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V Ravery

Publications and source records attributed to V Ravery.

90 records · Page 5Linked to original sources
PubMed1995

Prognostic value of epidermal growth factor-receptor, T138 and T43 expression in bladder cancer.

Tumour-associated markers defined by monoclonal antibodies have proven useful to phenotype bladder tumours. In order to evaluate the prognostic value of such markers, we performed an immunohistochemical study on 57 transitional cell carcinomas (23 infiltrative and 34 superficial tumours) and ten healthy bladders using monoclonal antibodies against the external domain of the epidermal growth factor receptor (EGFR) and against the tumour-associated antigens T43, 19A211 and T138. Immunohistochemistry was performed on frozen sections using a two-step alkaline phosphatase method. The staining pattern obtained with each antibody was analysed according to the TNM classification, and results were analysed according to the subsequent clinical course. 19A211 preferentially stained superficial tumours, and T43, T138 and EGFR preferentially stained invasive tumours. Three monoclonal antibodies appeared to have prognostic value, since progression rate survival was significantly (log-rank test) associated with their expression of EGFR (P = 0.017), T138 (P = 0.0009) and T43 (P = 0.031). T138 expression was found to have an independent significant prognostic value using a stepwise logistic regression. T138 antibody may add significant information to classical pathological parameters.

Antibodies, Monoclonal↗
PubMed1995

[The role of the laser in urology].

There is currently a renewed interest in laser in the field of urology, essentially for the treatment of benign prostatic hypertrophy, as a result of recent developments in the field of fibres. Laser is light coherent in time and space emitted continuously or in pulses. Only its thermal and photochemical properties are used in urology. Endoscopic coagulation of superficial bladder tumours by Nd YAG laser does not seem to be better than classical endoscopic resection, at the present time, as although it is less haemorrhagic, it does not decrease the recurrence rate. Photochemotherapy of bladder carcinoma in situ still constitutes a complex treatment protocol reserved for specialized centres. Lastly, upper urinary tract tumours can be treated by Nd YAG laser coagulation, in rare indications which are the same as those of ureteroscopic or percutaneous resection. The recent development of lateral firing laser fibres and contact tip fibres has led to a renewed interest in laser in benign prostatic hypertrophy. Two different techniques have been proposed: Nd YAG laser coagulation under direct visual or ultrasound control (TULIP), which gives delayed objective results (two or three months) and contact tissue vaporization (Nd YAG, diode), whose effects are more immediate. In both cases, intraoperative bleeding is minimal and the length of hospital stay is decreased, but the duration of urine drainage remains to be defined. Endoscopic pulsed laser urinary lithotripsy (dye, Ho YAG), although effective and atraumatic, is not justified at the present time because of its high cost compared to mechanical percussion lithotripters. Lastly, laser treatment for urethral stricture has not been found to be superior to classical scalpel urethrotomy and laser tissue welding is still in the experimental stages. In conclusion, laser technology, especially fibers, has currently reached an important phase of development with applications for urological disease, essentially in the treatment of benign prostatic hypertrophy in order to reduce the morbidity of classical endoscopic resection. However, other urological applications of laser could be validated in the near future due to the development of less expensive lasers (diode) and/or with multiple functions (Ho YAG).

Humans↗
PubMed1995

Fibroblast growth factors and their specific binding sites in normal urothelium and transitional cell carcinoma (TCC) of the human bladder.

In order to further investigate the involvement of FGF1 and FGF2 in the transitional cell carcinoma of the bladder (TCC), we compared the expression of FGF1, FGF2 and their membrane binding sites by biochemical and immunological methods in both human normal urothelium and transitional cell carcinoma of the bladder. Using a specific enzyme immunoassay (EIA), we observed that neoplastic tissue exhibited a lower FGF2 content than normal tissue. FGF1 and FGF2 Western-blot analysis revealed in both types of tissues a major FGF1 form with a low molecular weight (14 kDa) and a single FGF2 form (21 kDa). Immunohistological studies showed that FGF1 was specifically located in normal or transformed urothelial cells, while FGF2 was associated with bladder stroma. Binding analysis in tissue membrane preparations revealed a dramatic drop in both high and low affinity binding sites for FGF2 in TCC bladder in comparison to normal bladder. FGF2 cross-linking experiments illustrated a qualitative modification of FGF2 binding complexes in tumors. These data suggest that invasive bladder carcinoma is associated with modifications of FGF1 and FGF2 tissue levels and alterations in the characteristics of the FGF2 membrane binding sites.

