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Biomedical subjects

V Ravery

Publications and source records attributed to V Ravery.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Treatment of ureteral stenosis using high pressure dilatation catheters].

INTRODUCTION: High-pressure dilatation catheters have been proposed as an alternative to open surgery in the treatment of ureteric strictures because of the low morbidity and short hospital stay. The objective of this study was to evaluate the results of this technique in patients with inflammatory ureteric strictures or uretero-ileal strictures. METHODS: From April 1991 to September 1996, 25 strictures were treated by antegrade or retrograde dilatation with a high-pressure balloon catheter followed by stenting with a double J stent for an average of 2.1 months (1-5): 14 uretero-ileal strictures (tuberculosis, schistosomiasis, iatrogenic, radiotherapy). A good immediate result was defined as intraoperative rupture of the stricture under fluoroscopic control. A good long-term result was defined as absence of recurrence of the stricture, evaluated clinically and radiologically (IVU and/or ultrasonography). RESULTS: The good immediate result rate was 82% (19 out of 23 strictures, with 2 non-evaluable cases). One intraoperative complication was observed (double J stent advanced too for into the ureter). 22 strictures were evaluable after removal of the double J stent and the good long-term result rate was 64% with a mean follow-up of 8.5 months (0.3-24). 8 patients developed a recurrence: 4 after Bricker, 3 with inflammatory strictures after radiotherapy and J with peritoneal carcinomatosis. CONCLUSION: This study shows that high-pressure balloon catheter dilatation of non-neoplastic ureteric strictures provides good results and can be considered to be the first-line treatment for these lesions.

Adult↗
PubMed1997

T3 prostate cancer: how reliable is clinical staging?

The treatment of locally advanced stage T3 prostate carcinoma remains controversial. The reliability of the clinical assessment of extracapsular extension by digital rectal examination (DRE) is therefore crucial. Results from series of patients with T3 prostate cancer treated by radical prostatectomy indicate that DRE has shown a wide range of accuracy from 44% to 82%. The assessment of capsule perforation on biopsy provides a 96% specificity rate and a positive predictive value of 60%. Furthermore, if the apparent clinical status of the seminal vesicle is incorrect, sampling errors on biopsy may be substantial. Biopsy therefore appears to provide a more accurate assessment of the capsule than of the seminal vesicle. Information regarding the correlation between T3 clinical staging and conventional/endorectal coil magnetic resonance imaging staging is still needed. Finally, the accuracy rate of DRE for T3 staging increases to more than 90% if the prostate-specific antigen level is greater than 15 ng/mL.

Biopsy↗
PubMed1997

[Molecular staging of prostatic cancer].

Despite the improvement current evaluation techniques, approximately 30% of prostatic cancers clinically localized to the gland are understaged. RT-PCR is a sensitive and specific screening method for circulating prostatic cells, proposed as a molecular staging tool. The results obtained with this method and reported in the literature are critically discussed. These results, concerning the detection of circulating PSA- or PSMA-positive prostatic cells, are only indicative, as none of the teams used the same method. No consensus has been reached concerning the equipment used, the choice of oligonucleotide primers, the number of cycles to be applied or even the type of method, classical or "nested". Another possible application of this method is early detection of circulating prostatic cells, possibly neoplastic, during the follow-up of patients treated by radical prostatectomy. Once again, the results of the literature are contradictory. The reliability and reproducibility of molecular biology techniques in routine practice must therefore be demonstrated before these techniques can influence the therapeutic decision concerning prostatic cancer.

Humans↗
PubMed1996

[Early diagnosis of prostate carcinoma with reference to the density of prostate-specific antigen].

