Diagnostic improvement of prostate cancer using an extensive biopsy protocol.
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Journal Article↗
Biomedical subjects
V Delmas
Publications and source records attributed to V Delmas.
Urolithiasis and the protease inhibitor indinavir.
OBJECTIVE: To evaluate specific urological abnormalities in patients treated with the protease inhibitor indinavir. METHODS: A series of 155 consecutive human immunodeficiency virus-positive patients were treated with indinavir 800 mg p.o. three times a day. Of these, 14 (9%) treated for 1-321 (average 110) days experienced severe flank pain and were subjected to clinical and laboratory examinations. RESULTS: Abdominal X-ray was consistently negative for stones. Ultrasonography showed upper-tract dilatation in 12 patients. Intravenous urography showed obstruction above a radiolucent obstacle in 7 patients; in 2 cases, there was a marked delay in urine excretion on the obstructed side. The mean urine pH was 6. Urine culture was negative. Serum uric acid, phosphorus, and calcium levels were normal. In 8 patients there was slight renal insufficiency, and 4 patients required ureteral stenting. In all cases, hyperhydration and oral analgesia led to a favorable outcome. In 3 patients, chemical analysis of the stone demonstrated monohydrate indinavir crystals. CONCLUSIONS: In our experience, indinavir therapy is associated with urolithiasis in 9% of the cases. Hydration, analgesia, and acidification of the urine usually lead to a favorable clinical outcome. Prophylactic hydration and acidification of the urine are extremely important.
Adult↗
Diagnostic value of ten systematic TRUS-guided prostate biopsies.
OBJECTIVE: To evaluate the improvement in the rate of detection of prostate cancer using an extensive protocol involving ten transrectal biopsies. METHODS: A total of 162 patients submitted to transrectal ultrasound-guided biopsy for elevated prostate-specific antigen (PSA) and/or abnormality on digital rectal examination were studied consecutively and prospectively. Five biopsies were performed in each lobe: between the three standard biopsies on each side, two additional biopsy specimens were taken in the same plane and at the same 45 degrees angle. RESULTS: The complication rate with the ten-biopsy protocol was 1.85%. Prostate cancer was detected in 40.1% of the patients. In the overall series, the percentage of diagnostic improvement brought about by this ten-biopsy protocol was +3.1%. The percentage improvement was greatest (+4.9%) in patients with PSA </=10 ng/ml. CONCLUSION: Increasing the number of biopsy cores without altering the angle of biopsy and/or the zone sampled does not lead to a significant improvement in the detection of prostate cancer.
Adult↗
Reasons of dropout from short- and long-term self-injection therapy for impotence.
OBJECTIVE: To define the satisfaction rate and the dropout causes of intracavernous self-injection therapy in impotent patients. METHODS: A total of 250 impotent patients treated with intracavernous injection of drugs from 1991 to 1997 were mailed a questionnaire about their experience with this method. If the patient discontinued therapy, eight possible explanations for discontinuation were tested to identify reasons for terminating therapy (multiple choices were allowed). The causes of impotence were correlated with the rates of patients continuing or discontinuing therapy. RESULTS: 144 of 250 patients (57.6%) returned the questionnaire. Of the 106 non-responding patients, 50% could not be reached due to relocation. The patients were divided into three groups according to the duration of injection use. In group I, 35 of 144 patients (24%) did not continue therapy at home because either they felt it was unnatural (20%), they were dissatisfied (20%), or they experienced improvement of spontaneous erections (15%). In group II, 57 of 144 patients (40%) continued therapy at home and dropped out after a mean duration of 6.9 (range 0.5-48) months due to dissatisfaction (22%), cost reasons (20%), or insufficient erection for penetration (19.4%). In group III, 52 of 144 patients (36%) were continuing therapy with a mean follow-up period of 19.8 (range 2-72) months. The mean ages were not statistically different in the three groups. Also the aetiologies of impotence were similar: 35% psychogenic, 25% organic, and 40% mixed psychogenic/organic. Patients with psychogenic aetiology seem to continue therapy more frequently than others. CONCLUSIONS: The long-term follow-up revealed a high attrition rate of intracavernous self-injection therapy. Patient dissatisfaction, cost, and insufficient erection for penetration were the major causes of dropout.
Adult↗
[Value of the use of a questionnaire in the evaluation of incontinence surgery].