Binding Sites↗
PubMed1995

[Initial clinical experiences with the Storz Modulith SL 20 lithotripter: the results 3 months after a single session].

The objective of this study was to evaluate the performances of the Storz Modulith SL20 lithotriptor. Fifty patients with a total of 52 renal (31) or ureteric (21) stones were treated, in a single session, between June and October 1993. The mean stone diameter was 7.9 mm. All patients were reviewed after 3 months. The complete success rate, with radiological cure, was 65% at 3 months. The partial success rate, defined as fragmentation of the stone with persistence of residual fragments less than 3 mm in diameter, not requiring further treatment, was 12% at 3 months. The failure rate at 3 months was 23%. The commonest complication was renal colic in 12 patients (24%). Two patients developed an extrarenal haematoma. The Modulith SL20 possesses a good detection system: firing is well tolerated under minimal analgesia. Our success rates are slightly lower than those obtained by other teams using the same apparatus.

Adolescent↗
PubMed1995

[Priapism in the adult: report of 15 cases].

OBJECTIVES: The practical approach to the treatment of priapism is complicated by the rarity of this disease. Treatments for impotence by intracavernous injection of vasodilators have considerably increased the incidence of prolonged erections, although "antidote" protocols, when instituted rapidly, ensure detumescence in most cases. The objective of this study was to define a practical and rigorous approach based on comparison of our results with those reported in the literature concerning the management of priapism. METHODS: This series consists of fifteen consecutive cases observed in adults over a ten-year period. The pathophysiology and aetiologies are recalled. The authors evaluate the percentage of detumescence after primary treatment and after retreatment and discuss the incidence of secondary impotence. This information is compared with the data of the literature in order to define a practical approach. RESULTS: After a trial intracavernous injection of vasoconstrictors, creation of a cavernospongiosa fistula provided the best results with a 60% detumescence rate after primary treatment and 80% after retreatment. All treatments combined, 53.3% of good results were obtained after primary treatment and 66.7% after retreatment. In the long-term, 50% of patients with a sufficient follow-up are impotent. CONCLUSIONS: As a result of systematic surveillance of patients treated by an intracavernous injection protocol, the number of priapisms induced in our institution has remained stable over recent years. Patients treated for priapism within 36 hours have a better short-term and long-term prognosis.

Adult↗
PubMed1995

[Anatomopathologic reassessment of prostatic tumors exclusively affecting the organ with biologic progression and survival study of prostatectomized patients, in terms of the histologic characteristics of the tumor].

OBJECTIVES: The coexistence of tumours confined to the prostate and laboratory signs of progression is surprising unless we accept the possibility of errors of the pathological examination. In view of the high incidence of laboratory signs of progression after radical prostatectomy, it is important to define the most pejorative histological features in order to improve patient selection. METHODS: 129 radical prostatectomy specimens were studied, 8 out of 129 patients, with an immediate or secondary elevation of PSA while histological examination diagnosed a pT2 intracapsular cancer, were re-evaluated by reviewing the slides and resection of paraffin embedded blocks of prostate. The actuarial survival curves were analysed in 4 groups of patients, defined according to the various pathological characteristics of their tumour. RESULTS: Review of the slides led to the diagnosis of 2 cases of focal capsular effraction and I case of seminal vesicle invasion. Resection of paraffin blocks led to the diagnosis of 2 cases of focal capsular effraction and one positive resection margin. The differences between the 4 survival curves with no laboratory signs of progression (PSA < 0.1 by highly sensitive polyclonal assay) were statistically significant except between patients whose tumour had extended beyond the capsule and those with positive resection margins. CONCLUSION: Overall, resection of the blocks corrected the pathological staging in 2.3% of cases and global analysis of factors of poor prognosis can guide the urologist in this decision to administer adjuvant treatment.

