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Philippe Grise

Publications and source records attributed to Philippe Grise.

32 records · Page 2Linked to original sources
PubMed2003

[Solitary fibrous tumour of the kidney and other sites in the urogenital tract: morphological and immunohistochemical characteristics].

Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which can also occur in a large number of other sites. The authors report a case of solitary fibrous tumour involving the kidney and present a brief review of the main sites currently described in the urogenital tract and the most characteristic elements of the diagnosis based on histological and immunohistochemical examination designed to improve their subsequent recognition within the wide range of spindle cell tumours.

Female↗
PubMed2002

Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinence.

Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure profile was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three different pressure components were defined in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H(2)O in five cases of severe incontinence. No significant difference was observed for these patients on urethral profile components 6 months later. In contrast, in cases of significant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence.

Adrenergic alpha-Antagonists↗
PubMed2002

Assessment of clinical reasoning competence in urology with the script concordance test: an exploratory study across two sites from different countries.

OBJECTIVES: The script concordance (SC) test is designed to measure the organisation of knowledge that allows interpretation of data in clinical reasoning. This study explores the use of this new written examination tool in urology. MATERIALS AND METHODS: An 80 items SC test was administered to participants from a French and a Canadian university. Three levels of experience were tested: urologists (n = 22), residents in urology (n = 25) and students (n = 23). Scores between groups were compared by analysis of variance. Reliability analysis was studied with Cronbach alpha coefficient. RESULTS: Mean global scores were 51.45 +/- 5.29 for students, 58.19 +/- 3.81 for residents and 62.27 +/- 5.46 for urologists. The difference between the three groups was statistically significant (P < 0.00001). Interaction between levels of expertise and sites was apparently not significant (P = 0.326). Cronbach alpha was 0.79 for the test. CONCLUSIONS: This study shows that the SC test is able to discriminate among participants according to their levels of clinical experience in urology. The results are similar in two different learning environments. The SC test appears as a simple and direct approach to testing organisation and use of knowledge in urology.

Clinical Competence↗
PubMed2002

Nosocomial urinary tract infections in urologic patients: assessment of a prospective surveillance program including 10,000 patients.

OBJECTIVE: Hospital-acquired urinary tract infections (HUTI) represent a significant impairment in the quality of health care. Incidence in catheterized patients has been estimated at approximately 20%, however few data are available in urologic patients. We report a prospective surveillance program over 6 years in our urologic department and evaluate its evolution. METHODS: Population consists of all patients admitted to the urology ward for 48 hours or more over a 6-year period from 1994. Data recorded: age, gender, duration of stay, insertion and removal of catheters, diagnosis of HUTI. ANALYSIS: calculation of incidence, and incidence density for HUTI and for catheter-related HUTI, analysis of trends by chi(2) trend test. RESULTS: A total of 10,054 consecutive patients were included, 52% were catheterized. The median incidence of catheter-related HUTI in catheterized patients was 13.0%, the incidence density was 25.1 HUTI/1000 patient-days of catheterization. The proportion of HUTI and specific catheter-related HUTI patients decreased, respectively from 8.4% and 14.2% to 6.5% and 12.3% during the study period (p<0.05). CONCLUSION: The rate of HUTI was not as high as previously reported, perhaps due to a controlled catheter policy. Surveillance was associated with a significant decrease in infection rates, suggesting a beneficial feedback effect. Evaluation of diagnoses and surgical procedures would ensure an optimal quality control program.

Adult↗
PubMed2002

Stability of clinical reasoning assessment results with the Script Concordance test across two different linguistic, cultural and learning environments.

The Script Concordance (SC) test is designed to measure the organization of knowledge that allows interpretation of data in clinical reasoning. An originality of the test is that answer keys use an aggregate scoring method based on answers given by a panel of experts. Previous studies have shown that the SC test has good construct validity. This study, done in urology, explores (1) the stability of the construct validity of the test across two different linguistic and learning environments and (2) the effect of the use of experts who belong to different environments. An 80-item SC test was administered to participants from a French and a Canadian university. Two levels of experience were tested: 25 residents in urology (11 from the French university and 14 from the Canadian university) and 23 students (15 from the French faculty, eight from the Canadian faculty). Reliability analysis was studied with Cronbach's alpha coefficient. Scores between groups were compared by analysis of variance. Reliability coefficient of the 80 items test was 0.794 for the French participants and 0.795 for the Canadian participants. Scores increased with clinical experience in urology in the two sites. Candidates obtained higher scores when correction was done using the answer key provided by the experts from the same country. These data support the stability of the construct validity of the tool across different learning environments.

Adult↗
PubMed2002

Communication between consultants and referring physicians: a qualitative study to define learning and assessment objectives in a specialty residency program.

BACKGROUND: Outpatient consultation constitutes a major part of medical practice. However, little is known about the skills which should be taught to residents in order for them to improve their consultant-referring physician relationships. PURPOSES: To specify the consultant skills which are required to ensure an effective communication between specialists and referring physicians. METHODS: A qualitative study based on (a) a literature search and (b) focus group interviews. RESULTS: Skills thus identified and described are classified in two groups: observable skills and principles/attitudes. CONCLUSIONS: The consensual specification of these abilities permits a greater efficacy in the teaching of consultant skills.

Ambulatory Care↗
PubMed2002

[Value of mitoxantrone in metastatic hormone-resistant prostate cancer].

