Publications (45)52.59 Total impact
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Article: [Evaluation of a nurse educational program for intracavernous alprostadil injections after radical prostatectomy].
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ABSTRACT: To evaluate a nurse educational program for penile rehabilitation after radical prostatectomy (RP) based on intracavernous alprostadil injection (IAI). One hundred consecutive patients started IAI one month after RP under the supervision of a nurse practitioner (day 0). Patients performed the first injection (2.5 μg); they were advised to increase gradually the dose of alprostadil until having satisfactory erections. Patients having difficulties with IAI were called back by the nurse. They received a medical follow-up at the uro-oncology department at 6 months. We assessed at D0, D15 and at 6 months: the ability to complete the IAI, the occurrence of priapism, the injected doses, the recovery of sexual function (EHS and GAQ scores), and pain in erection (numeric rating scale). Eighty-one percent of patients were very satisfied with the educational program. On day 15, 93% of patients achieved IAI (mean injected dose: 5.2 μg). No priapism was noted. The treatment had ameliorated erections in 80% of cases (GAQ); 47% of patients had erections hard enough to allow penetration (EHS>2) and 39% had sexual intercourses. Pain to erection (3.9/10 on average) represented a motive of request for recall for 2/3 of the patients. At 6 months, the dropout rate was 31%; mean pain level, EHS score and injected dose were respectively 3.2/10, 2.9/4 and 8.8 μg. The nurse educational program for penile rehabilitation after RP was associated with satisfactory rates of self-injection accomplishment and treatment observance. However, close and prolonged follow up was necessary because of post-IAI penile pain.Progrès en Urologie 04/2011; 21(4):283-7. · 0.58 Impact Factor -
Article: Comparative expression of Hedgehog ligands at different stages of prostate carcinoma progression.
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ABSTRACT: Recent studies have revealed the potential involvement of Hedgehog (Hh) signalling in proliferation and invasive behaviour of prostate carcinoma (PCa). The aim of this study was to specify the role of Sonic Hh (Shh), Desert Hh (Dhh) and Indian Hh (Ihh) in the natural history of PCa. Hh ligands expression was compared in primary hormone-naive PCa (HNPC), hormone-treated PCa (HTPC) and hormone-refractory PCa (HRPC), using immunohistochemistry. Shh and Dhh were expressed by both epithelial and stromal cells of prostate tissues. Ihh was only expressed by stromal cells. For the three ligands, mRNA and immunostaining were not correlated. In HNPC, Shh epithelial expression was significantly associated with high Gleason scores (p = 0.03), metastatic lymph nodes (p = 0.004) and Dhh epithelial staining was associated with high pT stages (p = 0.003), seminal vesicle invasion (p = 0.03) and bladder neck invasion (p = 0.0008). Negative Shh staining in stromal cells was associated with high Gleason scores (p = 0.015), high pT stages (p = 0.01) and bladder neck invasion (p = 0.04). Concomitant absence of Shh and Dhh expression in stromal cells was an independent prognostic parameter for biological recurrence on multivariate analysis (p = 0.01). Epithelial expression of Shh and Dhh was increased in HTPC compared to HNPC (p = 0.02 and p = 0.04). Interestingly, in vitro, transcript analysis also showed increased expression of these 2 Hh ligands when androgen-sensitive LNCaP cells were maintained in androgen-free medium mimicking hormonal therapy. Epithelial expression of Dhh was increased (p < 0.0001) in HRPC compared to HNPC, while stromal expression of Shh and Dhh was decreased (p < 0.0001). In conclusion, the Hh signalling pathway is associated with pejorative pathological parameters in HNPC and is up-regulated in epithelial cells of HTPC and HRPC. Moreover, the lack of Hh molecules in stromal cells seems to be associated with invasive and hormone-refractory behaviours and suggests specific changes in stromal-epithelial crosstalks during PCa progression.The Journal of Pathology 09/2008; 216(4):460-70. · 6.32 Impact Factor -
Article: Immunologic events and long-term survival after combined heart and kidney transplantation: a 12-year single-center experience.