Actuarial Analysis↗
PubMed1994

Systematic biopsies accurately predict extracapsular extension of prostate cancer and persistent/recurrent detectable PSA after radical prostatectomy.

OBJECTIVES: To determine if methodic analysis of systematic echo-guided biopsies associated with prostatic-specific antigen (PSA) and PSA density can accurately predict the actual pathologic stage of prostate cancer (Ca P). METHODS: One hundred patients with clinically localized (T1, T2) Ca P who underwent radical prostatectomy (RP) were preoperatively staged by digital rectal examination (DRE), measurement of serum PSA (Yang Pros-check) and PSA density (PSAD), and transrectal echo-guided systematic biopsies (three in each lobe aiming to sample prostatic capsule) to evaluate T stage, Gleason grade, number of positive biopsies, and presence of cancer in the periprostatic tissues. Radical prostatectomy specimens were processed following the McNeal method. The PSA levels were measured every month for 2 years. RESULTS: Extracapsular disease was detected on the specimen in 45% of the patients, persistent/recurrent detectable PSA in 47% (mean follow-up 18 months). Clinical stage T2 B, presence of Gleason grade 4, PSA > 25 ng/mL, PSAD > 0.6, number of positive biopsies > 66% of the total number of cores taken had a positive predictive value (PPV), respectively, of 72%, 66%, 80%, and 87%. Periprostatic tissue was evaluable on the core biopsies in 77% of the cases. Presence of cancer in the periprostatic fat on the core biopsies had a PPV of 94% for extracapsular disease/biological recurrence. CONCLUSIONS: The presence of extracapsular cancerous tissue on prostatic core biopsies accurately predicts extracapsular extension of Ca P. Therefore, care should be taken when performing prostate biopsies to sample the prostate capsule and surrounding tissues to obtain a more accurate staging of the disease. The second best predictor of extracapsular disease is the percentage of positive biopsies.

Adult↗
PubMed1994

Predictive value of pathological features for progression after radical prostatectomy.

OBJECTIVE: 10-30% of patients with T1/T2 prostate cancer submitted to radical prostatectomy ultimately fail. It may be important to detect failure as early as possible in order to evaluate the extent of recurrent/residual disease and initiate adjuvant therapy. SUBJECTS AND METHODS: 100 consecutive patients with localized prostate cancer treated by radical prostatectomy have been monitored using the hypersensitive Pros-check prostate-specific antigen (PSA) assay (detection level 0.1 ng/ml). The predictive value of positive surgical margins, involvement of seminal vesicles and perineural spaces as well as Gleason's score for biological failure (persistent or recurrent detectable PSA) has been retrospectively evaluated. RESULTS: Overall 40% of the patients had biological failure (defined as persistence of a detectable or rising PSA after undetectability) and 38% had positive surgical margins. The three main predictive criteria of biological failure were capsular perforation, involvement of seminal vesicles and/or positive margins. All patients in whom these criteria were positive progressed. Seminal vesicle invasion was associated with biological failure in 95% of the cases. 66.7% of the patients with extracapsular disease but no seminal vesicle invasion progressed. 15% of pT2 patients experienced a persistent/recurrent postoperative PSA and were upstaged to pT3 after reevaluation of the specimen. CONCLUSION: Efforts should be made to increase the preoperative evaluation of seminal vesicle and pericapsular status by a more sophisticated technique of prostate biopsy in order to avoid noncurative surgery.

Adult↗
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↗
PubMed1993

Prognostic factors in superficial bladder cancer.

A large body of evidence suggests that intravesical prophylaxis using bacillus Calmette-Guérin can favorably alter the natural history of superficial bladder cancer. The search for prognostic factors impacting the clinical alternative between conservative and radical treatment has been the subject of numerous efforts and remains a major objective in improving the carcinological results and the quality of life patients with superficial bladder cancer. In this regard, information is available on three levels: clinicopathological parameters, quantitative analysis, and biological markers. Recent advances in as well as the limitations and pitfalls of the use of three kinds of information in prognostication are reviewed. The proper use of prognostic factors will modify our attitude toward superficial bladder cancer in the near future.

