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Metges JP, Lebot MA, Faroux R, Riaud F, Gamelin E, Capitain O, Guérin Meyer V, Leynia P, Douillard JY, Senellart H, Rochard S, Louvigné C, Campion L, Dupuis O, Grollier C, Achour NA, Person B, Raoul JL, Boucher E, Bertrand C, Ramée JF, Guivarch L, Etienne PL, Roussel S, Desclos H, Julien MN, Labarre MI, Klein V, Bessard R, Stampfli C, Royet F, Faycal J, Gouva S, Le Bihan G, Couturier M, Gourlaouen A, Bertholom C, Porneuf M, Jobard E, Peguet E, Grasset D, Bouret JF, Bicheler V, Ulvoas A, Miglianico L, Chouzenoux C, Deguiral P, Derenne L, Martin D, Langlet PM, Bodin C, Rossi V, Barré S, Cojocarasu O, Naveau Ploux C, Vidal AM, Cumin I, Egreteau J, Brouard A, Matysiak Budnik T, Thomaré P, Le Bris Michel AS, Piriou G, Largeau R, Elhannani C, Crespeau E, Suberville F, Bourgeois H, Riche C, Lagadec DD, Marhuenda F, Grudé F. Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas ( Observatoire dédié au Cancer Bretagne / Pays de la Loire). ONCOLOGIE 2014; 16:267-276. [PMID: 26190928 PMCID: PMC4496868 DOI: 10.1007/s10269-014-2391-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/07/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer. METHODS/RESULTS A study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks. CONCLUSION Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.
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Affiliation(s)
- J. P. Metges
- />CHU Brest Morvan, Brest, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | | | - R. Faroux
- />CH La Roche-Sur-Yon, La Roche-sur-Yon, France
| | - F. Riaud
- />CH La Roche-Sur-Yon, La Roche-sur-Yon, France
| | - E. Gamelin
- />ICO Paul Papin, Angers, France
- />Fondateur de l’Observatoire dédié au
cancer, Bretagne Pays de la Loire (ex-OMIT B PL), Rennes, France
| | | | | | | | - J. Y. Douillard
- />ICO René Gauducheau, Nantes, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | | | | | | | | | - O. Dupuis
- />Centre Jean Bernard/Clinique Victor-Hugo, Le Mans, France
| | - C. Grollier
- />Centre Jean Bernard/Clinique Victor-Hugo, Le Mans, France
| | | | | | | | | | | | - J. F. Ramée
- />Centre Catherine-de-Sienne, Nantes, France
| | - L. Guivarch
- />Centre Catherine-de-Sienne, Nantes, France
| | - P. L. Etienne
- />Clinique Armoricaine de Radiologie, Saint-Brieuc, France
- />Polyclinique Trégor-Lannion, Lannion, France
| | - S. Roussel
- />Clinique Armoricaine de Radiologie, Saint-Brieuc, France
| | | | | | | | - V. Klein
- />Hôpital Privé Océane/Centre Saint Yves
Vannes, Vannes, France
| | - R. Bessard
- />Hôpital Privé Océane/Centre Saint Yves
Vannes, Vannes, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | | | | | | | - S. Gouva
- />CH Landerneau, Landerneau, France
| | | | | | | | | | | | - E. Jobard
- />CH Saint-Brieuc, Saint-Brieuc, France
| | - E. Peguet
- />CH Saint-Brieuc, Saint-Brieuc, France
| | | | | | | | | | | | | | - P. Deguiral
- />Clinique Mutualiste de l’Estuaire, Saint-Nazaire, France
| | - L. Derenne
- />Clinique Mutualiste de l’Estuaire, Saint-Nazaire, France
| | - D. Martin
- />Polyclinique du Maine/Centre Mallet Proux Laval, Laval, France
| | | | - C. Bodin
- />Polyclinique du Maine/Centre Mallet Proux Laval, Laval, France
| | - V. Rossi
- />CH Haut Anjou Château Gontier, Château Gontier,
France
| | - S. Barré
- />CH Haut Anjou Château Gontier, Château Gontier,
France
| | | | | | - A. M. Vidal
- />CH Le Mans, Le Mans, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - I. Cumin
- />CH Sud Lorient Hennebont, Hennebont, France
| | - J. Egreteau
- />CH Sud Lorient Hennebont, Hennebont, France
| | - A. Brouard
- />CH Sud Lorient Hennebont, Hennebont, France
| | | | | | | | | | | | | | - E. Crespeau
- />Polyclinique du Parc Cholet, Cholet, France
| | | | - H. Bourgeois
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - C. Riche
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - D. Déniel Lagadec
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - F. Marhuenda
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - F. Grudé
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
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Cadranel JF, Lahmek P, Causse X, Bellaiche G, Bettan L, Fontanges T, Medini A, Henrion J, Chousterman M, Condat B, Hervio P, Periac P, Eugène C, Moindrot H, Grasset D, Nouel O, Pilette C, Szostak-Talbodec N, Cayla JM, Si-Ahmed SN, Dumouchel P, Pariente A, Lesgourgues B, Denis J. Epidemiology of chronic hepatitis B infection in France: risk factors for significant fibrosis--results of a nationwide survey. Aliment Pharmacol Ther 2007; 26:565-76. [PMID: 17661760 DOI: 10.1111/j.1365-2036.2007.03400.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Epidemiological data concerning hepatitis B are scarce in France. AIM To describe epidemiological, clinical, virological and histological features of HBsAg-positive patients followed at non-academic hospitals in France. METHODS Clinical, biological, virological and histological data of all HBsAg-positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed. RESULTS Nearly 1166 HBsAg-positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 +/- 15 years. Twenty-nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg-positive and 57% HBeAg-negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years (P < 0.05), HBeAg-negative status (P < 0.02) and histological activity (P < 0.0001). Factors associated with cirrhosis: age (P < 0.0001), platelet count <150 000/mm(3) (P < 0.0001) and viral co-infection (P < 0.03). CONCLUSION HBV infection represents a significant workload for hepatogastroenterologists at non-academic hospitals in France.
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Affiliation(s)
- J-F Cadranel
- Hepato-gastroenterology and Diabetology Section, Centre Hospitalier Laennec, 60109 Creil, France.
