Search PubMed⌕ Search

Biomedical subjects

V Ravery

Publications and source records attributed to V Ravery.

At least 55 records · Page 3Linked to original sources
PubMed1999

[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↗
PubMed1999

The significance of recurrent PSA after radical prostatectomy: benign versus malignant sources.

The purpose of this article is to review the available means to investigate whether an elevated serum prostate-specific antigen (PSA) after radical prostatectomy may be explained by the presence of residual benign tissue. To answer this question, one may consider the following features: the kinetics of recurrent/ persistent PSA, the incidence of rising PSA in the presence of capsular incisions exposing benign glands only, the level of urinary PSA and the ratio of free/total PSA in the urine, the results of anastomotic biopsy samples, and the detection of circulating prostate cells by PSA reverse transcriptase-polymerase chain reaction (RT-PCR) after surgery. Capsular incisions exposing benign tissue are not associated with a significant risk of biochemical failure. In case of an organ-confined cancer with negative surgical margins but a rising postoperative PSA, the systematic reevaluation of the initial pathological slides constantly shows capsular effraction or focal positive margins that have been overlooked at the first evaluation. Even when anastomotic biopsies document only benign tissue, the study of PSA doubling time is usually characteristic of the coexistence of residual tumoral cells. However, in a few cases, the persistent negative results of the detection of circulating prostate cells by PSA, RT-PCR in patients with organ-confined cancer and negative margins but elevated postoperative PSA might be explained by the presence of residual benign prostatic hyperplasia tissue. Most of the data in the literature are in favor of the responsibility of persistent/recurrent cancer in the recurring PSA rather than that of benign prostatic hyperplasia/normal residual tissue. Therefore, a persistent/recurrent detectable level of PSA is the serum after radical prostatectomy characterizes biochemical failure.

Biopsy↗
PubMed1998

[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↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1998

Clearance of free and total serum PSA after prostatic surgery.

INTRODUCTION: Although the biology and sites of secretion of PSA are well known, its pharmacokinetics are still unclear. This study analyzes the differences between the clearance of total and free serum PSA following open surgery for BPH and radical prostatectomy. METHODS: Free and total PSA were measured in 27 patients submitted to radical prostatectomy for clinically localized prostate cancer (group I) and in 27 patients submitted to open surgery for BPH (group II). In both groups, the clearance of free and total PSA was studied. RESULTS: Group I-the mean half-life was 1.416 +/- 0.723 days for free PSA and 2.43 +/- 0.688 days for total PSA. After prostate removal, free PSA showed a marked increase. Group II-the mean half-life of free PSA was 2.157 +/- 1.792 days and 3.391 +/- 2.337 days for total PSA. CONCLUSIONS: The increase in free PSA shortly after manipulative procedures of the prostate was higher than the increase in total PSA. Serum clearance of free PSA after eradicative prostatic surgery was related to the indication and type of procedure used.

Aged↗
PubMed1998

[W enterocystoplasty with resorbable staples: technic and functional results. Preliminary study].

INTRODUCTION: The use of absorbable staples for enterocystoplasty allows a marked reduction of the operating time. The long-term results on continence need to be evaluated at result term before adopting this technique. METHODS: Eight patients underwent "W" enterocystoplasty performed with absorbable staples according to the so-called "Detroit" technique, with direct uretero-ileal anastomosis. The continence of these patients was evaluated by clinical follow-up and urodynamic assessment (3 patients). Quality of life was studied by a questionnaire sent to the patient. RESULTS: The mean operating time was 5 hours 20 minutes, the plasty was performed in 25 to 35 minutes. The mean follow-up was 18.7 months, during which two uretero-ileal strictures were diagnosed. 7 of the 8 patients have a good diurnal continence (no leaks) and 1 patient has moderate continence (1 protection). Nocturnal continence was considered to be good in 3 cases, moderate in 2 cases and poor in 3 cases (> 1 protection). Four of the patients evaluated by questionnaire reported urinary disorders. CONCLUSION: The use of absorbable staples allows a definite reduction of the operating time, for a modes excess cost and satisfactory functional results.

Absorption↗
PubMed1998

[Complete perineal prostatectomy carries an increased risk of capsular incision in healthy and cancerous tissue].

