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Biomedical subjects

V Delmas

Publications and source records attributed to V Delmas.

At least 127 records · Page 7Linked to original sources
PubMed1992

[Penile endoscopy: technique, results].

The authors report their experience based on 200 consecutive examinations. Peniscopy is an outpatient examination of the penis using a magnification system: commercial magnifying glass or colposcope. It consists of examining the whole penis in detail with the naked eue and then with a magnitification system after application of 5% acetic acid to the glans and prepuce in order to identify subclinical lesions. Biopsies can be performed when necessary. Three basic types of lesions may be observed: concylomas, macules, papules. However, the signs of mucocutaneous lesions are difficult to interpret, especially when they are subclinical. There are 2 types of false lesions: physiological papules of the corona of the glans and a diffuse acidophilic reaction. Topical treatment or laser destruction of the lesions can be performed at the same time as the examination, when necessary. The current indications for this technique are discussed. When learning this technique, the authors recommend the extensive use of biopsies and training with an experienced examiner.

Humans↗
PubMed1992

Early gene expression in lymphoma-associated hamster polyomavirus viral genomes.

Hamster polyomavirus (HaPV) is the causal agent of hair follicle epithelioma in hamsters belonging to a colony bred in Berlin-Buch. These tumors shed virus particles that are assembled in the keratinized layer of the epidermis. By contrast, HaPV induces lymphomas after inoculation into newborn hamsters from a distinct colony bred in Potsdam. These lymphoid tumors accumulate massive amounts of episomal viral genomes characterized by deletions that alter specifically the regulatory and the late coding sequences. Assuming that these alterations of the regulatory region may affect the transcription of the viral oncogenes in the tumor cells, the transcriptional activity of the wild-type and deleted early promoters have been studied in vitro in transient chloramphenicol acetyltransferase (CAT) expression assays. These assays performed in various cell types demonstrate that both versions of the HaPV early promoter carry a weak constitutive activity. Simultaneous expression of the HaPV early gene products leads to a strong stimulation of CAT activity with a concomitant activation of the replication of the plasmid constructs. The results obtained with origin-defective CAT vectors indicate that the replication contributes significantly to the stimulating effect of the early gene products. Indeed, transfection of massive amounts of CAT vectors that are unable to replicate can simulate the dosage effect of replication and also leads to measurable CAT activities. Under these conditions, the wild-type promoter is more active than the deleted version, indicating that sequences within the deletion carry a distinct stimulatory effect on transcription. This conclusion is supported by the observation that the lymphoma cells contain a low level of early transcripts, indicating that the deleted episomal viral templates accumulated in these tumors carry a weak transcriptional activity.

Animals↗
PubMed1991

[The correlation between the level of prostate-specific antigen and prostate gland volume in the early diagnosis of prostatic cancer].

One hundred and eighty six patients (Pts) presenting with either an abnormal per rectum examination (P.R. suggestive of prostatic cancer (P.Ca) (excluding stage T3) or a prostatic specific antigen (P.S.A.) level greater than or equal to 2.5 ng/ml (radioimmunoassay) were submitted to transrectal ultrasonography (T.R.U.) using a 7 MHz transducer. The prostatic volume (Vol.P) was systematically calculated during T.R.U. and correlated with the P.S.A. level. Six systematic multiple ultrasound-guided biopsies (S.M.U.B.) were performed in the 2 prostatic lobes (3 per lobe) regardless of the result of T.R.U. In the 111 patients in whom the S.M.U.B. were negative, a highly significant correlation (p < 0.001) was observed between the serum P.S.A. level (y) and the prostatic volume (Vol.P): y = (4.13 +/- 0.15 Vol.P) +/- 8.43. In the 75 Pts with P.Ca, the P.S.A./Vol.P correlation was significantly different (p < 0.05) from the straight line of regression with the previous standard deviation. A similar difference in correlation (p < 0.05) was observed in the sub-group of 14 Pts with P.Ca despite normal P.R. and T.R.U. These results suggest: 1) that there is a correlation between the Vol.P measured by T.R.U. and the P.S.A. level in patients with negative S.M.U.B. 2) that the absence of correlation is highly suspicious of P.Ca and requires S.M.U.B. 3) that there is a 15% incidence of P.Ca in the sub-group of Pts with normal P.R. and T.R.U. which are only detected by the raised P.S.A. not correlated with the volume of the prostate.

