized incidence ratio (SIR). RESULTS: Overall, the cumulative incidence of SNGCM was 10.7% (14/131 cases). The SIR was equal to 2.81 (95% confidence interval (CI) 1.54-4.72; P < 0.001) and increased with follow-up duration. The SIR was significantly increased in 64 patients treated with IDRT + SDRT (SIR = 3.08; 95% CI 1.47-5.66; P = 0.002) but not in 55 patients treated with IDRT alone (SIR = 0.62; 95% CI 0.01-3.43; P = 0.8). The 12 patients who received chemotherapy had an SIR of 26.2 (95% CI 5.48-77.69; P < 0.001), while the SIR was 2.26 in the 119 patients who did not receive any chemotherapy (95% CI 1.13-4.04; P = 0.01 ). Of four hematologic malignancies, three appeared in the 12 patients who received chemotherapy. CONCLUSIONS: An increased risk of SNGCM after SDRT + IDRT has been demonstrated. After IDRT alone, the risk of second cancer is not incremented after a median follow-up of 6 years, but further observation of the patients is necessary to achieve final conclusions. Our results suggest that the risk of second cancer and especially of hematologic malignancy is increased by the association of chemotherapy and radiation.

Adult↗
PubMed1999

[Value of free PSA/total PSA ratio in therapeutic decisions in the case of a single positive biopsy of the prostate].

OBJECTIVES: Study of the value of the free PSA/total PSA ratio in the therapeutic decision concerning prostatic adenocarcinoma, in the case of a single positive biopsy. MATERIAL AND METHODS: The free PSA/total PAS ratio was calculated on serum samples derived from 37 patients with clinically localized prostatic carcinoma and only one positive biopsy, in whom radical prostatectomy was performed. RESULTS: The free PSA/total PSA ratio appeared to be independent of pathological stage and histological prognostic criteria (grade and score, degree of capsular effraction). CONCLUSION: In the case of a single positive biopsy, calculation of the free PSA/total PSA ratio does not appear to provide any decisional criteria in favour of radical prostatectomy.

Adenocarcinoma↗
PubMed1999

[Renal adenocarcinoma with retrohepatic vena cava thrombus: role of extracorporeal circulation in a retrospective series of 10 cases].

INTRODUCTION: Renal cell carcinoma is accompanied by tumour thrombus in the inferior vena cava (IVC) in 4 to 10% of cases. Since the use of cardiopulmonary bypass (CPB), surgery for extensive thrombus has been improved by reduction of blood loss, facilitating complete resection of the kidney and thrombus and possible repair of the inferior vena cava. OBJECTIVES: To analyse a retrospective series of 10 cases and to compare the complications of CPB and conventional surgery by direct clamping. MATERIAL AND METHODS: From February 1985 to December 1997, 413 patients were operated for renal cancer, including 23 (5.6%) patients with tumour thrombus in the inferior vena cava. Ten of these 23 cases of inferior vena caval thrombus were retrohepatic. Group I (5 patients) was operated under CPB and profound hypothermia at 16 degrees C (mean duration of bypass: 30 min). Group II (5 patients) was operated by conventional surgery (CS) (mean clamp time: 12 min). RESULTS: No difference in terms of intraoperative complications was observed between the two groups, but 2 deaths occurred in group II due to respiratory decompensation, 1 and 2 weeks postoperatively. CONCLUSION: The level of the thrombus in the inferior vena cava determines the mode of vascular management. The presence of invasion of the inferior vena cava wall is difficult to predict because of the poor sensitivity of radiological examinations. CPB did not induce any excess morbidity in this series. The use of CPB in renal cancers with retrohepatic thrombus facilitates the resection procedure and allows inferior vena cava reconstruction in a bloodless environment.

Adenocarcinoma↗
PubMed1999

[Risk of second non-germ cell cancer after treatment of stage I-II testicular seminoma].

OBJECTIVE: To determine the incidence of second non-germ-cell cancers (SNGC) in patients treated for stage I-II testicular seminoma. MATERIAL AND METHODS: This study is based on 131 evaluable patients treated at the Institut Claudius Regaud between 1970 and 1990. Treatment modalities, including salvage therapy for 6 patients developing recurrence, were as follows: infradiaphragmatic irradiation (infraDI) only in 55 cases, infra- and supradiaphragmatic irradiation (infraDI + supraDI) in 64 cases, and irradiation and chemotherapy (IC) in 12 cases. Five patients were lost to follow-up 4 months to 14 years after primary treatment (mean follow-up: 11 years). The cumulative incidence of SNGC was compared to the overall cancer incidence in the age-matched male population reported in the Tarn Cancer Registry. The relative risk was expressed as the Standardized Incidence Ratio (SIR). RESULTS: The cumulative incidence of SNGC was 10.7% (14/131 patients). SIR was equal to 2.81 (p < 0.001) and increased with the duration of follow-up. SIR was significantly increased in 64 patients treated with infraDI + supraDI (SIR) = 3.25; p = 0.002), but not in the 55 patients treated with infraDI only (SIR = 0.62; p = 0.8). The 12 treated patients with IC had an SIR of 26.2 (p < 0.001). Three of the 4 patients who developed a haematological malignancy belonged to the IC group. CONCLUSIONS: The risk of SNGC is increased after infraDI + supraDI. The risk of SNGC after infraDI only is not increased with a median follow-up of 6 years, but this follow-up is too short to allow any definitive conclusions. The risk of SNGC and particularly haematological malignancy appears to be increased by the combination of radiotherapy and chemotherapy.