Early diagnosis of prostate cancer is based on determination of serum prostate specific antigen (PSA) and digital rectal examination (DRE). In men with PSA values above 10 ng/ml and where there is a positive DRE, the indication for prostatic biopsy is given. However, there is controversy as to whether men with an intermediate PSA level of 4-10 ng/ml should undergo further evaluation. Since cancer secretes 12 times more serum PSA per volume than benign prostatic hyperplasia, PSA density (PSAD, serum PSA divided by the volume of the entire prostate) has been suggested as an additional diagnostic criterion. In 153 men with prostatism and PSA values between 4 and 10 ng/ml (Hybritech assay), the volume of the prostate was determined by transrectal ultrasonography and 6 systematic biopsies were performed. The groups with positive and negative biopsies respectively were compared according to age of the patient, results of DRE and PSAD. Histological grade of positive biopsies and pathological stage of patients who underwent radical prostatectomy were also compared with diagnostic criteria. Prostate cancer was found in 45 of 153 men (29.4%). Patient's age had no influence on detection rates. The positive predictive value of a PSAD of 0.2 or more was twice the value of a PSAD below 0.2, irrespective of DRE findings. An increasing number of positive biopsies was associated with increasing PSAD and histological grade. Only half of the tumors operated on were still confined to the prostate. Pathological stage could be predicted by the number of positive biopsies. We conclude that PSAD may be useful as a diagnostic parameter in men with prostatism and PSA values of 4-10 ng/ml. The prostate cancers that were detected in this setting are of clinical significance.

Adult↗
PubMed1996

Is the percentage of cancer in biopsy cores predictive of extracapsular disease in T1-T2 prostate carcinoma?

BACKGROUND: Information regarding the quantity of biopsy material invaded by cancer may supplement the usual criteria for the preoperative staging of patients suffering from clinically localized prostate carcinoma (T1-T2). However, conflicting conclusions have been drawn and this topic needs further investigation. METHODS: A total of 170 patients had radical prostatectomy for T1-T2 prostate carcinoma. Patients' mean age (+/- standard deviation [SD]) was 66.05 +/- 6.12 years and mean prostate specific antigen (PSA) level (+/- SD) was 22.5 +/- 21.4 ng/mL (Yang Proscheck). Of the patients, 110 underwent transrectal ultrasound-guided biopsy with removal of 6 cores, from whom we had the percentage of biopsy, material invaded by cancer, the Gleason score, and the preoperative PSA. These parameters were compared with the pathologic features of the surgical specimen (capsule penetration, surgical margins, and Gleason score) and biologic progression (defined as persistent/recurrent postoperative PSA > 0.1 ng/mL). RESULTS: The most valid threshold of biopsy material invaded by cancer for predicting surgical margins and capsule status, as well as biologic progression, was 10%. When < 10% of biopsy material was invaded by cancer, positive surgical margins (SM+) were present in 30.3%, capsular penetration (pT3, pathologic extracapsular involvement) in 27.3%, and biologic progression (P+) in 21.7%. The Gleason score did not improve this prognostic evaluation. The mean quantities of tissue invaded by cancer differed significantly between positive and negative surgical margin groups, between pT2 and pT3 groups, and between P- and P+ groups (no biologic progression/biologic progression). There was statistical significance (log rank test, P = 0.0320 in the survival without biologic postoperative progression between patients with < or = or > 10% of one core biopsy invaded by tumor. If < or = 10% of tissue in only 1 of 6 cores of a biopsy was invaded by tumor, the status was pT2, SM-, and P- in 87.5% of the patients. CONCLUSIONS: On an individual basis, the percent of tissue containing carcinoma in core biopsies was a factor that lacked the statistical power to predict the status of the capsule and surgical margins, and the biologic progression. The finding of < or = 10% of carcinoma in 1 of 6 cores of a biopsy was correlated with a good prognosis.

Adult↗
PubMed1996

High levels of tissue inhibitor of metalloproteinase-2 (TIMP-2) expression are associated with poor outcome in invasive bladder cancer.

The matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs) have been associated with tumor invasion and metastasis in many human cancers. Immunohistochemical studies were performed on frozen tumor samples from 42 patients with invasive bladder cancer treated by cystectomy with monoclonal antibodies against the Mr 72,000 gelatinase A (MMP-2), Mr 92,000 gelatinase B (MMP-9), and TIMP-2 to evaluate their significance in bladder cancer. Immunoreactivity for the gelatinases was predominantly tumor cell-associated, whereas strong TIMP-2 staining was mostly detected in the stroma. Tumor cells demonstrated moderate to strong reactivity for MMP-2 and MMP-9 in 71 and 71% of cases, respectively, which did not correlate with stage, grade, or outcome. Tumor cells were positive for TIMP-2 in 26 (62%) of 42 cases, and this correlated with a worse outcome (69 versus 25% died of disease; P < 0.05). In 31 (74%) of 42, there was moderate to strong stromal staining for TIMP-2; this also was associated with a poor outcome (65 versus 25% died of cancer; P < 0.05). Tumor basement membrane (BM) status was investigated using an antibody to type IV collagen. In 9 cases, the invasive tumor nests were surrounded by an intact BM; in 7 of these, stromal staining for TIMP-2 was absent. None of these 9 patients (0%) died of tumors compared with 7 (100%) of 7 with complete loss of BM staining (P < 0.001). These results suggest a potential role for TIMP-2 and BM staining as prognostic indicators in invasive bladder cancer.

Adult↗
PubMed1996

[Detection of prostatic cancer in symptomatic patients with serum levels of prostate-specific antigen between 4 and 10 ng/ml].

OBJECTIVES: Determine the incidence of prostate cancer in patients consulting for common miction disorders and serum prostatic specific antigen (PSA) between 4 and 10 ng/ml. METHODS: A total of 153 patients consulted for miction disorders. In 107 of them, the digital examination was abnormal and PSA was between 4 and 10 ng/ml. Transrectal sonography and prostatic biopsies were performed in these 107 patients. We determined the number of cancers detected and assessed the contribution of PSA density (PSAD) to diagnosis. In patients undergoing radical prostatectomy, invasion of the capsule (C+) and positive exeresis section (M+) were recorded. RESULTS: Cancer of the prostate was diagnosed in 29.4% of the patients on the basis of at least 1 of the 6 biopsies. This rate was 47.8% in patients with an abnormal and 21.5% with a normal digital examination. Radical prostatectomy was performed in 32 patients: 50% of them were C+ and 33% M+. CONCLUSION: Biopsy of the prostate is indicated in patients with an abnormal prostate at digital examination when PSA is between 4 and 10 ng/ml. When the prostate appears to be normal, PSAD may be helpful in determining when to perform a biopsy. Intermediary serum PSA levels do not guarantee favorable pathological characteristics.

Adenocarcinoma↗
PubMed1996

Early detection of prostate cancer in men with prostatism and intermediate prostate-specific antigen levels.

OBJECTIVES: To determine the prevalence of prostate cancer and the diagnostic ability of prostate-specific antigen density (PSAD) in men with lower urinary tract symptoms and intermediate prostate-specific antigen (PSA) levels of 4 to 10 ng/mL (Hybritech assay) and to assess the clinical significance of prostate cancers in men who subsequently underwent radical prostatectomy. METHODS: Six systematic transrectal ultrasonography (TRUS)-guided biopsies were performed in 153 symptomatic men (mean age, 66 years) with PSA levels between 4 and 10 ng/mL, irrespective of digital rectal examination (DRE) findings. Prostate volume was also determined by TRUS and PSAD was calculated (serum PSA divided by volume of entire prostate). The rate of positive biopsies was compared with PSAD (more than 0.2 versus less than 0.2), DRE (positive versus negative), and patient's age (more than 70 years versus 61 to 70 versus 60 or less). Eligible patients with cancer underwent radical prostatectomy, and specimens were analyzed with regard to clinical significance of tumors. RESULTS: The overall cancer detection rate was 29.4%. PSAD and DRE, but not age, were both statistically significant in differentiating negative from positive biopsies. Independent of DRE findings, mean PSAD was significantly lower in biopsy-negative cases (0.29 +/- 0.17 and 0.25 +/- 0.16) than it was in positive cases (0.34 +/- 0.17 and 0.35 +/- 0.15). Half of the patients who underwent radical prostatectomy had pathologically nonorgan-confined disease (more than pT3), 34% had positive margins, and 47% had a Gleason score of 8 to 10. PSAD, DRE, and age could not predict outcome, probably owing to the small number of patients. However, the number of positive biopsies (1 or 2 versus 3 to 6) was able to predict pathologic stage. CONCLUSIONS: In men with lower urinary tract symptoms and intermediate PSA levels of 4 to 10 ng/mL, PSAD may be useful in the selection of patients for prostate biopsy. Carcinomas found using these criteria are of clinical importance.