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Dubuc J, Legoux JL, Winnock M, Seyrig JA, Barbier JP, Barrioz T, Laugier R, Boulay G, Grasset D, Sautereau D, Grigoresco D, Butel J, Scoazec JY, Ponchon T. Endoscopic screening for esophageal squamous-cell carcinoma in high-risk patients: a prospective study conducted in 62 French endoscopy centers. Endoscopy 2006; 38:690-5. [PMID: 16874909 DOI: 10.1055/s-2006-925255] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND STUDY AIMS The prevalence of esophageal squamous-cell carcinoma in high-risk patients and the advantages of systematic Lugol staining during esophagoscopy have not yet been evaluated in a large prospective study. In this study we aimed to assess the prevalence of this type of tumor in high-risk patients, to examine the role of Lugol staining in endoscopic screening for esophageal squamous-cell carcinoma, and to establish whether it is possible to identify a particularly high-risk group which would benefit from systematic screening. PATIENTS AND METHODS A prospective study was undertaken in 62 endoscopy centers. A total of 1095 patients were enrolled, none of whom had any esophageal symptoms. These patients had presented with either a past history of or a recent head and neck or tracheobronchial squamous-cell carcinoma (group 1), with alcoholic chronic pancreatitis (group 2), with alcoholic cirrhosis (group 3), or were alcohol and tobacco addicts (group 4). The patients underwent a meticulous endoscopic examination of the esophagus, followed by Lugol staining. RESULTS The prevalence of esophageal squamous-cell carcinoma was 3.2 %. The group 1 patients showed the highest prevalence of carcinoma (5.3 %) and the highest prevalence of dysplasia (4.5 %). Of the 35 carcinomas detected in the 1095 patients, seven (20 %) were early lesions, and 20 % were only detected after Lugol staining (P = 0.02). High-grade dysplasia was only observed in group 1 patients and two-thirds of these lesions were only diagnosed after Lugol staining. The overall prevalence of low-grade dysplasia was 2.4 %, and 77 % of these were detected only after Lugol staining (P < 0.001). CONCLUSIONS Lugol dye staining increases the sensitivity of esophageal endoscopy for the detection of high-grade dysplasia and cancer. The prevalence of dysplasia and cancer reached 9.9 % in group 1, and we therefore believe that an endoscopic screening program could be justified for patients with head and neck or tracheobronchial cancer.
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Affiliation(s)
- J Dubuc
- Hepatogastroenterology Department, Haut Leveque Hospital, Bordeaux University Hospital, Pessac, France
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Busato F, Grasset D, Métivier S, Bordères C, Puech N, Seigneuric C. Co-infection VIH-VHC : attention aux mitochondries! Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Busato F, Grasset D, Métivier S, Chausseray F, Selves J, Seigneuric C. Insuffisance hépatique terminale au cours d'une maladie de Randall sans manifestation rénale symptomatique. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Grasset D, Seigneuric C, Morfoisse JJ. [Reply from Denis Grasset, Christian Seigneuric and Jean-Jacques Morfoisse to Bernard Maroy and Philippe Moullot]. Gastroenterol Clin Biol 2000; 24:859. [PMID: 11011271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- D Grasset
- Service de Gastroenterologie, Centre Hospitalier General, BP 765, 82013 Montauban Cedex
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Hausfater P, Cacoub P, Rosenthal E, Bernard N, Loustaud-Ratti V, Le Lostec Z, Laurichesse H, Turpin F, Ouzan D, Grasset D, Perrone C, Cabrol MP, Piette JC. Hepatitis C virus infection and lymphoproliferative diseases in France: a national study. The GERMIVIC Group. Am J Hematol 2000. [PMID: 10814989 DOI: 10.1002/(sici)1096-8652(200006)64:2<107::aid-ajh6>3.0.co;2-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The putative role of hepatitis C virus (HCV) infection in the pathophysiology of lymphoproliferative diseases (LPD) is supported by North American and southern European studies reporting high HCV seroprevalence in patients with B-cell-non-Hodgkin lymphoma (NHL). In order to evaluate the situation in France, we conducted a retrospective national study about the association of chronic HCV infection and LPD. 72 Internal Medicine and Infectious Diseases departments were contacted. Response rate was 51.4%. We recorded 43 LPD (19 males, 24 females): 31 B-cell-NHL, 4 Waldenström's macroglobulinemia, 3 chronic lymphocytic leukemia, 2 multiple myeloma, 2 lymphomas of the mucosa-associated lymphoid tissue, and 1 Hodgkin's disease. Mean age at HCV diagnosis was 62 years (range 33-84). In 16 cases, LPD occurred in patients known to be HCV-infected. For 11 patients, LPD diagnosis preceded the diagnosis of HCV infection, whereas diagnosis was done simultaneously in 11 patients. For those with accurate infection date, mean interval between both events was 15.2 years. Fourteen patients had HCV extrahepatic manifestations: 9 mixed cryoglobulinemia, including 7 with NHL, 5 sicca syndrome (5 NHL), and both in one patient. Cohort of HCV-infected patients could be accurately determined for 16 departments, totaling 1,485 patients and 37 cases. Thus, from our data the frequency of LPD among HCV-infected patients approximates 2. 49%. Despite possible bias inherent to this retrospective study, our data support the hypothesis of HCV-associated LPD and particularly B-cell-NHL. In France, this association is much lower than in Italy. Further studies are needed to assess the precise role of HCV in the multistep process leading to monoclonal proliferation.
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Affiliation(s)
- P Hausfater
- Service de Médecine Interne, Secrétariat du GERMIVIC, CHU Pitié-Salpêtrière, Paris, France
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8
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Hausfater P, Cacoub P, Rosenthal E, Bernard N, Loustaud-Ratti V, Le Lostec Z, Laurichesse H, Turpin F, Ouzan D, Grasset D, Perrone C, Cabrol MP, Piette JC. Hepatitis C virus infection and lymphoproliferative diseases in France: a national study. The GERMIVIC Group. Am J Hematol 2000; 64:107-11. [PMID: 10814989 DOI: 10.1002/(sici)1096-8652(200006)64:2<107::aid-ajh6>3.0.co;2-c] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The putative role of hepatitis C virus (HCV) infection in the pathophysiology of lymphoproliferative diseases (LPD) is supported by North American and southern European studies reporting high HCV seroprevalence in patients with B-cell-non-Hodgkin lymphoma (NHL). In order to evaluate the situation in France, we conducted a retrospective national study about the association of chronic HCV infection and LPD. 72 Internal Medicine and Infectious Diseases departments were contacted. Response rate was 51.4%. We recorded 43 LPD (19 males, 24 females): 31 B-cell-NHL, 4 Waldenström's macroglobulinemia, 3 chronic lymphocytic leukemia, 2 multiple myeloma, 2 lymphomas of the mucosa-associated lymphoid tissue, and 1 Hodgkin's disease. Mean age at HCV diagnosis was 62 years (range 33-84). In 16 cases, LPD occurred in patients known to be HCV-infected. For 11 patients, LPD diagnosis preceded the diagnosis of HCV infection, whereas diagnosis was done simultaneously in 11 patients. For those with accurate infection date, mean interval between both events was 15.2 years. Fourteen patients had HCV extrahepatic manifestations: 9 mixed cryoglobulinemia, including 7 with NHL, 5 sicca syndrome (5 NHL), and both in one patient. Cohort of HCV-infected patients could be accurately determined for 16 departments, totaling 1,485 patients and 37 cases. Thus, from our data the frequency of LPD among HCV-infected patients approximates 2. 49%. Despite possible bias inherent to this retrospective study, our data support the hypothesis of HCV-associated LPD and particularly B-cell-NHL. In France, this association is much lower than in Italy. Further studies are needed to assess the precise role of HCV in the multistep process leading to monoclonal proliferation.
