Search PubMed⌕ Search

Biomedical subjects

V Delmas

Publications and source records attributed to V Delmas.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Role of biological and anatomo-pathologic criteria in the prognosis evaluation of patients before and after radical prostatectomy].

Radical prostatectomy is the treatment of choice for organ-confined prostatic cancers (T1-T2). However, it has been reported to improve the long-term survival of patients and achieve its oncological objectives in only one half of patients despite a serious morbidity. Based on a consecutive series of one hundred patients, the authors performed univariate statistical analysis to determine the predictive value of eight preoperative criteria for biological progression and capsular effraction: clinical stage, PSA (using a highly sensitive test derived from the Yang Proscheck and lowering the limit of detection to 0.1 ng/ml), PSA density (PSAD), percentage and topography of positive biopsies, capsular effraction, perineural spaces and Gleason's score. The predictive value for progression of five postoperative histological criteria (Gleason's score, capsule, perineural spaces, seminal vesicles and resection margins) was also studied in the same group of patients. The presence of capsular effraction on the biopsy was shown to have a positive predictive value of 90%. The three preoperative criteria most closely correlated with tumour progression were PSA, PSAD and percentage of positive biopsies (p < 0.001). Analysis of the combined predictive value of PSAD, percentage of positive biopsies and capsular effraction revealed that progression was always present when two of these criteria were positive. Seminal vesicle invasion on the operative specimen is the most pejorative element for progression. In conclusion, analysis of the histological features of biopsies associated with PSA and PSAD allows a more accurate selection of patients with a high risk of progression and seminal vesicle invasion is so pejorative that it could be detected in subjects with a preoperative PSA greater than 25 ng/ml.

Adult↗
PubMed1994

[Endoscopic retropubic colpopexy for stress urinary incontinence in women (Stamey's operation). 55 cases].

Fifty five women with a mean age of 59 years, suffering from urinary stress incontinence (U.S.I.), were treated by endoscopic percutaneous cervicocystopexy (Stamey's operation), 39 patients (71%) suffered from pure U.S.I. and 16 (29%) presented a combination of stress and urge incontinence. Bonney's manoeuvre was positive in every case. With a mean follow-up of 21.5 months, 30 patients (58.8%) were completely continent, 9 (17.6%) presented occasional incontinence with intense effort, 12 (23.5%) were failures and 4 patients were lost to follow-up. The complications were minimal. The results were less favourable in patients with a history of pelvic surgery, particularly for correction of U.S.I., associated urge incontinence, detrusor hyperactivity or low urethral closure pressure, although one half of the patients in this group were nevertheless cured. Stamey's operation is a simple, reliable, easily reproducible technique which gives good results at the cost of low morbidity, short hospital stay and a low cost.

Adult↗
PubMed1994

DNA bending by transcription factors CREM and CREB.

DNA bending is postulated to be a major determinant of gene expression and has been shown to be specifically induced by some regulatory proteins with DNA-binding properties. Here we show that nuclear factors which naturally bind to CREs (cAMP-responsive elements) are able to induce bending in the sequences flanking this recognition site. In our assays we used a permutated binding site/gel retardation assay and bacterially generated nuclear factors. We have been studying the cAMP-responsive-element modulator (CREM) gene, which encodes both repressors (CREM alpha, beta and gamma) and an activator (CREM tau) of cAMP-responsive transcription by alternative splicing. In addition, two alternative DNA-binding domains can be encoded in different CREM isoforms. No differences in induction of DNA bending by the CREM proteins with the two DNA binding domains were detected. The activator CREB induced DNA bending in a fashion similar to CREM. Importantly, we show that phosphorylation of CREM or CREB alters their mobilities in a regular gel shift assay as well as enhances the angle of DNA bending induced by these proteins.

Base Sequence↗
PubMed1993

A mammalian DNA-binding protein that contains a chromodomain and an SNF2/SWI2-like helicase domain.