Adult↗
PubMed1996

A single positive prostate biopsy in six does not predict a low-volume prostate tumour.

OBJECTIVE: To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)-guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen. PATIENTS AND METHODS: Of 158 patients submitted to RP for T1-T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extra-capsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with postoperative biological progression (P+), having a prostate-specific antigen (PSA) level > 0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively. RESULTS: The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with < 10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow-up of 22 months. CONCLUSION: A single positive needle-biopsy in six systematic TRUS-guided prostate biopsies is not predictive of low-volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.

Aged↗
PubMed1996

Advances in the assessment of clinically localized prostate cancer.

OBJECTIVE: We review the advances in pathology, biology, and radiology which could improve the detection of extracapsular prostate cancer preoperatively. METHOD: The experiences of others are compared to ours to give a topical overview of advances in the assessment of clinically localized prostate cancer. RESULTS: Despite new technologies, such as colour Doppler and endorectal magnetic resonance imaging, radiology does not enhance the ability to detect small invasion through the prostatic capsule. Biopsy features are one of the new fields of investigation. The number of positive sextant biopsies and the analysis of periprostatic spaces on biopsies appear to be major prognosis factors. In our experience, capsular perforation on biopsy is very powerful with respect to the proportion of positive biopsies ( > 66.7%) and serum PSA ( > 25 ng/ml, polyclonal assay) to predict biological progression after radical prostatectomy. The utility of the proportion of invaded tissue on biopsy is still debated. CONCLUSIONS: Despite technical improvements, the staging of clinically confined prostate cancer is still a major issue. The best hope comes from the study of biopsy features in addition to PSA.

Biopsy↗
PubMed1996

Prostate specimen reevaluation in patients with organ confined prostate cancer and postoperative biological recurrence.

PURPOSE: We evaluated whether detectable levels of prostate specific antigen after radical prostatectomy for stage P2 disease are associated with unconfined cancer overlooked at pathological examination. MATERIALS AND METHODS: Among 129 patients with stages T1 and T2 prostate cancer treated with radical prostatectomy 60 had stage P2 disease. The initial slides from the 7 patients with biological failure were carefully reviewed and, if necessary, the embedded blocks were sectioned every 2 mm. RESULTS: The disease was upstaged histologically from P2 to P3 in 6 of 7 patients by reinspecting the initial slides (3) and examining new slides (3). CONCLUSIONS: A postoperative detectable prostate specific antigen level in cases of stage P2 cancer reflects the presence of unconfined disease that may be overlooked by histopathological examination.

Aged↗
PubMed1996

[A single positive prostatic biopsy out of six systematic biopsies is not correlated with the intracapsular nature of the tumor on an individual level].