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Affiliation(s)
- P Hausfater
- Service de Médecine Interne, Secrétariat du GERMIVIC, CHU Pitié-Salpêtrière, Paris, France
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Morfoisse JJ, Grasset D, Seigneuric C. [Patient opinions after colonoscopy. Results of a cross sectional, multicenter ANGH study (2)]. Gastroenterol Clin Biol 2000; 24:279-83. [PMID: 10804334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The aims of this study were to evaluate patient opinions following colonoscopy and to analyze the role of conditions of practice on patients' opinions. METHODS A study was suggested to all members of the ANGH. During one week of practice, a questionnaire was filled out by the gastroenterologist and a second one by the patient, alone, one day after colonoscopy. RESULTS Eighty six hospitals (229 gastroenterologists) took part in the study which included 815 patients; 752 of them (92%) filled out the satisfaction questionnaire. Five hundred and eighty four patients (78%) would accept a new endoscopy in the same conditions; 168 patients (22%) would accept if the conditions were different or would refuse a new endoscopy. The main factors associated with acceptance under the same conditions were: good tolerance (odds-ratio (OR): 5.08), old age (OR: 5), anesthesia (OR: 2.67) or conscious sedation (OR: 2.29), male gender (OR: 2.39) and ambulatory care (OR: 2). CONCLUSION This study of clinical practice underscored the different factors associated with better acceptance of colonoscopy. Individual gastroenterologists could use these data to guide practice.
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Affiliation(s)
- J J Morfoisse
- Service d'Information Médicale, Centre Hospitalier, Montauban
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Grasset D, Morfoisse JJ, Seigneuric C. [Conditions of practice and results of colonoscopy in non-university hospitals. Results of a cross sectional, multicenter ANGH study (1)]. Gastroenterol Clin Biol 2000; 24:273-8. [PMID: 10804333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The aim of the study was to describe the conditions of practice and results of colonoscopies performed in non university hospital endoscopy units. METHODS A study was suggested to all members of the National Association of non university Hospital Gastroenterologists (ANGH). During one week a questionnaire was filled out by the gastroenterologists for each colonoscopy. RESULTS Eighty six hospitals (229 gastroenterologists) took part in this study including 840 explorations. Ninety one percent of them were complete and the result was abnormal in 49%: cancers (3%), polyps > or =1 cm (8%), polyps < 1 cm (20%) and colitis (5%). Colonoscopies were ambulatory in half of the cases. Sedation was used in 95% of the patients, 80% by the anesthesist and 15% by the gastroenterologist (conscious sedation). The recommendations of the French Society of Anesthesia and Intensive Care for ambulatory sedation were not totally respected (15% of patients left the endoscopy unit without assistance). Only 6% of colonoscopies were not well tolerated, because of pain or incidents rarely necessitating intensive care monitoring (5 cases) or prolonged hospitalization (2 cases). CONCLUSION Colonoscopy provides good diagnostic yield although conditions of use can be improved.
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Affiliation(s)
- D Grasset
- Service de Gastroentérologie, Centre Hospitalier, Montauban
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Hausfater P, Cacoub P, Bernard N, Loustaud-Ratti V, Le Lostec Z, Laurichesse H, Turpin F, Ouzan D, Grasset D, Perrone C, Cabrol MP, Piette JC. Hémopathies malignes et infection par le virus de l'hépatite C: enquête nationale multicentrique. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)80137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grasset D, Delbos O, Muir GH, Robert M, Guiter J. Orthotopic bladder substitution by detubularized sigmoid using a new method of neovesico-urethral anastomosis. Br J Urol 1998; 81:623-7. [PMID: 9598641 DOI: 10.1046/j.1464-410x.1998.00561.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D Grasset
- Service d'Urologie, Hôpital Lapeyronie, Montpellier, France
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Boucher N, Seigneuric C, Grasset D, Nougué J, Morin T, Druart F, Guibert A. Influence de l'interféron sur l'évolution de la porphyrie cutanée tardive associée à l'hépatite C. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)90064-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Robert M, Marotta J, Rakotomalala E, Muir G, Grasset D. Piezoelectric extracorporeal shock-wave lithotripsy of lower pole nephrolithiasis. Eur Urol 1997; 32:301-4. [PMID: 9358217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the EDAP LT 02 lithotriptor for the treatment of lower pole nephrolithiasis. METHODS From January 1994 to September 1995, 91 patients presenting with solitary radiopaque calculi of the lower pole calix were treated by piezoelectric extracorporeal shock-wave lithotripsy (ESWL) with the EDAP LT 02. Among them, 82 were available for follow-up. The stones' largest diameter of these patients varied from 5 to 15 mm (mean = 8.1). Indications for ESWL were pain in 63 (77%), hematuria in 5 (6%), associated infection in 6 (7.5%) and stone size in 8 (10%) asymptomatic patients. Stone localization was assessed as very easy in 74 cases (90%) and difficult in 8 cases (10%) but no intraoperative IVP was needed. ESWL sessions were performed with intravenous sedo-analgesia in 69 cases (80%) and general anesthesia in 17 cases (20%). After ESWL we advised patients to combine a diuresis with postural drainage. RESULTS Most patients were treated with one session of ESWL: none required more that two (mean = 1.05). The mean hospital stay for one session was 1.2 +/- 0.7 days. Obstructive complication rate was 11% and auxiliary treatments were necessary in 6%. The stone-free rate of in situ piezoelectric ESWL monotherapy was overall 84%, and 95% of patients with pain were cured. CONCLUSION In the absence of abnormality of the upper urinary tract, the vast majority of small lower pole caliceal stones can be completely removed by piezoelectric ESWL without recourse to more invasive methods.