OBJECTIVES: To compare positive resection margin rates in tumour tissue and healthy tissue according to whether total prostatectomy for cancer is performed via a retropubic or transperineal approach. PATIENTS AND METHODS: This retrospective, non-randomized study was based on 94 patients suffering from clinically localized cancer (T1-T2) of the prostate operated either via a retropubic (46: group 1) or perineal (48: group II) approach. All slides were reviewed by two pathologists not informed about the clinical course. The frequency of tumour margins associated with extracapsular invasion, capsular incision, without extracapsular extension of the tumour, and finally the incidence of capsular incisions exposing tumour tissue, were determined. RESULTS: While the number of positive resection margins was equivalent in the two groups (61% for group I versus 56% for group II), it was higher in the perineal group (43% versus 29%, p < 0.05) when the tumour was confined to the gland (pT2). A higher incidence of resection margins in healthy tissue was also observed in group II (90% versus 37%). CONCLUSION: Transperitoneal prostatectomy is associated with a higher incidence of resection margins in tumour tissue in patients with prostate-confined cancer. Analysis of the resection margins in healthy tissue suggests that the surgical incision is a predisposing factor to their creation.

Aged↗
PubMed1998

[Inverted Y partial ureteral duplication. Apropos of an unusual case].

Inverted Y partial ureteric duplication corresponds to the presence of a variable length of duplicated ureter before entering the bladder in an orthotopic or ectopic position. A case od inverted Y partial ureteric duplication with ureteric confluence in the hilum of the kidney associated with anastomosis of an ectopic ureter in the epididymis is reported. The description of this original case is compared with the data of the literature.

Adult↗
PubMed1998

[Florid glandular cystitis: study of 3 cases and review of the literature].

The authors report three cases of florid, recurrent cystitis glandularis in white men, inducing dilatation of the upper urinary tract due to invasion of the ureteric meatus. Treatment consisted of cystectomy, with preservation of the prostatic capsule, allowing preservation of continence and sexual potency. Cystitis glandularis is a rare, generally asymptomatic, benign metaplasia; it is favoured by chronic irritation and is sometimes associated with pelvic lipomatosis. Its transformation into adenocarcinoma is exceptional and occurs in the case of persistence of the predisposing factor. However, annual surveillance by cystoscopy with bladder biopsies is necessary. The florid form is much rarer and more disabling and usually requires wide resection of the lesions.

Adult↗
PubMed1998

[Diagnostic value of 10 systematized and ultrasound-guided transrectal prostatic biopsies].

OBJECTIVE: To study the improvement of prostatic cancer detection provided by ten strictly systematized transrectal prostatic biopsies. MATERIAL AND METHODS: This prospective study was conducted in 162 patients submitted to a series of 10 ultrasound-guided transrectal prostatic biopsies due to the presence of elevated PSA and/or an abnormality on digital rectal examination. Five biopsies were taken from different sites in each lobe: 2 biopsies were inserted between the 3 biopsies usually performed in the standard protocol, while maintaining the angle of entry of the needle recommended in this protocol. RESULTS: The complication rate was 1.85% with the 10-biopsy technique. Prostatic cancer was detected in 40.1% of the 162 patients. The percentage diagnostic improvement provided by the 10-biopsy protocol in the overall patient population was +3.1% compared to the standard protocol. The highest percentage diagnostic improvement was observed in the group of patients with PSA < or = 10 ng/ml (+4.9%) and in the group of patients with an ultrasound prostatic volume < or = 40 cc (+4%). CONCLUSION: The most marked diagnostic improvement appears to be related more to sampling of prostatic zones presenting a statistically increased risk of cancer (peripheral zone) than to the increased number of prostatic biopsies performed.

Adenocarcinoma↗
PubMed1998

[Effects of a 6F urethral catheter on uroflowmetry in men with benign prostatic hypertrophy].

OBJECTIVE: To determine whether the presence of a 6F catheter in the urethra modifies uroflowmetric parameters in a population of men with benign prostatic hyperplasia. PATIENTS AND METHODS: 260 patients, 45 to 86 years old, presenting with benign prostatic hyperplasia, underwent two uroflowmetries, one with the urethra free, the other with a 6F urethral catheter. Patients with a history of neurological disease, diabetes mellitus, prostatic cancer, lower urinary tract surgery or taking drugs likely to affect micturition, were excluded from the study. Maximum flow rate (Qmax) and voided volume were then compared during the 2 recordings, using Wilcoxon's non parametric test. RESULTS: No significant difference was observed between voided volumes in the 2 groups (m: 207 ml versus m: 226 ml), but a very significant difference was observed for maximum flow rate measurements (m: 8.62 ml/s versus m: 6.97 ml/s p = 0.0001). CONCLUSION: The presence of an urethral catheter, even small calibre (6F), modifies the flow rate by more than 1.5 ml/s. This element must be taken into account when performing and interpreting measurements of the pressure-flow relationship in men.

