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Saint-Pierre-du-Chemin, France

Durand M.,University of Paris Descartes | Durand M.,University of Nice Sophia Antipolis | Barret E.,University of Paris Descartes | Galiano M.,University of Paris Descartes | And 11 more authors.
BJU International | Year: 2014

Objectives To assess oncological (biochemical and histological recurrence) and functional (urinary and potency) outcomes in patients with unilateral low-risk organ-confined prostate cancer (PCa) treated with focal cryoablation (FC). Patients and Methods From January 2009 to March 2012, patients with localized PCa who refused active surveillance were assigned to a FC protocol. This was a prospective, single-arm cohort study. Inclusion criteria were: unilateral disease, clinical stage T1c to T2a, prostate-specific antigen (PSA) concentration <10 ng/mL, low volume index lesion and Gleason score ≤6 (3+3). Hemi-ablation was carried out using the PreciseTM cryoablation system (Galil Medical, Inc., Arden Hills, MN, USA). Oncological (PSA values) and functional (International Prostate Symptom Score and International Index of Erectile Function (IIEF)-5 score) outcomes were analysed at 3-, 6- and 12-month follow-up. The primary endpoint for oncological efficacy, no cancer in ipsilateral side, was based on the 12-month mandatory biopsy. Results A total of 48 consecutive patients with a mean age of 67 years were included. The median (interquartile range) follow-up was 13.2 (7.4-26.5) months. Follow-up prostate biopsies were negative for the treated lobe in 86% of patients. The mean PSA concentration dropped significantly at 3 months (by 55%) but did not correlate well with positive biopsy results. Urinary symptoms were unchanged. A slight decrease in the IIEF-5 score was present at 3 months, but did not differ significantly from baseline at 6-month follow-up. There were 15% grade 1 and 4% grade 2 complications (Clavien classification). Conclusions Focal cryoablation is a low-morbidity option in selected patients with low-risk PCa. We showed PSA concentration to be an unreliable marker for monitoring FC and recommend a protocol of mandatory biopsies for follow-up. A multicentre randomized controlled trial is necessary to confirm the low-morbidity and the biopsy-proven PCa cure rates. © 2013 The Authors. BJU International © 2013 BJU International. Source

Endometrial ablation can be used in heavy menstrual bleeding due to symptomatic submucosal myomas in women without desire of pregnancy. Those methods used alone, lead to an improvement on bleeding but results are not as good as in women without myomas. They can be associated with hysteroscopic myomectomy and, then, the results on bleeding are better than myomectomy alone. Second generation endometrial ablation methods must be used preferentially as they present less surgical complications than first generation methods. As the pregnancies that may occur after endometrial ablation have high risk of complications, a contraceptive mean is highly recommended after surgery. Transcervical sterilisation by intratubal insert (Essure ®) can also be proposed, but for women with Essure ® placed before endometrial ablation, only Thermachoice ® and bipolar resection have proven their safety. Finally, economical outcomes of endometrial ablation in myomas haven't been assessed yet. © 2011 Elsevier Masson SAS. All rights reserved. Source

Breaud J.,Service de chirurgie infantile | Montoro J.,Service de chirurgie infantile | Lecompte J.F.,Service de chirurgie infantile | Valla J.S.,Service de chirurgie infantile | And 4 more authors.
Journal of Pediatric Urology | Year: 2013

Adolescent males involved in motorcycle accidents are particularly at risk for pelvic injury, which may provoke a posterior urethral injury. The aim of this study was to develop a model to analyze the association between injuries and fractures of the pelvic ring and the risk of posterior urethral injury. Method: Based on experience with traffic accident modeling, a computerized finite-element model was extrapolated from a computerized tomography scan of a 15-year-old boy. The anatomic structures concerned in urethral and pelvic ring trauma were isolated, rendered in 3D and given biomechanical properties. The model was verified according to available experiments on pelvic ring trauma. Results: To apply the model, we recreated three impact mechanisms on the pelvic ring: lateral impact, antero-posterior impact and a real carmotorcycle accident situation (postero-lateral impact). In all three situations, stretching of the posterior urethra was identified prior to bony fracture visualization. Conclusion: Application of this model allowed us to analyze precisely the link between trauma of the pelvic ring and lesions of the posterior urethra. The results should help to establish guidelines for urethral catheterization in male adolescents in cases of pelvic trauma, even when no bony fracture is present, in order to prevent iatrogenic worsening of a misdiagnosed posterior urethral trauma. © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. Source

Favier J.-C.,Center Hospitalier Of Bretagne Sud | Da Conceicao M.,Center Hospitalier Of Grasse | Levron A.,Center Hospitalier Of Bretagne Sud | Argo V.,Center Hospitalier Of Bretagne Sud
Praticien en Anesthesie Reanimation | Year: 2015

Fiberoptic intubation in the gold standard in case of predicted difficult intubation. It can be performed under local anaesthesia but most of the time it is done under sedation, using propofol, remifentanil or even inhaled sevoflurane. During intubation, non-invasive ventilation can be performed through specific masks allowing the introduction of the fiberoptic. The nasal route is more frequently used than the oral route that requires more time, and has to be guided with an oral device, although it would be less traumatic. © 2014 Elsevier Masson SAS. Source

Grimaldi-Bensouda L.,LA SER | Grimaldi-Bensouda L.,French National Conservatory of Arts and Crafts | Grimaldi-Bensouda L.,French Institute of Health and Medical Research | Alperovitch A.,French Institute of Health and Medical Research | And 55 more authors.
Annals of the Rheumatic Diseases | Year: 2015

Background: Gout therapy includes xanthine oxidase inhibitors (XOI) and colchicine, which have both been associated with decreased cardiovascular risk. However, their effects on major cardiac events, such as myocardial infarction (MI), need to be investigated further. Objectives: To investigate whether XOIs and colchicine are associated with decreased risk of MI. Methods: This case-control study compared patients with first-ever MI and matched controls. Cases were recruited from the Pharmacoepidemiological General Research on MI registry. Controls were selected from a referent population (n=8444) from general practice settings. Results: The study sample consisted of 2277 MI patients and 4849 matched controls. Use of allopurinol was reported by 3.1% of cases and 3.8 of controls, and 1.1% of cases and controls used colchicine. The adjusted OR (95% CI) for MI with allopurinol use was 0.80 (0.59 to 1.09). When using less stringent matching criteria that allowed for inclusion of 2593 cases and 5185 controls, the adjusted OR was 0.73 (0.54 to 0.99). Similar results were found on analysis by sex and hypertension status. Colchicine used was not associated with a decreased risk of MI (aOR=1.17 (0.70 to 1.93)). Conclusions: Allopurinol may be associated with a reduced risk of MI. No decreased risk of MI was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect. Source

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