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Affiliation(s)
- M Robert
- Urology Department, Lapeyronie University Hospital, Montpellier, France
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Robert M, Drianno N, Marotta J, Delbos O, Guiter J, Grasset D. [The value of retrograde ureterorenoscopy in the treatment of bulky kidney calculi]. Prog Urol 1997; 7:35-41. [PMID: 9116736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the value of retrograde endoscopic lithotripsy for very large pyelocaliceal stones. MATERIAL AND METHODS Eighteen patients between the ages of 28 and 80 years (mean : 52) and presenting a staghorn renal calculus (n = 7) or with a maximal diameter greater than or equal to 20 mm (n = 11) were initially managed by rigid or flexible retrograde ureterorenoscopy, with ballistic (Lithoclast) or electrohydraulic (Riwolith) stone fragmentation. In 16 cases (89%), an additional extracorporeal shock-wave lithotripsy (ESWL) session was performed immediately after the endoscopic procedure. Early complications consisted of 3 cases of bacteraemic discharge rapîdly responding to medical treatment and 1 death from septic shock on the 8th postoperative day. Twelve patients (67%) were subsequently treated by ureteroscopy (n = 4) or ESWL (n = 11). RESULTS 17 patients were evaluated after this therapeutic procedure, with a follow-up of 3 to 6 months (mean : 4). Stone elimination was complete for 8 patients (47%), 3 of whom initially presented a staghorn calculus. A residual stone was observed in 9 cases (53%), with a maximal diameter < 5 mm in 7 cases (41%). One patient (5%) underwent secondary percutaneous nephrolithotomy. CONCLUSION Technological progress has clearly facilitated the ureteroscopic approach to very large pyelocaliceal stones, but fragmentation and stone elimination remain problematical. This unconventional approach constitutes a potential field of technical progress, but does not represent a really efficient alternative to PCNL at the present time.
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Affiliation(s)
- M Robert
- Service d'Urologie I, Hôpital Lapeyronie, Montpellier, France
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Robert M, Boularan AM, El Sandid M, Grasset D. Double-J ureteric stent encrustations: clinical study on crystal formation on polyurethane stents. Urol Int 1997; 58:100-4. [PMID: 9096271 DOI: 10.1159/000282959] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the crystalline composition of encrustations on double-J ureteric stents in order to prevent their formation on the base of urolithiasis prophylaxis. PATIENTS 40 patients had a polyurethane double-J ureteric stent inserted between June 1994 and March 1995. Group 1 comprised 22 stone formers whose stents were placed in support of endourological treatment or extracorporeal shock wave lithotripsy of renal or ureteric calculi. Group 2 comprised 18 patients whose stents were inserted for advanced and obstructive malignancy (n = 8) or as an adjunct to reconstructive surgery or endourological techniques (n = 10). After removal, stents were examined for encrustation and obstruction. A biochemical semiquantitative analysis was performed for deposits > 5 mg, and smaller sediments were examined with a polarizing optical microscope. RESULTS The incidence of encrustation was significantly higher (p = 0.009) for stone formers. In addition, in this group indwelling times of encrusted and obstructed stents were significantly shorter (p = 0.03 and 0.02, respectively). No particular relationship was found between the incidence of encrustation and indwelling times for stone formers. Conversely, for patients without urolithiasis, indwelling times were significantly longer for encrusted or obstructed stents than for unaffected ones (p = 0.05 and 0.02, respectively). Biochemical and optical analyses of encrustations mainly revealed calcium oxalate, calcium phosphate and ammonium magnesium phosphate. Calcium oxalate was the main crystalline phase, especially in the absence of urinary infection. CONCLUSION Calcium oxalate represents the principal component of double-J ureteric stent encrustations. Thus, prophylaxis of encrustation may consist of preventive measures usually applied in cases of recurrent idiopathic calcium oxalate urolithiasis.
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Affiliation(s)
- M Robert
- Urology Department, Lapeyronie University Hospital, Montpellier, France
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Robert M, Burgel JS, Serre I, Guiter J, Grasset D. [Urethral recurrence after cysto-prostatectomy for bladder tumor]. Prog Urol 1996; 6:558-63. [PMID: 8924933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the frequency, predictive parameters and prognosis of urethral recurrence after cystoprostatectomy for urothelial bladder cancer. MATERIAL AND METHODS From 1989 to 1994, 8 of a series of 185 patients (4.3%) treated by cystoprostatectomy for bladder carcinoma between 1988 and 1993 developed urethral recurrence revealed by urethral bleeding, with a follow-up of 6 to 36 months (m = 16). RESULTS The initial bladder tumour was localized in 3 cases and multifocal in 5 cases. The posterior urethra was not involved in 5 cases, but presented lesions of CIS in 1 case and neoplastic infiltration also involving the prostate in 2 cases. These recurrences were treated by urethrectomy, as first-line treatment in 7 cases and after failure of endoscopic treatment in 1 case. A balanic recurrence required distal penectomy following insufficient urethral resection. The course was very rapidly unfavourable for 3 patients with generalized cancer and an intercurrent disease was fatal in 1 other case. With a follow-up of 12 to 44 months (m = 26), 4 patients are alive with no obvious signs of disease progression. CONCLUSION The indications for prophylactic urethrectomy can be reserved to patients with positive urethral resection margins, provided all other cases are submitted to strict surveillance. In the context of a replacement bladder, it is essential to exclude neoplastic involvement of the posterior urethra or prostate, especially in patients previously treated by intravesical instillations.
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Affiliation(s)
- M Robert
- Service d'Urologie I, Hôpital Lapeyronie, Montpellier, France
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Selves J, Meggetto F, Brousset P, Voigt JJ, Pradère B, Grasset D, Icart J, Mariamé B, Knecht H, Delsol G. Inflammatory pseudotumor of the liver. Evidence for follicular dendritic reticulum cell proliferation associated with clonal Epstein-Barr virus. Am J Surg Pathol 1996; 20:747-53. [PMID: 8651355 DOI: 10.1097/00000478-199606000-00013] [Citation(s) in RCA: 132] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe an "inflammatory pseudotumor" of the liver that, which on detailed investigation, proved that the spindle-cell component of this lesion is derived from follicular dendritic reticulum cells (FDRC). This contention is supported by morphologic observations and by immunophenotype. The FDRC population contain Epstein-Barr virus (EBV). It is known that FDRC express the EBV receptor CD21. In this particular case, the FDRC contained clonal EBV genomes, EBV RNA (EBER) transcripts, and expressed EBV latent membrane protein (LMP1). DNA sequencing of PCR products showed three point mutations compared with the standard LMP1 sequence of the EBV strain B95-8. The findings in this case corroborate those of other investigators concerning the possible role of EBV in the development of some inflammatory pseudotumors, including the recent production of functionally active EBV-transformed FDRC-like cell lines. This association could prove instructive in delineating the histogenesis of these tumors and further assist in making prognostic and therapeutic decisions.