OBJECTIVE: To assess the contribution of a questionnaire in the evaluation of patients operated for urinary stress incontinence. PATIENTS AND METHODS: From 1988 to 1996, 42 patients underwent bladder neck suspension for urinary stress incontinence. Only 7 patients had no history of pelvic surgery, 24 patients presented pure urinary stress incontinence and 19 presented mixed incontinence, 37 patients were evaluable with a mean follow-up of 2 years. The evaluation consisted of two aspects: clinical assessment, based on review of the case files, showing that 77% of patients were continent, and a questionnaire (non-validated translation of "Q7" and "UD16"). This questionnaire evaluated quality of life (7 items) and symptoms. Each item was scored from 0 to 3. RESULTS: To interpret the results we divided the three main scores into three intervals, the first third corresponding to good results. The percentage of good results for the overall score, quality of life score and symptom score was 62%, 73% and 46% respectively. The most discriminative questions of the questionnaire can be used to analyse urine leaks related to effort, urgency episodes of incontinence. A score of 0 or 1 was considered to be a good result. The percentage of good results for these three questions was therefore 72%, 60% and 64%, respectively. CONCLUSION: The cure rate therefore varies as a function of the criteria selected: the questionnaire allows the urologist to more accurately assess the patient's postoperative state.
Adult↗
[The anatomic lobulation of the prostate, a controversial description].
Vésalius, in 1543, described, for the first time, the prostate as an unique organ. But, in the 19th century, two schools confronted; for Cruveilhier and Testut, the prostate was made of several lobes, when Cloquet and Sappey thought it as a unique zone. Albarran, in 1902, described the sub-uretral glands. Thereafter, Cuneo, in 1911 and Franks, in 1954, described two zones, one, internal, formed by the Albarran's glands, and the other, external, concerning the whole prostatic gland. On the contrary, Lowsley, in 1912, and Gil Vernet, in 1953, described several lobes, 5 for Lowsley, 3 for Gil Vernet. Recently, in 1968, and 1978, McNeal had made the proof that the prostate is histologically and anatomically heterogeneous, with three zones, transitional, central and peripheral ones.
Anatomy↗
[Pectineal ligament of Cooper. Micromorphometric study].
The pectineal ligament is used in surgery as a support element in the treatment of groin hernias and female urinary stress incontinence. The question is to determine the anatomical characters that account for its strength. Three complementary approaches have been considered: an anatomical dissection study established the origin of the different fibers the ligament is composed of; a morphometric study determined the areas where the ligament is the thickest; and microscopic anatomy clearly showed the arrangement of the fibers. The pectineal ligament continues the near-by fibers fibrous elements, notably thanks to its ends. The latter are significantly thicker. At microscopic level, the regular layout of the pectineal ligament fibers accounts for its resistance.
Aged↗
[Lipodystrophy: a complication of protease inhibitors in HIV seropositive patients].
Indinavir-induced lipodystrophy constitutes a new complication of this therapeutic category. It is characterized by loss of fat from the face and limbs and accumulation of fat in the abdominal wall (possibly simulating an abdominal mass), but also in the abdominal cavity (retroperitoneum, greater omentum, mesocolon, mesentery). This complication, whose frequency is currently assessed to be between 24 to 64%, occurs an average of 10 months after starting treatment. It is often accompanied by laboratory abnormalities, such as hypertriglyceridaemia, hypercholesterolaemia or insulin resistance. The pathophysiology and long-term consequences of this complication are still poorly understood.
Anti-HIV Agents↗
[Physiopathology and evaluation of urinary incontinence in non-institutionalized aged patients].
The prevalence of urinary incontinence increases with age, with a predominance of incontinence due to detrusor instability. The development of incontinence in an elderly person can be explained pathophysiologically by the development of age-related histological and functional alterations of the bladder, by increased nocturnal diuresis at the expense of diurnal diuresis and finally, in women, by a reduction of urethral pressure. The initial assessment is essentially clinical and must comprise evaluation of concomitant diseases and drugs likely to favour the development of incontinence, a voiding diary and assessment of the post-voiding residual volume. Only a test for urinary tract infection by dipsticks or urine culture constitutes an essential first-line complementary investigation, as urodynamic studies can be reserved for more complex situations.
Age Factors↗
[Comparative study of 230 women to determine the maximum closure pressure and functional length of the urethra at 0, 3, 6 and 9 o'clock].