Two overlapping cDNAs that encode a 197-kDa sequence-selective DNA-binding protein were isolated from libraries derived from mouse lymphoid cell mRNA. In addition to a DNA-binding domain, the protein contains both a chromodomain, which occurs in proteins that are implicated in chromatin compaction, and an SNF2/SWI2-like helicase domain, which occurs in proteins that are believed to activate transcription by counteracting the repressive effects of chromatin structure. A Southern blot analysis indicated that this protein, which we have named CHD-1, for chromodomain-helicase-DNA-binding protein, is present in most, if not all, mammalian species. A Northern blot analysis revealed multiple CHD mRNA components that differed both qualitatively and quantitatively among various cell types. The various mRNAs, which are probably produced by alternative RNA processing, could conceivably encode tissue-specific and developmental stage-specific isoforms of the protein. Based on its interesting combination of features, we suspect that CHD-1 plays an important role in gene regulation.

Amino Acid Sequence↗
PubMed1993

Extraperitoneal endosurgical lymphadenectomy with insufflation in the staging of bladder and prostate cancer.

A new technique of endosurgical pelvic lymph node dissection was performed for the staging of 10 prostate and 8 bladder cancers. The technique, involving an exclusive extraperitoneal space development with CO2 insufflation, is described in detail. Using the standard endosurgical (laparoscopic) equipment, we performed a complete bilateral ilio-obturator lymph node dissection in 15 patients (83%). In the remaining three patients, because of technical difficulties, only unilateral dissection was performed. The average operating time was 84 minutes. Morbidity was low (one instance of sepsis). Prospective assessment of CO2 homeostasis showed that arterial CO2 pressure (PaCO2) increased significantly but could be controlled by increasing minute ventilation output. Our results show that perioperative assessment of end-tidal CO2 partial pressure is necessary and sufficient for the adaptation of minute ventilation output. Two patients with prostate cancer had positive nodes. No intraoperative or postoperative morbidity related to the procedure was observed in patients submitted to radical surgery. Extraperitoneal endosurgical pelvic lymphadenectomy with CO2 insufflation is a rapid, safe, and effective method in the staging of urologic pelvic malignancies and represents an alternative to traditional open surgery as well as to conventional transperitoneal laparoscopic lymphadenectomy.

Carbon Dioxide↗
PubMed1993

Induction of CREM activator proteins in spermatids: down-stream targets and implications for haploid germ cell differentiation.

The cAMP-responsive element modulator (CREM) gene encodes a family of transcriptional regulators that bind to promoter sequences activated by increased intracellular cAMP levels. Both activators and repressors are generated by alternative splicing and alternative translational initiation. During the development of male germ cells, there is a switch in the transcripts generated by CREM. Specifically, from the prophase of meiosis, there is an increase in the CREM tau activator transcript. Here we present results showing that expression of the CREM activator protein is restricted to postmeiotic germ cells. We show that CREM tau is efficiently phosphorylated at a serine residue at position 117 by the protein kinase-A endogenous to germ cells, indicating that it constitutes a natural target of the adenylyl cyclase pathway during spermatogenesis. Phosphorylation of serine-117 turns CREM tau into a powerful activator. The rise in CREM tau protein coincides with the transcriptional activation of several genes. We show that CREM tau efficiently binds to CREs present in the promoters of these genes, suggesting that they could constitute down-stream targets of CREM. We have analyzed in more detail the regulation of one of these genes, the male germ cell-specific RT7. The RT7 promoter is cAMP inducible and activated by CREM tau in transfection assays. The RT7 promoter is efficiently transcribed in vitro with nuclear extracts from seminiferous tubules. CREM-specific antibodies block RT7 in vitro transcription, implicating a role for CREM tau in a cascade of transcriptional events during spermatogenesis.

Animals↗
PubMed1993

[Sub-urethral diverticulum in women. Apropos of 6 cases].