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ABSTRACT: In this study we compare the incidence of cardiac rejection and long-term survival after combined heart and kidney transplantation (HK) and single heart transplantation (H). Combined HK transplantation is a surgical option for patients with irreversible cardiac and renal failure. However, long-term results of combined HK transplantation on immunologic events and patient survival remain unknown. Between 1988 and 1997, 12 consecutive patients underwent combined HK transplantation (HK group) at a single institution. A control group (H group) of 24 single heart transplant recipients operated on within the same period was matched for age, pre-operative pulmonary vascular resistance, hepatic insufficiency and gender mismatch. Recipients and donors were ABO compatible without HLA antigen matching. All patients received immediate triple immunosuppression that included cyclosporine. Because of early renal dysfunction, cyclosporine was switched to anti-thymocyte globulin in 5 patients from the HK group and in 1 patient from the H group (p = 0.01). Actuarial freedom from heart rejection at 6 months and at 1 year following transplantation averaged 90 +/- 9% and 70 +/- 14% in the HK group, and 65 +/- 10% and 49 +/- 11% in the H group, respectively (p = 0.023). Actuarial survival at 1, 5 and 12 years was not significantly different between groups, at 66%, 55% and 28% in the HK group, and 66%, 44% and 32% in the H group, respectively (p = 0.66). The incidence of cardiac rejection was significantly lower. Long-term survival in the HK group was similar to that in the H group. Putative mechanisms of decreased cardiac rejection in the HK group include allogeneic stimulation, donor-derived dendritic cells and induction by anti-thymocyte globulins. The need for long-term immunosuppression may be reduced after combined heart and kidney transplantation.The Journal of Heart and Lung Transplantation 11/2001; 20(10):1084-91. · 4.33 Impact Factor -
Article: Immunologic events and long term survival after combined heart and kidney transplantation : a twelve-year single-center experience.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 03/2001; 20(2):247. · 3.54 Impact Factor -
Article: Hormone-refractory prostate cancer: a multi-step and multi-event process.
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ABSTRACT: Since the pioneering studies of Huggins in 1941, it has been known that prostate cancer cells, like certain normal epithelial cells, can chronically depend on a critical level of androgenic stimulation for their continuous growth and survival. The entire issue of the development of resistance to androgen ablation therapy for metastatic prostate cancer is based on the fact that a portion of cells can survive without androgen stimulation. The cell mechanism of androgen independent status is unclear. For some authors, a portion of the cells present within a patient with a prostate cancer before therapy is naturally androgen independent (selection hypothesis). However, this hypothesis does not consider gene alteration during prostate cancer natural history and probably hormone-refractory prostate cancer (HRPC) is due to a multi-step and multi-event process. In this literature review, different cell pathways that lead to HRPC are described.Prostate Cancer and Prostatic Diseases (2001) 4, 204-212.Prostate cancer and prostatic diseases 02/2001; 4(4):204-212. · 2.10 Impact Factor -
Article: Small intestine protection from radiation by means of a removable adapted prosthesis.
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ABSTRACT: A prosthesis has been designed to protect intestinal loops from radiation when postsurgical radiotherapy is necessary in cancer treatment. It is a silicone balloon that allows the small bowel to be pushed back away from the radiation field, and it is easily removed at the conclusion of radiotherapy. The device was used in 22 patients: 5 retroperitoneal tumors and 17 pelvic cancers. After surgical resection of the tumor, the device is placed either in the retroperitoneal area or in the pelvic cavity. A polyglactine 910 mesh is placed between the spacer and the bowel to prevent incarceration of the loops. The prosthesis can be filled or emptied between each radiation course and finally removed by means of a short incision under local or locoregional anesthesia. The tolerance of the small intestine to radiation therapy has been satisfactory in each case, with a mean follow-up of 24.5 months (range 10 to 73). No modification of biological parameters was observed during the pelvic radiation therapy at 30, 45, and 65 Gy. This device should appears to efficient for prevention of bowel injury during postsurgical radiation in successful treatment of abdominal, pelvic, or retroperitoneal tumors when indicated.The American Journal of Surgery 08/1999; 178(1):22-5; discussion 25-6. · 2.78 Impact Factor -
Article: [Results of pyeloureteral anastomoses onto the native ureter after complication of ureterovesical anastomosis in kidney transplantation].