OBJECTIVE: The maximum closure pressure (MCP) of the urethra, measured by the urethral profile, constitutes an index of urinary continence. The objective of this study, in a large population of women, was to evaluate the possible variations of MCP and functional length (FL) of the urethra, according to the position of a urodynamic probe designed to perform lateral sectorial measurements. MATERIAL AND METHODS: Measurements were performed between July and December 1998, in 230 patients with a mean age of 55 years, using a probe perfused with water and equipped with an urethral side orifice. We compared, by analysis of variance for repeated measures, MCP and mean FL at 0 o'clock (MCPm0, LFm0), 3 o'clock (MCPm3, LFm3), 6 o'clock (MCPm6, LFm6) and 9 o'clock (MCPm9, LFm9). RESULTS: The values for MCPm and LFm obtained according to the rotation of the probe were as follows: MCPm0 = 65.68 +/- 12.46 cmH20, MPCm3 = 55.44 +/- 16.97 cmH20, MCPm6 = 58.07 +/- 15.85 cmH20, and MCPm9 = 53.85 +/- 16.89 cmH20, LFm0 = 28.92 +/- 5.32 mm, LFm3 = 30.18 +/- 6.82 mm, LFm6 = 32.40 +/- 6.82 mm and LFm9 = 30.83 +/- 6.07 mm. CONCLUSION: LCP may variable considerably in the same subject according to rotation of the probe. In our series, MCPm at 0 o'clock was significantly higher than MCPm at 3 o'clock, 6 o'clock and 9 o'clock. This difference appears to increase with age. The lowest values for MCPm were observed at 3 o'clock and 9 o'clock. The MCPm at 6 o'clock was intermediate and the closest value to the mean pressure calculated from MCPm in the four positions. On the other hand, FL varied only slightly according to the position of the probe.
Adolescent↗
Experimental study of the interaction range and association rate of surface-attached cadherin 11.
We describe a method allowing quantitative determination of the interaction range and association rate of individual surface-attached molecules. Spherical beads (1.4 micro(m) radius) were coated with recombinant outer domains of the newly described classical type II cadherin 11, a cell adhesion molecule. Beads were driven along cadherin-coated surfaces with a hydrodynamic force of approximately 1 pN, i.e., much less than the mechanical strength of many ligand-receptor bonds. Spheres displayed periods of slow motion interspersed with arrests of various duration. Particle position was monitored with 50 Hz frequency and 0.025 micro(m) accuracy. Nearly 1 million positions were recorded and processed. Comparison between experimental and computer-simulated trajectories suggested that velocity fluctuations might be related quantitatively to Brownian motion perpendicular to the surface. The expected amplitude of this motion was of order of 100 nm. Theoretical analysis of the relationship between sphere acceleration and velocity allowed simultaneous determination of the wall shear rate and van der Waals attraction between spheres and surface. The Hamaker constant was estimated at 2.9 x 10(-23) J. The frequency of bond formation was then determined as a function of sphere velocity. Experimental data were consistent with the view that the rate of association between a pair of adhesion molecules was approximately 1.2 x 10(-3) s-1 and the interaction range was approximately 10 nm. It is concluded that the presented methodology allows sensitive measurement of sphere-to-surface interactions (with approximately 10 fN sensitivity) as well as the effective range and rate of bond formation between individual adhesion molecules.
Cadherins↗
[Nephritic colic due to indinavir].
OBJECTIVE: Evaluate the frequency and assess curative and preventive measures against urinary lithiasis in patients treated with indinavir. PATIENTS AND METHODS: Fourteen HIV seropositive patients who developed severe and acute flank pain were included. Four of the patients receiving 800 mg indinavir t.i.d. had fever (38.5 degrees C) or delayed secretion (> 2 h). Delay from indinavir treatment onset was 1 to 321 days. During the same period, 155 patients had been treated with indinavir. Clinical features, radiology and laboratory results were recorded in addition to an analysis of the lithiasis if possible. RESULTS: Transient moderate renal failure occurred in 8 patients. Mean urine pH was 6. Serum phosphorus, calcium, and uric acid, liver tests and urinalysis were normal. A JJ ureteral stent was inserted in 4 cases due to complications. In all cases, fluids, analgesics and antispasmodics provided favorable outcome. Inversely, nonsteroid antiinflammatory drugs given in 2 patients had a deleterious effect on renal function. The lithiasis was eliminated in 3 cases and infrared spectrophotometry demonstrated a structure compatible with indinavir monohydrate. CONCLUSION: The formation of urinary lithiasis is a frequent complication of indinavir therapy (9%). Hyperhydration and urine acidification are usually successful but emergency drainage is required in approximately 3% of cases. Nonsteroidal antiinflammatory drugs should be avoided due to the risk of renal toxicity. A precise evaluation of fluid intake and diet, drug associations and personal history is needed to recognize patients at risk of recurrent lithiasis formation.