Biopsy↗
PubMed1991

[Value of voiding ultrasonography combined with urodynamic studies in the assessment of vesical sphincter dyssynergy].

Fifteen paraplegic patients all presenting with vesico-sphincteric dyssynergia underwent, between January and September 1990, a urodynamic and electromyographic examination combined with pre-voiding or voiding transrectal ultrasonography. The ultrasound apparatus used was a Siemens Sonoline SL1 with a MHz linear intracavitary probe giving a strictly longitudinal plane of section. The urodynamic apparatus used was a Wiest 6000 with a Böhler 7 F urethral catheter and an electromyography needle-electrode implanted in the striated sphincter. This type of ultrasonography provided a precise and dynamic image of the bladder neck, prostatic urethra and external striated sphincter during the phases of filling and voiding. Spastic contractions of the striated sphincter during detrusor contraction were observed in 8 patients with an intermittent and jerky urinary stream. In 7 patients, the striated sphincter remained closed during detrusor contraction and only opened briefly as soon as detrusor contraction decreased, allowing only a weak and transient flow. By allowing the direct visualisation of the sphincteric obstruction during voiding, dynamic transrectal ultrasonography clearly confirmed the diagnosis of vesico-sphincteric dyssynergia. In contrast with classical voiding cystourethrography, this is a non-invasive, inexpensive and, most importantly, repeatable technique, as it does not require any irradiation. It is therefore suitable for drug evaluation trials, particularly of alpha-blockers and to assess one of the many treatments proposed in vesico-sphincteric dyssynergia.

Adult↗
PubMed1991

["Clam" enteroplasty in the treatment of unstable or low compliance bladders].

The treatment of urinary incontinence due to unstable bladder remains difficult. In the case of failure of medical or physiotherapeutic treatments, clam enterocystoplasty represents a major and important therapeutic possibility. The operation consists of frontal section of the bladder to form a bivalve followed by interposition, between the two valves, of a detubed ileal graft in order to increase the functional vesical capacity and to interrupt the transmission of detrusor contraction waves from one valve to the other. 10 patients (7 men and 3 women) suffering from urinary incontinence due to neurogenic unstable bladder (4 cases: 3 meningoceles, 1 operated cauda equina neuroma) or to another cause (6 cases, including one sequela of radiotherapy for prostatic cancer and 5 cases of apparently primary urinary incontinence) underwent enterocystoplasty combined, in the case of neurogenic incontinence (2 cases simultaneously and 2 cases previously), with the insertion of an AMS 800 sphincter. No major complication was observed. 9 patients are continent and 1 had to be reoperated to undergo an augmentation enterocystoplasty (failure of the initial operation due to radiation changes of the bladder), 3 retain a post-voiding residual of about 200 ml but not requiring self catheterisation due to the absence of any repercussions on the upper urinary tract. Lastly, urodynamic studies demonstrated a spectacular increase in compliance and functional capacity of the bladder together with a reduction of the amplitude of intravesical pressure peaks.

Adolescent↗
PubMed1991

[Multiple condylomata of the urethra and bladder disclosing HIV infection].

The authors report the case of a 26 year old man, in whom recurrent hematuria revealed the diagnosis of urethral condylomata with bladder extension, and HIV serology positive. This case reminds us that it is essential to search for immunodeficiency in every case of extensive or recurrent condylomata. The analysis of such cases in the literature allows discussion of the various clinical courses according to the Human Papilloma Virus types found in condylomatous tissues.

Adult↗
PubMed1991

[Use of papillotome for antegrade treatment of ureteral stenoses and uretero-ileal anastomotic strictures under radioscopic control. Experimental study in dogs and clinical application].

A new technique of electro-incision of ureteral stenoses and strictured uretero-enteric anastomoses is presented. Incision is performed with a papillotome, routinely used to achieve endoscopic retrograde sphincterotomy of the duodenal papilla. Group I: 7 ureteral stenoses were performed, on a dog model after surgical ligation of the lumbar ureter. Ten days later, through a percutaneous approach, the papillotome was placed through the stenosis, deflected, and cutting current was applied to incise the stenosis. The IVP performed one month later showed disappearance of the stenosis in 4 cases, a residual stenosis without obstacle in 2 cases and a residual stenosis with obstacle in one case. Group II: 7 strictured uretero-enteric anastomoses on 6 patients. After placement of a percutaneous nephrostomy, a wire guided papillotome was placed into the stenosis. Cutting current was then applied to cut the stenosis. A 18 F ureteral stent was subsequently placed for 8 weeks. Two patients have a patent anastomosis, 7 and 10 months after removal of the stent. One patient died from metastases of bladder tumor. The three remaining patients are still stented. An urinoma occurred in one patient the day following removal of the stent, and was surgically drained. This new technique which combines electro-incision and stenting with a large caliber stent may be proposed as an alternative to surgery or balloon dilatation for the treatment of strictured uretero-digestive anastomoses.