BCG Vaccine↗
PubMed1993

Variations in arterial blood supply and the risk of hemorrhage during percutaneous treatment of lesions of the pelviureteral junction obstruction: report of a case of testicular artery arising from an inferior polar renal artery.

Acute hemorrhage during percutaneous surgery on the pelviureteric junction obstruction has been estimated to be 2-3%. Following the experience of peroperative bleeding from a vascular variation, the authors discuss the arterial anomalies of the renal pedicle which may carry the risk of hemorrhage during percutaneous surgery in this region. Arteries in front of or behind the renal pelvis are the cause of ureteropelvic function obstruction in 15-52% of cases and because of their close relationship with the upper urinary tract can complicate the procedure of endopyelotomy. Endourological techniques are inadequate for avoiding the risk of vascular damage during the necessary maneuvers. Inferior polar arteries occur in 9% of the population and their different courses are described. They are not always responsible for the vascular obstruction in the pelviureteric syndrome, and it is the exact determination of this responsibility that makes imaging essential. Arteriography performed in our case allowed embolisation of the damaged inferior polar artery and also showed the anomalous origin of the testicular artery from this polar artery; this appears to be only the second description of this anomaly. This variation is discussed in a review of the literature. In fact the testicular artery has a high or aberrant origin in 20% of cases; in 5-6% of these the origin is from a main or supernumerary renal artery. Origin from an inferior polar artery is exceptional.

Adult↗
PubMed1993

Increased immunodetection of acidic fibroblast growth factor in bladder cancer, detectable in urine.

Acidic fibroblast growth factor is a regulatory peptide involved in cell proliferation, differentiation and motility. We used a polyclonal antiserum raised against purified native bovine acidic fibroblast growth factor, with no cross-reactivity for basic fibroblast growth factor to detect acidic fibroblast growth factor in tissue extracts and urine samples by means of a competitive enzyme immunoassay. Histochemical analysis was also performed on 10 specimens of normal urothelium and 50 of bladder cancer. Acidic fibroblast growth factor immunoreactive material was found in normal urothelium (1.77 +/- 2 ng./gm. tissue) and was increased more than 10-fold in patients with transitional cell carcinoma of the bladder (20.36 +/- 12 ng./gm. tissue). Immunohistochemical analysis localized immunoreactivity in the epithelial compartment of bladder tumors. Acidic fibroblast growth factor was assayed in urine from 579 individuals comprising a control group (114) and patients with benign prostatic hypertrophy (133), carcinoma of the prostate (96) or transitional cell carcinoma of the bladder (236). There was a significant difference in the frequency of urinary acidic fibroblast growth factor detection among the patients with invasive transitional cell carcinoma, the control group (p < 0.001) and the patients with prostatic disease (p < 0.01). The sensitivity was 72% and the specificity was 91%. Furthermore, the frequency of acidic fibroblast growth factor detection by enzyme immunoassay in the urine and the intensity of immunostaining was correlated with the stage of the disease. These data strongly suggest that acidic fibroblast growth factor is a potential marker for bladder tumors that may be of use in the noninvasive followup of patients with bladder cancer. We present a simple and reliable enzyme immunoassay for the detection of acidic fibroblast growth factor in voided urine that might be useful to quantitate this marker.

Biomarkers, Tumor↗
PubMed1993

[Results of the treatment of bladder tumors infiltrating the muscle].

Recent studies have shown improvements in survival in patients with invasive bladder cancer, perhaps as a result of stage selection and reduced perioperative morbidity rather than of increased effectiveness of treatments. The main ongoing therapeutic trials (combined use of chemotherapy with either surgery or radiation therapy) aim at controlling occult metastases which may be present in up to 50% of apparently localized bladder cancers. Identification of risk factors for metastatic disease is therefore crucial. In this study, factors potentially associated with response to treatment were analyzed on the basis of a review of outcomes reported with current treatments.

Combined Modality Therapy↗
PubMed1993

[The use of monoclonal antibodies in the evaluation of the aggressiveness of tumors of the bladder].