Six female patients with a mean age of 40 years presenting with a suburethral diverticulum were treated between August 1990 and October 1992. The commonest functional symptoms were recurrent urinary tract infections (2/3 of cases) and post-voiding urethral discharge (1/2 of cases). Clinical examination revealed a tender anterior vaginal mass in only one half of cases. Only retrograde and voiding cystourethrography and transvaginal ultrasonography always demonstrated a direct or indirect image of the diverticulum. The suburethral diverticulum was resected via a transvaginal approach in the ventral supine position after sterilisation of the urine by prolonged antibiotic therapy. Urine drainage was generally ensured by a suprapubic catheter allowing antegrade cystography on the 15th day, prior to clamping then removal of the catheter. All but one of the patients immediately regained satisfactory micturition without dysuria or stress incontinence. Restoration of micturition was delayed in one patient with feelings of incomplete bladder emptying, but she urinated normally at three months. Postoperative imaging (retrograde and voiding cystourethrography, transvaginal ultrasonography) demonstrated resolution of the diverticulum in 5 cases. One patient had persistent signs of a small, residual diverticulum on antegrade cystography on the 15th day. Suburethral diverticulum is a rare disease of middle-aged women for which transvaginal surgical excision in the ventral supine position gives very good results.

Adult↗
PubMed1993

[Treatment of sexual impotency by intra-cavernous injections of prostaglandin E1. Report of 180 patients].

As already reported, PGE1 induces a valid erection, when administered intracavernously, without causing prolonged erection or general side effects. We have tested PGE1 (< 20 micrograms) in 180 patients suffering from organic erectile impotence, a complete erection was observed in 130 (72.2%), while incomplete erection was noted in 37 (20.5%). In both groups (92.7%) erection was sufficient for sexual intercourse. Among the best results, 41 patients had previously received high doses intracavernous injection of papaverine, without any benefit, and 15 patients have cavernosal venous leakage documented by cavernosometry and cavernosography before prostaglandin E1 test. Tumescence without rigidity was noted in 13 (7.2%). Of these 167 patients, 95 entered an autoinjection protocol for treatment of erectile dysfunction, using special device. In our series neither systemic reaction nor prolonged erection occurred. No fibrosis of cavernous tissue or scar formation was observed after up to 125 injections. However, 19 patients (10.5%) reported burning sensations during the entire period of erection and one patient (0.5%) had an haematoma at the site of the injection. PGE1 is effective in inducing artificial penile erection and it has a role in the diagnosis and treatment of erectile dysfunction, it is considered to be a more suitable agent than other vasoactive drugs.

Adult↗
PubMed1993

[Intravesical instillations of BCG and bladder carcinoma in situ].

32 patients with bladder carcinoma in situ (CIS) were treated by intravesical instillations of BCG immun F Pasteur between 1988 and 1991. The CIS was isolated (13 cases, 40.6%) or associated with a pTa papillary tumour (10 cases, 31.2%), pT1 tumour (8 cases, 25.1%) or pT2 tumour (1 case, 3.1%). The protocol consisted of a series of weekly instillations of 150 mg of BCG for 6 weeks, repeated once in the case of persistent lesions on the first endoscopic follow-up examination. Patients were reviewed in the outpatients department every 3 months for 1 year, then every 6 months for 2 years in the absence of recurrence. Follow-up consisted of clinical examination, urine cytology and histology. The overall success rate, defined by complete resolution of the cytological and histological lesions for the total population was 81.25% (25/32) with a mean follow-up of 22.5 months. 18.75% (6/32) of cases were considered to be failures. Complications of treatment were observed in 59% of patients, but only required discontinuation of instillations in five patients (15.6%). In conclusion, intravesical BCG is the treatment of choice of bladder carcinoma in situ in the absence of detrusor invasion and contraindications to BCG.

Administration, Intravesical↗
PubMed1993

[Posterior vertical lumbar approach in the treatment of pyelo-ureteral junction syndromes in the adult].