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Affiliation(s)
- J Selves
- Anatomical Pathology Laboratory, CHU Purpan, France
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19
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Robert M, Serre I, Bennani A, Iborra F, Guiter J, Averous M, Grasset D. [Fibroepithelial polyps of the ureter and the kidney pelvis. Report of 3 cases]. Prog Urol 1996; 6:282-7. [PMID: 8777425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors report 3 cases of fibroepithelial polyps, one of which was an incidental finding and 2 were symptomatic, presenting in the form of macroscopic haematuria and chronic back pain, respectively. These lesions required 2 nephroureterectomies because of their renal repercussions or their multifocal nature, combined with segmental resection of the ureter, including the base of the tumour. In the light of these cases, the authors review the literature and analyse the current management of this rare disease, in particular the indications for endourological techniques which appear to have a major diagnostic contribution as a complement to IVU and retrograde urography, but whose therapeutic value has yet to be defined.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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20
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Robert M, Boularan AM, Delbos O, Monnier L, Grasset D. Evaluation of the risk of stone formation: study on crystalluria in patients with recurrent calcium oxalate urolithiasis. Eur Urol 1996; 29:456-61. [PMID: 8791054 DOI: 10.1159/000473796] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the usefulness of the morning calcium oxalate crystalluria in detecting stone formers particularly prone to recurrence. METHODS Over a 24-hour period of urine collection, the morning calcium oxalate crystalluria was evaluated as well as the risk of stone formation, established with Tiselius and Parks indices, for 25 recurrent stone formers (group 1) and 25 normal controls (group 2). RESULTS Morning crystalluria (type, size, number/ml and state of aggregate) and the Tiselius index were comparable in the two groups. Conversely, calciuria as well as the citrate/ calcium ratio and the Parks index varied significantly for stone formers and normal controls. No particular correlation appeared between crystalluria and indices of Tiselius and Parks, calciuria, calcium-oxalate product or calcium/ oxalate and citrate/calcium ratios. CONCLUSIONS Morning calcium oxalate crystalluria does not enable an efficient characterization of recurrent stone formers. Its discordance with others potential indicators of the risk of stone formation poses the problem of their respective validity and evokes the prevalence of still unknown inhibiting agents in the phenomenon of crystallization.
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Affiliation(s)
- M Robert
- Department of Urology, Hôpital Lapeyronie, Montpellier, France
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21
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Robert M, Drianno N, Guiter J, Averous M, Grasset D. Childhood urolithiasis: urological management of upper tract calculi in the era of extracorporeal shock-wave lithotripsy. Urol Int 1996; 57:72-6. [PMID: 8873360 DOI: 10.1159/000282882] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the management of urolithiasis in children since the development of extracorporeal shock-wave lithotripsy (ESWL). METHODS Between 1988 and 1994, 37 children, aged from 2 to 15 years (mean 10), with upper tract urolithiasis were evaluated and treated. Lithogenic metabolic disorders or anomalies of the urinary tract were present in 11 children (30%) Urolithiasis was multiple in 9 cases and bilateral in 2 cases. A total of 47 renal (30) or ureteral (17) stones were managed, of which 5 were partial or complete staghorn calculi. Initial treatment was surgery in 4 cases (1 nephrectomy, partial nephrectomy and 2 pyelolithotomies) and piezoelectric ESWL in 43 cases. RESULTS The overall ESWL success rate was 82.2%, with auxillary endoscopic procedures in 3 cases. ESWL failures required surgical stone removal in 5 cases, endoscopic ureterolithotripsy in 1 case and electrohydraulic ESWL in 1 case. Residual fragments after pyelolithotomies were also treated by ESWL. CONCLUSION ESWL is the mainstay of treatment of childhood upper tract urolithiasis, but other therapeutic methods retain specific indications. Its application requires great vigilance and its long-term effects are uncertain. It is therefore important to rule out any underlying pathology and where possible to prevent further stone formation.
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Affiliation(s)
- M Robert
- Department of Urology, Lapeyronie University Hospital, Montpellier, France
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22
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Abstract
OBJECTIVE To evaluate the efficacy of the EDAP LT 02 lithotripter for the in situ treatment of ureteric calculi. PATIENTS AND METHODS One hundred consecutive patients presenting with ureteric calculi were treated with in situ piezoelectric extracorporeal shock wave lithotripsy (ESWL) using the EDAP LT 02 lithotripter. There were 49 patients with upper, nine with mid and 42 with lower ureteric stones. The largest diameter of the stones varied from 7 to 21 mm (mean 9.6 mm). Mild or severe hydronephrosis was present in 53 cases. Mid and lower ureteric stones were treated with the patients in the prone position, with no anaesthesia or pre-medication, and upper ureteric stones in the supine position, with intravenous sedation in 44 cases. RESULTS Localization of the stones was easy in 81 cases and more difficult in 19, but an intravenous pyelogram was only necessary in three cases. The number of sessions per patient varied from 1 to 3 (mean 1.17). Complete success rate was achieved in 75% of patients and partial success (residual stones < or = 3 mm) in 6%. The stone-free rate was statistically affected by stone size but was independent of stone localization or the degree of obstruction. The rate of infective and obstructive complications was 14% and auxiliary treatments were necessary in 5% of patients. CONCLUSION In situ piezoelectric ESWL with the EDAP LT 02 device is a convenient and efficient method for the treatment of ureteric stones.
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Affiliation(s)
- M Robert
- Urology Department, Lapeyronie University Hospital, Montpellier, France
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23
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Robert M, Bennani A, Ohanna F, Guiter J, Avérous M, Grasset D. The management of upper urinary tract calculi by piezoelectric extracorporeal shock wave lithotripsy in spinal cord injury patients. Paraplegia 1995; 33:132-5. [PMID: 7784114 DOI: 10.1038/sc.1995.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
From May 1988 to September 1994, 15 spinal cord injury patients were treated by piezoelectric extracorporeal shock wave lithotripsy. Aged from 23 to 71 years (mean = 39), they presented with a total of 23 stones, of which 18 were located in the calyces, three in the renal pelvis and two in the proximal ureter. The maximum dimensions of calculi varied from 5 to 35 mm (mean = 11). Patients were placed in a dorsal decubitus position during the sessions, three being sedated with diazepam, while the other 12 remained unsedated. All were treated routinely with systemic antibiotics. Auxiliary procedures consisted of two pyelocalyceal flushings, three double J ureteral stenting and three ureteroscopies with fragment removal with a Dormia basket. No episode of autonomic dysreflexia was observed. Short term side effects were limited to a few cases of gross haematuria which regressed spontaneously. Overall, eight successes (53%), and seven failures (47%), were registered. Of the failures, one was the result of a partial fragmentation, while six were related to intrarenal retention of residual fragments resulting in four cases in rapid recurrences. Extracorporeal shock wave lithotripsy can be easily applied to spinal cord injury patients. Its usefulness and limitations need to be well understood and a global consideration must be applied to the prevention and early detection of the upper urinary calculi in this exposed population of patients.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier, France
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Vantaux P, Grasset D, Nougué J, Metivier S, Seigneuric C. Porphyrie cutanée tardive et hépatite chronique C. Évolution sous interféron. Rev Med Interne 1995. [DOI: 10.1016/0248-8663(96)86634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Robert M, Roux JO, Boularan AM, Bourelly F, Monnier L, Grasset D. Idiopathic calcium oxalate urinary lithiasis: usefulness of Parks' and Tiselius' indices in the evaluation of the risk of stone formation. Urol Int 1995; 55:88-92. [PMID: 8533202 DOI: 10.1159/000282758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Different indices of the risk of urinary calcium oxalate crystallization were compared to determine their usefulness in detecting the stone-formers particularly prone to recurrence. Urine volume and calcium, oxalate, citrate, magnesium or creatinine were determined in 55 patients presenting with an idiopathic calcium oxalate urolithiasis, as well as in 50 control subjects. On 24-hour urine samples, these elements allowed for the calculation and comparison of different indices of lithogenous risk as proposed by Parks and Tiselius. Both Parks' indices and the urinary citrate-calcium ratio varied significantly between the two groups, but conversely Tiselius' indices were statistically comparable. The three Tiselius' indices taking the 24-hour urine volume into account were also strongly correlated. Parks' index and the urinary citrate-calcium ratio are highly discriminating and potentially relevant to select the stone-formers with a high risk of relapse. Tiselius' indices basically reflect urinary calcium oxalate saturation, and can only be used clinically to control the treatment interfering with this. In this respect, the formula based simply on urine volume, calcium and oxalate over 24 h (Ca0.71.Ox.V-1.2) appears to be sufficient.