Adult↗
PubMed1999

[Large-cell calcifying Sertoli cell tumors: apropos of a case and review of the literature].

The authors report the case of a 22-year-old man presenting with a tumour of the lower pole of the left testis, present for 4 months, which proved to be a calcified Sertoli large cell tumour, an extremely rare group of sex cord tumours of the testis presenting specific clinical and histological features. These tumours are usually benign, occur during the first two decades of life and can be associated with dysplastic complexes or endocrinopathies (Carney's complex, Peutz-Jeghers syndrome). They present either in the form of bilateral, multifocal tumours in the context of a pathological association, or in the unilateral form, without association. Several malignant forms with metastases have been described. Conventional treatment is transinguinal radical orchidectomy.

Adult↗
PubMed1998

[Can the prostatic capsule be preserved during cystectomy for bladder tumors: a study of urethral and prostatic involvement in the cystectomy specimens].

OBJECTIVES: To evaluate the frequency of urethral and prostatic lesions on cystectomy specimens for bladder tumour. MATERIAL AND METHODS: This retrospective histological study was based on 260 specimens: radical cystectomies performed in 7 operative sites. The prostate and urethra were analysed in 3 planes (upper, middle and lower thirds). The apex was studied separately. Urethral invasion was identified by continuity of the tumour or by the presence of vesical CIS. RESULTS: Urethral involvement is frequent (30.6% cases) essentially due to contiguous invasion (43/80). CIS is the second pathological association (44 urethral CIS/75 bladder CIS). Prostatic adenocarcinoma was present in 17.8% of cases with a Gleason score > 6 for 30% of lesions. CONCLUSION: The high frequency of urethral and prostatic involvement does not justify preservation of the prostate during cystectomy. A serial prospective study should define the precise criteria able to minimize the risk of conservative surgery.

Adenocarcinoma↗
PubMed1998

[The use of MRI with a pelvic phased array antenna in the evaluation of the gland and tumor volume of clinically localized prostatic adenocarcinoma].

UNLABELLED: Prostate cancer is clinically understaged in 50% of cases. It was improved with the use of random biopsies, PSA analysis (balanced and unbalanced) and Gleason grade on biopsies. Traditional imaging techniques such as endorectal ultrasonography and CT Scan are known to be of no interest. MRI is a non-evasive technique which allows the three dimensional study of an organ with a high quality of tissue contrast. Moreover, the positioning of surface antennae or "phased array" allowed improvement in spatial resolution. OBJECTIVE: To determine whether MRI allows an accurate staging of clinically localised adenocarcinoma by the direct estimation of capsular effraction, measure of glandular and tumor volumes and finally by obtaining reliable PSAd. MATERIAL AND METHODS: A prospective study was done from March 1995 to November 1996 on 55 patients with a clinically localised adenocarcinoma. MRI 1 Tesla Imager (SIEMENS), pelvic phased array antennae. FSE sequences (T1 and T2), axial and frontal. Evaluation of volumes by on-screen. Standford protocol for histo-pathologic reading on the axial cuts. Direct planimetry on a millimetre paper. RESULTS: Reliable estimation of glandular volume (average difference 0.7 cc). Sub-evaluation of tumoral volume (average difference 1.04 cc) with a 30% margin of error, accuracy 87%. Tumoral stage exact in almost 90% of the cases with a PPV of 94%. CONCLUSION: Prostatic MRI, using surface antennae, allows to complete the conventional stage by stage development by correctly diagnosing 75% of locally evolved stages. Its limits are linked to the nature of the signal of the tumorous tissue as to the localisation of neoplasic lesions.

Adenocarcinoma↗
PubMed1997

[Prevention of sterility in spinal cord injured men].

The reproductive function of spinal cord injured males is not the primary concern of health professionals responsible for the management of these young adults. However, the fertility of these patients is threatened right from the first days after trauma, as indicated by abnormalities of the sperm count, reflecting the histological alterations observed on testicular biopsy. The factors predisposing to asthenoteratospermia, responsible for impaired fertility, are analysed and discussed. Urinary tract infection is the leading factor. This acute situation must be managed early, by preventing urinary tract infection and by obtaining a semen donation as soon as possible, after improvement of the general status.

Adult↗