Posterior vertical lumbar incision is an alternative incision for the treatment of hydronephrosis due to ureteropelvic junction anomaly in adults. The authors have performed 18 pyeloplasties via this incision in adults between the ages of 19 and 72 years (mean 36 years). The results of pyeloplasty (88% success rate) were comparable to those obtained via other incisions. The operating time varied between 50 and 110 minutes (mean: 75 minutes) and the mean hospital stay was of the order of one week. The morbidity was low and essentially consisted of parietal complications such as hypoaesthesia or hypotonia. The technique is simple to perform provided the contraindications, especially those related to patient anatomy, are respected.

Adult↗
PubMed1993

[Is the urodynamic assessment of enuresis in young adults justified?].

Primary or secondary nocturnal enuresis in adults (over the age of 15 years) is rare, but is associated with considerable psychosocial repercussions. The aim of this retrospective study was to determine whether urodynamic studies have any predictive value for the efficacy of the treatments proposed in these patients. This study was based on 20 patients (8 females and 12 males) between the ages of 15 and 33 years (mean: 23.75 years), studied between 1982 and 1990 with a mean follow-up of 13.35 months. Enuresis was primary in 12 patients and secondary in 8 patients. 11 patients had already received one or more treatments without success. Patients with clinically obvious neurological disease were excluded from the study. The urodynamic assessment included water cystomanometry, water urethromanometry with a perfused catheter and uroflowmetry. In addition to the investigation of other associated disturbances of micturition, the following complementary investigations were performed: urine culture in every case, IVU and/or cystography (n = 18), cystoscopy (n = 3), renal and vesical ultrasonography (n = 1). The urodynamic assessment was abnormal in 16 out of 20 cases: marked detrusor hyperactivity (n = 15), impaired compliance (n = 6), significant urethral instability (n = 7), isolated premature urge (n = 1). 15 patients presented with diurnal disorders dominated by frequency (n = 13), urgency (n = 9) and urge incontinence (n = 4); detrusor hyperactivity was detected in every case. The abnormalities observed on the urodynamic assessment guided treatment, allowing correction of enuresis in 3/4 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Neuroendocrine cancers of the prostate].

This article is a transcription of several papers on neuroendocrine cancers of the prostate presented to the Uropathology Club in Angers in 1990. It consists of three parts: Firstly, a study of neuroendocrine cells in various organs of the human body, followed by the demonstration of these cells in the normal and pathological prostate. The second part reports 3 cases of neuroendocrine cancers as they are observed in routine practice. A total of 66 cases of pure neuroendocrine cancers have been reported to date in the English language literature. This type of cancer is characterised by a rapid, hormone-resistant course with the development of multiple metastases, frequently visceral. Periods of remission in response to chemotherapy may be observed in some cases. The third part concerns the systematic demonstration of neuroendocrine cells in prostatic adenocarcinoma. The percentage of neuroendocrine cells demonstrated by various histological techniques is directly correlated to an increasingly severe prognosis of the cancer.

Adenocarcinoma↗
PubMed1993

[Computerization in private urologic practice with multiple practice locations: the use of medical software and a portable microcomputer].

The authors have used a medical programme, Medistory, since June 1990 to computerize a private urological practice. This programme allows personalization of data collection adapted to urology: interview sheets related to the disease, standard report forms, edition of letters, creation of a multi-entry file and entering of accounts. The consultation was always held without a paper support with real-time data acquisition and the accounting was performed at the end of the visit. Letters were printed separately at home, at the end of the day, so as not to delay the patient. A back-up was performed every second day on hard disk. We used a portable Macintosh with 20 mega octets of REM and a 40 mega octet internal hard disk as our practice is based at several sites. This computerisation benefited from the Macintosh interface which facilitated learning and use of the programme. No time loss and no patient discomfort were recorded in comparison with a conventional consultation. The possibility of opening several files at the same time allowed a simple reply to any demands for other information. Two files out of 700 were lost (0.3%) due to an error when saving data. No accounting errors were detected. The use of a medical programme is particularly well adapted to private urological practice with multiple offices. The advantages of a personal computer include the gain of place, rapidity, unlimited storage capacity and the possibility of recovering data with other standard programmes. Medistory, a programme created for general practitioners, is perfectly adapted to this use due to the ease of personalization allowing the creation of interview sheets related to the disease and the edition of reports and various letters.

