Créteil, France
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Ukimura O.,University of Southern California | Ukimura O.,Kyoto Prefectural University of Medicine | Coleman J.A.,Sloan Kettering Cancer Center | De La Taille A.,CHU Henri Mondor | And 10 more authors.
European Urology | Year: 2013

Context: Prostate cancer (PCa) screening to detect early stage PCa has resulted in increased identification of small-volume, low-grade PCa, many of which meet criteria for clinically indolent disease. Nevertheless, there remains some degree of underdetection of high-risk PCa in substantial numbers of men despite current diagnostic strategies. Objective: To discuss the contemporary role of prostate biopsy (PB), focusing on the indications, techniques, and limitations of current PB techniques and evolving techniques affecting patient care. Evidence acquisition: A comprehensive Medline search was performed using the medical subject heading search terms prostate cancer, detection, prostate biopsy, significant cancer, and diagnosis, with restriction to the English language. Emphasis was given to publications within the past 5 yr. Evidence synthesis: Because abnormal digital rectal examination (DRE) and prostate-specific antigen (PSA) tests alone lack specificity for cancer, there is no universal indication for PB. This lack has inspired exploration for a cancer-specific biomarker and prediction tools such as risk calculators. Indication for biopsy should involve a balance between the underdiagnosis of high-risk cancers and the potential risks for the overdetection of clinically insignificant cancers as well as biopsy-related morbidity. Evidence supports the inclusion of laterally directed cores during transrectal ultrasound (TRUS) PB in addition to the traditional sextant pattern, which significantly improves cancer detection without a demonstrable increase in morbidity. These data indicate that such PB templates, typically 12 cores, represent the optimal template in initial PB. Optimised techniques and templates for repeat PB remain controversial. However, debate continues regarding indications, sampling number, and location as well as on the potential of modern image-guided approaches or three-dimensional (3D) mapping biopsy in this unique setting. Additional limitations of repeat PB techniques include associated procedural risks if general anaesthesia is required and inherent sampling errors of template-based techniques that are not targeted to the specific tumour site. Conclusions: Current data support the utility of extended PB templates for initial TRUS PB intended to detect clinically significant PCa. Repeat PB in the setting of prior negative PB on the grounds of clinical suspicion or for risk-stratified approaches to management of low risk PCa requires balancing overdetection of low-risk cancer with the potential to miss significant cancer. Several options, including modern image-guided targeting, biomarker development, transrectal saturation PB, and 3D template mapping PB, are changing the clinical paradigms for evaluation and management. Evidence to support adopting approaches other than the current established standards should be tested through appropriately designed prospective studies. © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.


Plante-Bordeneuve V.,CHU Henri Mondor | Plante-Bordeneuve V.,University of Paris Descartes | Kerschen P.,CHU Henri Mondor | Kerschen P.,University Paris Est Creteil
Handbook of Clinical Neurology | Year: 2013

TTR FAP is characterized by phenotypic and genotypic heterogeneity. The severity of polyneuropathy along with autonomic dysfunction and heart involvement makes it a life-threatening disease. This protein is mainly produced by the liver. Molecular genetic testing is essential in the diagnostic strategy. TTR-Val30Met is the most frequent substitution, resulting in a guanine to cytosine mutation in exon 2 of the gene. It is virtually the only variant detected in Portugal, Brazil, and Sweden. By contrast, as many as 30 different TTR variants are reported in Japan and in other European countries. A less severe phenotype with late onset has been reported. Diagnosis should be performed as early as possible since upcoming pharmacological therapeutic approaches are now available, in addition to liver transplantation. © 2013 Elsevier B.V.


Bach T.,Asklepios Klinik Barmbek | Muschter R.,Diakoniekrankenhaus Academic Teaching Hospital | Sroka R.,Ludwig Maximilians University of Munich | Gravas S.,University of Thessaly | And 9 more authors.
European Urology | Year: 2012

Context: Laser treatment of benign prostatic obstruction (BPO) has become more prevalent in recent years. Although multiple surgical approaches exist, there is confusion about laser-tissue interaction, especially in terms of physical aspects and with respect to the optimal treatment modality. Objective: To compare available laser systems with respect to physical fundamentals and to discuss the similarities and differences among introduced laser devices. Evidence acquisition: The paper is based on the second expert meeting on the laser treatment of BPO organised by the European Association of Urology Section of Uro-Technology. A systematic literature search was also carried out to cover the topic of laser treatment of BPO extensively. Evidence synthesis: The principles of generation of laser radiation, laser fibre construction, the types of energy emission, and laser-tissue interaction are discussed in detail for the laser systems used in the treatment of BPO. The most relevant laser systems are compared and their physical properties discussed in depth. Conclusions: Laser treatment of BPO is gaining widespread acceptance. Detailed knowledge of the physical principles allows the surgeon to discriminate between available laser systems and their possible pitfalls to guarantee high safety levels for the patient. © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.