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ABSTRACT: Complications of the ureterovesical anastomosis after renal transplantation are the most frequent surgical complications, estimated to occur in 3 to 20% of cases, depending on the series. Various techniques have been used to treat anastomotic leaks, stenoses or reflux. We present the results of pyeloureterostomy using the recipient's own ureter. 520 cadaver kidney renal transplantations were performed between 1988 and 1996. The ureterovesical anastomosis was performed according to the Lich Gregoir technique. Sixteen recipients (3%) developed an anastomotic complication: 9 stenoses (1.7%), 6 leaks (1.1%), 1 reflux (0.2%). The mean age of the donor was 37 years and the mean cold ischaemia time was 30 hours. There were 8 right kidneys and 8 left kidneys, transplanted in the right iliac fossa in 11 cases and left iliac fossa in 5 cases. The mean age of the recipients was 42 years, and they were transplanted for nephropathy in 15 cases and uropathy in 1 case. Surgical revision was performed 1 month after transplantation for anastomotic leaks and after 14 months for stenoses. In every case, the native ureter was identified by a ureteric catheter via a midline incision except for 3 cases of early anastomotic leak (< 3 days). The native ureter was sectioned without associated ipsilateral nephrectomy then anastomosed to the renal pelvis of the transplant, which was then drained by a Gil-Vernet catheter (10 cases) or ureteric stent (6 cases). One transplant was lost on D1 due to renal vein thrombosis. One nephrostomy was inserted on D2 due to obstruction of the ureteric stent. Follow-up pyelography on D15 was normal in every case. The mean follow-up was 2.5 years (2.9 years for anastomotic leaks, 2.2 for stenoses, 3.6 for reflux). One patient died with a functional renal transplant 3 years after the operation and one transplant was lost due to chronic rejection 4 years later. No complications involving the native kidney ipsilateral to the anastomosis were observed and there were no repeated ureteric complications. Mean creatinine 3 years after the operation was 141 mumol/l. Pyeloureterostomy is a reliable technique in the case of complications of the ureterovesical anastomosis. Pyeloureterostomy via a midline incision allowed one-stage definitive treatment of all anastomotic complications of the ureterovesical anastomosis with a low morbidity.Progrès en Urologie 02/1999; 9(1):47-51. · 0.58 Impact Factor -
Article: [Embryologic hypotheses of prostatic ectopy: apropos of a case].
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ABSTRACT: Events implicated in the development and the differentiation of the prostate gland are determinant to understand the pathology. Mc Neal's zonal anatomy is essential, the basis of which are found in the differences of embryonic origins. We describe a case of prostate ectopia, localized on the lateral aspect of the rectum. Final pathology report showed prostate adenoma. Different types of prostate ectopia have been described in the literature. Histological results showed that we can distinguish two types of ectopia: one which develops from the uro-genital sinus and the other from the mesonephrotic structures.Progrès en Urologie 10/1998; 8(4):573-7. · 0.58 Impact Factor -
Article: The suspensory ligament of the penis: an anatomic and radiologic description.
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ABSTRACT: The suspensory system of the penis acquires clinical importance in reparative surgery, traumatology and through its role in erection. The aim of this study was to identify the different anatomic structures constituting the suspensory ligament by dissection and by magnetic resonance imaging (MRI). Ten unembalmed male subjects were used for dissection of the region of the base of the penis. Ten volunteer patients underwent MRI of the penis before and after the injection of prostaglandin (PGE1). The suspensory apparatus consisted of separate ligamentous structures: the fundiform ligament, which is lateral, superficial and not adherent to the tunica albuginea of the corpora cavernosa; the suspensory ligament properly so-called, further back, stretching between the pubis and the tunica albuginea of the corpora cavernosa and consisting of two lateral, circumferential, and one median bundles, which circumscribed the dorsal vein of the penis. These structures were identifiable in MRI and their supporting role was evidenced during tests of erection. The suspensory ligament seemed to maintain the base of the penis in front of the pubis and to behave as a major point of support for the mobile portion of the penis during erection.Surgical and Radiologic Anatomy 02/1998; 20(6):413-7. · 1.06 Impact Factor -
Article: Decreased expression of keratinocyte growth factor receptor in a subset of human transitional cell bladder carcinomas.