OBJECTIVE: To evaluate whether or not a single positive prostatic biopsy out of six systematic ultrasound-guided biopsies, is reliably correlated manner with favourable histopathological features of the tumour on the radical prostatectomy (RP) specimen. MATERIALS AND METHODS: In a series of 158 patients undergoing RP for clinically localized prostatic cancer, 15.2% had only one positive biopsy out of 6 systematic biopsies. We compared the rates of capsular effraction (C+) and positive resection margins (RM+), assessed on the operative specimen, in this group of patients with a single positive biopsy (group 1) and in the group (group 2) diagnosed by more than one positive biopsy. The postoperative biological progression rate (P+), defined as an immediate or secondary postoperative elevation of PSA beyond 0.1 ng/ml by polyclonal assay, was also evaluated in the two groups. The Gleason score was evaluated and compared on biopsies and on RP specimens. RESULTS: 29.2 of cases were C+, 16.7% were RM+ and 26% were P+ in group 1, versus 70%, 46.5% and 49.5%, respectively, in group 2. All differences were statistically significant. All patients in group 1 with less than 10% of prostatic tissue invaded on the positive biopsy had stage P2, while all patients with 100% of the length of the biopsy invaded by tumour had stage P3. The Gleason score was accurately predicted by the positive biopsy in 39% of cases and was underestimated in 39% of cases. CONCLUSION: A single positive prostatic biopsy out of six systematic biopsies is a useful predictive factor of local extension, but, in the individual patient, does not guarantee favourable histopathological characteristics of the tumour, nor a favourable course of the disease.

Aged↗
PubMed1996

[Does the proportion of tumor tissue in biopsies reflect the extent of localized prostate cancer?].

OBJECTIVES: To evaluate whether the percentage of biopsy tissue invaded by tumour provides any supplementary information to laboratory and/or biopsy data (Gleason, number...) in the preoperative staging of patients with localized prostatic cancer (T1-T2). MATERIALS AND METHODS: 170 patients with a mean age of 65.05 +/- 6.12 years and a mean PSA of 22.5 +/- 21.4 ng/mL were submitted to radical prostatectomy (RP) for T1-T2 prostatic cancer. 110 patients were submitted to a series of 6 transrectal prostatic biopsies to establish the diagnosis. We evaluated the percentage of biopsy tissue invaded. This parameter, as well as the Gleason score and the preoperative PSA, were studied in comparison with pathological criteria of the operative specimen (capsule status, resection margins) and postoperative PSA. RESULTS: The cut-off value of 10% of invaded biopsy tissue was calculated as being the most discriminant for the prediction of resection margins, capsule status and progression of laboratory parameters. When less than 10% of biopsy tissue was invaded, there were 31.2% positive margins (RM+). 28% of invaded capsules (pT3), and 21.7% of laboratory progression (P+) versus 44.1%, 71.4% and 47%, respectively, when more than 10% of tissue was invaded. The Gleason score of the biopsy did not improve this prognostic evaluation. The mean quantities of invaded biopsy tissue were statistically different between pT3 and pT2, RM+ and RM-and P+ and P-. When only one positive biopsy was invaded by less than 10%, 87.5% of these operated patients remained stable, RM- and pT2. CONCLUSIONS: On an individual level, the percentage of invaded tissue does not reflect the degree of extension or progression of localized prostatic cancer. Only a single positive biopsy invaded over less than 10% of its length is statistically correlated with a good prognosis.

Adult↗
PubMed1996

[Cancer of the prostate. Should men be screened, how to screen, when to screen?].

The individual screening of the general population can only be envisaged after the age of 50 years when the incidence of prostatic cancer increases significantly. Individual screening by PSA in an asymptomatic subject must only be proposed to men likely to benefit from curative treatment, i.e. between the ages of 50 and 70 years, and only after performing digital rectal examination. The combination of these two methods detects 54% of prostatic cancers in men over the age of 50 years. PSA assay can be made more reliable by comparison with age-dependent normal limits, PSA density compared to prostatic volume, rate of progression, and assay of the free and bound fractions.

Age Factors↗
PubMed1996

[The current approach to the management of benign hypertrophy of the prostate].