Anastomosis, Surgical↗
PubMed1990

A novel upstream element compensates for an ineffectual octamer motif in an immunoglobulin V kappa promoter.

The octamer (or dc/cd) motif is considered to be a critical component of all immunoglobulin (Ig) promoters. Although the sequence of this motif is highly conserved among most Ig promoters, there are some notable examples in which efficiently expressed Ig genes contain divergent octamers with base substitutions that are demonstrably deleterious when tested with heterologous proximal promoter elements. To elucidate the mechanisms that enable these naturally occurring Ig genes to cope with divergent octamers, we analyzed two such promoters with regard to their ability to interact with relevant transcription factors. We found that the divergent octamer in the kappa O germline promoter strongly binds both Oct-1 and Oct-2 factors, presumably because of compensatory contributions by flanking DNA sequences. A more surprising result was obtained with the V kappa 19 promoter. In this case, the divergent octamer is a very weak Oct factor binding site and, without help from another upstream element, is inadequate for efficient promoter function. This additional element, termed kappa Y because of its high pyrimidine content (CTTCCTTA), serves as a binding site for a novel lymphoid-specific factor. When the divergent V kappa 19 octamer was converted to a strong Oct factor binding site by a single point mutation, the need for kappa Y was obviated. Interestingly, VH promoters that contain the same divergent octamer also contain an upstream element that is very similar to kappa Y.

Animals↗
PubMed1990

[The value of ultrasound-guided multiple systematic biopsies in the early diagnosis of cancer of the prostate].

Endorectal ultrasonography using a 7 mHZ probe was performed in 99 patients with a negative history for surgery of the prostate and either findings on rectal examination suggestive of cancer (T3 stage excluded) or a serum level of prostate-specific antigen of 2.5 mg/ml or more. A biopsy gun was used to harvest 1.5 centimetre long specimens. Ultrasound-guided biopsies were performed in peripheral hypoechogeneic areas; in addition, regardless of the result of the endorectal ultrasonography, routine multiple ultrasound-guided biopsies were performed in both lobes of the prostate (3 per lobe). Morbidity consisted in two cases of prostatitis (2%). Among the 99 patients, ultrasound guided biopsies found 16 carcinomas (16.1%), and routine multiple ultrasound-guided biopsies found 32 (32.3%) carcinomas. Four patients with normal results upon rectal examination and endorectal ultrasonography were found to have carcinoma of the prostate. These findings suggest that the morbidity of routine multiple ultrasound-guided biopsies is low; that routine multiple ultrasound-guided biopsies is more sensitive than ultrasound guided biopsies, with 16/99 (16%) additional carcinomas detected in this study and 56% of carcinomas among those patients with findings upon the rectal examination suggestive of malignant disease; and that routine multiple ultrasound-guided biopsies can allow the detection of carcinomas responsible for isolated elevation of prostate-specific antigen levels without anomalies of the rectal examination or endorectal ultrasonography (8% of the carcinomas in this study).

Antigens, Neoplasm↗
PubMed1990

[The dynamic study of the human body using MRI].

This work deals with dynamic anatomy of human body explored by magnetic resonance imaging (MRI). Recent development of MRI pulse sequences allow very fast data acquisition. Using an 1,5 Tesla system (General Electric--CGR, Signa), different body segments have been explored, in two different ways. The first approach consisted in a cinematographic display of anatomical sections of an articulation obtained in different positions. The result shows the movement of the articulation. The second approach consisted in the examination of a single slice several times, with cardiac synchronization ("gating"). the result is the evaluation of phase desynchronization, measuring the flow directions and the velocity of circulating fluids. The results are shown as a video tape with commentary. It starts with the joints: the ankle, the knee, the wrist, the hand, the cervical spine, de cervico-occipital junction, the temporo protrusion during deglutition and the ocular movements (normal and pathological), according to different planes, are successively proposed. Finally, flow kinetics are shown: cardiac movements and supra-aortic arterial flow, the intracranial cerebro-spinal fluid circulation, in normal and pathologic (intra-cranial hypertension) cases. The exposition is concluded by showing a work in progress on urine flow during micturition.