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ABSTRACT: Growth factors and growth factor receptors are involved in tumor progression. The fibroblast growth factor receptor 2 gene encodes distinct isoforms. The isoforms which bind KGF (keratinocyte growth factor or FGF-7) are called KGF-R or FGFR2b. KGF-R is expressed in different epithelia and is involved in the control of epithelial-mesenchymal interactions. Expression of KGF-R mRNA was examined in normal human bladder and transitional cell carcinoma of the bladder (TCC) by semi-quantitative RT-PCR using TFIID and GAPDH as internal standards. In normal bladder, the KGF-R mRNA was detected in the urothelium but not in the underlying stroma. In TCCs, the level of KGF-R mRNA was generally either normal or low. Eighteen out of 54 TCCs had a KGF-R mRNA level below 30% of that found in normal urothelium. This decrease in KGF-R mRNA was not accompanied by an increase in BEK (FGFR2c) mRNA, the other major splice variant of the fibroblast growth factor receptor 2 gene. Expression of the KGF-R was also monitored by immunohistochemistry using a functional KGF-immunoglobulin chimera. The receptor was uniformly expressed throughout the normal urothelium except for the umbrella cells. Immunoreactivity for KGF-R was found to be negative in tumors with low levels of KGF-R mRNA, while the peritumoral normal urothelium was positive. Among patients with muscle invasive tumors, those exhibiting a low level of KGF-R mRNA had a significantly higher proportion of cancer deaths. Our results suggest that decreased expression of KGF-R can be considered as a marker of tumor progression in muscle invasive TCCs.Oncogene 02/1997; 14(3):323-30. · 6.37 Impact Factor -
Article: Evaluation of local immune response after intravesical bacille Calmette-Guérin treatment for superficial bladder cancer.
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ABSTRACT: To help define the optimal protocol of Bacille Calmette-Guérin (BCG) treatment for transitional cell carcinoma (TCC) of the bladder by examining cytokine production and antigen presentation to effector cells after instillations of BCG in patients with bladder TCC. Sixty-four urine samples from 11 patients were tested for the production of interferon gamma (IFN-gamma) using a modified commercial enzyme-linked immunosorbent assay (ELISA) kit. Urine was collected before and at intervals up to 24 h after the intravesical instillation of BCG. Immunohistological studies were also carried out using a two-step alkaline phosphatase technique to explore the expression of tumour-associated antigens (TAAs) (E7, 19A211, T138), major histocompatibility complex (MHC) molecules and lymphocyte subset infiltrates (CD3, CD4, CD8) in bladder biopsies before and 3 weeks after the completion of treatment in seven patients. IFN-gamma was only detected 4, 6 and 8 h after instillation, with a maximum concentration at 6 h (2.9-34.7 IU/mL in 10 patients). During a 6-week course of BCG, IFN-gamma was barely detectable after the first two instillations, but gradually increased from the third instillation onwards. TAA and MHC II antigens, which were absent or faintly expressed on normal urothelial cells before treatment, were expressed strongly in five patients after treatment. The local recruitment of immunocompetent cells was detected in all patients. These results suggest that the local immune response after the intravesical instillation of BCG can be quantified using simple ELISA tests and could be useful in defining objective criteria for rationalizing treatment (dose and duration), and in determining the relation between the immune response and anti-tumour activity. There is evidence that antigen presentation is enhanced after BCG instillations, suggesting that a T cell-MHC restricted pathway might be involved in the anti-tumour response. This study supports the search for tumour-rejection antigens in bladder cancer.British Journal of Urology 12/1996; 78(5):709-14. -
Article: Prospective randomized study of quadruple versus triple therapy in long-term kidney allografts.
Transplantation Proceedings 11/1996; 28(5):2819. · 1.00 Impact Factor -
Article: [Electrovaporization of the prostate (EVP) for the treatment of prostatic adenoma].