Epidemiology. The incidence of benign prostatic hyperplasia (BPH) has increased in proportion to the life expectancy and has become the third leading cause of health expenditure in industrialized countries. Eighty per cent of men are treated for benign prostatic hyperplasia during their lifetime. In Europe, the mean age of diagnosis is 65 years. The clinical symptoms are assessed by the IPSS score (International Prostate Symptom Score) and by the maximum flow rate, where frank dysuria is defined as a flow rate of less than 10 ml/sec. Physiology. The prostate contains equal proportions of glandular epithelial structures and fibromuscular connective tissue stroma. The glandular prostate is innervated by cholinergic nerves, while the smooth muscle of the stroma and the urethra are innervated by adrenergic nerves. BPH arises in the transitional zone (fairly glandular). Androgen deprivation (castration, antiandrogens, progestogens, 5-alpha-reductase inhibitors) induces a 30% reduction of the prostatic volume (especially epithelial). BPH could be due to reactivation of the embryonic potential of the stroma. Certain growth factors appear to be involved in BPH. Inflammatory and immunological phenomena may also be involved. Evaluation. Plan of clinical interview, clinical examination and laboratory and radiological data. A 40-year-old man has one chance in 30 of being operated for benign prostatic hyperplasia if he lives to the age of 80. Medical treatments have been developed since 1980 which inhibit the course of BPH and minimize some of the clinical symptoms: plant extracts, alpha-blockers, 5-alpha-reductase inhibitors. Conventional surgical treatments, open prostatectomy and endoscopic resection, have been completed by laser therapy, thermotherapy and cryotherapy.

Adult↗
PubMed1996

[Post-treatment PSA, indicator of radical treatment effectiveness of localized cancer of the prostate].

Prostate specific antigen (PSA) has become essential to the follow-up of radical treatment for T1-T2 tumours. Various assays are available, but require a correlation coefficient to homogenize their results. PSA is probably the most reliable marker for the follow-up of radical prostatectomy (RP), as this operation should make PSA undetectable after 3 weeks. Highly sensitive tests, with a limit of detection of 0.1 ng/ml, allow the earlier laboratory detection of tumour escape (20 to 45%). Anastomotic biopsies are positive in 35 to 50% of cases. Seminal vesicle invasion and positive resection margins are more frequently associated with recurrence. The doubling time and rate of progression of PSA after RP can be used to distinguish local recurrence from metastasis. Urinary PSA is not useful in the follow-up of RP, as it is secreted by the periurethral glands. The use of the PSA after radical radiotherapy is less clearly established, as this treatment is not designed to eliminate all prostatic tissue or render PSA undetectable. Therapeutic efficacy is situated between 1 and 1.5 ng/ml according to the tests and is achieved in approximately 40% of cases after 4 years. A PSA level greater than 3 ng/ml at 3 months is indicative of a poor prognosis. Prospects for the future include the use of highly sensitive assays and reverse transcriptase polymerase chain reaction (RT-PCR) to detect circulating prostatic cells. The use of PSA has led to a re-evaluation of the efficacy of radical treatments and could influence the indications for adjuvant treatments.

Forecasting↗
PubMed1995

[Prostate specific antigen. Clinical applications of ultrasensitive assay].

Recent progress in the techniques used to assay prostate specific antigen (PSA) have made this diagnostic tool even more useful in the management of patients with cancer of the prostate. However, although "ultrasensitive" methods can now detect minute levels, there still is no widely accepted definition of the detection threshold making it difficult to compare results reported with the different techniques. Ultrasensitive assay is particularly interesting in patients who have had radical prostatectomy, offering complementary information to the pathology examination of the surgical specimen. Used as a tool for following disease course after surgery, ultrasensitive PSA is currently the most sensitive measure of disease recurrence. Ultrasensitive assay can also give an evaluation of the effect of post-surgery complementary radiotherapy. Inversely, it adds no further information compared with regular assay before surgery. Thus, ultrasensitive assay is not indicated for differential diagnosis or screening programmes but is a valuable tool for evaluating the effectiveness of curative surgery or exclusive curative radiotherapy.

Humans↗