INTRODUCTION: The second-line treatment of hormone-resistant metastatic prostate cancer is controversial. This study was designed to evaluate the efficacy and toxicity of mitoxantrone in this clinical situation. MATERIALS AND METHODS: The author report a retrospective study of 16 patients with a mean age of 69 years (range: 51-80 years). In each case, the treatment regimen consisted of castration followed by fosfestrol tetrasodium after hormonal escape and second-line treatment with mitoxantrone at a dose of 12 mg/m2 per course (1 to 10 courses) associated with prednisone at a dose of 10 mg/day. The authors evaluated the response to treatment (clinical status and survival) as a function of the following parameters: initial PSA, Gleason score, number of bone metastases, time to hormonal escape, PSA and Karnofsky index on inclusion and total number of courses of mitoxantrone. RESULT: Two groups of eight patients were defined as a function of clinical status at the end of each course: group 1 (partial regression and no change) and group 2 (tumour progression). A correlation was demonstrated between the time to hormonal escape and the number of courses and the response to treatment (p = 0.058). The mean survival after introduction of mitoxantrone was 13 months with a significant difference (p = 0.0004) for a cut-off value of 4 courses: 7 months (n < or = 4) and 18 months (n > 4). CONCLUSION: Mitoxantrone is a minimally toxic chemotherapeutic agent, which justifies its current indication in hormone-resistant advanced prostate cancer.

Aged↗
PubMed2002

[Systematic planning of technical training in urologic surgery: methodologic trial].

OBJECTIVES: Trainee urologists must be helped and guided in order to acquire surgical techniques and professional skills. This methodological trial was designed to define the training objectives based on the needs formulated in terms of basic technical procedures. MATERIALS AND METHODS: Systematic planning based on the training cycle was used in this study. Training needs were identified by a questionnaire sent to 4 groups composed of a limited number (about twelve) of urologists, but representative of the various modes of urological practice in several regions of France. Data were acquired according to the Delphi method. RESULTS: A list of 10 operations to be mastered at the end of urology training was defined consensually based on the replies (79.2%) to the questionnaire. This list was used as the basis for the design of general and specific training objectives for each operation. These objectives were validated by the urologists consulted. Three examples of these objectives are presented. CONCLUSION: A clear determination of the surgical technique training needs and objectives could lead to standardization of the practical training of urology residents. This would subsequently need to be completed by determination of the methods of evaluation of achievement of these objectives for tutors and trainee urologists.

Education, Medical↗
PubMed2002

[A rare entity: cystadenoma of the prostate].

The authors report the case of a 40-year-old man with cystadenoma of the prostate. This rare disease is difficult to diagnose despite a complete radiological assessment (transrectal and bladder ultrasound and MRI of pelvis). Only histological examination of the operative specimen demonstrated absence of malignancy. However, follow-up is required in view of the risk of recurrence of this prostatic lesion.

Adult↗
PubMed2002

[Testicular microlithiasis and cancer of the testis].

The authors report the case of a patient with a history of testicular cryptorchidism followed for 4 years for infertility and who developed seminoma. Bilateral testicular microlithiasis was initially detected on ultrasonography. On the basis of this case and a review of the literature, the authors discuss the aetiopathogenesis and management of these microscopic stones in a context of cancer.

Adult↗
PubMed2002

Segmental testicular infarction: diagnosis and strategy.

OBJECTIVES: We report the usefulness of ultrasonography and magnetic resonance imaging (MRI) findings in testicular infarction, in order to avoid surgical exploration. METHODS: In December 2000, a 37-year-old African male presented with left testicular pain and no prior history of trauma. Physical examination, ultrasonography and MRI were performed by an experienced radiologist (D.T.), which suggested a segmental testicular infarction. Surgical exploration was not performed and a period of watchful waiting with evolution control by ultrasonography was decided. RESULTS: After a 3 month follow-up, the ultrasonography control revealed a total re-vascularization of the vessels and a reduction of the lesion size. CONCLUSION: The authors suggest that the combination of ultrasonography and MRI, in the management of testicular infarction, may avoid invasive surgery.

Adult↗
PubMed2002

[Breast metastasis of kidney cancer. Diagnostic and therapeutic features].

The breast is a rare site of metastasis from renal cancer and the preoperative diagnosis is often difficult. The treatment recommended for this type of metastasis is tumourectomy associated with frozen section examination, while mastectomy and lymph node dissection are unnecessary. The prognosis is often poor with a life expectancy rarely exceeding one year. The authors report a case of isolated right breast metastasis occurring two and a half years after left radical nephrectomy for renal cell carcinoma. Tumourectomy and frozen section examination were performed. The patient died four years later in a context of disseminated metastases despite immunotherapy.

Adenocarcinoma, Clear Cell↗
PubMed2002

[The future of biomaterials in urology].

The fields of application of implanted biomaterials will continue to grow, ranging from the use of catheters and slings for the genitourinary tract, to the production of tissues and organs. The scale of research has changed over recent years, passing from a macroscopic view to a microscopic view, resulting in a change from mechanical devices, such as prostheses, catheters and slings to the cellular unit and more particularly in vitro cell cultures. New techniques, such as gene therapy and cell reconstruction have been recently introduced into the field of urology. Prospective biocompatibility studies must be conducted to establish appropriate biocompatibility standards adapted to new materials. The development of these new materials required a multidisciplinary approach involving engineers, biologists and physicists. It must be conducted in specialized centres skilled in biocompatibility research and in close collaboration with a basic bioscience and clinical practice. In the future, synthetic biomaterials will have an almost unlimited range of mechanical properties allowing much more specific applications. Another improvement of materials will concern a reduction of the risk of infection, erosion, mineral deposits, migration of particles, secondary reactions, and finally improved durability. However, the long-term properties of synthetic materials will probably not be as good as those of natural or almost natural biomaterials derived from biotechnology by tissue engineering.

Biocompatible Materials↗