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ABSTRACT: Electrovaporization of the prostate consists of the use of a high energy section current to destroy hyperplastic prostatic tissue. The authors present the preliminary results obtained with this new technique. 15 patients presenting indications for transurethral resection of the prostate were included in this prospective study. Three patients were in complete retention. Three patients presented a high operative risk (ASA 3). Electrovaporization of the prostatic tissue was performed according to the plans of resection using a round loop and a pure section current of 250 to 300 W. The mean operating time was 22 min (+/- 13) for a mean prostatic weight of 43 g (+/- 7.7). No immediate postoperative haematuria was observed. The duration of catheterization was 2.2 days, and the mean hospital stay was 2.8 days (range: 2-4 days). With a minimum follow-up of 6 months, all patients were improved with an average flow rate of 22.17 +/- 8.6 mL/s, and a score less than 7. Two patients developed haematuria on D5 and D7, one patient developed resorption hyponatraemia and one patient died on D2 from acute respiratory failure. EVP is an effective new resection technique designed to limit postoperative morbidity and the length of hospital stay, which uses inexpensive material. A randomized study versus loop resection should allow identification of the advantages of this technique.Progrès en Urologie 05/1996; 6(2):236-9. · 0.58 Impact Factor -
Article: [How to treat testicular cancer?].
Progrès en Urologie 05/1996; 6(2 Suppl 1):57-63. · 0.58 Impact Factor -
Article: [Comparative study of the treatment of prostatic adenoma: laser photocoagulation versus endoscopic resection].
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ABSTRACT: Resection of the prostate using a Nd YAG laser is designed to destroy benign prostatic hyperplasia responsible for bladder neck obstruction. This technique is currently under investigation. PATIENTS AND TECHNIQUE: A total of 56 patients, with a minimal follow-up of 6 months and presenting indications for endoscopic resection of the prostate were treated by TULIP [22] or VLAP [34] laser coagulation. The objective and subjective results were compared to a group of patients [30] treated by endoscopic resection during the same period. Results are expressed as the percentage of patient responding to treatment in terms of objective (peak flow rate > 15 ml/s with improvement > 30% or between 12 and 15 ml, but improvement > 50%) and subjective parameters (IPSS < 7 and improvement > 30% or between 7 and 10, but improvement < 50%). With a minimal follow-up of 6 months, the objective response rates were 55.5% (TULIP), 84.6% (VLAP) and 83.2% (TURP), while the subjective response rates were 55.5% (TULIP), 92.3% (VLAP) and 83.3% (TURP). The hospital stay was significantly shorter in the laser group (2.1 VLAP and 3.3 TULIP; 4.93 TURP). In the TULIP group, 3 patients were incontinent and 4 developed chronic prostatitis. At 6 months, 4 patients in the VLAP group and 6 patients in the TULIP group had to undergo a complementary TURP. These results indicate that laser photocoagulation is effective in the treatment of benign prostatic hyperplasia. The VLAP technique appears to be better adapted to this indication. The benefit of VLAP will be more clearly demonstrated by the randomized study currently underway, provided the length of hospital stay, postoperative complications and cost-effectiveness ratio are taken into account. In contrast, the TULIP system is associated with numerous complications which appear to be unacceptable.Progrès en Urologie 12/1995; 5(6):974-9. · 0.58 Impact Factor -
Article: Vesicovaginal fistula after laser vaporization of vaginal condyloma.
The Journal of Urology 12/1995; 154(5):1860. · 3.75 Impact Factor -
Article: Androgen suppressed apoptosis is modified in p53 deficient mice.