Monoclonal antibodies produced using hybridoma technology have enabled identification of new tumor markers. Targets include tumor-associated antigens, growth factors and their receptors, blood group antigens, cell proliferation antigens, oncogene or tumor suppressor gene products, and markers for drug resistance. Immunohistochemical or flow cytometry studies performed with monoclonal antibodies can be used to determine the immunophenotype of normal and tumoral urothelium; specificity may be primarily for superficial or deep tumors, or for different tumor grades. A number of monoclonal antibodies have been found of prognostic value independently from conventional prognostic criteria. Others have shown diagnostic value. The most promising monoclonal antibodies are reviewed herein.

Antibodies, Monoclonal↗
PubMed1993

[Surgical anatomy of the lymphatic drainage of the bladder].

Descriptive anatomy teaches us that the lymphatic drainage of the bladder converges directly on to the middle and internal chains of the external iliac nodes, but never on to the external chain, sometimes on a sacral common iliac node and widely on internal iliac nodes. Surgical observations confirm this: no lymph node metastasis in the external chain of external iliac nodes is noticed, nor common iliac adenopathy without upstream invasion. On the basis of these descriptions, lymphadenectomy was performed from inguinal ligament to iliac bifurcation. Anatomical data largely explain pelvic recurrences due to the existence of unremoved common iliac nodes or unrecognized hypogastric nodes because of difficult access without sacrificing efferent branches of internal iliac artery.

Humans↗
PubMed1993

[Surgical cure of anomalies of the pyelo-ureteral junction with posterior vertical lumbar excision: report of 25 cases].

Posterior vertical lumbar (PVL) incision does not involve any muscle or nerve section. It is minimally painful, does not give rise to incisional hernias and reduces the hospital stay. Pyeloplasty for cure of the ureteropelvic junction (UPJ) is a good indication, as this incision provides access to the renal pelvis without renal mobilisation and without interference by the vascular pedicle and allows a more superficial operative field. This retrospective study is based on 25 PVL incisions performed between 1979 and 1992 in 24 patients (15 females and 6 males with a mean age of 31.8 years) on the left kidney in 11 cases, right kidney in 12 cases and bilaterally in 1 case. No intraoperative complications were observed. The anastomosis was stented with a Gil-Vernet ureteronephrostomy tube for an average of eight days in every case. Early complications (< or = 1 month) consisted of six cases of fever, one wound abscess and one urinary fistula. Normal feeding was always rapidly restored. Long-term follow-up did not reveal any incisional hernias, but two cases of recurrence (8%), two cases of stones and one case (4%) of refractory neuralgia (> or = 6 months) in the territory of the ilioinguinal nerve. In this indication, there is no gain in terms of hospital stay due to the need to maintain the ureteronephrostomy tube for at least five days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Immunohistochemical detection of acidic fibroblast growth factor in bladder transitional cell carcinoma.

Acidic fibroblast growth factor (aFGF) is a regulatory peptide which, on account of its structural homologies with the products of oncogenes, is involved in cell proliferation, differentiation, and motility. We previously reported the presence of aFGF in the urine of patients with transitional cell carcinoma (TCC). aFGF can also induce the motility of a rat-derived bladder carcinoma cell line (NBTII). This immunohistochemical study used polyclonal rabbit antibodies against acidic and basic FGF and peroxidase detection. Native NBTII nude mice xenografts and aFGF transfected NBTII (NFS14) nude mice xenografts were used as tissue controls for antibody specificity. The samples included 4 normal urothelia and 12 TCC. In addition, cytospins of 4 different tumoral cell lines of human bladder and normal bladder cells were stained. The results showed strong immunostaining in all tumoral urothelium samples using anti-aFGF and a very low amount of staining or none at all in healthy tissues. A primary analysis suggested that the strongest reaction was obtained in high-grade tumors (3 + vs + for lower-grade tumors). Using bFGF antibody, strong immunohistochemical staining was detected on basal membranes and stromal vessels and none in urothelium. These data confirm aFGF expression in the epithelial cell compartment of bladder cancer and the likely involvement of this regulatory peptide in the biology of TCC.

Animals↗