Irani J.,University of Poitiers | Blanchet P.,CHU | Salomon L.,CHU Henri Mondor | Coloby P.,Pontoise Hospital | And 3 more authors.
Journal of Urology | Year: 2013

Purpose: We determined the impact of increasing the number of cores from 12 to 20 at initial prostate biopsy in men suspicious of prostate cancer. Materials and Methods: From December 2009 to November 2011, patients in 7 centers scheduled for a first prostate biopsy, with a prostate specific antigen less than 20 ng/ml and no nodule on digital rectal examination, were invited to participate in this superiority trial. Patients were randomized to a 12-core (PB12 group) or a 20-core (PB20 group) protocol. The primary end point was cancer detection rate. Secondary end points were cancer characteristics, rate of complications and patient tolerance assessed by a self-completed booklet before prostate biopsy and at day 5 and day 15. Results: A total of 339 patients were randomized. Preoperative variables were similar in both groups. Cancer was detected in 71 patients (42.0%) in PB12 group and in 81 patients (48.8%) in PB20 group, and the difference was not significant (p >0.2). Gleason score and cancer length measured on prostate biopsy cores were not significantly different between groups. Although the cancer detection rate was linked to prostate volume, this was not affected by the number of extracted cores (p >0.4). Complications number and seriousness were comparable in both arms. No significant difference was noted regarding side effects and tolerance as self-assessed by the patient at day 5 and day 15 after prostate biopsy. Conclusions: Our findings suggest that there is no significant advantage in using a 20-core biopsy protocol vs 12-core protocol during an initial prostate biopsy. © 2013 American Urological Association Education and Research, Inc.


Auprich M.,Medical University of Graz | Bjartell A.,Skåne University Hospital | Chun F.K.-H.,University of Hamburg | De La Taille A.,CHU Henri Mondor | And 6 more authors.
European Urology | Year: 2011

Context: Newly discovered biomarkers ideally should prove clinical usefulness, provide additional detection, staging, and prognosis information to improve individual risk assessment, and potentially permit targeted cancer therapy. Objective: To review, display, and evaluate the current evidence regarding the biologic and analytic approach of urinary prostate cancer gene 3 (PCA3) in prostate cancer (PCa) detection, staging, and prognosis, and its therapeutic potential. Evidence acquisition: A systematic and comprehensive Medline search was performed using the Medical Subject Headings search terms PCA3, DD3, UPM3, prostate cancer, cell-lines, prostate tissue, prostate biopsy, detection, diagnosis, radical prostatectomy, staging, grading, progression, and gene therapy. Results were restricted to English-language papers published within the period 1999-2011. Evidence synthesis: The PCA3 gene is highly overexpressed in specific PCa cell lines and prostatic tumours. In 2006, a simple and robust urine test (Progensa) became commercially available. Despite its costs, prostate cancer antigen 3 (PCA3) is superior to prostate-specific antigen (PSA) and percent free PSA in the early detection of PCa. PCA3 improves the diagnostic accuracy of externally validated nomograms among men with an elevated PSA undergoing biopsy. PCA3 independently predicts low-volume disease and pathologically insignificant PCa but is not associated with locally advanced disease and is limited in the prediction of aggressive cancer. Preliminary data demonstrate that combining PCA3 with other new biomarkers further improves diagnostic and prognostic accuracy. Finally, findings of the first PCA3-Gene-ViroTherapy study suggest therapeutic potential by exploiting PCA3 overexpression. Conclusions: PCA3, integrated in novel biopsy nomograms or risk stratification tools, can be used to counsel or confirm biopsy indications. If confirmed in further studies, using PCA3 together with established staging risk factors could assist clinicians in specific pretreatment decision making. So far no evidence for the usefulness of PCA3 in active surveillance programs has been presented. © 2011 European Association of Urology.


Abi-Jaoudeh N.,U.S. National Institutes of Health | Kobeiter H.,CHU Henri Mondor | Xu S.,U.S. National Institutes of Health | Wood B.J.,U.S. National Institutes of Health
Techniques in Vascular and Interventional Radiology | Year: 2013

Image fusion may be useful in any procedure where previous imaging such as positron emission tomography, magnetic resonance imaging, or contrast-enhanced computed tomography (CT) defines information that is referenced to the procedural imaging, to the needle or catheter, or to an ultrasound transducer. Fusion of prior and intraoperative imaging provides real-time feedback on tumor location or margin, metabolic activity, device location, or vessel location. Multimodality image fusion in interventional radiology was initially introduced for biopsies and ablations, especially for lesions only seen on arterial phase CT, magnetic resonance imaging, or positron emission tomography/CT but has more recently been applied to other vascular and nonvascular procedures.Two different types of platforms are commonly used for image fusion and navigation: (1) electromagnetic tracking and (2) cone-beam CT. Both technologies would be reviewed as well as their strengths and weaknesses, indications, when to use one vs the other, tips and guidance to streamline use, and early evidence defining clinical benefits of these rapidly evolving, commercially available and emerging techniques. © 2013.