Aged↗
PubMed1997

Evaluation of epidermal growth factor receptor, transforming growth factor alpha, epidermal growth factor and c-erbB2 in the progression of invasive bladder cancer.

INTRODUCTION: Determination of the risk of invasive bladder tumors progressing is still imprecise due to the heterogeneous biological behavior of this neoplasm. The goals of this study were to evaluate the patterns of expression of the epidermal growth factor (EGF) system in invasive bladder cancer and to assess its prognostic value. METHODS: This immunohistochemical study was performed using fresh frozen tumor samples and a panel of monoclonal antibodies on a series of 43 invasive bladder cancers treated by cystectomy. RESULTS: EGF was detected in 45% of the tumors and did not correlate with survival from bladder cancer. Transforming growth factor alpha (TGF alpha) was expressed by 60% of the tumors and correlated strongly with death from bladder cancer. Epidermal growth factor receptor (EGF-R) expression was seen in 86% of cases and had no prognostic significance. c-erbB2 was expressed in 50% of cases and was inversely related to a poor prognosis. When EGF and TGF alpha were both expressed, there was little or no expression of c-erbB2. CONCLUSION: The accumulation of several growth factors and the relevant receptor are necessary for the progression of invasive bladder cancers. They could be used as indicators of tumor aggressiveness.

Adult↗
PubMed1997

Free/total prostate-specific antigen ratio--hope and controversies.

Prostate-specific antigen (PSA) forms in serum two stable complexes with alpha 1-antichymotrypsin and alpha 2-macroglobulin. PSA complexed to alpha 1-antichymotrypsin is the predominant fraction of PSA. A minor fraction of serum PSA is not associated with proteinase inhibitors. These molecular differences explain the possibility to distinguish free from total PSA (F/T ratio). Free and complexed PSA have different clearances and significant differences between clearance of free PSA after radical prostatectomy (RP) and after open surgery for benign prostatic hyperplasia (BPH) are observed. These differences are explained by the entire removal of prostatic cells responsible for PSA synthesis and storage during RP, i.e. the source of free PSA present in the intravascular pool. The proportion of free PSA is significantly lower in patients with prostate cancer than in patients with BPH. Thus, the mean F/T ratio in prostate cancer is lower than that in BPH and may be helpful to distinguish cancer from BPH especially in the gray zone of total PSA (4-10 ng/ml). The reason why complexed PSA increases in patients with prostate cancer remains unknown but could be explained by the requirement of an enzymatically active PSA released by the malignant prostate tissue to bind to alpha 1-antichymotrypsin. However, a consensual threshold value for L/T ratio is yet to be found to be of widespread clinical use in the differential diagnosis between cancer and BPH.

Blood Proteins↗
PubMed1997

Value of the preoperative detection of prostate-specific-antigen-positive circulating cells by nested RT-PCR in patients submitted to radical prostatectomy.

OBJECTIVE: To assess the value of the detection of circulating prostate cells [prostate-specific antigen (PSA) positive] by reverse-transcriptase nested polymerase chain reaction (nested RT-PCR) to improve the staging of clinically localized prostate cancer. METHODS: Nested PCR was performed on blood samples of 29 patients submitted to radical prostatectomy for clinically localized (T1-T2) prostate cancer. Nine patients with various benign urologic diseases comprised the negative control group. Incubation was for 25 cycles for each PCR, using beta 2-microglobulin to test the integrity of RNA samples. Each sample was tested in quadruplicate and analyzed by agarose gel electrophoresis, blotted and hybridized with specific internal primers. Nested PCR results were compared with the pT stage of the prostate specimen, processed according to the Stanford method. RESULTS: In 6 out of 29 patients (20.7%) with clinically localized prostate cancer, circulating prostate cells were detected by nested PCR. There was no relationship between pathologic stage and RT-PCR results. Eleven out of 14 pT2 patients (78.6%) were PCR negative and only 3 out of 15 pT3 patients (20%) were PCR positive. All control samples were PCR negative. CONCLUSIONS: In selected patients with T1-T2 prostate cancer, there was no relationship between pathologic stage and the presence of circulating PSA-positive cells detected by nested PCR. However, in 20.7% of patients with clinically localized prostate cancer, circulating prostate cancer cells were detected. A further follow-up based on PSA is necessary to clarify the clinical relevance of this biologic anomaly.

Aged↗