Cerebrospinal Fluid↗
PubMed1990

[Treatment using an endo-urologic approach of stenoses following uretero-intestinal anastomosis].

Twenty-one strictures following uretero-digestive anastomoses were treated by percutaneous transrenal dilatation. In 20 cases, an Olbert type angioplasty balloon on a guidewire was used. Rigid coaxial dilators were used in one patient after failure of the preceding technique and an electroincision was performed prior to dilatation in the remaining case. Overall, percutaneous transrenal dilatation was successful in nine patients, whereas ten dilatations failed and two patients are undergoing continued modeling with a mean follow-up of 16 months (range 1-42 months). Success rates by type of anastomosis were as follows: Bricker 5/12; Coffey 1/4; enterocystoplasty 2/4 and ureteroileovesical anastomosis 1/1. The date of development of the stricture, duration of modeling, and caliber of the indwelling catheter were apparently without influence on results. Because morbidity is low with percutaneous transrenal dilatation, this technique is advocated as first-line treatment, with surgery being reserved to failures.

Adult↗
PubMed1990

[Infectious manifestations of AIDS in the urogenital tract].

Urogenital manifestations of AIDS appear today with an increasing incidence. Among 43 seropositive patients, seen in our department between 1985 and 1989, 19 were treated for an infection: 11 cases of epididymitis, 6 cases of prostatitis, 1 renal abscess, 1 case of extensive condylomata of the urethra. The clinical signs and follow up of these infections were straightforward in half of the cases. However, in some patients, the infection was fulminant with progression to an abscess despite the use of antibiotics or were unusual because of the pathogens isolated. Any urologist is likely to encounter cases of genitourinary complications of AIDS and should develop general measures of protection of the surgical team.

Abscess↗
PubMed1989

[Treatment of urethral stenosis using Olbert's balloon dilatation angioplasty. Re-evaluation of the results].

Twenty-eight patients with an urethral stricture underwent Olbert's angioplasty balloon dilatation under local anaesthesia and fluoroscopic control. Four dilatations failed. Six were performed palliatively after failure of classical urethral catheterisation. Sixteen dilatations were performed curatively: thirteen patients developed a recurrent stricture after periods of between 3 days and 12 months. Three patients were cured. Our results suggest that angioplasty balloon dilatation is ineffective as a curative procedure and should be reserved for inoperable patients requiring and indwelling catheter, in whom classical catheterisation has failed.

Angioplasty, Balloon↗
PubMed1989

[Endoscopically "impassable" urethral stenosis. Catheterization under fluoroscopic guidance. Apropos of 11 cases].

In eleven patients with impassable urethral stenoses, we attempted retrograde catheterisation with an angiographic guide under fluoroscopic control. The stenosis was able to be negotiated with the guide in 10 cases (91% success). After dilatation by dilators (coaxial or rigid) or by Olbert's angioplasty balloon, we were able to introduce a Foley catheter into the bladder. The only failure was caused by a very marked separation of the two ends of the urethra due to trauma. This simple and effective method constitutes an alternative to immediate surgical treatment of endoscopically impassable urethral stenoses.

Fluoroscopy↗
PubMed1989

[Technical problems raised by renal puncture in the percutaneous extraction of coralliform calculi].

Initial puncture and dilation of nephrostomy track(s) remain difficult procedures in percutaneous extraction of staghorn calculi. Technical s adjuvants are necessary and are exposed in detail. The choice of the needle, of the wires and of the catheters for initial puncture and ureteral catheterization is explained. Techniques of "Y" tract and double puncture are exposed. Severe complications (3 cases) are reported. Extraction of up to 90% of the stone can be expected if these technical adjuvants are optimally used.

Humans↗
PubMed1989

[Early endoscopic treatment of a complete traumatic rupture of the membranous urethra].

A man presenting complete traumatic disruption of the membranous urethra, with a 1 cm gap between the proximal and distal urethra, underwent successful endoscopic reconstruction ten days after the injury. When the urethral catheter was removed after fifteen days, peak flow rate was 25 cc per second. One internal urethrotomy was necessary 8 months later. Twenty months after the injury, cystography and retrograde urethrography revealed satisfactory restoration of urethral continuity. We suggest that this treatment be considered in complete traumatic disruption without hematoma and with less than a 1 cm gap between the proximal and distal urethra.

Cystoscopy↗