Acute Kidney Injury↗
Partial ureteral duplication in an inverted Y with epididymal ureteric ectopia and intrasinusal ureteral junction.
Partial ureteral duplication in an inverted Y is evidenced by the presence of a ureter duplicated at a variable level before reaching the bladder, in either an orthotopic or an ectopic position. A case of ureteral duplication at the level of the renal hilum with opening of a ureter at the level of the epididymis is reported. The description of this original case is compared with the data in the literature. The stages of organogenesis of the superior excretory pathway leading to ureteral ectopia and ureteral anomalies of number are reviewed.
Abnormalities, Multiple↗
The suspensory ligament of the penis: an anatomic and radiologic description.
The suspensory system of the penis acquires clinical importance in reparative surgery, traumatology and through its role in erection. The aim of this study was to identify the different anatomic structures constituting the suspensory ligament by dissection and by magnetic resonance imaging (MRI). Ten unembalmed male subjects were used for dissection of the region of the base of the penis. Ten volunteer patients underwent MRI of the penis before and after the injection of prostaglandin (PGE1). The suspensory apparatus consisted of separate ligamentous structures: the fundiform ligament, which is lateral, superficial and not adherent to the tunica albuginea of the corpora cavernosa; the suspensory ligament properly so-called, further back, stretching between the pubis and the tunica albuginea of the corpora cavernosa and consisting of two lateral, circumferential, and one median bundles, which circumscribed the dorsal vein of the penis. These structures were identifiable in MRI and their supporting role was evidenced during tests of erection. The suspensory ligament seemed to maintain the base of the penis in front of the pubis and to behave as a major point of support for the mobile portion of the penis during erection.
Aged↗
Radical prostatectomy for prostate cancer: the perineal approach increases the risk of surgically induced positive margins and capsular incisions.
PURPOSE: We compare the incidence of positive surgical margins in patients who underwent perineal or retropubic radical prostatectomy for clinically localized (stage T1, T2) prostate cancer. MATERIALS AND METHODS: In this retrospective, nonrandomized study we reexamined the specimens of 94 consecutive patients who underwent radical perineal (48) or retropubic (46) prostatectomy for clinically localized prostate cancer (stage T1, T2) and with pathological stage pT2 (intracapsular), pT3A (established extracapsular extension without positive margins) or pT3B (extracapsular extension with positive margins) without lymph node involvement (N0). We assessed the presence or absence of extracapsular cancer with or without positive margins, incisions of the prostatic capsule exposing cancer (surgically induced positive margins) or benign glandular tissue. Patients were followed for 3 to 66 months (mean 25) using an ultrasensitive prostate specific antigen assay with a lower detection limit of less than 0.05 ng./ml. RESULTS: The overall incidence of positive margins in cancer tissue was 56% in the perineal and 61% in the retropubic group, and biochemical failure-free survival was 67% each. However, surgically induced positive margins in patients with organ confined disease were more frequent in the perineal than retropubic group (43 versus 29%, p < 0.05) and associated with a 37% risk of biochemical failure (prostate specific antigen greater than 0.1 ng./ml.) at mean followup. In addition, capsular incisions exposing benign tissue were more frequent in the perineal than retropubic group (90 versus 37%, p < 0.05) irrespective of pathological stage. CONCLUSIONS: Although overall positive margins and biochemical failure rates are similar or identical for the perineal and retropubic approaches for organ confined prostate cancer, the perineal approach is associated with a significantly higher risk of capsular incisions and surgically induced positive margins and, thus, a higher risk of biochemical failure.
Aged↗
Adjuvant radiation therapy for recurrent PSA after radical prostatectomy in T1-T2 prostate cancer.