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Affiliation(s)
- M Robert
- Urology Department, Hôpital Lapeyronie, Montpellier, France
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26
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Robert M, Souaiby N, Guiter J, Avérous M, Grasset D. [Long-term results of Burch's cervico-cystopexy. Apropos of 40 cases]. Prog Urol 1994; 4:555-60. [PMID: 7920729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Forty patients with stress urinary incontinence, treated between April 1982 and June 1988 according to Burch's technique, were reviewed. 24 (60%) successes, 8 (20%) major improvements and 8 (20%) failures were recorded with a mean follow-up of 85 months. Compared to the early postoperative findings, a marked deterioration in urinary continence was observed in 4 cases (10%). These results are in contrast with earlier papers reporting remarkable stability of the therapeutic performance of this type of cervicocystopexy. Although too brief to allow reliable statistical analysis, this series simply draws attention to the hypothetical long-term efficacy of Burch's operation.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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27
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Robert M, Villéna P, Guiter J, Avérous M, Grasset D. [Piezo-electric extracorporeal lithotripsy of non-coralliform kidney calculi with a maximal measurement of greater than or equal to 25 mm. Apropos of 25 cases]. Prog Urol 1994; 4:234-9. [PMID: 8199630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
From June 1991 to April 1993, 25 non-staghorn renal stones with a maximal diameter greater than or equal to 25 mm were treated by piezoelectric extracorporeal lithotripsy (EDAP LT 01). The complete success rate was 56% after 1 (16%), 2 (12%), 3 (16%) or 4 sessions (12%). 14 double J ureteric stents were implanted (56% of cases) and 4 complications were observed (2 cases of acute pyelonephritis and 2 cases of ureteric silting). These results were inferior to those obtained with percutaneous surgery, but help to define the potential indications of extracorporeal shock-wave lithotripsy. This treatment modality can therefore be applied to large friable weddellite or even struvite stones, particularly when the anatomical conditions are unfavourable for percutaneous surgery.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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28
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Robert M, Bennani A, Chevallier P, Guiter J, Avérous M, Grasset D. [Early postoperative complications of rigid uretero-renoscopy: screening for iatrogenic vesico-ureteral reflux. 30 cases]. Prog Urol 1994; 4:51-5. [PMID: 8186794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
From April to September 1992, systematic screening for iatrogenic vesicoureteric reflux was performed in a series of 30 patients treated by rigid ureterorenoscopy. Most of these endoscopies were performed for renal stones using a Wolff Multiscope (7.5/12 F) without prior dilatation of the urinary tract. The study protocol was essentially based on pre- and postoperative retrograde and voiding cystography. The site and tone of the ureteric orifice and the compliance of the intramural ureter were also evaluated and the operating time was determined. Out of 33 ureteric endoscopies, only one case of type I pelvic vesicoureteric reflux was demonstrated following an operation with no particular technical problems. This rare and benign deferred complication draws attention to the potential consequences of rigid ureterorenoscopy on the vesicoureteric antireflux device.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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29
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Abstract
From May 1992 to October 1993, 150 ureteral stones, impervious to piezoelectric extracorporeal shock wave lithotripsy (ESWL) with ultrasound localization (EDAP LT.01), were treated with the Lithoclast. The maximum dimensions varied from 5 to 25 mm with a mean of 11 mm. 46 calculi were situated in the pelvic ureter, 82 in the abdominal ureter, and 22 were stuck in the ureteropelvic junction. There was no complete failure of fragmentation, but 39 abdominal calculi (48%) required additional treatment by ESWL due to migration of the fragments into the calyces. Apart from a few needle-sized perforations, ureteral tissue was not damaged by the Lithoclast. The use of this endoscopic lithotripter, which is highly efficient and painless, is, however, limited by the significant effect of retrograde propulsion of very mobile stones or fragments in the urinary tract.
