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Sainte-Foy-lès-Lyon, France

Aptel F.,Edouard Herriot Hospital | Cucherat M.,University of Lyon | Denis P.,Croix Rousse Hospital
European Journal of Ophthalmology

Purpose. To evaluate the intraocular pressure (IOP)-lowering effects and tolerability of the 3 prosta-glandin-timolol fixed combinations (PG-timolol FCs). methods. Clinical trials comparing directly the PG-timolol FCs or comparing the PG-timolol FCs to their individual components were thoroughly searched. The main outcome measures were efficacy assessed by IOP (taken at 9 am, noon, 4 pm, and over the mean diurnal curve) change at 3 months (or after 1 to 6 months of treatment if no data were available at month 3) from baseline and tolerability assessed by the incidence of conjunctival hyperemia. results. Twenty trials were identified (n=4684 patients). Intraocular pressure reduction was usually greater with the 3 PG-timolol FCs than the individual PG (mean difference [MD] 0.00 mmHg to 2.59 mmHg; p>0.1 to p<0.001). The incidence of hyperemia was significantly less with latanoprost- and bi-matoprost-timolol FCs than with the individual PG (relative risk = 0.66 and 0.61; p=0.05 and p<0.001). From direct comparisons, IOP reduction was significantly greatest with bimatoprost-timolol FC, at 9 am, 4 pm, and over the mean diurnal curve compared to latanoprost-timolol FC (MD = 0.90 mmHg to 1.48 mmHg; p<0.001) and at all time points compared to travoprost-timolol FC (MD = 0.66 mmHg to 0.90 mmHg; p<0.001). The incidence of hyperemia was not significantly less with latanoprost-timolol FC than with bimatoprost-timolol FC (relative risk = 1.32; p>0.1). ConClusions. The 3 PG-timolol FCs provide a greater IOP reduction and lower incidence of hyperemia than the 3 PGs alone. The direct comparisons suggest a greater efficacy of the bimatoprost-timolol FC compared with latanoprost- and travoprost-timolol FCs. © 2011 Wichtig Editore. Source

Kaouk J.H.,Cleveland Clinic | Haber G.-P.,Cleveland Clinic | Autorino R.,Cleveland Clinic | Crouzet S.,Edouard Herriot Hospital | And 3 more authors.
European Urology

Background The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery.Design, setting, and participants This was a prospective institutional review board-approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. Intervention Different types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port.Outcome measurements and statistical analysis The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes.Results and limitations A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38 min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group.Conclusions We describe the first clinical application of a novel robotic platform specifically designed for single-port urologic surgery. Major urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings.Patient summary A novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major urologic procedures through a single small abdominal incision. Trial registration The study was registered on www.ClinicalTrials.gov (NCT02136121). © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. -absp. Objective To determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. Source

Poncet G.,Edouard Herriot Hospital | Faucheron J.-L.,Michallon Hospital | Walter T.,Pavillon H
World Journal of Gastroenterology

Well-differentiated endocrine carcinomas of the small bowel are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that may cause carcinoid syndrome. However, many are clinically silent until late presentation with major effects. Initial treatment aims to control carcinoid syndrome with somatostatin analogs. Even if there is metastatic spread, surgical resection of the primitive tumor should be discussed in cases of retractile mesenteritis, small bowel ischemia or subocclusive syndrome in order to avoid any acute complication, in particular at the beginning of somatostatin analog treatment. The choice of treatment depends on the symptoms, general health of the patient, tumor burden, degree of uptake of radionuclide, histological features of the tumor, and tumor growth. Management strategies include surgery for cure (which is rarely achieved) or for cytoreduction, radiological interventions (transarterial embolization or radiofrequency ablation), and chemotherapy (interferon and somatostatin analogs). New biological agent and radionuclide targeted therapies are under investigation. Diffuse and non-evolving lesions should also be simply monitored. Finally, it has to be emphasized that it is of the utmost importance to enroll these patients with a rare disease in prospective clinical trials assessing new therapeutic strategies. © 2010 Baishideng. Source

Aptel F.,Joseph Fourier University | Aptel F.,Grenoble University Hospital Center | Chiquet C.,Joseph Fourier University | Chiquet C.,Grenoble University Hospital Center | And 2 more authors.
Investigative Ophthalmology and Visual Science