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ABSTRACT: Several in vitro studies have provided evidence that the tumor suppressor protein, p53, is involved in the cell death process referred to as apoptosis. The recent development of p53 knock-out mice has enabled further investigation into the function of p53 for apoptosis, in vivo. Radiation-induced apoptosis is suppressed in such mice, yet other forms of apoptosis do not seem to be significantly affected. In this report, we present evidence that such male p53 nullizygous mice have less apoptosis in the prostate glands associated with the first 4 days following castration. Ventral prostate glands were obtained from normal, heterozygous p53-null and p53 nullizygous mice at daily intervals after castration. These tissues were stained for apoptosis with the use of the in situ and labeling method and apoptotic bodies were quantified by microscopy. Although labeled apoptotic bodies were observed in post-castrated tissues from all of these genetic variant mice, the onset of apoptosis was delayed and the occurrence of apoptosis was significantly reduced in the p53 nullizygous mice when compared to normal controls. Heterozygous p53-null mice were intermediate for these criteria. Examination of the internucleosomal DNA fragmentation pattern at 2 days of castration supports a significant diminution of prostate cell apoptosis in nullizygous p53 mice. Additionally, large nucleated and multinucleated cells were detected in the prostate epithelium of noncastrated p53 nullizygous mice and these abnormal cells were increased after castration. Flow cytometric analysis of these tissues confirmed a high number of 4C and 8C DNA content cells in the p53 nullizygous prostates and their frequency was increased by castration. In concordance with an earlier study, we conclude that functional p53 protein is not essential for prostate epithelial cells to undergo castration-induced apoptosis. However, wild-type p53 does appear to enhance this process, especially in the early period following castration, and this protein may regulate an aberrant prostate cell cycling activity that follows castration.Oncogene 05/1995; 10(7):1269-74. · 6.37 Impact Factor -
Article: Combined heart and kidney transplantation.
Transplantation Proceedings 05/1995; 27(2):1694. · 1.00 Impact Factor -
Article: Prognostic evaluation of morphonuclear parameters in superficial and invasive bladder cancer.
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ABSTRACT: To assess the prognostic value of morphonuclear parameters determined by means of computerized image analysis in untreated bladder tumours. Fifty patients had untreated bladder cancer; in 28 patients the tumours were superficial (7pT1G1; 14pT1G2; 7pT1G3) and in 22 they were invasive (6T2G2, 9T2G3, 2T3G2, 5T3G3). Feulgen-stained imprints were processed for morphonuclear analysis on a SAMBA 200 computerized image analysis system (T1TN, France), which measures optical density (integrated optical density, IOD; surface area, SURF; mean optical density, MOD), texture (long run length, LRL; short run length, SRL; run length distribution, RLD; run length percentage, RLP; grey level distribution, GLD) and contrast (contrast, C; energy, E). Morphonuclear parameters IOD, SURF, LRL, SRL and C were found to correlate with the risk of recurrence and progression of superficial bladder tumours (results for ANOVA respectively IOD P < 0.001; SURF P = 0.02; LRL P = 0.05; RLD P = 0.04; SRL P = 0.04; C P < 0.001). In invasive bladder cancer, parameters IOD and C only correlated with the risk of progression (ANOVA respectively IOD P < 0.001; C P < 0.001). On the other hand, progression-free curve analysis using the Kaplan Meier method showed that morphonuclear parameters may be useful in predicting the outcome for superficial tumours (Log/Rank test: SURF P < 0.001; RLD < 0.001; SRL = 0.003; LRL < 0.001; C < 0.001; IOD < 0.001). In the case of invasive tumours, only two parameters provided prognostic information (Logrank test: C < 0.001; IOD < 0.001). Nuclear morphometry assessed by image analysis is potentially useful in assessing the prognosis of bladder tumours; it provides objective and quantitative parameters. Further studies will determine whether morphonuclear analysis can be used to monitor the treatment of bladder cancer, particularly superficial tumours.British Journal of Urology 04/1995; 75(3):364-9. -
Article: [Research analysis of local immune response after intravesicular treatment with BCG: a review].
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ABSTRACT: Initial reports focused on purified protein derivative skin test reactivity and granuloma formation in patients treated with intravesical bacillus Calmette-Guérin. Then some investigators using immunohistochemical methods showed that some lymphocyte phenotypes where predominant in such infiltrates and that HLA DR antigens where strongly expressed following BCG therapy. Similar results where obtained in urine using flow cytometric analysis. Additionally some cytokines where found at significant levels in urine after BCG instillations. In this paper we reviewed these studies, we discussed the meaning of these results and the potential value for treatment monitoring.Progrès en Urologie 11/1993; 3(5):745-51. · 0.58 Impact Factor
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1993–2011
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Hôpital Henri Mondor – Hôpitaux Universitaires Henri Mondor
Créteil, Ile-de-France, France
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