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Affiliation(s)
- M Robert
- Department of Urology, La Peyronie Hospital, Montpellier, France
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30
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Robert M, Lavabre-Bertrand T, Guiter J, Averous M, Grasset D. [Urologic manifestation of Waldenström's disease. Apropos of a case with pyelo-ureteral location]. Prog Urol 1993; 3:666-70. [PMID: 8401628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The authors report a case of Waldenström's disease in which the initial staging assessment reveals an isolated tumour of the left upper urinary tract. Combination chemotherapy (6 courses of protocol M2) induced a marked reduction in the monoclonal IgM peak and in the tumour mass. In the light of this atypical case, which emphasises the diversity of the potential sites of Waldenström's macroglobulinaemia, the authors review its potential for progression and the various therapeutic modalities available.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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31
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Robert M, Bennani A, Chevallier P, Guiter J, Averous M, Grasset D. [Ballistic (Lithoclast) and hydro-electric (Riwolith) endo-ureteral lithotripsy. Report of 60 cases]. Prog Urol 1993; 3:438-43. [PMID: 8369822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
25 hydroelectric endoureteric lithotripsies (Group 1, Riwolith) and 35 ballistic endoureteric lithotripsies (Group 2, Lithoclast) were analysed. 60 stones were treated, including 18 pelvic stones (Group 1 : 10, Group 2 : 8), 39 iliolumbar stones (Group 1 : 14, Group 2 : 25), and 3 stones of the ureteropelvic junction (Group 1 : 1, Group 2 : 2). The mean maximal diameter was 9.9 mm (Group 1 : 8.2, Group 2 : 11). Complementary Dormia extraction was performed in 24 cases (Group 1 : 8, Group 2 : 16), 55 double J stents were implanted (Group 1 : 24, Group 2 : 31) and 23 immediate ECL sessions were performed (Group 1 : 8, Group 2 : 15). Overall, 57 good results were recorded, but 3 complete failures of fragmentation and 2 severe ureteric lesions were attributed to hydroelectric lithotripsy. The Lithoclast, much less traumatic, had a greater stone fragmentation potential, but its efficacy on very mobile stones is limited due to its more intense stone propulsion effect.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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32
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Robert M, Averous M, Besset A, Carlander B, Billiard M, Guiter J, Grasset D. Sleep polygraphic studies using cystomanometry in twenty patients with enuresis. Eur Urol 1993; 24:97-102. [PMID: 8365450 DOI: 10.1159/000474272] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Polygraphic exploration during sleep using cystomanometry was performed in 20 patients aged 7-17 years with primary (17) or secondary (3) enuresis. In this group of patients, 9 presented with isolated nocturnal enuresis while 11 patients had associated diurnal micturition troubles. During this study we documented 24 episodes of enuresis. There was no disturbance in sleep architecture or correlation between the uncontrolled micturition and any particular state or stage of sleep. Most episodes of enuresis occurred in a unique pattern in which a sudden or progressive intravesical increased pressure was associated with an awakening reaction. From a physiopathologic point of view, our findings are in favor of immaturity of the central system of inhibition of micturition reflex during sleep.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier, France
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Robert M, Averous M, Serre I, Iborra F, Guiter J, Grasset D. [Leiomyosarcoma of the inferior vena cava]. Prog Urol 1992; 2:1018-22. [PMID: 1302125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The authors report a case of leiomyosarcoma of the infrarenal inferior vena cava presenting as an abdominal mass. CT and MR imaging and immunotyping led to the diagnosis of retroperitoneal leiomyosarcoma whose origin in the inferior vena cava was only confirmed by histological examination of the resection specimen. Surgical resection was followed by radiotherapy (4,500 rads) with a favourable course after 12 months. The progress in medical imaging and histology has considerably simplified the diagnosis of these rare retroperitoneal tumours. In the absence of any truly effective adjuvant therapy, treatment essentially consists of surgery and the clinical course is characterised by a high incidence of local recurrences.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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Robert M, Morin D, Averous M, Guiter J, Dumas R, Grasset D. [Piezoelectric extracorporeal lithotripsy in children: first results and reflections after 18 sessions]. Prog Urol 1992; 2:402-8. [PMID: 1302078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
From 1988 to 1990, we treated 13 children between the ages of 2 and 15 years with stones of the upper urinary tract. These stones were treated by means of 18 sessions of piezoelectric extracorporeal lithotripsy: 14 under general anaesthesia and 4 without even any analgesia. We obtained an 84.5% success rate with no particular adverse effects. These results are similar to those reported for hydroelectric or electromagnetic shock wave lithotripsy, which are associated with a higher morbidity. The efficacy of extracorporeal lithotripsy in paediatrics is remarkable, but clinical studies in adults as well as animal experimentations have demonstrated severe renal contusion and do not formally exclude the possibility of delayed complications. At the present time, this technique should therefore be used very cautiously and must be accompanied by systematic prevention of recurrent stones.
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Affiliation(s)
- M Robert
- Clinique Urologique, Hôpital Lapeyronie, Montpellier
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Robert M, Averous M, Guiter J, Grasset D. [Endo-urologic treatment of ureteral fistulas occurring after pelvic surgery for carcinoma: report of 5 cases]. Prog Urol 1992; 2:436-41. [PMID: 1302083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The authors report 5 cases of ureteric fistula after radical pelvic cancer surgery. Three patients had a recurrent tumour and 3 had received radiotherapy. Endourological methods achieved 4 immediately satisfactory results, but only one complete long-term success. Isolated percutaneous drainage of the pyelocaliceal cavities effectively dried up the urine leak, but carried a high risk of secondary stenosis of the excretory tract in the absence of concomitant intubation of the fistula zone. However, endourological treatment, combined with urinary diversion and catheterisation of the pathological ureter, represented a reliable alternative to conventional surgery.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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Robert M, Averous M, Galifer RB, Guiter J, Grasset D. [Abdominal injuries in children. Diagnosis and treatment of renal lesions. Apropos of 26 cases]. J Chir (Paris) 1992; 129:88-94. [PMID: 1601937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
During the past ten years, we have treated 26 children with closed renal injuries. Hematuria appeared in 19 cases, but was not detected in 7 other cases, 6 of which corresponded to severe, especially pedicular, lesions. The diagnostic means for the lesion included IVP in 24 cases, ultrasonography in 23, angiography in 8 and computed tomography in 7. The treatment was medical for 18 children and surgical for 8. Observation revealed 4 cases of renal atrophy, including 1 of general atrophy without residual arterial hypertension. On the basis of this series and of a review of the literature, we study the evolution of the diagnosis and treatment of this condition with the development of new medical imaging techniques, especially of CT.
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Affiliation(s)
- M Robert
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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Bouillier-Oudot M, Bozzolo G, Phrem G, Manse H, Grasset D, Coutaud JM. Optimisation du jugement de la fermeté du gras de couverture des carcasses d'agneaux de bergerie. ACTA ACUST UNITED AC 1992. [DOI: 10.1051/animres:19920206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Grasset D. [Urology in Montpellier, from the beginning to our days]. Prog Urol 1991; 1:1083-94. [PMID: 1844744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D Grasset
- Clinique Urologique-Hôpital Lapeyronie, Montpellier
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Rébillard X, Mourad G, Cristol JP, Daurès JP, Iborra F, Guiter J, Mion C, Grasset D. [Prognostic factors of success in renal transplantation]. Presse Med 1991; 20:1985-8. [PMID: 1837105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
From January 1984 to January 1989, 139 kidneys were retrieved from 74 brain dead donors in our institution. The transplantation was performed either locally (79), or in an other French institution (40). The five year actuarial survival rate, for the 139 kidneys retrieved in Montpellier, was 65 percent. Many factors about the donor, the retrieval and the recipient, which may affect the graft survival, were entered in a Cox multivariate analysis. The minimal follow up duration was 18 months. The risk factors studied included: donor parameters (age, sex, cause of death, haemodynamic parameters and renal function); retrieval parameters (kidney alone or multiorgan harvesting, discoloration and renal perfusion quality); organ characteristics (multiple arteries and cold ischemia time); recipients parameters (age, sex, prior transplantation, local transplantation or not, and HLA matching). A first multivariate analysis included only pretransplant risk factors. The risk factors for graft loss, as identified by the Cox model, were in the order: donor's age (P = 0.03), arterial pressure (P = 0.01), prior transplantation of the recipient (P = 0.01) and kidney discoloration quality during the retrieval (P = 0.008). Early post transplant parameters were included within this Cox model (poor early renal function, need for dialysis, serum creatinine level at one week). The need for dialysis therefore was identified as the main predictive value (P = 0.002). The 4 other risk factors, selectioned in the first model, always remained significant.