Computer Security↗
PubMed1992

Alternative usage of initiation codons in mRNA encoding the cAMP-responsive-element modulator generates regulators with opposite functions.

The cAMP-responsive-element modulator (CREM) gene encodes both antagonists (CREM alpha/beta/gamma) and an activator (CREM tau) of cAMP-responsive transcription by alternative splicing. In adult mouse brain a predominant 21-kDa protein, not corresponding to any previously characterized transcript, is detected with specific CREM antibodies. A developmental switch occurs in brain as expression changes at birth from CREM alpha/beta to the 21-kDa protein. We show that the 21-kDa protein corresponds to S-CREM (short CREM), a protein produced by the use of an internal AUG initiation codon in the CREM tau transcript. S-CREM shares with the other CREM proteins the basic DNA-binding and leucine-zipper dimerization domain. S-CREM functions as a transcriptional repressor of cAMP-induced transcription. Thus, two proteins with opposite functions are generated by alternative translation using two AUG codons within the same reading frame.

Animals↗
PubMed1992

Advantage of systematic random ultrasound-guided biopsies, measurement of serum prostate-specific antigen level and determination of prostate volume in the early diagnosis of prostate cancer.

Two hundred and sixteen patients, presenting with a suspicious digital examination (stage T3 excluded) or a level of prostate-specific antigen (PSA) greater than or equal to 2.5 ng/ml, assessed by radioimmunoassay, underwent a transrectal ultrasound examination. Prostate volume was systematically calculated and correlated to PSA level. Biopsies were performed: (1) on suspicious peripheral hypoechoic areas; ultrasound-guided biopsies; (2) systematically on the 2 prostate lobes, whatever the result of transrectal ultrasound imaging:random systematic ultrasound-guided biopsies. In the 186 patients who had never undergone prostate surgery, ultrasound-guided biopsies showed 42 prostate cancers and random systematic ultrasound-guided biopsies showed 75; 14 of the 76 patients with normal digital rectal examination and transrectal ultrasound imaging had a prostate cancer. In the 30 patients who had previously undergone surgery for benign prostatic hypertrophy, random systematic ultrasound-guided biopsies showed 18 prostate cancers, 13% more than ultrasound-guided biopsies; 75% of patients with a serum PSA greater than 5 ng/ml had a prostate cancer. A very significant correlation was found between PSA level and prostatic volume (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1992

[Extraperitoneal endoscopic lymph node dissection with insufflation in the staging of bladder and prostate cancer].

Endoscopic pelvic lymph node dissection was performed in 30 patients as part of the staging of prostate (19) or bladder (11) cancers. The technique, using a procedure of detachment of the retroperitoneal space with CO2 insufflation, is described. Complete bilateral dissection of the ilio-obturator lymph nodes was performed in 24 patients (80%) using conventional laparoscopic surgical equipment. Only a unilateral dissection could be performed in 6 other patients because of technical difficulties. The mean operating time was 72 minutes. The intraoperative and postoperative complications consisted of 2 venous injuries and one infection. A prospective study of systemic diffusion of CO2 demonstrated that the blood Co2 level increased significantly during the procedure, but could be controlled by adaptation of the ventilation. Postoperative monitoring of blood CO2 levels using a capnograph is recommended. 4 out of 30 patients (13%), 2 with prostate cancer and 2 with bladder cancer, had lymph node metastases. Amongst the other 26 patients, 12 were treated by radiotherapy (bladder cancer), 12 patients underwent perineal prostatectomy and 12 others underwent retropubic prostatectomy (5) or prostatocystectomy (7]). No intraoperative and postoperative morbidity related to endoscopic lymph node dissection was observed in the patients subsequently undergoing a radical operation. Endoscopic retroperitoneal lymph node dissection with CO2 insufflation is a rapid, safe and effective technique for staging of malignant pelvic tumours and constitutes an alternative to open surgery and to endoscopic transperitoneal surgery.

Endoscopy↗