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Renaud C.J.,National University of Singapore | Francois M.,CHU Bretonneau | Francois M.,Center Hospitalier | Nony A.,Polyclinique | And 2 more authors.
Nephrology Dialysis Transplantation | Year: 2012

Background. Witholding treatment in asymptomatic/pauci-symptomatic high-grade central vein stenosis (CVS), i.e. those not causing debilitating painful extremity oedema, the benefits of which have been shown in only one study in grafts, is debatable. The aim of our study was to assess the short-and long-term benefits of such a strategy in mainly autogenous fistulas. Methods. We retrospectively compared the outcomes of 53 untreated asymptomatic/pauci- symptomatic and 50 symptomatic high-grade CVS treated by dilation with or without stenting between January 1998 and August 2010 at a single center. Central vein and access patency was estimated by Kaplan-Meier analysis. Results. Mean age, central catheter use and location of stenosis (brachiocephalic vein) in asymptomatic/pauci-symptomatic and symptomatic CVS were significantly different at 69 versus 75 years, 28 versus 48% and 74 versus 56%, respectively. Ninety percent of the cases had an autogenous fistula. The mean degree of stenosis was >80%. Fourty percent of asymptomatic/pauci-symptomatic CVS became severely symptomatic after 4 years. Primary central vein patency at 3, 12, 24 and 36 months in asymptomatic/pauci-symptomatic and symptomatic CVS were 87 ± 5 versus 82 ± 6, 77 ± 6 versus 55 ± 9, 71 ± 7 versus 35 ± 9 and 67 ± 7 versus 18 ± 9%, respectively (P = 0.002). Primary access circuit patency rate was not significantly different between the two groups with 66 ± 5 versus 50 ± 4% at 1 year. Secondary central vein and access circuit patency rates at 1 and 3 years were 100 and 93 ± 7 versus 89 ± 5 and 84 ± 7% (P = 0.014). Conclusions. Withholding treatment in asymptomatic/pauci- symptomatic CVS in dialysis fistulas yielded significantly better short-and long-term central vein patency than treatment of symptomatic cases without detrimental effects on overall dialysis circuit. © 2011 The Author.

Chaillon A.,French Institute of Health and Medical Research | Le Vu S.,Institute of Veille Sanitaire | Brunet S.,French Institute of Health and Medical Research | Gras G.,CHU Bretonneau | And 4 more authors.
Clinical and Vaccine Immunology | Year: 2012

The aim of this study was to estimate the rate of misclassification in treated HIV patients who initiated treatment at the chronic stage of HIV infection using an enzyme immunoassay (EIA) that discriminates between recent infection (RI; within 6 months) and established infection. The performance of EIA-RI was evaluated in 96 HIV-1 chronically infected patients on highly active antiretroviral therapy (HAART) with an undetectable viral load (VL) for at least 3 years. Demographic data, HIV-1 viral load, CD4+ T-cell count, viral subtype, and treatment duration were collected. The subset of misclassified patients was further analyzed using samples collected annually. The impact on incidence estimates was evaluated by simulation. The specificity in treated patients was significantly lower (70.8 to 77.1%) than that observed in untreated patients (93.3 to 99.3%, P <0.001). Patients falsely classified as recently infected had been treated for a longer period and had longer-term viral suppression than those correctly classified. The loss of specificity of the test due to treatment may have a dramatic impact on the accuracy of the incidence estimates, with a major impact when HIV prevalence is high. The cross-sectional studies intended to derive HIV incidence must collect information on treatment or, alternatively, should include detection of antiretroviral drugs in blood specimens to rule out treated patients from the calculations. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

Rozet F.,University of Paris Descartes | Bastide C.,Marseille University Hospital Center | Beuzeboc P.,University Pierre and Marie Curie | Cormier L.,CHU de Dijon | And 8 more authors.
Progres en Urologie | Year: 2015

Introduction: The widespread use of prostate cancer screening has led to a stage migration resulting in an increase in the diagnosis of low-risk disease, which currently accounts for 40-50% of diagnosed forms. New therapeutic strategies have been developed in order to minimize the risk of overtreatment. Methods: A systematic review of the literature over the past 20 years was performed using the Medline database. The literature selection was based on evidence and practical considerations. Results: Low-risk tumors are conventionally defined by the d'Amico classification. The use of multiparametric MRI helps to better characterize these tumors. The contribution of molecular biology remains to be determined in clinical practice. Novel therapeutic options for low-risk disease are currently being evaluated. Conclusion: The new therapeutic strategies are evolving. They seek to reduce overtreatment without compromising oncological success. © 2014 Elsevier Masson SAS.