To evaluate retrospectively the efficacy of adjuvant radiation therapy (ART) in patients with T1-T2 prostate cancer (CaP) in whom extracapsular cancer (pT3) was detected after radical prostatectomy (RP), together with biochemical failure characterized by a recurrent level of serum prostate-specific antigen (PSA)>0.1 ng/mL. Twenty-two patients with T1-T2 CaP treated by RP who subsequently were found to have pT3 CaP with (13) or without (9) positive surgical margins and/or seminal vesicle invasion, exhibited biochemical failure characterized by a recurrent level of serum PSA, 2-40 (mean: 25) months after RP and were treated with ART (65 Gy). Bone and CT scans were negative in every patient, 15 of whom were submitted to TRUS biopsy (Bx) of the anastomosis (resection site), which was positive in 8. Patients were followed up for between 6 and 60 (mean: 32.5) months. Transient side effects (urgency, proctitis, diarrhea) were experienced by 9 patients after ART. A decrease in serum PSA was observed in 19 patients; however, only 14 of these achieved an undetectable level (<0.1 ng/mL) on one or more occasions after completion of ART (in 12 cases this was after 3 months). Of the 14 patients, 8 achieved a persistently unmeasurable PSA level at a mean follow-up of 20.4 (range: 9-48) months. There was no difference between patients in whom an undetectable level of serum PSA was attained and those in whom it was not, with regard to specimen pathology, PSA doubling time, timing of ART, and the result of Bx. Patients who achieved an undetectable PSA had a lower mean PSA at the time of ART (1.1 vs 2.9 ng/mL, P<0.05) and a lower preoperative mean PSA. Although ART for biochemical failure after RP may lead to undetectable PSA levels in a significant proportion of patients for a significant period of time, a longer follow-up shows that such unmeasurable levels persist in only 36.4% of such patients.
Journal Article↗
Balloon catheter dilatation in the treatment of ureteral and ureteroenteric stricture.
Balloon catheter dilatation is a low-cost alternative to open surgery in patients with ureteral strictures, leading to low morbidity and short hospitalization. The goal of this study was to evaluate the results of this technique in patients with inflammatory ureteral strictures or ureteroenteric strictures after radical cystectomy. Twenty-five ureteral strictures in 20 (15 male, 5 female) patients were consecutively treated by high-pressure balloon dilatation: 14 cases of ureteroenteric stricture (9 after ileal cutaneous diversion, and 5 after orthotopic enterocystoplasty) and 11 of ureteral stricture from various inflammatory causes (tuberculosis, iatrogenic injury, radiation therapy, parasitosis). Dilatation was performed by an antegrade (ureteroenteric strictures) or retrograde (inflammatory strictures) approach using a balloon insufflated up to 10 to 20 atm for 5 to 15 minutes. The ureter was stented for a mean time of 2.1 months (range 1-5 months). Results were evaluated clinically and radiologically (intravenous urogram or CT scan). Immediate success was assessed by intraoperative radiologic monitoring. Long-term success was defined as the absence of recurrence of the stenosis after 6 months. Nineteen procedures were successful among the 23 evaluable cases. With a mean follow-up of 16 months (range 6-39 months), the long-term success rate was 52%: 40% in ureteral strictures and 61% in ureteroenteric strictures. Five strictures secondary to cutaneous diversion and six caused by radiation therapy recurred after dilatation. After cutaneous diversion, the failure occurred mostly at the anastomosis and involved the crossed-over ureter. This study shows that high-pressure balloon dilatation of ureteral strictures has a high early success rate and a long-term success rate of 52%. It can therefore be considered as an alternative to open surgery.
Adult↗
Hemodialysis access fistula creation: preoperative assessment with MR venography and comparison with conventional venography.
PURPOSE: To prospectively evaluate magnetic resonance (MR) venography in the assessment of the adequacy of superficial veins for creation of hemodialysis access fistulas. MATERIALS AND METHODS: Twenty-eight upper limbs in 24 patients were imaged with MR and conventional venography. MR venography was performed with sequential multisection two-dimensional fast low-angle shot acquisitions in the axial plane from the wrist through the arm. Two observers independently evaluated MR venograms without knowledge of conventional venographic results. MR and venographic data were compared with each other and with surgical data in 21 patients. Diameters measured on MR and conventional venograms were compared by using linear regression analysis. Qualitative comparisons were performed with the kappa coefficient. RESULTS: Conventional and MR venographic diameter measurements were closely correlated overall (r = 0.91, P < .001) and on a vein-by-vein basis (r = 0.84-0.98, P < .001). MR and conventional venographic results were also well correlated in terms of demonstration of superficial veins (kappa = 0.83). MR venography demonstrated more patent veins than venography did, but the difference was not significant. The correlation between MR venographic and surgical findings (kappa = 0.78) was superior to that between conventional venographic and surgical findings (kappa = 056). CONCLUSION: MR venography is an accurate, noninvasive technique that is as useful as conventional venography for the planning of hemodialysis access fistula creation.
Adolescent↗