Meningaud J.-P.,CHU Henri Mondor
Plastic and Reconstructive Surgery | Year: 2010

Background: The authors report the technical difficulties involved in the procurement of a total human face graft for allotransplantation. Methods: After completing a preclinical study that involved 13 fresh cadavers, the authors harvested a total face graft for allotransplantation onto a patient in April of 2009. The harvested tissue specimen included the entire face along with the scalp and the auricles. The authors then removed the unnecessary parts, specifically, the lips and the skin overlying the chin. Results: The preclinical study and clinical results confirmed that complete revascularization of a total face graft, complete with the scalp and auricles, from a single external carotid vascular pedicle was possible. All dissections were completed in less than 6 hours during the preclinical study. Graft procurement for the clinical case took 11 hours. Facial soft tissues were harvested en bloc to decrease graft harvest time and prevent tissue injury. A resin mask that covered the entire face of the donor provided excellent cosmetic results. All nerves and eyelid structures were easily reattached. One month after transplantation, skin necrosis necessitated several stages of excision. Biopsy specimens from the transplanted tissue were negative for immune-mediated rejection. Unfortunately, the patient experienced a cardiac arrest during follow-up surgery and died 2 months after the transplant procedure. Conclusions: A composite tissue allotransplantation of the total face along with the scalp and the auricles is technically feasible. The authors' flap provided reliable vascularization and was obtained in a standardized fashion in less than 11 hours. The graft contained all of the perioral muscles, branches of the facial nerve, eyelid structures, and major salivary glands. Copyright © 2010 by the American Society of Plastic Surgeons.


Pouessel D.,CHU Henri Mondor | Culine S.,CHU Henri Mondor
Anti-Cancer Drugs | Year: 2012

Zoledronic acid has been the standard of care for the prevention of skeletal-related events in patients with bone metastases from prostate cancer for the past 10 years. However, its potent antitumor activity has been questioned. We report the occurrence of a complete clinical and biological response to zoledronic acid in a patient with bone metastases from castrate-resistant prostate cancer. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Michel M.,URC Eco Ile de France | Becquemin J.-P.,CHU Henri Mondor | Clement M.-C.,URC Eco Ile de France | Marzelle J.,CHU Henri Mondor | And 2 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2015

Objective To compare 30 day outcomes and costs of fenestrated and branched stent grafts (f/b EVAR) and open surgery (OSR) for the treatment of complex abdominal aortic aneurysms (AAA) and thoraco-abdominal aortic aneurysms (TAAA). Methods The multicenter prospective registry WINDOW was set up to evaluate f/b EVAR in high risk patients with para/juxtarenal AAA, and infradiaphragmatic and supradiaphragmatic TAAA. A control group of patients treated by OSR was extracted from the national hospital discharge database. The primary endpoint was 30 day mortality. Secondary endpoints included severe complications, length of stay, and costs. Mortality was assessed by survival analysis and uni/multivariate Cox regression analyses using pre- and post-operative characteristics. Bootstrap methods were used to estimate the cost-effectiveness of f/b EVAR versus OSR. Results Two hundred and sixty eight cases and 1,678 controls were included. There was no difference in 30 day mortality (6.7% vs. 5.4%, p = 0.40), but costs were higher with f/b EVAR (€38,212 vs. €16,497, p < .001). After group stratification, mortality was similar with both treatments for para/juxtarenal AAA (4.3% vs. 5.8%, p = .26) and supradiaphragmatic TAAA (11.9% vs. 19.7%, p = .70), and higher with f/b EVAR for infradiaphragmatic TAAA (11.9% vs. 4.0%, p = .010). Costs were higher with f/b EVAR for para/juxtarenal AAA (€34,425 vs. €14,907, p < .0001) and infradiaphragmatic TAAA (€37,927 vs. €17,530, p < .0001), but not different for supradiaphragmatic TAAA (€54,710 vs. €44,163, p = .18). Conclusion f/b EVAR does not appear justified for patients with para/juxtarenal AAA and infradiaphragmatic TAAA fit for OSR but may be an attractive option for patients with para/juxtarenal AAA not eligible for surgery and patients with supradiaphragmatic TAAA. Clinical Trial Registration: http://www.clinicaltrials.gov/ct2/show/NCT01168037; identifier: NCT01168037 (WINDOW registry). © 2015 European Society for Vascular Surgery.


Lantieri L.,CHU Henri Mondor
The Journal of craniofacial surgery | Year: 2012

Face transplantation is a new surgical technique that could be considered as a paradigm change in facial reconstruction. In recent years, 17 cases have been realized around the world. The author reviews these cases enlightened by his personal 7 cases.

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