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Affiliation(s)
- X Rébillard
- Service d'Urologie, Hôpital Lapeyronie, Montpellier
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40
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Avérous M, Robert M, Billiard M, Guiter J, Grasset D. [Urination control during sleep]. Rev Prat 1991; 41:2282-7. [PMID: 1792487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors present their approach to the sleep factor in children with enuresis, based on a still on-going exploration of manometric changes in bladder activity. Twenty patients have already been examined by cystomanometry in day time and polygraphic sleep recording at night, combined with continuous measurement of bladder pressure. This method derives from the studies of Gastaut and Broughton, in 1963, but takes into account the concept of bladder immaturity. The patients studied fell into two homogeneous groups, depending on whether enuresis was obviously due to bladder immaturity (Group I) or was strictly isolated (Group II). No disorder of sleep organization has been found in none of these two groups, but both had apparently nonspecific irritant factors. The enuresis episode is described. It tends to occur frequently at the beginning of the night, is prepared by an increase in bladder pressure which is always very pronounced in Group I subjects, and is associated with insufficient awakening reaction due to an apparently exceedingly high awakening threshold. The physiopathological and therapeutic implications of these findings are discussed.
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Affiliation(s)
- M Avérous
- Service d'urologie, hôpital Lapeyronie, Montpellier
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41
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Grasset D. [Epididymitis. Etiology, diagnosis, course prognosis, principles of treatment]. Rev Prat 1991; 41:271-3. [PMID: 2006388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D Grasset
- Clinique urologique, Hôpital Lapeyronie, Montpellier
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Veyrac M, Fedkovic Y, Grasset D, Michel H. [Extracorporeal lithotripsy in gallbladder calculi. Results of a single-center experience of 31 patients]. Ann Gastroenterol Hepatol (Paris) 1990; 26:101-4. [PMID: 2193597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors studied thirty one cases (18 women, 13 men) of extracorporeal shock-waves lithotripsy on symptomatic gallbladder stones realized with piezoelectric generators. There were one to six stones per patient with individual stone size from 8 to 40 mm; among them 16% were calcified. Any anesthesia was necessary. Shock-wave frequency was 1.25 and 2.5 Hz. The average number of shock waves administered was 4,600 per treatment. Fragmentation occurred in 67% after first treatment and in 74% after second treatment. Gallstones disappeared in 9.5% and 19.5% of patients after 6 weeks and 4 months respectively. There was no modification after four treatments in 22.5% of patients. Minor side effects were noted: back pain (29%) probably because of uncomfortable position during treatment; increased thickness of gallbladder wall (26%); biliary pain (22%). Two episodes of biliary tract obstruction by stone fragments (one mild pancreatitis, one jaundice with liver enzymes elevation) disappeared spontaneously. These results were comparable with those of other groups using the same shock waves lithotripter.
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Affiliation(s)
- M Veyrac
- Service des Maladies de l'Appareil Digestif, Hôpital Saint-Eli, Montpellier
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Grasset D. [First cystomanometries]. Rev Prat 1990; 40:467-8. [PMID: 2408133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- D Grasset
- Clinique Urologique, hôpital Lapeyronie, Montpellier
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Bozzolo G, Bouillier-Oudot M, de Boisseson E, Ghassan M, Grasset D. Influence des performances zootechniques sur les caractéristiques des tissus adipeux d'agneaux de bergerie, sevrés précocement et alimentés avec un régime à forte concentration énergétique. ACTA ACUST UNITED AC 1990. [DOI: 10.1051/animres:19900201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Calès P, Grasset D, Ravaud A, Meskens C, Blanc M, Vinel JP, Cotonat J, Pascal JP. Pharmacodynamic and pharmacokinetic study of propranolol in patients with cirrhosis and portal hypertension. Br J Clin Pharmacol 1989; 27:763-70. [PMID: 2569324 PMCID: PMC1379803 DOI: 10.1111/j.1365-2125.1989.tb03438.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
1. The aim of this study was to investigate the pharmacokinetics and the beta-adrenoceptor blocking activity according to time of conventional (C) and long acting (LA) propranolol in cirrhotic patients. Twenty-four patients with alcoholic cirrhosis and oesophageal varices were randomly assigned to receive either 160 mg C propranolol, 160 mg LA propranolol or placebo acutely and then following repeated administration (acute and chronic phases). Thereafter propranolol concentrations and beta-adrenoceptor blockade (resting and exercise heart rates) were measured at different intervals. 2. The Cmax was significantly higher with C propranolol in both phases. The time of Cmax was significantly later with LA propranolol in both phases. The AUCs were significantly higher after chronic administration with both formulations of propranolol. 3. The exercise peaks of beta-adrenoceptor blockade were similar between the two formulations and between the two phases of administration of propranolol. The duration of effective beta-adrenoceptor blockade was significantly longer in the chronic phase and seemed to be longer with LA than with C propranolol although this was not significant (72 +/- 31 vs 48 +/- 18 h, respectively). 4. There was a significant correlation between the log propranolol concentration and exercise heart rate but not with resting heart rate. No correlation could be demonstrated between pharmacological data and the Child Pugh score. 5. We conclude that in cirrhotic patients exercise testing was a reliable method in the assessment of beta-adrenoceptor blockade. Pharmacology of propranolol was found to be different according to the formulation or to the phase of administration.
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Affiliation(s)
- P Calès
- Service d'Hépato-Gastroentérologie, CHU Purpan, Toulouse, France
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Blanc M, Cales P, Grasset D, Ravaud A, Meskens C, Cotonat J, Pascal JP. [Study of bioavailability parameters of propranolol in cirrhotic patients after oral administration of the delayed-action form]. Therapie 1987; 42:187-91. [PMID: 3616995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lamarque JL, Rouanet JP, Pujol J, Lestienne H, Prosmanne O, Benhaim M, Grasset D, Vavdin F, Guitter J. Magnetic resonance imaging of prostato-vesical obstruction. Rays 1986; 11:23-31. [PMID: 3602461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Denoyel P, Cales P, Grasset D, Huguet-Rigal F, Vinel JP, Pascal JP. [Acute severe pancytopenia due to triamterene in alcoholic cirrhotic patients: failure to recognize the pharmacology of triamterene?]. Gastroenterol Clin Biol 1985; 9:746. [PMID: 4065498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Grasset D, Guillaume A, Cuenant E. [Cystometry and female incontinence]. Acta Urol Belg 1984; 52:171-3. [PMID: 6720467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Jardin A, Brisset JM, Grasset D. [Surgical treatment of reno-ureteral lithiasis]. Rev Prat 1981; 31:2499-502, 2505-6, 2509. [PMID: 7280526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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