Masson-Lecomte A.,Pitie Salpetriere | Masson-Lecomte A.,University Paris - Sud | Bensalah K.,Reims University Hospital Center | Bensalah K.,University Of Reims Champagnes Ardenne | And 17 more authors.
BJU International | Year: 2013

What's known on the subject? and What does the study add? Nephron-sparing surgery has become the standard of care for small renal masses because it allows for the same oncological control as radical nephrectomy and achieves better overall survival, while lowering the risk of subsequent chronic renal failure. Mini-invasive surgical approaches have also been developed, e.g. laparoscopic partial nephrectomy (LPN) and robot-assisted laparoscopic PN (RAPN), which result in less bleeding, reduced postoperative pain, shorter length of stay (LOS) and shorter recovery time. LPN requires advanced surgical skill, has a longer learning curve and requires perseverance, which limits its large diffusion. From this prospective comparative study, we can now claim that RAPN is not inferior to pure LPN in terms of perioperative outcomes (i.e. blood loss, operative duration, warm ischaemia time, LOS). Objective To prospectively compare the surgical and pathological outcomes obtained with robot-assisted laparoscopic partial nephrectomy (RAPN) or laparoscopic PN (LPN) for renal cell carcinoma in a multicentre cohort. Patients and Methods Between 2007 and 2011, 265 nephron-sparing surgeries were performed at six French urology departments. The patients underwent either RAPN (n = 220) or LPN (n = 45) procedures. The operative data included operative duration, warm ischaemia time (WIT) and estimated blood loss (EBL). The postoperative outcomes included length of stay (LOS), creatinine variation (Modification of Diet in Renal Disease group), Clavien complications and pathological results. The complexity of the renal tumour was classified using the R.E.N.A.L. nephrometry scoring system. Student's t-test and chi-squared tests were used to compare variables. Results The median follow-ups for the RAPN and LPN groups were 7 and 18 months, respectively (P < 0.001). Age and American Society of Anesthesiology score were significantly higher in the LPN group (P = 0.02 and P = 0.004, respectively). These variables were lower in the RAPN group: WIT [mean (sd) 20.4 (9.7) vs 24.3 (15.2) min; P = 0.03], operative duration [mean (sd) 168.1 (55.5) vs 199.7 (51.2) min; P < 0.001], operating room occupation time [mean (sd) 248.3 (66.7) vs 278.2 (71.3) min; P = 0.008], EBL [mean (sd) 244.8 (365.4) vs 268.3 (244.9) mL; P = 0.01], use of haemostatic agents [used in 78% of RAPNs and 100% of LPNs; P < 0.001] and LOS [mean (sd) 5.5 (4.3) vs 6.8 (3.2) days; P = 0.05). There were no significant differences between pre- and postoperative creatinine levels, pathology report or complication rates between the groups. The main limitation was due to the study's non-randomised design. Conclusion RAPN is not inferior to pure LPN for perioperative outcomes (i.e. EBL, operative duration, WIT, LOS). Only a randomised study with a longer follow-up can now provide further insight into oncological outcomes. © 2012 BJU International.

Bruyere F.,CHU Bretonneau | Namdarian B.,Royal Melbourne Hospital | Corcoran N.M.,Royal Melbourne Hospital | Pedersen J.,TissuPath Pty. Ltd. | And 5 more authors.
Urologic Oncology: Seminars and Original Investigations | Year: 2010

Background: Epithelial-mesenchymal transition (EMT) is known to play an important role in the development of tumor invasion and progression in tumors of epithelial origin. Objectives: Our aim was to investigate the role of Snail transcription repressor family members in human bladder pathogenesis. Material and methods: We evaluated levels of Snail and Slug in 87 patients who received transurethral resection of a transitional cell carcinoma at our institution during the period from June 1999 until November 2003. Immunohistochemistry was performed on tissue microarrays, and expression correlated with pathological variables and clinical outcomes. Degree and intensity of Snail and Slug staining was quantified by immunohistochemistry. Results: There was no apparent enrichment in strong vs. weak staining for either Snail (43.7% vs. 56.3%) or Slug (46% vs. 54%) in the superficial bladder tumors. Univariate analysis determined that tumor focality and Snail expression were significantly associated with tumor recurrence (P < 0.05). Only for tumor focality did such a relationship exist when assessing tumor progression. Multivariate analysis using the Cox's proportional hazards model revealed similar results to that of the univariate analysis. Snail expression (P = 0.038) and tumor focality (P = 0.011) were independent and significant prognostic factors for tumor recurrence in all patients. However, only tumor focality was an independent predictor of tumor progression (P = 0.034). Conclusions: High expression of Snail in superficial bladder tumors is a strong predictor of tumor recurrence enhancing risk stratification and prognostication. © 2010 Elsevier Inc.

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