PURPOSE. We evaluated changes in anterior chamber (AC) morphology and iris volume induced by physiological mydriasis in fellow eyes of acute angle-closure patients, and age-, sex-, and central AC depth-matched primary angle-closure suspects (PACS). METHODS. In our study, 21 fellow eyes of patients with acute angle closure; 40 age-, sex-, and central AC depth-matched PACS eyes; and 40 age- and sex-matched normal open-angle eyes were imaged using a Pentacam and anterior segment optical coherence tomography (AS-OCT) under light conditions, and after 5 minutes of darkness using AS-OCT. Iris volume was estimated using AS-OCT and a customized imageprocessing software. RESULTS. Central AC depth, corneal curvature, axial length, and lens thickness did not differ significantly between the PACS and fellow eyes. When going from light to dark, angle opening distance at 500 lm decreased significantly more in fellow eyes than in PACS (-68% vs. -52%, P < 0.001). When going from light to dark, the mean iris volume increased significantly in the fellow eyes (from 45.34 ± 2.1 to 47.68 ± 3.2 mm3, P < 0.01), whereas it decreased significantly in most PACS eyes (from 45.01 ± 2.2 to 42.11 ± 2.3 mm3, P < 0.01), and in all openangle eyes (from 44.68 ± 1.16 to 41.67 ± 1.20 mm3, P < 0.01). Based on multivariate analysis, significant predictors of angle narrowing under darkness (relative change in angleopening distance 500) were fellow eyes compared to PACS (β = -2.98, SE = 0.249, P = 0.005) and higher iris volume increase with pupil dilation (β =-3.146, SE = 0.432, P = 0.015). CONCLUSIONS. Under dark conditions, angles of fellow eyes closed dramatically more than did those of PACS. Iris volume increase per millimeter of pupil dilation is an independent predictor of angle narrowing in darkness. © 2012 The Association for Research in Vision and Ophthalmology, Inc. Source

Cordeiro E.R.,University of Amsterdam | Cathelineau X.,Institute Mutualiste Montsouris | Thuroff S.,Harlaching Hospital | Marberger M.,Medical University of Vienna | And 2 more authors.
BJU International

What's known on the subject? and What does the study add? Novel therapeutic methods have emerged in recent years as 'focal' treatment alternatives in which cancer foci can be eradicated and greatly reducing the associated side-effects of radical treatment. High-intensity focused ultrasound (HIFU) seems to result in a well fitted technology, which has proven short- to medium-term cancer control, with a low rate of complications comparable with those of established therapies. This is an up-to-date review of the available literature on HIFU as a definitive treatment of prostate cancer. It describes the technique in a comprehensive approach in terms of technical features, procedure, indications, and gives an overview of its historical background; finally, we present the future applications of HIFU and its development trend. Objectives: To provide an up-to-date review of the available literature on high-intensity focused ultrasound (HIFU) as a definitive treatment of prostate cancer. To present the technique in a comprehensive approach, comparing the available devices according to the existing evidence in terms of technical features, procedure, indications, and to give an overview of its historical background; and finally, to discuss future applications of HIFU and its development trend. Materials and Methods: A systematic literature search was conducted using MEDLINE and EMBASE via Ovid databases (January 2000 to December 2011), to identify studies on HIFU for treatment of prostate cancer. Only English-language and human-based full manuscripts that reported on case series studies with >50 participants, patient characteristics, efficacy and safety data were included. Results: No randomised controlled trials were identified by the literature search. We identified 31 uncontrolled studies that examined the efficacy of HIFU as primary treatment and two studies that examined the efficacy of HIFU as salvage treatment. Most treated patients had localised prostate cancer (stage T1-T2); Gleason scores of 2-10 and mean prostate specific antigen (PSA) values of 4.6-12.7 ng/mL. The mean age range of the patients was 64.1-72 years. The mean follow-up ranged from 6.4 to 76.8 months. Negative biopsy rates ranged from 35 to 95%. PSA nadirs ranged from 0.04 to 1.8 ng/mL. The 5-year disease-free survival rates ranged from 61.2 to 95%; 7- and 8-year disease free survival rates ranged from 69 to 84%. The most common complications associated with the HIFU procedure as the primary treatment included: urinary retention (<1-20%); urinary tract infections (1.8-47.9%); stress or urinary incontinence (<1-34.3%); and erectile dysfunction (20-81.6%). Recto-urethral fistula was reported in <2% of patients. Treatment-related morbidity appeared to be reduced by the combination of transurethral resection (TURP) of the prostate and HIFU. Conclusions: Novel therapeutic methods have emerged in recent years as 'focal' treatment alternatives, in which cancer foci could be eradicated by greatly reducing the associated side-effects of radical treatment. HIFU seems to result in short- to medium-term cancer control, with a low rate of complications comparable with those of established therapies. However, longer-term follow-up studies are needed to evaluate cancer-specific and overall survival. If available promising results on HIFU for definitive treatment of prostate cancer are confirmed in future prospective trials, focal therapy could start to challenge the current standard of care. © 2012 BJU International. Source

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